The early and accurate diagnosis of sarcomatous lesions holds significant importance for improving patient outcomes. This study aims to analyze the spiral CT imaging characteristics of osteosarcoma, chondrosarcoma, and Ewing sarcoma in the maxillofacial bones.

The CT imaging features of patients with osteosarcoma, chondrosarcoma, or Ewing sarcoma were retrospectively identified and statistically analyzed.

A total of 163 patients were recruited, including 139 cases with osteosarcoma, 11 with chondrosarcoma, and 13 with Ewing sarcoma. The median ages of three lesions were 39, 54, and 14 years respectively (Kruskal-Wallis test). Osteosarcoma cases included 54 lesions in the maxilla, 83 in the mandible and 2 involving both. Chondrosarcoma lesions involved the maxilla in 3, the mandible in 3, and the temporomandibular joint region in 5 cases. Ewing sarcoma cases included 3 lesions in the maxilla and 10 in the mandible. Tumor size differed among three tumor types. The bone destruction patterns (osteoblastic, osteolytic and mixed) showed no significant differences among tumor types. However, χ ² test showed significant differences in the tumor matrix mineralization among three tumors: osteosarcoma predominantly exhibited spiculated (33.1%) and irregular plaque-like (39.6%); chondrosarcoma did not show tumor bone in 36.4% of cases; while Ewing sarcoma demonstrated spiculated tumor bone in 38.5% of cases. Characteristic widening of the periodontal ligament space was more frequently seen in osteosarcoma cases (59.5%, χ ² test) than that in chondrosarcoma (20%) or Ewing sarcoma (27.3%).

CT imaging manifestations hold certain value in the diagnosis and differentiation of sarcomatous lesions in maxillofacial bones.