Management of maxillofacial osteosarcomas in Kenya

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.

Diagnostic challenges of maxillofacial sarcomas – literature review and case reports

“…Over 70 subtypes of sarcomas were desribed so far [3,17]. They can be subdivided into two groups: soft-tissue sarcomas (STS, 80% of cases) and osteo/chondrosarcomas (20%) [15][16][17][18][19]. Both types can occur in the maxillofacial region, as noted in the case reports above.…”

“…The role of chemotherapy as induction (pre-operative), adjuvant or paliative treatment is equivocal [34]. It was reported effective in the treatment of long bone osteosarcomas, whereas its effectiveness in maxillo-facial sarcomas is the subject of discussion [18,[38][39].…”

Editorial: Efficiency in healthcare delivery

“…It behoves health practitioners in developing settings to be aware of the different faces of efficiency-technical versus allocative (3)-even as they continue to serve patients the best way they know how. In this issue, Bello and others (4) showcase the use of autogenous molar transplantation to address the dual challenge of cost-effectiveness and functional adaptability Guthua and others share their experience with multidisciplinary teams in securing good outcomes for patients with maxillofacial osteosarcomas (5). Both experiences are seemingly different from Ndegwa et al (6), who though reporting on safe laparoscopic Heller myotomy in a rural setting, also cite "issues encountered… unreliable electricity, lack of operative support personnel to assist in trouble shooting problems that occur intraoperatively, supply chain issues, and patients who have limited resources to fund the procedure and to allow appropriate follow-up. "…”

“…If we drill down technical efficiency to a surrogate such as operating room efficiency, there is no consensus on how the latter should be measured. Some studies focus on access to care (3) while others examine the number of operations performed (4) or overtime costs (5). Unfortunately, the measures are typically from intermediate components derived from the fundamental purpose of the healthcare system: to maximize the produced health with the given resources.…”