Hi, I had a partial maxillectomy to remove an osteosarcoma in 2008. I also had a failed temporalis flap graft followed by a successful rectus abdominis graft to fill the defect. The graft runs from the right (healthy) side of the hard palate and runs to the left cheek and left mandible. I therefore have a lop-sided bite and painful trismus but can open the mouth to a finger's width. Recently an mri scan revealed a suspicious area close to the left mandibular condyle. Could this be due to tmj and trismus problems from the surgery? I'm awaiting biopsy results, but from my limited anatomical knowledge the condyle is a long way (2 bones away ) from the maxillectomy surgery site. Any ideas would be welcome in advance of biopsy results.

Hello richat

You have been to the wars! The surgery and flap failure would have resulted in scarring causing the trismus. As the anatomy in the area is 'messed up' often the scans confuse. It is often that's the biopsy is negative but they have to check it out. Hence the biopsy.

Best wishes
Vinod

Thank you for your reply Vinod. I've just got the first biopsy result from US guided fna - just muscle fragments and blood showed up. My consultant has now referred me for a CT guided fna biopsy under general for which there is a 2 week waiting list. He's not sure if the US fna went deep enough so wants more definitive testing. Symptom-wise I have experienced some sl pressure pains in the left preauricular -> temple region. Also partial numbness in the left lower lip, left chin, left lower cheek areas. I should point out that my final surgery of Aug '08 involved lateral lower lip splitting down through the chin skin, through the upper throat skin and round to just behind the left area. This enabled my surgeon to provide a huge flap which he pulled to the side thus giving good access to the maxillary defect. He said I would suffer partial numbness in these areas because of the stretching of the nerve, for about 6 months. I still have this feeling, and have to say it has felt more numb these past few weeks following the mri results. (it's really partial numbness or reduced sensitivity) This may be a case of mind over matter, dwelling on the sensation, or I wonder could it be a symptom of what has become long term uneven biting which may have caused more wear and tear on the TMJ and associated muscles such as the pterygoid which is close to the "suspicious area" on mri. I am still very anxious understandably. If there were local osteosarcoma recurrence, then the "tumour" has gone from zero to an area of 2x3 cm in just 6 months based on mri screenings (Sep '09 mri was clear ); this would make it a very aggressive cancer, and osteosarcoma recurrence is known to be extremely aggressive. In which case, surely it would have shown up in the 12 months period post surgery and 14 months post chemo, between Aug '08 and Sep '09. I look forward to your comments and will inform you of any developments. My consultant says there is evidence of muscle necrosis, but said the suspicious area may not necessarily be a tumour; it could be muscle inflammation, which would be in line with what you said in your reply.

Vinod, Just to update you. Where do I begin? A deep (and painful) biopsy through the oral cavity into the deep masseteric/temporalis region eventually revealed osteosarcoma recurrence. So on 21st April I underwent a partial mandibullectomy and extra maxillectomy to remove the walnut sized tumour plus as much surrounding tissue as possible. Immediate recovery was a nightmare (included tracheostomy), and subsequent histology showed complete cancer removal but with margins only down to 2mm. Hence, as had been pre-arranged, I had radiotherapy of 64 Gy 2 months later aimed at the infratemporal fossa, original surgery area and left skull base. Now 10 weeks post radiation I am recovering very well all things considered, but am recently experiencing pains and tightness on the left side of my head. For the past 4 weeks I've been using a Therabite to ward off trismus, and am hoping that the new discomfort is due only to jaw muscle tightening from the radiation and Therabite usage. To make matters worse just 2 weeks ago I had a pronounced acute swelling in the preauricular/parotid area. A night in hospital with IV Augmentin, followed by U/S and an OPG saw off that problem. But I still worry about what is coming next. I am seeing my consultant tomorrow.
Regards Rich