1225
KAWAI ET AL
References 1. Frederiksen NL, Wesley RK, Sciubba JJ, et al: Massive osteolysis of the maxillofacial skeleton: A clinical, radiographic, histologic and ultrastructural study. Oral Surg 55:470, 1983 Pedicelli G, Mattia P, Zorzoli AA, et al: Gorham syndrome. JAMA 252:1449, 1984 Hamptom J, Arthur JF: Massive osteolysis affecting the mandible. Br Dent J 120:538, 1966 Ellis DJ, Adams TO: Massive osteolysis: Report of case. J Oral Surg 29:659, 1971 Cherrick HM, King OH, Dorsey JN: Massive osteolysis (disappearing bone, phantom bone, acute absorption of bone) of the mandible and maxilla. J Oral Med 27:67, 1972 Kriens 0: Progressive maxillofacial osteolysis. A case report. Dentomaxillofac Rad 2:73, 1973 Murphy JB, Doku HC, Charter BL: Massive osteolysis: Phantom bone disease. J Oral Surg 36:318, 1978 Black MJ. Cassisi NJ, Biller HF: Massive mandibular osteolysis. Arch Otolaryngol 100:314, 1974 Philips RM, Bush OB. Hall HD: Massive osteolysis (phantom bone, disappearing bone). Report of a case with mandibular involvement. Oral Surg 34:886, 1972
J Oral Maxillofac 48:1225-1228.
10. Malter JJ: Massive osteolysis of the mandible: Report of case. JAMA 85: 148. 1972 11. Booth DF, Burke CHI Massive osteolysis of the mandible: An attempt at reconstruction. J Oral Surg 32:787, 1974 12. El Mofty S: Atrophy of the mandible (massive osteolysis). Oral Surg 31:690, 1971 13. Heuck F: Massive osteolysis of mandible: Skeletal Radio1 3:241, 1979 14. Heyden G, Kindblom LG, Nielsen JM: Disappearing bone disease. A clinical and histologic study. J Bone Joint Surg (Am) 59:57, 1977 IS. Gorham LW, Wright AW, Schultz HH, et al: Disappearing bones: A rare form of massive osteolysis. Am J Med 17:674, 1954 16. Gorham LW, Stout AP: Massive osteolysis (acute spontaneous absorption of bone, phantom bone, disappearing bone). Its relation to hemangiomatosis. J Bone Joint Surg (Am) 37:985, 1955 17. Kessler HB, Recht MP, Dalinka MK: Vascular anomalies in association with osteodystrophies-A spectrum. Skeletal Radio1 10:95, 1983 18. Gorham LW: Circulatory changes associated with osteolytic an osteoblastic reactions in bone. Arch Intern Med 105:199, 1966 19. Pearse HE Jr, Morton JJ: Stimulation of bone growth by venous stasis. J Bone Joint Surg (Am) 28:97. 1930
Surg
1990
Elongated Styloid Process as a Cause of Difficult In tuba tion TOSHIHIKO
KAWAI, DDS, PHD,* KAZUO SHIMOZATO, DDS, PtiD,t AND SHIGEKI OCHIAI, DDS*
The normal styloid process is from 2.5 to 3.0 cm in length,‘*2 and any process exceeding this is thought to be elongated. Elongation of the styloid process and its ossification were described as early as 1650.3 The reported incidence of elongated styloid process is estimated to be 4% by Gossman4 and 18.2% by Carrel.’ The etiology is not well understood. The elongated styloid process occurs with or without symptoms. Related symptoms were sepa-
rated into two distinct groups by Eagle; the typical syndrome and the carotid artery syndrome. The typical syndrome includes pain, dysphagia, dysphoria around the throat, otalgia, and the sensation of a vague facial pain radiating to the mandible, and is found in patients who have had a tonsillectomy.2*6*7 The following case report describes an additional complication of elongated styloid process, difficulty of endotracheal intubation associated with general anesthesia. Report of a Case
* Assistant Professor, the Second Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Nagoya, Japan. t Chief, Department of Oral and Maxillofacial Surgery, Japanese Red-Cross Nagoya First Hospital. $ Resident, the Second Department of Oral and Maxillofacial Surgery, Aichi-Gakuin University, Nagoya, Japan. Address correspondence and reprint requests to Dr Kawai: The Second Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, 2-l 1 SuemoriDori, Chikusa-Ku, Nagoya, 464, Japan. 0 1990 American Association of Oral and Maxillofacial geons 0278-2391/901481 l-0018$3.00/0
Sur-
A 58-year-old Japanese man came to the outpatient department of the hospital complaining of a left submandibular swelling and a sensation of a foreign body in his throat. He had noticed these symptoms for 3 years. He gave a history of psychiatric disease since 1980. He had never had a tonsillectomy. The initial clinical examination disclosed a bony mass in the left side of the mouth floor, which extended anteriorly beneath the lobe of the submandibular gland (Fig 1). When swallowing, his larynx immediately moved obliquely and superiorly to the right side and then returned to the normal rest position at the end of swallowing.
