Oral and general health quality of life following a subtemporal preauricular infratemporal approach with condylar fossa osteotomy in surgical skull base tumor resection.

Abstract

Objective: With the capacity to provide maximal lesion exposure, the subtemporal preauricular infratemporal (SPI) approach with condylar fossa osteotomy is highly utilized in radical resection of skull base tumors. While this approach requires disruption of the temporomandibular joint (TMJ) for access, the effects of this maneuver are poorly appreciated in neurosurgery. The aim of this study was to assess the morbidity of condylar fossa osteotomies by comparing oral health quality of life (OHQOL) and general health quality of life (GHQOL) outcomes after TMJ-involving and TMJ-sparing skull base approaches.

Methods: A retrospective review of the medical records of patients who underwent surgery with the SPI approach (TMJ-involving approach) for skull base chondrosarcoma (CS) by a single senior surgeon at Vancouver General Hospital between 2002 and 2022 was performed. Patients undergoing TMJ-sparing anterolateral approaches for trigeminal schwannoma (TS) during the same study period by the same surgeon were included as controls. GHQOL was evaluated using the 36-item Short Form Health Survey from preoperative and postoperative periods. Postoperative OHQOL was evaluated using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Axis I/II screening instrument.

Results: Data regarding quality of life were available for 13 of 19 CS patients and 12 of 15 TS patients surgically managed between 2002 and 2022. CS patients demonstrated less jaw dysfunction in all parameters of the DC/TMD Axis I/II components when specifically assessing OHQOL. CS patients had a lower likelihood of temporomandibular disorder (TMD) presence on the TMD pain screener than TS patients (25% vs 45%, p = 0.40). Chronic pain scores were higher in the TS group, with significantly more patients with grade 2 or higher pain (36.4% vs 0%, p = 0.01). The mean Jaw Functional Limitation Scale (JFLS) scores were lower in CS patients than in TS patients. Both CS and TS patients demonstrated lower mean JLFS scores (0.50 and 0.81, respectively) than patients with chronic TMD (1.76), but higher mean JLFS scores than patients without TMD (0.16).

Conclusions: The authors report novel findings regarding the impact of the SPI approach with a condylar fossa osteotomy on OHQOL and GHQOL among skull base tumor patients. Anatomical disruption of the TMJ was not associated with significant clinical TMJ dysfunction. Compared with TS patients, CS patients had even lower mean scores in TMJ-related morbidity, and both groups had lower TMJ morbidity than patients diagnosed with chronic TMJ dysfunction. Condylar fossa osteotomies can therefore be considered without concern of significant additional morbidity.