Hosp Report 1- odontogenic myxoma

8/12/2019 Hosp Report 1- odontogenic myxoma

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Centro Escolar University School Of Dentistry

ODONTOGENIC MYXOMA OF THE MANDIBLE: A SERIES OF CASE

REPORTS AND REVIEW OF LITERATURE

A Series of Case Reports

Presented to

Quirino Memorial Medical Center

Dentistry Department

in Partial Fulfillment

of the Requirements for the Course

Hospital Dentistry 1

by

Marrion ules Mendo!a

Precious An"elica Mortel

#en$ Delos Reyes

Mhia Dianne %umbres

Ru&ina Ara yne Quinto

Pari!ad 'iamiri

(horbanipar&ar Hamidre!a

Centro Escolar University

School Of Dentistry

1


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TABLE OF CONTENTS

Page

I. ABSTRACT

........... 3

II. INTRODUCTION ..

3

Re&ie) of

%iterature**********************+*

3

III. PATIENT CASE PRESENTATION

4

Case,1

*****************************

*+ 4

Case,-

*****************************

**+

Case,. **********+

********************+ 4

IV. DISCUSSION

..

!

V. CONCLUSION

.

"#

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VI. APPENDICES ..

"


I. ABSTRACT

/donto"enic My0oma other terms are 2/donto"enic my0oma34 and

2My0ofibroma5 is a tumor of the $a)s )hich apparently arises from the

mesenchymal portion of the tooth "erm4 either the dental papilla4 the follicle or

the periodontal li"ament+ 6t occurs most frequently in the second or third decades

of life4 the a&era"e a"e in the &arious reported series ran"in" from -. 7 .8 years+

Accordin" to Shafer4 there is no particular se0 predilection for occurrence in the

mandible+ /ccasional cases occur outside the tooth9bearin" areas4 se&eral cases

ha&in" been reported in the condyle or nec: of the condyle+ ;he roent"eno"ram

may present a mottled or honeycombed appearance of bone in some cases4

)hile others may appear as a destructi&e4 e0pandin" radioluscency )hich

sometimes has a multilocular pattern+ ;he treatment of odonto"enic my0omas is

sur"ical e0cision4 follo)ed by cautery+


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mana"ement of odonto"enic my0omas= the first case is a .- year old male

patient reported to ha&e a slo) "ro)in"4 painless s)ellin" in the left mandibular

re"ion+ ;he second case is a >. year old male patient )ith a complaint of left

ma0illary s)ellin"+ ;he third case is a 1? year old male patient )hose complaint

is of mild pain and s)ellin" in the ri"ht posterior mandible+ ;he sur"ical

mana"ement that )as chosen in each case is discussed thorou"hly+ Conclusions

of each cases su""ested treatment modalities for odonto"enic my0omas and

particular inhibition to any recurrences+

II. INTRODUCTION

/donto"enic my0omas ha&e been found in patients ran"in" in a"e bet)een 18

and @8 years4 ho)e&er4 they are most commonly dia"nosed in youn" adults

specifically bet)een -@ and .@ years of a"e5+;hemandible is more li:ely to be

affected than thema0illa+ ;he re"ion bet)een the molar and premolar is the site of

most common occurrence for multilocular lesions )hile the anterior portion of the

mouth fa&ors a smaller4 unilocular &ariety+ Patients afflicted )ith an odonto"enic

my0oma "enerally notice a painless4 slo)ly enlar"in" e0pansion of the $a) )ith

possible tooth loosenin" or displacement+ As the tumor e0pands4 it frequently

infiltrates ad$acent structures+ Ma0illary lesions frequently enter the sinuses )hile

mandibular tumors often e0tend into the ramus+Radio"raphically4


odonto"enic my0omas appear most commonly as multilocular radiolucencies )ith ill9

defined borders4 thou"h unilocular cyst9li:e tumors can occur4 especially )hen

associated )ith impacted teethor )hen disco&ered in childhood+ 6deally4 the

septa that cause the multilocular feature are thin and strai"ht4 producin" a tennis

rac:etor stepladder pattern+ 6n reality4 the ma$ority of the septa &isible in the tumor

are cur&ed and coarse4 causin" a soap bubble or honeycomb appearance4

thou"h locatin" one or t)o strai"ht septa can aide in the dia"nosis of this tumor+

Small unilocular lesions ha&e been successfully treated )ith enucleation and

curetta"e follo)ed by chemical bone cautery+ Multilocular tumors e0hibit a -@B

recurrence rate and4 therefore4 must be treated more a""ressi&ely+ 6n the case of a

multilocular my0oma4 resection of the tumor )ith a "enerous portion of surroundin"

