Another complex mandibular tumor resection surgery at Children's Hospital in Olsztyn

Interventional radiologists and maxillofacial surgeons were involved in helping a 7-year-old patient suffering from a giant cell tumor of the left condylar process of the mandible. Doctors preceded the complex surgery with embolization of the tumor's feeding vessels, which greatly increased the safety of the procedure.

The Olsztyn Children's Hospital is the only pediatric facility in the country to provide comprehensive treatment to children with craniofacial tumors, allowing interventional radiology to be performed on site, as well as providing customized temporomandibular joint prostheses.

- A 7-year-old patient came to us from Cracow with a very advanced tumor of the mandible," says Dr. Maciej Borowiec, deputy head of the Department of Maxillofacial Surgery at the Children's Hospital in Olsztyn. - Such a tumor is an unusual rarity in this location. The tumor, growing distensively, destroyed her temporomandibular joint on the left side along with a fragment of the mandibular branch. The surgery was necessary because the patient's left temporomandibular joint was already non-functional. The girl had difficulty opening her mouth and increasing pain. In addition, the location near the base of the skull carried the risk of severe complications or damage to vital structures. Together with Krzysztof Dowgierd, MD, head of the Department of Maxillofacial Surgery, and our interventional radiologists under the direction of Gregory Wasilewski, MD, coordinator of the Vascular Research Laboratory, we undertook the removal of this lesion. In the first stage, based on the CT scan, we planned the procedure and prepared an individual prosthesis of the temporomandibular joint of the left side together with a fragment of the mandibular angle. Such a prosthesis is "tailor-made," i.e. made on the model of the healthy side. It is fully functional and tailored to the needs of the individual patient. The tumor was highly vascularized, so we had to perform embolization before the operation. To do this, our radiologists performed angiography, which involves visualizing the feeding vessels to the tumor and closing these vessels during the same procedure. This greatly increased the patient's safety during the procedure, as the tumor did not bleed during removal.

Three days after vessel closure, a tumor resection procedure was performed with simultaneous reconstruction of the mandibular branches and temporomandibular joint. The procedure lasted five hours and was almost bloodless. After a few days, the patient was discharged from the hospital and transferred to the care of our physiotherapists on an outpatient basis.

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