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Case Reports
. 2019 Mar 12;13(1):58.
doi: 10.1186/s13256-019-1975-1.

A modified preauricular and transmandibular approach for surgical management of osteosarcoma of the mandibular condyle within the masticator space and infratemporal fossa: a case report

Tadahide Noguchi  1 , Yasushi Sugiura  2 , Naruo Okada  2 , Yoshiyuki Tsuchiya  2 , Jun-Ichi Hyasaka  2 , Ken-Ichi Sasaguri  2 , Shunji Sarukawa  3 , Akifumi Fujita  4 , Yusuke Amano  5 , Yoshiyuki Mori  2
Affiliations
Case Reports

A modified preauricular and transmandibular approach for surgical management of osteosarcoma of the mandibular condyle within the masticator space and infratemporal fossa: a case report

Tadahide Noguchi et al. J Med Case Rep. .

Abstract

Background: Osteosarcomas of the head and neck region are rare entities that comprise < 10% of all osteosarcomas. Multimodality treatment of patients with osteosarcoma is well-established for osteosarcoma in long bones, and the benefits of chemotherapy in long bones are clearly known. However, there is no consensus regarding the effects of chemotherapy in cases of head and neck osteosarcoma. The prognostic factor for head and neck osteosarcoma is complete tumor resection with negative margin, which is a radical surgery. However, a clear margin may be difficult to achieve in the head and neck region.

Case presentation: We present a case of a 69-year-old Japanese woman who developed osteosarcoma of the condyle within the masticator space and infratemporal fossa, which was treated with radical surgery using a modified preauricular and transmandibular approach. Although we recommended adjuvant treatment after surgery, the patient refused this treatment. There was no evidence of local recurrence or distant metastasis through 30 months of follow-up.

Conclusions: Our modified preauricular and transmandibular approach allowed access to the masticator space and infratemporal fossa, thereby increasing complete resection of the tumor and resulting in minimal functional and cosmetic deficits.

Keywords: Mandibular condyle; Masticator space; Osteosarcoma; Preauricular approach; Transmandibular approach.

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Not applicable.

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Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Panoramic radiographic examination showing resorption of the right mandibular condyle to the ramus
Fig. 2
Fig. 2
Computed tomography (CT) showing destruction of the right mandibular condyle and a large mass lesion, with margin enhanced in the masticator space. A cystic lesion was present inside the tumor mass. a Axial plane. b Coronal plane. c Three-dimensional CT
Fig. 3
Fig. 3
T1-weighted magnetic resonance imaging showing an enhanced mass lesion in the right masticator space. Because some portions of the mass lesion showed high intensity in T2-weighted images, cystic lesions were suspected with changes in blood flow or retention of high-protein liquid  a. Axial plane, b. Coronal plane
Fig. 4
Fig. 4
Histopathologically, much of the tumor was composed of proliferative, atypical, spindle-shaped cells. Some tumor cells showed increasing mitotic changes and a high degree of atypia (H&E stain, 100× magnification)
Fig. 5
Fig. 5
Surgical procedure. a Incision line. b Facial nerve trace. c Facial nerve preservation. d After tumor resection. e Reconstruction of fibula. f After suture
Fig. 6
Fig. 6
H&E staining. a The resected specimen was almost identical to the histological findings of the biopsy. b It involved periosteal reaction, corresponding partially to Codman’s triangle. The magnification is 100× in (a) and 40× in (b)
Fig. 7
Fig. 7
Preoperative (a, b, c) and 27 months postoperative (d, e, f) images
Fig. 8
Fig. 8
Postoperative images of facial function. a Closed eyes. b Wrinkling of forehead. c Whistling motion. d Mouth opening
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