Oral and General-Health Quality of Life following a Subtemporal Preauricular Infratemporal Approach with Condylar Fossa Osteotomy in Surgical Skull-Base Tumor Resection
Notice bibliographique
Résumé
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. Publication History Article published online: 05 February 2024 © 2024. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».