Аннотация:Background: Temporomandibular joint involvement by the tumor
is a rare condition in neurosurgical practice. In such cases middle
cranial fossa tumors spread to the infratemporal fossa and reduce
the mandible mobility. These patients suffer from facial pain and
masticatory difficulties. A mouth opening difficulties become a
problem for anesthesiologist. Fiber optic laryngoscopy assistance is
essential for intubation in some cases. In several cases tracheostomy
was performed when intubation was not possible.
Method: We present 11 cases with temporomandibular joint
involvement and intradural extension. Multidisciplinary team,
formed by neurosurgeons, neurologists, anesthesiologists and
otorhinolaryngologists was take part in surgical planning and
treatment options discussion.
Results: Craniomaxillofacial resection with skull base
reconstruction was performed in all cases. Clinical variables,
different treatment modalities, complications and outcomes are
highlighted. In case of joint capsule involvement we noticed the
ankyloses and movement block. In these cases condyle resection
was made for masticatory improvement. In some cases we saw
mandible fracture and pseudarthrosis formation as movement
compensation. Mouth open ability was estimated before and after
surgery. Auditory tube is usually involved in these cases. Different
surgical techniques used for scull base reconstruction. Translocated
pericranial flap and buccal fat pad were the best material for this
purpose. In some cases a part of temporal muscle used for scull base
closure. The most common complications were described: CSF leak,
infection and neurological deterioration. Conclusion: Craniomaxillofacial surgery with condyle resection
and meticulous scull base reconstruction is a feasible option for
these patients.