1226
ELONGATED
STYLOID PROCESS
1. Intraoral view showing bulging of the mouth floor. FIGURE
Panoramic and orbito-ramus radiographs showed an abnormally thick, nodular, elongated styloid process (Figs 2 and 3). Occlusal radiographs demonstrated a close connection between the enlarged caudal end of the styloid process and the hyoid bone, and an additional jointlike structure within the process (Fig 4). Palpation of the tonsillar fossa and the neck elicited no radiating pain. Elongation of the styloid process was diagnosed. After evaluation of the general condition, the patient was scheduled for surgery to shorten the styloid process. It was decided to use an extraoral approach due to the size of the lesion and its anatomic complexity. At the time of induction of general anesthesia, problems were encountered with intubation of the patient. Despite the use of a muscle relaxant, it was difficult to lift the epiglottis away from the posterior laryngeal wall. The vocal cords could not be exposed directly and the displacement of the laryngeal complex was marked. Digest intubation was tried unsuccessfully several times; finally, use of the fiberscope enabled intubation to be accomplished.
After initial incision through the platysma muscle, a skin platysmal flap was raised. The parotid tail and submandibular gland was reflected and the posterior part of the suprahyoid muscles was exposed. The surface of the submandibular gland was normal and the stylohyoid muscle was intact. The stylohyoid muscle was freed from the hyoid bone, and the posterior belly of the digastric muscle
Panoramic radiograph shows thick and elongated styloid process (arrow).
FIGURE 3. Orbito-ramus radiograph shows thick styloid process (arrow).
FIGURE 2.
1227
KAWAI ET AL
ynx during swallowing was decreased. Other symptoms
had disappeared. Discussion
Close connection between the tip of the styloid process and the hyoid bone. Note a jointlike structure within the FIGURE 4.
styloid process.
was divided at its intermediate tendon. Retraction of the digastric muscle posterosuperiorly revealed the elongated styloid process joined directly to the hyoid bone. The
elongated process was shortened to match the opposite side. The tip, bound to the hyoid bone by fibrous tissue, was bluntly dissected and the excised part of the process was removed (Fig 5). At the l&month follow-up examination, the patient was found to be comfortable and displacement of the lar-
The styloid process is a slender osseous projection, located in front of the stylomastoid foramen, that is fused with the inferior aspect of the temporal bone. It is positioned between the internal and external carotid arteries and lies posterior to the tonsillar fossa. Attached to it are the stylopharyngeus, the stylomandibular and the styloglossus muscles, and the stylohyoid and the stylomandibular ligaments. The styloid process, the stylohyoid ligament, and the lesser cornu of the hyoid bone develop from the second branchial arch, called Reichert’s cartilage. According to Dwight,* the styloid process consists of four sections: the tympanohyal, stylohyal, ceratohyal and hypohyal portions. Also noted is the occasional occurrence of a false joint that forms at the junction of the stylohyal and ceratohyal portions.’ Because of the anatomic location, the elongated styloid process can cause many symptoms (Eagle’s syndrome). 9-1’ In contradiction to Eagle’s description,* a past history of tonsillectomy is not necessary to diagnose the typical syndrome. In addition to the symptoms that have been reported, our patient complained of a swelling in the submandibular area and displacement of the larynx during swallowing. The former was assumed to be the result of anterolateral displacement of the submandibular gland by the elongated styloid process. Magendi describes the act of swallowing as occurring in three stages: the oral stage, the pharyngeal stage, and the esophageal stage. During these stages. many muscles work coordinately. Mobility of the larynx is essential to the second stage of deglutition, and any disease that prevents the larynx from ascending to lie beneath the base of the tongue is said to cause marked dysphagia. ” In our
__--- -.______-_
FIGURE 5.
