Management of maxillofacial osteosarcomas in Kenya

Symon Guthua,Nicholas Abinya,Martin Kamau

doi:10.4314/aas.v17i1.7

Abstract

Background: Though not common, maxillofacial osteosarcomas present a unique challenge in management due to a multitude of factors, such as difficulty in diagnosis and local complex anatomy, making surgical excision difficult as well as debate necessary on the usefulness of adjunct treatment modalities, such as chemotherapy and radiotherapy. Nonetheless, osteosarcomas are a significant health burden because of their high morbidity and mortality. Method: Retrospective cross-sectional study of records archived in the School of Dental Sciences, University of Nairobi. Results: 25 cases of maxillofacial sarcomas were seen over 26 years. Mean age of occurrence was 35.68 years with a preponderance for females (17 cases). The mandible was the most affected site, accounting for 18 cases. Discussion: The management of maxillofacial sarcomas in our setting presents significant challenges arising from multiple factors such as lack of standardised treatment protocol, late presentation of patients, diagnostic challenges and loss to follow-up. Keywords: Maxillofacial osteosarcomas, Management protocol, Kenya

Highlights

With an incidence of 1:100,000 [1,2], osteosarcoma is the most common primary neoplasm of bone
The mandible and maxilla are the predominant sites of head and neck osteosarcoma (HNOS), extragnathic bone as well as soft tissue sites may be affected [6]
The use of multidrug chemotherapy in the management of skeletal OS is well established with notable improvements in survival rates, but the same cannot be said for OS in the maxillofacial region

Summary

Introduction

With an incidence of 1:100,000 [1,2], osteosarcoma is the most common primary neoplasm of bone. Most head and neck sarcomas are of the soft tissue type with only 20% being of bony or cartilaginous origin [3]. The mandible and maxilla are the predominant sites of head and neck osteosarcoma (HNOS), extragnathic bone as well as soft tissue sites may be affected [6]. Maxillofacial sarcomas have a biological behaviour that differs from that of the long bones: the average age of onset is 10–20 years later than their skeletal variants, distant metastases are rarer and survival rates are more favourable [9]. The use of multidrug chemotherapy (both neoadjuvant and adjuvant) in the management of skeletal OS is well established with notable improvements in survival rates, but the same cannot be said for OS in the maxillofacial region.

Materials and Methods

Results

Discussion

Conclusion