Oral and General-Health Quality of Life following a Subtemporal Preauricular Infratemporal Approach with Condylar Fossa Osteotomy in Surgical Skull-Base Tumor Resection

Background: Although temporomandibular joint (TMJ) disorders constitute a significant portion of public health, it is poorly appreciated in the neurosurgical field despite its high prevalence of procedures that invoke TMJ disruption. Chondrosarcomas (CS) resection in particular is problematic; these tumors are centered at the petroclival suture often requiring the subtemporal preauricular infratemporal (SPI) approach with condylar fossa osteotomy. With this necessary TMJ disruption, patients can have significant symptomatology and exacerbation of premorbid impaired quality of life. Despite conjecture regarding the morbidity of this approach and others advocating TMJ sparing approaches, there remains an absence of studies that assess oral health quality of life (OHQoL). To our knowledge, this is the first article to present long-term results of general health-related quality of life (GHRQoL) and OHRQoL among surgically managed patients to evaluate the effects of TMJ disruption in the SPI approach for skull-base tumor resection.

Methods: All patients who underwent surgery for skull-base CS using the SPI approach and trigeminal schwannoma (TS) without the SPI approach by a single senior skull-base surgeon at Vancouver General Hospital and the British Columbia Cancer Agency between 2002 and 2022 were included. CS resected through a frontotemporal craniotomy and zygomatic/orbito-zygomatic osteotomy were selected as a comparison to TS, which are resected in a similar fashion with notable sparing of a condylar osteotomy. Retrospective review of clinical records and radiology was performed to gather patient demographic, tumor characteristics, clinical presentation to inform the validity of comparing these two groups to assess the influence of condylar osteotomy. Prospective data for OHQoL and GHQoL was collected to collate a two decade progression of patient quality of life.

Results: A total of 38 patients were identified, of which 19 CS and 15 TS were surgically managed between 2002 and 2022. CS/SPI patients demonstrated less jaw dysfunction in all parameters of the TMD axis I/II components when specifically assessing OHQOL. CS/SPI patients had lower likelihood of TMD presence on the TMD pain screener than TS patients. Furthermore, chronic pain scores were higher in the TS group, with statistically significantly more patients with Grade 2 or higher pain (45 vs. 0%, p = 0.01). Average Jaw Function Limitation scores (JFLS) were lower in CS/SPI patients than TS. Both CS/SPI and TS patients (JFLS 0.81 and 0.50) demonstrate lower scores than patients with chronic TMD (1.76) but higher than normal patients without TMD (0.16).

Conclusion: We report notable findings regarding the impact of the SPI approach with a condylar fossa osteotomy on OHQoL and GHQoL among skull-base tumor patients who was previously unavailable. From an anatomical standpoint, while a condylar fossa osteotomy may increase the risk of TMJ dysfunction development, we found low absolute scores for TMJ dysfunction. When compared to a similar surgical control group without a condylar fossa osteotomy, CS/SPI patients had by comparison even lower scores in TMJ-related morbidity, suggesting the mechanism of TMJ dysfunction in skull base tumor patients may largely be attributed to the nature of tumor rather than the surgical approach used in resection.

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Artikel online veröffentlicht:
05. Februar 2024