Ewing's sarcoma of the mandible.

Ewing's sarcoma is an uncommon neoplasm that primarily occurs in the long bones of the lower and upper extremities. Only 2% involve the mandible, and the maxilla is involved one eighth as often as the mandible. The most common site of metastases is the lung. Increasing pain is the most common presenting symptom. A case of mandibular involvement is presented. The combination of a large, soft tissue mass adjacent to an area of bone destruction in a young male should suggest the diagnosis. The previously poor five- and ten-year survival rates of 8 and 4% respectively, may have promise of marked improvement. This improvement lies in a changing philosophy of treatment. Four-drug chemotherapy combined with prophylactic whole-lung irradiation has been added to local irradiation of the tumor bed. Five-year survival figures of 20 to 30% appear obtainable. Although extensive surgical resection of the primary tumor in the long bones has for the most part been replaced by local irradiation for control, surgery in mandibular cases may still be the treatment of choice.