Surgically resected specimen.
--K-r.-------
---
____--.
-_
__
____
_____
gated styloid process was discussed. The extraoral approach has two advantages: 1) surgical visualization is optimal, and 2) the risk of deep cervical in-
1228
ORAL INFANT FIBROSARCOMA
fection is minimal. The extraoral approach also has two disadvantages: 1) presence of a postoperative scar, and 2) necessity for general anesthesia.13,‘4 In our case, the elongated styloid process was attached to the lesser cornu of the hyoid bone. Because of this, the mobility of the larynx and associated muscles was decreased. Also, difficulty in lifting the epiglottis away from the posterior laryngeal wall occurred during laryngoscopy, and difficulty in intubation was encountered.‘59’6 The possibility of difftculty of intubation is therefore another point to consider when selecting the best remedial appreach. References
J Oral Maxillofac
7.
8. 9.
10. 11. 12.
13.
1. Eagle WW: Elongated styloid process. Report of two cases. Arch Otolaryngol 25584, 1937 2. Eagle WW: Elongated styloid process: Symptoms and treatment. Arch Otolaryngol 67: 172, 1958 3. Moore I: Osseous and cartilaginous formations in the tonsils. J Laryngol Otol 39: 195, 1924 4. Gossmann JR, Tarsitano JJ: The styloid-stylohyoid syndrome. J Oral Surg 35:555, 1977 5. Correll RW, Jensen JL, Taylor JB, et al: Mineralization of
48:1228-l
6.
14.
IS. 16.
the styloid stylomandibular ligament complex. Oral Surg 48:286, 1979 Eagle WW: Elongated styloid process. Further observation and a new syndrome. Arch Otolaryngol47:630, 1948 Eagle WW: Symptomatic elongated styloid process. Report of two cases of styloid process-carotid artery syndrome with operation. Arch Otolaryngol 49:490, 1949 Dwight T: Stylo-hyoid ossification. Ann Surg 46:721, 1907 Marano PD, Fenster GF, Gasselin CF: Eagle’s syndrome necessitating bilateral styloid amputation. Oral Surg 33:874, 1972 Ettinger RL, Hanson JG: The styloid or “Eagle” syndrome: An unexpected consequence. Oral Surg 40:336, 1978 Baddour HM, McAnear JT, Titson HB: Eagle’s syndrome. Oral Surg 46:486, 1978 Brobeck JR: Best and Taylor’s Physiological Basis of Medical Practice (9th ed). Baltimore, MD, William & Wilkins. 1973, p 95 Strauss M, Zohar Y, Laurian N: Elongated styloid process syndrome. Intraoral versus external approach for styloid surgery. Laryngoscope 95:976, 1985 Chase D, Zarmen A, Bigelow WC, et al: Eagle’s syndrome: A comparison of intraoral versus extraoral surgical approaches. Oral Surg 62:625, 1986 Geoffrey H, Sharwood-Smith: Difficulty in intubation. Anaesthesia 31:508, 1976 Akinyemi 00, Elegbe EO: Difficult laryngoscopy and tracheal intubation due to the calcified stylohyoid ligaments. Can Anaesth Sot J 28:80. 1981
Surg
230. 1990
