Reconstruction of Temporomandibular Joint and Skull Base Defect Following Osteosarcoma Resection.

ABSTRACT: Osteosarcoma of the jaw is uncommon, occurring in about 6% to 8% of cases. The authors present the case report of a (woman 72-year-old) with osteosarcoma involving the temporomandibular joint (TMJ). Radical surgery was chosen with resection of the tumor together with the condyle, the coronoid process, the zygomatic arch and eroded bone of the skull base at the site of the joint cavity. Contact of the tumor with the dura mater was not confirmed perioperatively.Reconstruction of the TMJ was 24 months after resection. The fossa component was concurrently formed in such a way as to cover the defect in the skull base and allow the reconstruction of the fossa and resected zygomatic arch. Four years after tumor resection there are no signs of local recurrence or metastases. Two years after TMJ reconstruction, the patient is symptom-free-occlusion is satisfactory, jaw movement is within normal range.

External fixation greatly improves outcomes in the surgical treatment of osteoradionecrosis of the jaws without affecting quality of life: a five-year retrospective study.

Osteoradionecrosis of the jaw can be treated using both conservative treatment and surgery. External fixation may be used to bridge large resection defects after sequestrectomy for stabilisation and before secondary mandibular reconstruction. We designed a retrospective analysis of 70 patients with osteoradionecrosis treated between the years 2014 and 2018, and found that the use of external fixation greatly improves their outcomes. Patients were grouped according to Notani's classification: those who had Notani I disease were treated surgically but without external fixation; and those with Notani II and Notani III disease were eligible for external fixation. In those with Notani II disease, there was a significant reduction in the number of pathological fractures that occurred with external fixation. In those with Notani III disease, the success rate of primary sequestrectomy was only 1:14; however, those treated with external fixation all successfully healed after their first operation. It was hypothesised that although external fixation would improve outcome, it would come at a detriment to their quality of life (QoL). However, in a subset of these patients, we showed that in addition to increasing successful healing, patients' QoL with the external fixator was no worse than when they had an active osteonecrotic lesion. The treatment of osteoradionecrosis is cumbersome and advanced stages are associated with more complications. The use of an external fixator significantly reduces the probability of pathological fractures and increases the rate of successful healing in patients after mandibular resection. It does this without greatly interfering with patients' lives, while improving their condition sufficiently to allow for subsequent mandibular reconstruction.