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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).

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FIGURE I. View of erythematous area below the right mandibular vermilion border noted by patient’s mother 1% weeks before admission.

The patient’s workup included chest radiograph, computed tomographic (CT) scan of the chest and abdomen, a liver/spleen scan, a bone scan, a bone marrow aspirate and biopsy, liver function tests, and routine laboratory tests. All were within normal limits. Four days after her admission, the lesion had increased in size to 2.0 x 2.5 cm (Fig 3) and the overlying skin color had changed from erythematous to ecchymotic, with notable excoriation of the buccal mucosa. A wide resection, including the oral commissure and the outer cortical plate of the mandible was performed (Fig 4). Primary closure was attained and the infant had a benign postoperative course. In spite of adequate oral

FIGURE 2. Photomicrograph showing low-grade malignant mesenchymal neoplasm consistant with fibrosarcoma. Note the high degree of cellular atypia and mitotic activity (hematoxylin-eosin stain, original magnification x 470).

FIGURE 3. View of lesion at time of resection. of previous biopsy in the center of the lesion.

Note the area

competence, the baby was unable to breast-feed. However, she tolerated bottle feeding, developed normally, and has been free of disease for 6 years. Scar revision was performed on three occasions (Fig 5).

Discussion Lesions of the head and neck tend to grow more slowly, infiltrate less extensively, metastasize less often, and be associated with a better prognosis than other soft-tissue sarcomas.’ There appears to be little histologic difference between adult and pediatric lesions, but, in general, children less than 5

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FIGURE 4. Intraoperative view showing surgical resection including the commissure and outer cortical plate of the mandible.

years old have a better prognosis.’ Nuclear pleomorphism is not a prominent feature and the mitotic index is moderate. No histologic features have been successfully related to clinical behavior or prediction of the biologic course.’ Infiltration and recurrence are characteristic of this lesion, but it rarely metastasizes. Fibrosarcoma has a predilection for males. It is reported to have the highest rate of recurrence of all soft-tissue sarcomas. Local recurrence ranges between 30% and 60% and more than doubles the probability the patient will die of his disease. In the Mayo Clinic series,’ children less than 5 years of age had a more favorable prognosis than adults, with only a 7.3% chance of dying of their tumor even though there is a significant recurrence rate of 43%. Chung and Enzinger reported a j-year survival rate of 84% in their patients with infantile fibrosarcoma. Children over the age of 5 may be expected to have a course and prognosis similar to adults. In general, there appears to be a relation between the mitotic index and the rate of proliferation. This histologic grading can be of some aid in predicting the clinical course of most fibrosarcomatous lesions. According to Batsakis,’ no histologic feature or group of features has been successfully related to the clinical behavior of fibrosarcoma in the young. The successful management of oral tibrosarcoma depends more on size and location of the lesion, with local recurrence associated with inadequate resection. Death is due to local uncontrolled growth, with metastasis being relatively infrequent. Large en bloc local excision appears to be the treatment of choice.’ There is little support for radiation treatment or chemotherapy except in non-

FIGURE 5. Six-year postoperative photograph. There is marked intraoral scarring and decreased right lower facial muscle function. The patient is free of disease.

surgical cases for the relief of pain.6 Ninane et al concluded “that infants with congenital fibrosarcoma should be treated by surgery without jeopardizing significant function of the affected part. If the location and extent of the tumor renders this impossible on initial presentation, preoperative chemotherapy should be contemplated.“’ References 1. Batsakis JG: Tumors of the Head and Neck-Clinical and Pathological Considerations (2nd ed). Baltimore, MD. William & Wilkins, 1979, pp 252-277 2. Shafer WC, Hine MK, Levy BM: A Textbook of Oral Pathology (4th ed). Philadelphia, PA, Saunders, 1983. pp 169-171 3. Soule EH, Pritchard DJ: Fibrosarcoma in infants and children-A review of 110 cases. Cancer 40: 1711, 1977 4. Chung EB, Enzinger FM: Infantile fibrosarcoma. Cancer 38:729, 1976 5. Blocker S, Koenig J, Temberg J: Congenital fibrosarcoma. J Pediatr 22:665, 1987 6. Yoel J, Gonzalez Aguilar 0, Simkin DO, et al: Sarcomas of the jaw. Semin Surg Oncol 3:215, 1987 7. Ninane J, Gosseye S, Panteon E, et al: Congenital tibrosarcoma. Preoperative chemotherapy and conservative surgery. Cancer 58: 1400, 1986

Oral infantile fibrosarcoma: report of a case.

1228 ORAL INFANT FIBROSARCOMA fection is minimal. The extraoral approach also has two disadvantages: 1) presence of a postoperative scar, and 2) nec...
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