Oral In fan tile Fibrosarcoma: Report of a Case BEN F. TARSITANO, DDS* Fibrosarcoma is an uncommon neoplasm, comprising less than 1% of all malignancies and only 6% of soft-tissue sarcomas.’ It may occur in any part of the body, with a predilection for the skin, subcutaneous tissue, muscles, tendons, tendon sheaths, and periosteum.2 In a series of 144 cases of fibrosarcoma, Stout reported that 18% occurred in the head and neck.2 Soule and Pritchard reported 110 cases of fibrosarcoma in infants and children, and found 20% involving the head and neck.3 The AFIP reported 53 cases of infantile fibrosarcoma, 13% of which were
* Staff, Oral and Maxillofacial Surgeon, Scott USAF Medical Center (Reserve), IL: and Student, St Louis University, School of Medicine. Address correspondence and reprint requests to Dr Tarsitano: 306 Weber Dr, O’Fallon, IL 62269. 0 1990 American geons 027%2391/90/481
Association l-001 9$3.00/O
of Oral and Maxillofacial
Sur-
located in the head and neck.4 Intraoral and paraoral lesions are primarily found in the cheek, maxillary sinus, pharynx, palate, lip, and periosteurn of the maxilla and mandible.2 A case of oral fibrosarcoma in a neonate is presented, with a discussion of the treatment, clinical course, histopathology, and 6-year follow-up. Report of a Case The oral and maxillofacial surgery service was consulted regarding a 4-week-old white girl admitted to the pediatric service with a preliminary diagnosis of buccal abscess. An exophytic, indurated lesion with an ulcerated mucosal surface measuring approximately 1.5 X 1.5 cm, was seen in the right lower buccal vestibule. The patient’s mother had noted the lesion about 10 days before admission, when it appeared as a slightly erythematous area below the right mandibular vermilion border (Fig 1). There was no history of trauma to the area or of purulent exudate. The baby was otherwise in good health. An intraoral incisional biopsy was performed the following day under general anesthesia. The histologic report was welldifferentiated fibrosarcoma (Fig 2).
KAWAI ET AL
References 1. Frederiksen NL, Wesley RK, Sciubba JJ, et al: Massive osteolysis of the maxillofacial skeleton: A clinical, radiographic, histologic and ultrastructural study. Oral Surg 55:470, 1983 Pedicelli G, Mattia P, Zorzoli AA, et al: Gorham syndrome. JAMA 252:1449, 1984 Hamptom J, Arthur JF: Massive osteolysis affecting the mandible. Br Dent J 120:538, 1966 Ellis DJ, Adams TO: Massive osteolysis: Report of case. J Oral Surg 29:659, 1971 Cherrick HM, King OH, Dorsey JN: Massive osteolysis (disappearing bone, phantom bone, acute absorption of bone) of the mandible and maxilla. J Oral Med 27:67, 1972 Kriens 0: Progressive maxillofacial osteolysis. A case report. Dentomaxillofac Rad 2:73, 1973 Murphy JB, Doku HC, Charter BL: Massive osteolysis: Phantom bone disease. J Oral Surg 36:318, 1978 Black MJ. Cassisi NJ, Biller HF: Massive mandibular osteolysis. Arch Otolaryngol 100:314, 1974 Philips RM, Bush OB. Hall HD: Massive osteolysis (phantom bone, disappearing bone). Report of a case with mandibular involvement. Oral Surg 34:886, 1972
J Oral Maxillofac 48:1225-1228.