>
http://en.wikipedia.org/wiki/Human_mandiblehttp://en.wikipedia.org/wiki/Maxillahttp://en.wikipedia.org/wiki/Painhttp://en.wikipedia.org/wiki/Ramus_of_the_mandiblehttp://en.wikipedia.org/wiki/Radiographhttp://en.wikipedia.org/wiki/Tooth_impactionhttp://en.wikipedia.org/wiki/Septumhttp://en.wikipedia.org/wiki/Rackets_(sport)http://en.wikipedia.org/wiki/Rackets_(sport)http://en.wikipedia.org/wiki/Ladderhttp://en.wikipedia.org/wiki/Soap_bubblehttp://en.wikipedia.org/wiki/Honeycombhttp://en.wikipedia.org/wiki/Human_mandiblehttp://en.wikipedia.org/wiki/Maxillahttp://en.wikipedia.org/wiki/Painhttp://en.wikipedia.org/wiki/Ramus_of_the_mandiblehttp://en.wikipedia.org/wiki/Radiographhttp://en.wikipedia.org/wiki/Tooth_impactionhttp://en.wikipedia.org/wiki/Septumhttp://en.wikipedia.org/wiki/Rackets_(sport)http://en.wikipedia.org/wiki/Rackets_(sport)http://en.wikipedia.org/wiki/Ladderhttp://en.wikipedia.org/wiki/Soap_bubblehttp://en.wikipedia.org/wiki/Honeycomb


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bone is required+ #ecause of the "elatinous nature of the tumor4 it is crucial for the

sur"eon to remo&e the lesion intact so as to further reduce the ris: of recurrence+

;he purpose of this is to re&ie) the current literature of odonto"enic my0omas

and to present three cases that )ere dia"nosed to ha&e the tumor at different

locations and treated )ith an emphasis on the different sur"ical mana"ement and

reconstruction possibilities+

III. PATIENT CASE PRESENTATION

CASE $ :

A .- year old male patient reported to the department of /ral medicine and

Radiolo"y4 Faculty of dentistry4 amia Milia 6slamia )ith a slo) "ro)in"4 painless

s)ellin" in the left mandibular re"ion since - years+ History re&ealed that the patient

initially had mobility in mandibular left first and second molar teeth4 follo)in" )hich

the patient noticed a small s)ellin" )hich has pro"ressi&ely increased to attain the

present si!e+ ;he past medical history )as noncontributory+


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Haemo"lobin )as sli"htly belo) the normal limits &alue of 18+@"mB+

/rthopantomo"ram /P(5 re&ealed a multilocular radiolucent lesion e0tendin" from

mandibular ri"ht central incisor4 lateral incisor and canine tooth upto the si"moid

notch on the left side+ Condyle and coronoid process )ere not in&ol&ed+ Destruction

of left lo)er border of mandible )as e&ident alon" )ith fine radiatin" bony trabeculae

o&er the lo)er border+ ;here )as liftin" of periosteum alon" left an"le of the

mandible+ Root resorption )ith mandibular ri"ht central incisor4 lateral incisor4 canine

and mandibular left central and lateral incisor teeth )as seen4 and /P( sho)ed

tooth floatin" in air appearance+ ;he lesion )as differentially dia"nosed as

/donto"enic neoplasm Ameloblastoma4 odonto"enic my0oma4 :eratocystic

odonto"enic tumor54 Mali"nancy )ithin odonto"enic neoplasm Ameloblastic

carcinomasarcoma54 central "iant cell "ranuloma and &ascular neoplasm of bone

Haeman"ioma5+ After the informed consent of the patient4 incisional biopsy )as

done and it re&ealed typical features of odonto"enic my0oma4 containin" loosely

arran"ed stellate or spindle shaped cells )ithin a my0oid matri0+ H < stained

section sho)s para:eratinised stratified squamous epithelium of &ariable thic:ness+

;he underlyin" connecti&e tissue )as loose and not hi"hly cellular+ Ender the

histopatholo"ic dia"nosis of odonto"enic my0oma4 a lo)er chee: flap )as raised

usin" Rou0 lip split incision+ Se"mental mandibulectomy )as done and the tumor

mass )as resected alon" )ith it+ ;he resected specimen includin" ri"ht canine upto

left condyle5 )as sent for histopatholo"ical analysis ;he histopatholo"y of the

e0cised tumor mass re&ealed loose my0oid stroma consistin" of loosely arran"ed

stellate and spindle9shaped cells4 alon" )ith round cells+ Fe) of the colla"en fibrils

)ere seen that tended to intermesh+ Small islands of inacti&e9appearin"


odonto"enic rests )ere seen scattered throu"h the my0oid stroma4 histopatholo"y

su""esti&e of odonto"enic my0oma+


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Centro Escolar University SchoolOf Dentistry

