Multimodal Treatment of Osteogenic Sarcoma of the Jaw

ABSTRACT

Osteosarcomas (OSs) account for 40 to 60% of primary malignant bone tumors. About 10% occur in the head and neck region, frequently in the mandibula or maxilla. We treated a 30-year-old patient with 26-month history of right-sided facial pain and paresthesia. Investigation showed high-grade OS of the right mandibular coronoid process, affecting the mandibular nerve, middle cranial fossa, internal jugular vein, and internal carotid artery (ICA). True en bloc resection was performed after upfront adjuvant chemotherapy. The ICA was trap-ligated intradurally, whereafter the floor of the middle fossa, including the mandibular nerve and the glenoid fossa, was detached from the skull base in one piece. Subsequently, a hemimandibulectomy, total parotidectomy, ICA sacrifice, and removal of the pterygoid plates and muscles were performed, and the abovementioned structures were removed as a solitary specimen, including the facial nerve branches overlying the tumor. A sural nerve graft was interposed between five major facial nerve branches to reanimate the face. The patient had an uneventful recovery, is able to eat, and has a partial facial nerve palsy. He has no tumor recurrence 26 months after surgery. OS of the jaw should be treated with radical surgery as the primary modality.

KEYWORDS

Osteosarcoma - en bloc resection - tumor of the skull base - craniofacial surgery - jaw tumor

REFERENCES

• 1 Tanzawa H, Uchiyama S, Sato K. Statistical observation of osteosarcoma of the maxillofacial region in Japan.  Oral Surg Oral Med Oral Pathol. 1991;  72 444-448
• 2 Dahlin D C. Bone Tumors: General Aspects and Data on 6221 Cases. 3rd ed. Springfield, IL; Charles C Thomas 1978
• 3 Spjut H J, Dofman H D, Fechner R E, Ackerman L V. Tumors of bone and cartilage. In: Silverberg S Atlas of Tumor Pathology. Washington, DC; Armed Forces Institute of Pathology 1970
• 4 August M, Magennis P, Dewitt D. Osteogenic sarcoma of the jaws: factors influencing prognosis.  Int J Oral Maxillofac Surg. 1997;  26 198-204
• 5 Russ J E, Jesse R H. Management of osteosarcoma of the maxilla and mandible.  Am J Surg. 1980;  140 572-576
• 6 Regezi J A, Zarbo R J, McClatchey K D, Courtney R M, Crissman J D. Osteosarcomas and chondrosarcomas of the jaws: immunohistochemical correlations.  Oral Surg Oral Med Oral Pathol. 1987;  64 302-307
• 7 Chindia M L. Osteosarcoma of the jaw bones.  Oral Oncol. 2001;  37 545-547
• 8 Archer D, Langdon J O. Primary tumours of the jaws. In: Langdon JD, Henk JM Malignant Tumours of the Mouth, Jaws and Salivary Glands. London; Edward Arnold 1995: 222-239
• 9 Kassir R R, Rassekh C H, Kinsella J B, Segas J, Carrau R L, Hokanson J A. Osteosarcoma of the head and neck: meta-analysis of nonrandomized studies.  Laryngoscope. 1997;  107 56-61
• 10 Bilsky M H, Bentz B, Vitaz T, Shah J, Kraus D. Craniofacial resection for cranial base malignancies involving the infratemporal fossa.  Neurosurgery. 2005;  57(4 Suppl) 339-347 discussion 339-347
• 11 August M, Magennis P, Dewitt D. Osteogenic sarcoma of the jaws: factors influencing prognosis.  Int J Oral Maxillofac Surg. 1997;  26 198-204
• 12 Jasnau S, Meyer U, Potratz J et al.. Craniofacial osteosarcoma. Experience of the cooperative German-Austrian-Swiss osteosarcoma study group.  Oral Oncol. 2008;  44 286-294
• 13 Canadian Society of Otolaryngology-Head and Neck Surgery Oncology Study Group . Osteogenic sarcoma of the mandible and maxilla: a Canadian review (1980–2000).  J Otolaryngol. 2004;  33 139-144
• 14 Ha P K, Eisele D W, Frassica F J, Zahurak M L, McCarthy E F. Osteosarcoma of the head and neck: a review of the Johns Hopkins experience.  Laryngoscope. 1999;  109 964-969
• 15 van Es R J, Keus R B, van der Waal I, Koole R, Vermey A. Osteosarcoma of the jaw bones. Long-term follow up of 48 cases.  Int J Oral Maxillofac Surg. 1997;  26 191-197
• 16 Smeele L E, van der Wal J F, van Diest P J, van der Waal I, Snow G B. Radical surgical treatment in craniofacial osteosarcoma gives excellent survival. A retrospective cohort study of 14 patients.  Eur J Cancer B Oral Oncol. 1994;  30B 374-376
• 17 Laskar S, Basu A, Muckaden M A et al.. Osteosarcoma of the head and neck region: lessons learned from a single-institution experience of 50 patients.  Head Neck. 2008;  30 1020-1026
• 18 Sæter G, Bruland ØS, Follerås G, Boysen M, Høie J. Extremity and non-extremity high-grade osteosarcoma. The Norwegian Radium Hospital experience during the modern chemotherapy era.  Acta Oncol. 1996;  35(Suppl 8) 129-134
• 19 Oda D, Bavisotto L M, Schmidt R A et al.. Head and neck osteosarcoma at the University of Washington.  Head Neck. 1997;  19 513-523
• 20 Sorteberg A, Bakke S J, Boysen M, Sorteberg W. Angiographic balloon test occlusion and therapeutic sacrifice of major arteries to the brain.  Neurosurgery. 2008;  63 651-660 discussion 660-661
• 21 Dolenc V V. A combined epi- and subdural direct approach to carotid-ophthalmic artery aneurysms.  J Neurosurg. 1985;  62 667-672