Chondrosarcoma of the jaw: report of two cases

Surgical management and final outcomes of chondrosarcoma of the temporomandibular joint: case series and comprehensive literature review

BACKGROUND

Surgical management for chondrosarcoma of the temporomandibular joint (TMJ) is challenging due to the anatomical location involving the facial nerve and the functional joint. The purpose of this case series was to analyze the largest number of TMJ chondrosarcoma cases reported from a single institution and to review the literature about chondrosarcoma involving the TMJ.

METHODS

Ten TMJ chondrosarcoma patients at Seoul National University Dental Hospital were included in this study. Radiographic features, surgical approaches, histopathologic subtypes, and treatment modalities were evaluated. All case reports of TMJ chondrosarcoma published in English from 1954 to 2021 were collected under PRISMA guidelines and comprehensively reviewed.

RESULTS

The lesions were surgically resected in all 10 patients with efforts to preserve facial nerve function. Wide excision including margins of normal tissue was performed to ensure adequate resection margins. All TMJs were reconstructed with a metal condyle except one, which was reconstructed with vascularized costal bone. At last follow-up, all patients were still alive, and there had been no recurrence. Among 47 cases (patients from the literature and our cases), recurrence was specified in 43 and occurred in four (9.5%).

CONCLUSIONS

For surgical management of TMJ chondrosarcoma, wide excision must consider preservation of the facial nerve. Reconstruction using a metal condyle prosthesis and a vascularized free flap is reliable. A more conservative surgical approach correlates with a favorable prognosis for facial nerve recovery. Nevertheless, wide excision is imperative to prevent tumor recurrence. In cases in which the glenoid fossa is unaffected by the tumor, it is deemed unnecessary to reconstruct the glenoid fossa within an oncological setting.

Chondrosarcoma of the jaw bones: a review of 224 cases reported to date and an analysis of prognostic factors

The objective was to integrate the available published data on chondrosarcoma (CHS) of the jaw bones into a comprehensive analysis of its clinical and histological features, treatment, and prognostic factors. An electronic search was undertaken in October 2017. To be eligible, the publication had to provide sufficient clinical/histological data to confirm the diagnosis. One hundred and ten publications (224 cases of CHS) were identified and included. There was a slightly higher prevalence of CHS in males than in females. Most subjects with CHS were in the second to fifth decades of life. The most common symptom was swelling and the most commonly observed location was the maxilla. Histologically, most tumours were of the conventional type and were low grade tumours. The treatment of choice was tumour resection. Histological grade, treatment with chemotherapy alone, and the presentation of recurrence or metastasis were found to be significant independent prognostic factors: patients who presented high-grade tumours, who received chemotherapy alone as the treatment of choice, and those who presented recurrence or metastasis were more likely to have a worse prognosis. In addition, radical surgery associated with radiotherapy as the treatment protocol showed a better prognosis.

Myxoid Chondrosarcoma of Maxilla in a Pediatric Patient: A Rare Case Report

Myxoid variant of chondrosarcoma is an uncommon potentially lethal malignant tumor which is even rare in pediatric age group. In the present paper, we report one such case of intermediate grade myxoid chondrosarcoma of left side of maxilla in a 12-year-old girl. The present case had a firm, painless, and lobulated growth in premolar-molar region which was associated with bicortical expansion. Maxillofacial imaging showed ill-defined radiolucency with displaced maxillary molars. Osteolytic changes were evident with the alveolus and walls of maxillary sinus. Owing to the age of the patient, surgical excision was selected as the modality of management followed by postoperative radiotherapy. This report encompasses the entire gamut of clinicopathological, radiological, and treatment modalities employed for chondrosarcoma.

Central chondrosarcoma of a pediatric mandibular condyle: A case report and review

Chondrosarcoma of mandibular condyle is an extremely rare clinical entity with only 18 cases reported till date. We report a rare case of central myxoid chondrosarcoma in a 7 year old male child with a complaint of slow growing bony hard swelling of left mandibular condyle. Panoramic radiography and CT scan revealed a 5×3cm osteosclerotic and osteolytic lesion with cortical perforation on the medial side of the left mandibular condyle with a cortical expansion of lateral side. Segmental mandibulectomy with disarticulation of the left condyle was done. To the best of our knowledge it is the first case of chondrosarcoma of the paediatric mandibular condyle to be reported. The etiopathogenesis, clinical, radiological diagnosis and various treatment modalities of chondrosarcoma are discussed.

Chondrosarcoma of the parapharyngeal space

Chondrosarcomas are the malignant cartilagenous tumors and they are seen rarely in the head and neck area. They are usually slow growing lesions. The head and neck chondrosarcomas may show an aggressive course and the occurrence of this malignant cartilagenous tumor in the parapharyngeal space is only a few. They are mostly located in relation with jaw bones and base of the skull. Chondrosarcomas of the parapharyngeal space are limited in number and among them there is no low-grade one. In this case report, a case of low-grade chondrosarcoma which was treated with a simple excision without neck dissection was reported.

Chondrosarcoma of the mandible presenting as periodontal lesions: report of 2 cases

A review of the literature and the addition of 2 cases in the mandibular symphyseal region serve to illustrate the protean presentation of chondrosarcomas. These 2 cases presented as periodontal lesions with associated bone loss. A high index of suspicion is required to make an early diagnosis. The importance of submitting biopsy specimens for histology is stressed, and it is recommended that definitive treatment be carried out as rapidly as possible after diagnosis is known. The surgical procedures undertaken were conservative, and patients have remained disease-free after 3.5 years and 3 years respectively. For small lesions, early segmental resection is not necessary in this region. Only recurrence should be treated by symphyseal resection with its increased morbidity. Close follow-up is mandatory.

Chondrosarcoma of the jaws: clinical findings, histopathology, and treatment

Three cases of chondrosarcoma involving the jaws are presented, one in the maxilla and two in the mandible. The salient points of clinical presentation elucidated by this series of cases are that a widened periodontal ligament space is present in chondrosarcomas as well as in osteosarcomas, and that a slowly increasing diastema may be the earliest clinical sign. The most important lesson to be learned from the histopathology is that one should not accept a diagnosis of a benign cartilaginous tumor of the jaws. Treatment of these lesions should consist of wide surgical excision and consideration of adjunctive or palliative radiotherapy, especially in the maxilla. It should also be noted that recurrences may develop 10 to 20 years later, and follow-up should be lifelong.