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A >.9year9old male )as referred to our department )ith a complaint of left

ma0illary s)ellin" that had been noticed a fe) )ee:s before+ Epon admission4 the

patient had already been dia"nosed as ha&in" an /M and had been treated t)ice

relati&ely conser&ati&ely in other institution4 usin" curetta"e and peripheral ostectomy

alone+ ;he tumour had recurred t)ice and the patient )as then referred to our

department+ ;he patient under)ent radio"raphic in&esti"ation4 )hich su""ested a

cystic4 IIsoap bubble4JJ li:e lesion in&ol&in" the left ma0illa+ ;he patientJs medical

history and re&ie) of systems )ere unremar:able+ /n e0amination of the oral ca&ity4

a mar:ed s)ellin" on the left side of the upper $a) )as noticed+ ;he rest of the

patientJs clinical head and nec: e0amination and "eneral e0amination )ere non9

contributory+ Computeri!ed tomo"raphy )as performed )hich sho)ed that the lesion

occupied the left ma0illary sinus+ A biopsy )as ta:en and the patholo"ical result

concurred )ith the pre&ious dia"nosis of /M+ Esin" a Keber Fer"uson incision4 a

left total ma0illectomy )as performed includin" the left orbital floor+ Macroscopically4

the sur"ical specimen measured appro0imately 0 18 0 cm+ ;he orbital floor )as

reconstructed usin" ;itanium Mesh4 and the ma0illary defect )as primarily

reconstructed usin" a temporary obturator that )as fi0ed )ith t)o palatal scre)s on

the ri"ht side and suspension !y"omatic )ire on the left side+ ;he final obturator )as

fabricated 1 year later+ ;he patient has been follo)ed up for @ years and has

remained disease free+

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bone "raft )as remo&ed . months later+ .8 months after the sur"ical procedure4

there )ere no radio"raphic or clinical si"ns of recurrence and patient )as not

interested for rehabilitation+

Centro Escolar University

School Of Dentistry

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;he current recommended therapy depends on the si!e of the lesion and on its

nature and beha&iour and can &ary from curetta"e to radical e0cision+ Complete sur"ical

remo&al4 usin" curetta"e and peripheral ostectomy alone is not sufficient as the lesion is

not encapsulated and because the my0omatous tissue infiltrates ad$acent bone+ ;hese

characteristics may e0plain the hi"h rate of recurrence of my0omas )hich ran"es from

18 to ..B )here simple enucleation and curetta"e alone can ha&e recurrence rates of

up to -@+ ;he treatment options can include curetta"e )ith peripheral ostectomy4

se"mental resection up to radical resections for the more a""ressi&e lesions reported a

@89year follo) up of 18 cases of /Ms4 nine )ere treated by resection and one case )as

treated conser&ati&ely by local e0cision+ /nly the conser&ati&ely treated case recurred @

years follo)in" the treatment+

Reconstruction can be"in immediately follo)in" the sur"ical procedure or delayed

until an adequate disease free period has past+ 6n our e0perience4 small bony defects

smaller than @ cm5 can be reconstructed usin" buccal fatpad ma0illa54 or usin"

corticocancellous iliac crest bone "raft+ %ar"er defects more than @ cm5 usually require

primary prosthetic reconstruction obturator5 follo)ed by a final obturator+ Mandibular

lesions can be mana"ed primarily usin" a


reconstruction plate follo)ed by an immediate or delayed &asculari!ed fibular free flap4

iliac crest "raft4 costochondral "raft4 or scapular osteocutaneous free flap+ Esually in

lar"e /Ms4 a disease free period of se&eral years is ad&ised due to the hi"h recurrence

rates of the tumour and the morbidity of the donor site+

6n this4 a series of three ne) case reports )ith different approaches )ere chosen4 the

first presented )ith an asymptomatic slo) "ro)in" s)ellin" in&ol&in" the body of the

mandible and ramus+ 6ncisional bipsy )as done it re&ealed typical features of

odonto"enic my0oma+ A lo)er chee: flap )as raised usin" Rou0 %ip Split incision=

Se"mental Mandibulectomy )as done and the tumor mass )as resected alon" )ith it+

;he second case reported4 )as a smaller /M that demanded a less a""ressi&e

approach4 Computer ;omo"raphy )as performed )hich sho)ed that the lesion occupied

the left ma0illary sinus+ Esin" a Keber Fer"uson incision4 a left total ma0illectomy )as

needed for total clearance of the lesion+ ;he orbital floor )as reconstructed usin"

--


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;itanium Mesh and the ma0illary defect )as primarily reconstructed usin" a temporary

obturator+

;he third and final case displayed a lesion of a 1? year old patient in&ol&in" posterior

ri"ht mandible area+ 6t )as in&adin" )ith intermediate pain and more a""ressi&e+ An

e0tra oral approach )as chosen due to the si!e and caudal e0pansion of the lesion+ ;he

immediate reconstruction of the mandible usin" reconstruction plate made the

mandibular morbidity less profound )hen compared )ith its ma0illary lesions4 from the

functional point of &ie)+

V. CONCLUSION

/donto"enic my0omas are rare beni"n $a) neoplasms4)ith a "reat deal of

contro&ersies re"ardin" the histo"enesis+;he neoplasm should be dia"nosed on the

basis of radio"raphic ima"in" modalities and histopatholo"ical e0amination+

Appropriate treatment modalities should be instituted and recurrences should be

a&oided+ %ocally a""ressi&e /Ms should be treated accordin" to the si!e and

beha&iour of the tumour+ Ke belie&e thatdue to the hi"h recurrence rates of these

lesions4 delayed reconstruction is the treatment of choice4 especially in the more

locally a""ressi&e tumours+

Documents

Hosp Report 1- odontogenic myxoma