10. Malter JJ: Massive osteolysis of the mandible: Report of case. JAMA 85: 148. 1972 11. Booth DF, Burke CHI Massive osteolysis of the mandible: An attempt at reconstruction. J Oral Surg 32:787, 1974 12. El Mofty S: Atrophy of the mandible (massive osteolysis). Oral Surg 31:690, 1971 13. Heuck F: Massive osteolysis of mandible: Skeletal Radio1 3:241, 1979 14. Heyden G, Kindblom LG, Nielsen JM: Disappearing bone disease. A clinical and histologic study. J Bone Joint Surg (Am) 59:57, 1977 IS. Gorham LW, Wright AW, Schultz HH, et al: Disappearing bones: A rare form of massive osteolysis. Am J Med 17:674, 1954 16. Gorham LW, Stout AP: Massive osteolysis (acute spontaneous absorption of bone, phantom bone, disappearing bone). Its relation to hemangiomatosis. J Bone Joint Surg (Am) 37:985, 1955 17. Kessler HB, Recht MP, Dalinka MK: Vascular anomalies in association with osteodystrophies-A spectrum. Skeletal Radio1 10:95, 1983 18. Gorham LW: Circulatory changes associated with osteolytic an osteoblastic reactions in bone. Arch Intern Med 105:199, 1966 19. Pearse HE Jr, Morton JJ: Stimulation of bone growth by venous stasis. J Bone Joint Surg (Am) 28:97. 1930
Surg
1990
Elongated Styloid Process as a Cause of Difficult In tuba tion TOSHIHIKO
KAWAI, DDS, PHD,* KAZUO SHIMOZATO, DDS, PtiD,t AND SHIGEKI OCHIAI, DDS*
The normal styloid process is from 2.5 to 3.0 cm in length,‘*2 and any process exceeding this is thought to be elongated. Elongation of the styloid process and its ossification were described as early as 1650.3 The reported incidence of elongated styloid process is estimated to be 4% by Gossman4 and 18.2% by Carrel.’ The etiology is not well understood. The elongated styloid process occurs with or without symptoms. Related symptoms were sepa-
rated into two distinct groups by Eagle; the typical syndrome and the carotid artery syndrome. The typical syndrome includes pain, dysphagia, dysphoria around the throat, otalgia, and the sensation of a vague facial pain radiating to the mandible, and is found in patients who have had a tonsillectomy.2*6*7 The following case report describes an additional complication of elongated styloid process, difficulty of endotracheal intubation associated with general anesthesia. Report of a Case
* Assistant Professor, the Second Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Nagoya, Japan. t Chief, Department of Oral and Maxillofacial Surgery, Japanese Red-Cross Nagoya First Hospital. $ Resident, the Second Department of Oral and Maxillofacial Surgery, Aichi-Gakuin University, Nagoya, Japan. Address correspondence and reprint requests to Dr Kawai: The Second Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, 2-l 1 SuemoriDori, Chikusa-Ku, Nagoya, 464, Japan. 0 1990 American Association of Oral and Maxillofacial geons 0278-2391/901481 l-0018$3.00/0
Sur-
A 58-year-old Japanese man came to the outpatient department of the hospital complaining of a left submandibular swelling and a sensation of a foreign body in his throat. He had noticed these symptoms for 3 years. He gave a history of psychiatric disease since 1980. He had never had a tonsillectomy. The initial clinical examination disclosed a bony mass in the left side of the mouth floor, which extended anteriorly beneath the lobe of the submandibular gland (Fig 1). When swallowing, his larynx immediately moved obliquely and superiorly to the right side and then returned to the normal rest position at the end of swallowing.
1226
ELONGATED
STYLOID PROCESS
1. Intraoral view showing bulging of the mouth floor. FIGURE
Panoramic and orbito-ramus radiographs showed an abnormally thick, nodular, elongated styloid process (Figs 2 and 3). Occlusal radiographs demonstrated a close connection between the enlarged caudal end of the styloid process and the hyoid bone, and an additional jointlike structure within the process (Fig 4). Palpation of the tonsillar fossa and the neck elicited no radiating pain. Elongation of the styloid process was diagnosed. After evaluation of the general condition, the patient was scheduled for surgery to shorten the styloid process. It was decided to use an extraoral approach due to the size of the lesion and its anatomic complexity. At the time of induction of general anesthesia, problems were encountered with intubation of the patient. Despite the use of a muscle relaxant, it was difficult to lift the epiglottis away from the posterior laryngeal wall. The vocal cords could not be exposed directly and the displacement of the laryngeal complex was marked. Digest intubation was tried unsuccessfully several times; finally, use of the fiberscope enabled intubation to be accomplished.
