Massive Pediatric Mandibular Ewing’s Sarcoma Presenting with Life-Threatening Airway Obstruction: A Case Report

Abstract

Introduction: Ewing’s sarcoma is a rare and aggressive malignant small round-cell tumor that typically arises in the long bones and pelvis, with only 1–2% of cases involving the maxillofacial skeleton. Mandibular presentation is exceptionally uncommon and presents diagnostic and therapeutic challenges. This study reports a clinical case and includes a focused literature review. A 9-year-old girl presented with a large mandibular mass associated with airway compromise and recurrent intraoral bleeding. Clinical, radiological, and histopathological examinations were performed. The patient underwent urgent tracheostomy, near-total mandibulectomy with a lip-split incision and 2 cm margins, followed by immediate titanium plate reconstruction. Postoperative care included adjuvant multiagent chemotherapy. A literature review of cases reported between 1988 and 2025 was conducted for comparison. Surgery achieved complete tumor resection with immediate stabilization of the airway and mandibular continuity. Postoperative histopathology confirmed the diagnosis of Ewing’s sarcoma with clear margins. The patient recovered with stable airway function and initiated adjuvant chemotherapy. Review of published cases demonstrated variability in presentation, management, and survival outcomes. A summary of comparative mandibular cases is presented in Table 1. Pediatric mandibular Ewing’s sarcoma is rare but may present with airway emergencies. Early recognition, multidisciplinary planning, and prompt surgical intervention with airway protection are critical for favorable outcomes.