J Korean Assoc Oral Maxillofac Surg.  2016 Oct;42(5):288-294. 10.5125/jkaoms.2016.42.5.288.

Temporomandibular joint chondrosarcoma: a case report and literature review

• Lee K
• Kim SH
• Kim SM
• Myoung H

• KMID: 2356256
• DOI: http://doi.org/10.5125/jkaoms.2016.42.5.288

Abstract

Chondrosarcoma is a malignant tumor that originates from cartilaginous cells and is characterized by cartilage formation. Only 5% to 10% of chondrosarcoma occurs in the head and neck area, and it is uncommon in the temporomandibular joint area. This report describes an unusual case with a rare, large chondrosarcoma in a 47-year-old woman who presented with painless swelling and trismus. Computed tomography showed a large mass approximately 8.5×6.0 cm in size arising adjacent to the lateral pterygoid plate and condyle. There were features suggestive of bone resorption. The tumor was resected in a single block with perilesional tissues, and a great auricular nerve graft was performed because of facial nerve sacrifice. Microscopic examination of sections stained with H&E revealed chondrocytes with irregular nuclei and heterogeneous hyper chromatic tumor cells embedded in the chondrocyte lacuna. The diagnosis was a grade I chondrosarcoma. There was no evidence of recurrence at the 8-month follow-up, and a reconstruction surgery with fibular osteocutaneous free flap was performed. We report this unusual entity and a review of the literature.

Keyword

Osteosarcoma; Temporomandibular joint

MeSH Terms

Bone Resorption
Cartilage
Chondrocytes
Chondrosarcoma*
Diagnosis
Facial Nerve
Female
Follow-Up Studies
Free Tissue Flaps
Head
Humans
Middle Aged
Neck
Osteosarcoma
Recurrence
Temporomandibular Joint*
Transplants
Trismus

Figure

• 

  Fig. 1 A-C. Frontal view of the patient before tumor resection. Right-side preauricular swelling, occlusal discrepancy and trismus on presentation. D-G. Low-enhanced tumor around the right condylar head on contrast-enhanced computed tomography and magnetic resonance imaging.

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  Fig. 2 The surgical process. An extraoral approach with an extended preauricular incision and submandibular incision was used to dissect and resect the large mass. The glenoid fossa and cranial base with adjacent tissues, facial nerve, and condyle were involved in the mass.

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  Fig. 3 A. Resected mass with the right condylar head. B, C. Atypical chondrocytic cells in myxoid or chondroid matrix (B; H&E staining, ×400), pleomorphism with bizarre nucleus appearance (C; H&E staining, ×50).

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  Fig. 4 Frontal view of the patient after tumor resection and before reconstruction. There was a soft tissue depression on the right side of the preauricular area.

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  Fig. 5 Frontal view of the patient after reconstruction. The soft tissue in the preauricular area was augmented with a vascularized flap. The left two pictures show partial improvement in facial nerve weakness after great auricular nerve graft.

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