After initial incision through the platysma muscle, a skin platysmal flap was raised. The parotid tail and submandibular gland was reflected and the posterior part of the suprahyoid muscles was exposed. The surface of the submandibular gland was normal and the stylohyoid muscle was intact. The stylohyoid muscle was freed from the hyoid bone, and the posterior belly of the digastric muscle
Panoramic radiograph shows thick and elongated styloid process (arrow).
FIGURE 3. Orbito-ramus radiograph shows thick styloid process (arrow).
FIGURE 2.
1227
KAWAI ET AL
ynx during swallowing was decreased. Other symptoms
had disappeared. Discussion
Close connection between the tip of the styloid process and the hyoid bone. Note a jointlike structure within the FIGURE 4.
styloid process.
was divided at its intermediate tendon. Retraction of the digastric muscle posterosuperiorly revealed the elongated styloid process joined directly to the hyoid bone. The
elongated process was shortened to match the opposite side. The tip, bound to the hyoid bone by fibrous tissue, was bluntly dissected and the excised part of the process was removed (Fig 5). At the l&month follow-up examination, the patient was found to be comfortable and displacement of the lar-
The styloid process is a slender osseous projection, located in front of the stylomastoid foramen, that is fused with the inferior aspect of the temporal bone. It is positioned between the internal and external carotid arteries and lies posterior to the tonsillar fossa. Attached to it are the stylopharyngeus, the stylomandibular and the styloglossus muscles, and the stylohyoid and the stylomandibular ligaments. The styloid process, the stylohyoid ligament, and the lesser cornu of the hyoid bone develop from the second branchial arch, called Reichert’s cartilage. According to Dwight,* the styloid process consists of four sections: the tympanohyal, stylohyal, ceratohyal and hypohyal portions. Also noted is the occasional occurrence of a false joint that forms at the junction of the stylohyal and ceratohyal portions.’ Because of the anatomic location, the elongated styloid process can cause many symptoms (Eagle’s syndrome). 9-1’ In contradiction to Eagle’s description,* a past history of tonsillectomy is not necessary to diagnose the typical syndrome. In addition to the symptoms that have been reported, our patient complained of a swelling in the submandibular area and displacement of the larynx during swallowing. The former was assumed to be the result of anterolateral displacement of the submandibular gland by the elongated styloid process. Magendi describes the act of swallowing as occurring in three stages: the oral stage, the pharyngeal stage, and the esophageal stage. During these stages. many muscles work coordinately. Mobility of the larynx is essential to the second stage of deglutition, and any disease that prevents the larynx from ascending to lie beneath the base of the tongue is said to cause marked dysphagia. ” In our
__--- -.______-_
FIGURE 5.
Surgically resected specimen.
--K-r.-------
---
____--.
-_
__
____
_____
gated styloid process was discussed. The extraoral approach has two advantages: 1) surgical visualization is optimal, and 2) the risk of deep cervical in-
1228
ORAL INFANT FIBROSARCOMA
fection is minimal. The extraoral approach also has two disadvantages: 1) presence of a postoperative scar, and 2) necessity for general anesthesia.13,‘4 In our case, the elongated styloid process was attached to the lesser cornu of the hyoid bone. Because of this, the mobility of the larynx and associated muscles was decreased. Also, difficulty in lifting the epiglottis away from the posterior laryngeal wall occurred during laryngoscopy, and difficulty in intubation was encountered.‘59’6 The possibility of difftculty of intubation is therefore another point to consider when selecting the best remedial appreach. References
J Oral Maxillofac
7.
8. 9.
10. 11. 12.
13.
1. Eagle WW: Elongated styloid process. Report of two cases. Arch Otolaryngol 25584, 1937 2. Eagle WW: Elongated styloid process: Symptoms and treatment. Arch Otolaryngol 67: 172, 1958 3. Moore I: Osseous and cartilaginous formations in the tonsils. J Laryngol Otol 39: 195, 1924 4. Gossmann JR, Tarsitano JJ: The styloid-stylohyoid syndrome. J Oral Surg 35:555, 1977 5. Correll RW, Jensen JL, Taylor JB, et al: Mineralization of
48:1228-l
6.
