A 13-year-old woman presented to our hospital with persistent chordoma located in the coccus, after partial intraoral resection at another centre.
The patient had bilateral paralysis of the VI cranial nerve and headaches of 3 and 5 months of evolution, respectively.
Magnetic resonance imaging (MRI) confirmed the presence of a lesion of approximately 3 cm in diameter located in the posterior region of the anterior cavity, with prepontine dry destruction of the posterior wall of the sphenoid bone, partially obliterating the right sinus.
It also produced bilateral displacement of the pituitary gland and the VI cranial nerve.
1.
The treatment of choice for chlamydia, according to most consulted authors, is surgical removal.
In cases where resection is not total and in recurrences, radiotherapy is indicated.
Complete excision is achieved in 43 to 72% of cases, since these tumors are benign, aggressive and have a high sensitivity29.
The approach to malignant sinus, to attempt total removal of the chordomas that infiltrate their structures, is controversial.
The risk of injury to structures related to this lesion (internal carotid artery, III, IV, V and VI cranial nerves), minimal published differences regarding prognosis and conservative management of this tumor, recommended a statistically significant radiosensitivity and lack of success 30
In our patient, MRI did not confirm the involvement of the malignant sinus but did not rule out it.
We assume, therefore, that in the worst of the cases, the "minimum", and in conjunction with the neurosurgery service, it was decided not to approach the sinus node as entry point.
The patient underwent surgery under general anesthesia and orotracheal intubation.
A bilateral translocation of the facial middle third was carried out, which allowed us to the adequate lesion and the almost total resection of the facial middle third, without being able to remove a small portion of the right sinus access.
For the prior placement of plates and subsequent fixation of bone structures we used the new system of resorbable plates and pins Sonic Weld® (KLS Martin, LP, Jacksonville, Florida, USA).
The plates were first shaped by a warming process for placement prior to osteotomies.
Subsequently, we performed osteotomies and excision of the lesion.
For the fixation of the facial skeleton, we replace the resorbable plates, already molded, on the bone structures, we drilled the holes and then applied the thermoplastic device with an ultrasound device.
