Demographic Data and Reason for Contact

Figure 2.39 Panoramic radiograph showing abnormal patters over the right TMJ, zygomatic arch, and mandibular ramus.

F. Extraoral Status

Weight and height

  • Within normal limits.

Facial asymmetry

  • Asymmetry with diffuse preauricular swelling on the right side.

Neurologic findings

  • Sensory paresthesia for touch and cold in the right mental region.

Motor function abnormalities

  • Movement of the extremities is within normal limits.

Temporomandibular joint

  • Palpation reveals elastic hard mass, 30 mm in diameter, in the right TMJ region.
  • Palpation pain.

Masticatory muscles

  • No palpation pain.

Jaw movement capacity

  • Maximum unassisted mouth opening 32 mm.
  • No mandibular movement pain.

Neck

  • Within normal limits; no movement or palpation pain.

G. Intraoral Status

Soft tissues

  • Within normal limits.

Hard tissues

  • No caries, but restorations on several teeth.

Occlusion

  • Within normal limits.

H. Additional Examinations and Findings

Photo of a man facing the viewer.

Figure 2.40 Images of the chondrosarcoma of the right condyle: (a) CT scan, (b) T2-weighted axial MRI image, (c) T1-weighted axial, and (d) coronal MRI images.

I. Diagnosis/Diagnoses

Expanded DC/TMD

  • Malignant neoplasm in the TMJ.

Other

  • Chondrosarcoma of the condyle.

J. Evidence-based Treatment Plan, including Aims

Aim

  • Immediate removal of malign tissue.

Treatment

  • Resection of the tumor.

K. Prognosis and Discussion

  • Prognosis is poor regarding survival, especially in a high-grade lesion like this.
  • Individualized treatment based on the principles of resection achieving clear margins and consideration of adjuvant radiotherapy or chemotherapy may improve the prognosis.

Background Information

  • Chondrosarcoma of the head and neck is rare, although it constitutes 40% of the reported TMJ sarcomas. In terms of the bony skeleton, head and neck lesions account for only 1%.
  • The production of malignant cartilage along with cellular pleomorphism are the hallmarks of the chondrosarcoma. No osteoid formation is observed.
  • Histopathologically, cellularity is increased with a myxomatous matrix, and the cartilage cells tend to be large, and may contain multiple nuclei or a large nucleus (Figure 2.41).
  • Chondrosarcoma develops from mesenchymal stem cells, which show partial chondroblastic differentiation. Typically, it is a slow-growing tumor and the majority is low grade.
  • High-grade tumors may metastasize to regional lymph nodes. Low-grade tumors have an excellent prognosis, but recurrences are often observed.
Illustration of Hard occlusion showing contacts on the following teeth in the upper jaw.

Figure 2.41 Histopathological finding of the chondrosarcoma. Cellularity is increased with a myxomatous matrix and the cartilage cells tend to be large. The cells may contain multiple nuclei or a large nucleus.

(Plesh et al., 2005)

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Mar 9, 2017 | Posted by in General Dentistry | Comments Off on Demographic Data and Reason for Contact
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