PDF(Pubmed)
Abstract：
Osteosarcomas are rare and highly malignant bone tumours which are composed of malignant mesenchymal cells producing osteoid or immature bone. Maxillary osteosarcomas are rare tumours accounting for less than 1% of head and neck malignancies. Aggressive surgical resection is the main modality of treatment with good reconstruction. Due to the complex anatomy and location of maxilla as well as its proximity to the skull, resection with negative margins is always a challenge and so is the reconstruction so as to reduce the morbidity of the patient and to also give a good functional and cosmetic outcome. Clinical outcomes can be improved with administration of neoadjuvant or adjuvant chemotherapy in selected cases and radiotherapy in case of positive margins. A 41-year-old male patient presented to the outpatient department with complaints of a bulge over the hard palate for the past 1 year. CT scan showed a 6 × 5 × 4 cm osseous expansile lesion arising from the maxillary bone. Biopsy of the tumour showed features of conventional high-grade osteosarcoma. Plate-preserving maxillectomy with tracheostomy was done followed by reconstruction with a double free flap. On post-operative day 1, the flap showed signs of venous congestion and a new free anterolateral thigh flap was done. Patient was discharged on day 7 with a Ryles tube and a tracheostomy tube in situ. Final histopathological examination showed that the tumour was a high-grade chondroblastic osteosarcoma. After regular post-operative visits in the outpatient department and evaluation with flexible laryngoscopy, patient was started on oral feed by day 10 and decannulated by day 15. He has been on regular follow-up for the past 1 year and shows no signs of recurrence or residual disease on clinical examination as well as imaging. Maxillary osteosarcoma is a rare bone tumour which requires accurate imaging and biopsy for accurate surgical planning. The ideal treatment modality is radical resection with negative margins and appropriate reconstruction. With the advent of microvascular surgery, free flaps form the backbone for reconstruction of such large defects.
摘要：
骨肉瘤是罕见且高度恶性的骨肿瘤，由产生类骨质或未成熟骨的恶性间充质细胞组成。上颌骨肉瘤是罕见的肿瘤，占头颈部恶性肿瘤的不到1％。积极的手术切除是重建良好的主要治疗方式。由于上颌骨复杂的解剖结构和位置，以及它靠近头骨，具有阴性切缘的切除始终是一个挑战，重建也是如此，以降低患者的发病率并提供良好的功能和美容效果。在选定的病例中给予新辅助或辅助化疗，在切缘阳性的情况下给予放疗，可以改善临床结果。一名41岁的男性患者出现在门诊部，抱怨过去1年硬腭隆起。CT扫描显示上颌骨出现6×5×4厘米的骨膨胀性病变。肿瘤活检显示了常规高级骨肉瘤的特征。进行保留钢板的上颌骨切除术和气管造口术，然后用双游离皮瓣进行重建。术后第1天，皮瓣显示出静脉充血的迹象，并进行了新的游离股前外侧皮瓣。患者在第7天用Ryles管和原位气管造口管出院。最终的组织病理学检查显示肿瘤是高级软骨母细胞骨肉瘤。在门诊定期术后就诊并使用柔性喉镜检查进行评估后，患者在第10天开始口服喂养,并在第15天脱管.在过去的1年中，他一直在定期随访，在临床检查和影像学检查中没有发现复发或残留疾病的迹象。上颌骨肉瘤是一种罕见的骨肿瘤，需要准确的成像和活检才能进行准确的手术计划。理想的治疗方式是具有阴性切缘和适当重建的根治性切除。随着微血管手术的出现，游离皮瓣形成了重建这种大缺损的骨干。