14.
IS. 16.
the styloid stylomandibular ligament complex. Oral Surg 48:286, 1979 Eagle WW: Elongated styloid process. Further observation and a new syndrome. Arch Otolaryngol47:630, 1948 Eagle WW: Symptomatic elongated styloid process. Report of two cases of styloid process-carotid artery syndrome with operation. Arch Otolaryngol 49:490, 1949 Dwight T: Stylo-hyoid ossification. Ann Surg 46:721, 1907 Marano PD, Fenster GF, Gasselin CF: Eagle’s syndrome necessitating bilateral styloid amputation. Oral Surg 33:874, 1972 Ettinger RL, Hanson JG: The styloid or “Eagle” syndrome: An unexpected consequence. Oral Surg 40:336, 1978 Baddour HM, McAnear JT, Titson HB: Eagle’s syndrome. Oral Surg 46:486, 1978 Brobeck JR: Best and Taylor’s Physiological Basis of Medical Practice (9th ed). Baltimore, MD, William & Wilkins. 1973, p 95 Strauss M, Zohar Y, Laurian N: Elongated styloid process syndrome. Intraoral versus external approach for styloid surgery. Laryngoscope 95:976, 1985 Chase D, Zarmen A, Bigelow WC, et al: Eagle’s syndrome: A comparison of intraoral versus extraoral surgical approaches. Oral Surg 62:625, 1986 Geoffrey H, Sharwood-Smith: Difficulty in intubation. Anaesthesia 31:508, 1976 Akinyemi 00, Elegbe EO: Difficult laryngoscopy and tracheal intubation due to the calcified stylohyoid ligaments. Can Anaesth Sot J 28:80. 1981
Surg
230. 1990
Oral In fan tile Fibrosarcoma: Report of a Case BEN F. TARSITANO, DDS* Fibrosarcoma is an uncommon neoplasm, comprising less than 1% of all malignancies and only 6% of soft-tissue sarcomas.’ It may occur in any part of the body, with a predilection for the skin, subcutaneous tissue, muscles, tendons, tendon sheaths, and periosteum.2 In a series of 144 cases of fibrosarcoma, Stout reported that 18% occurred in the head and neck.2 Soule and Pritchard reported 110 cases of fibrosarcoma in infants and children, and found 20% involving the head and neck.3 The AFIP reported 53 cases of infantile fibrosarcoma, 13% of which were
* Staff, Oral and Maxillofacial Surgeon, Scott USAF Medical Center (Reserve), IL: and Student, St Louis University, School of Medicine. Address correspondence and reprint requests to Dr Tarsitano: 306 Weber Dr, O’Fallon, IL 62269. 0 1990 American geons 027%2391/90/481
Association l-001 9$3.00/O
of Oral and Maxillofacial
Sur-
located in the head and neck.4 Intraoral and paraoral lesions are primarily found in the cheek, maxillary sinus, pharynx, palate, lip, and periosteurn of the maxilla and mandible.2 A case of oral fibrosarcoma in a neonate is presented, with a discussion of the treatment, clinical course, histopathology, and 6-year follow-up. Report of a Case The oral and maxillofacial surgery service was consulted regarding a 4-week-old white girl admitted to the pediatric service with a preliminary diagnosis of buccal abscess. An exophytic, indurated lesion with an ulcerated mucosal surface measuring approximately 1.5 X 1.5 cm, was seen in the right lower buccal vestibule. The patient’s mother had noted the lesion about 10 days before admission, when it appeared as a slightly erythematous area below the right mandibular vermilion border (Fig 1). There was no history of trauma to the area or of purulent exudate. The baby was otherwise in good health. An intraoral incisional biopsy was performed the following day under general anesthesia. The histologic report was welldifferentiated fibrosarcoma (Fig 2).
