BACKGROUND: Maxillofacial sarcomas are rare tumors, varying according to their type, grade, site of occurrence, response to treatment and prognosis. Approximately 10% of all cases of osteosarcoma, a subtype with a particularly poor prognosis, occur in the head and neck. PATIENTS AND METHODS: During the 35 years from 1963 until 1997, the 25 patients treated for sarcomas at our center were identified and evaluated according to a variety of parameters. RESULTS: Overall 2- and 5-year survival rates were 72% and 60%, respectively. Sarcomas were found most commonly in the mandible, maxilla and tongue. Survival was not significantly correlated with gender, ethnic origin or histopathological staging, but significant correlation was found between type of sarcoma and survival whilst younger patients had better survival rates. CONCLUSION: Advanced facial reconstruction methods may enable the performance of more radical ablative surgery, thereby improving survival outcome for head and neck osteosarcoma patients. Osteosarcoma appears to be as lethal in the maxillofacial region as in the extremities.