Metastases of the articular process, temporomandibular joint (TMJ), are rare findings. Their frequency is around 5% of patients with metastatic involvement of the mandible. The most common primary tumor is adenocarcinoma of the lung in women and adenocarcinoma of the prostate in men. The authors present 3 patients with TMJ metastasis. These were metastasis of breast adenocarcinoma, prostate adenocarcinoma, and lung adenocarcinoma. TMJ metastases are rare but complicated to diagnose because their presence may be accompanied by symptoms typical of other TMJ diseases (discopathy, arthritis, osteoarthritis). However, the authors recommend the unequivocal exclusion of a metastatic process in cases where the patient has a positive cancer history and their complaints do not respond to usual therapy.
- MeSH
- adenokarcinom * sekundární patologie MeSH
- diferenciální diagnóza MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- nádory mandibuly * sekundární MeSH
- nádory plic * patologie MeSH
- nádory prostaty * patologie MeSH
- nádory prsu * patologie MeSH
- nemoci temporomandibulárního kloubu MeSH
- počítačová rentgenová tomografie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
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.
- MeSH
- baze lební chirurgie MeSH
- lidé MeSH
- nemoci temporomandibulárního kloubu * diagnóza chirurgie MeSH
- osteosarkom * chirurgie MeSH
- protézy kloubů * MeSH
- senioři MeSH
- temporomandibulární kloub chirurgie MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Cíl: Podat přehled nejčastějších nádorů očnice, navrhnout vyšetřovací postup a možný způsob řešení na základě zkušeností s vlastním souborem pacientů. Metodika a soubor: Z dokumentace Oční kliniky a Stomatologické kliniky 1. LF UK a VFN v Praze byli vybráni pacienti, kteří se v letech 2005-2019 podrobili operaci pro podezření na nádorový proces očnice. Z operačních záznamů jsme dohledali údaje o 497 případech. Na stomatologii bylo provedeno 282 výkonů v celkové anestezii, na oční klinice 215 operací častěji v lokální anestezii. Výsledky: Počet operací u mužů i žen byl stejný, zastoupeni byli pacienti všech věkových skupin. Medián věku u operovaných na stomatologii byl 53 let, na oční klinice 63 let. Nejčastějším primárním benigním nádorem byl kavernózní hemangiom (9 %), nejčastějším nepravým nádorem byla dermoidní cysta (7 %), nejčastějším maligním nádorem byl maligní lymfom (17,5 %). Ten byl i nejčastější diagnózou v celém souboru. Závěr: Naše sestava je srovnatelná rozložením dle věku a pohlaví pacientů s velkými publikovanými soubory. Rozdíly v zastoupení některých afekcí lze vysvětlit tím, že naše sestava zahrnuje pouze operované pacienty. Článek si neklade za cíl vyhodnocení všech možných orbitálních afekcí v péči našeho pracoviště. Maligní lymfom byl nejčastější diagnózou určenou k chirurgickému výkonu, většinou k biopsii. Při porovnání sestav z našich pracovišť s odstupem 20let zůstává maligní lymfom nejčastější indikací k výkonu, ale poklesl výskyt adenomů a adenokarcinomů slzné žlázy. Nabízené operační přístupy jsou doporučením na základě mnohaletých zkušeností, ale v některých situacích je třeba volit operační postup individuální.
Aim: To report an overview of the most frequent tumors of the orbit, suggest diagnostic approach and possible solution according to experience with own cohort of patients. Material and Methods: From patients' files from the Department of Ophthalmology and Department of Stomatology, First Medical Faculty, Charles University, and General Faculty Hospital in Prague, Czech Republic, there were selected patients, who underwent the surgery due to the suspicion of malignant development in the orbit during the period 2005 – 2019. From the surgical records we found information about 497 cases. At the Department of Stomatology, there were 282 surgeries under general anesthesia performed, and at the Department of Ophthalmology, there were 215 surgeries, mostly under local anesthesia performed. Results: The number of surgeries in men and women was equal; patients of all ages were present. The median of patients' age operated on at the Department of Stomatology was 53 years, and at the Department of Ophthalmology 63 years. The most common primary benign tumor was the cavernous hemangioma (9 %), the most common non-tumorous expansion was the dermoid cyst (7 %); the most common malignant tumor was the lymphoma (17,5 %). The last mentioned tumor was the most common diagnosis in the whole cohort as well. Conclusion: Our cohort of patients is comparable with large cohorts published in the literature concerning age and gender distributions. Differences in frequencies of some lesions may be explained by that our cohort includes patients after the surgery only. The malignant lymphoma is the most common diagnosis indicated to surgical procedure, mostly biopsy. Comparing the two cohorts from our departments 20 years apart, the malignant lymphoma remains the most common indication for surgery, but the incidence of adenomas and adenocarcinomas of the lacrimal gland decreased. It is not the goal of this paper to evaluate all possible orbital affections. Suggested surgical approaches are just recommendations according to years of experience; however, in some situations, to choose an individual surgical approach is necessary.
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.
- MeSH
- externí fixátory MeSH
- fixace fraktury MeSH
- kvalita života * MeSH
- lidé MeSH
- osteoradionekróza * chirurgie MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
