Using the condylar prosthesis after resection of a large odontogenic myxoma tumor in the mandible

ABSTRACT: Odontogenic myxomas are considered to be a benign odontogenic tumor with locally aggressive behavior. Because these neoplasms are rare in the oral cavity, the possible surgical management can be quite variable. Literature recommendation can vary from simple curettage and peripheral ostectomy to segmental resection. The authors report a case of a 20-year-old patient with an odontogenic myxoma tumor located in the left mandibular angle, ascending ramus, and mandibular symphysis. It was treated by radical resection followed by titanium reconstruction with condylar prosthesis, which allowed rapid return of function with improvement in quality of life and restoration of cosmetic and functional deficits. The lesion did not recur after surgical procedure.     

Odontogenic myxoma. Surgical management and an ultrastructural study.

Odontogenic myxoma is a tumor of primitive mesenchyme, probably derived from the dental apparatus. Surgical management of this benign but locally aggressive tumor is either by curettage or en bloc resection. Two cases of odontogenic myxoma of the mandible are reported. In one case, en bloc resection. Two cases of odontogenic myxoma of the mandible are reported. In one case, en block resection with immediate reconstruction was undertaken. In the second case, the neoplasm was thoroughly curetted. The first case was studied by electron microscopy. Six ultrastructural studies of seven odontogenic myxomas have been previously reported. The ultrastructural features of odontogenic epithelium that may be present in myxomas of the jaws have been examined by electron microscopy once before. Our observations are in agreement with those of other workers who suggest that the connective tissue cell is the proliferating component of the tumor and is very similar to a fibroblast but has enough ultrastructural and functional features to deserve the term myxoblast. The majority of the tumor cells are metabolically active and secretory and there is adequate evidence that the tumor matrix consists of large amounts of mucopolysaccharides. It is reasonable, therefore, to conclude that myxoblasts secrete the mucoid matrix that is so characteristic of odontogenic myxomas. Unlike normal or neoplastic fibroblasts, the myxoblasts are not engaged in abundant synthesis of banded collagen throughout the entire lesion.     

Odontogenic myxoma: report of a case

The odontogenic myxoma is an uncommon tumor of the jaws. It occurs mainly on posterior mandible and affecting patients aged between second and third decade. This paper calls about an unusual case on a 57 years-old female patient. It appeared after extraction of lower bicuspid tooth. It was enucleated by curettage and has developed no recurrence up to this date.     

Central giant cell granuloma of the jaws: experiences in the management of thirty-seven cases

This report reviews experiences in the management of 37 cases of central giant cell granuloma of the jaws. The statistical analysis includes location, age, sex, size on initial presentation, and other variables relating to incidence and distribution. The technique of curettage or curettage with peripheral ostectomy was used in all cases treated surgically, resulting in no evidence of disease in 21 out of 23 cases followed postoperatively for 2 or more years. Radiation therapy was curative in one instance. Preoperative endodontic therapy for teeth in the field of surgery has proved to be advantageous. The pathogenesis of the giant cell granuloma of the jaws is discussed.     

Odontogenic tumors in an Iranian population: a 30-year evaluation

Oral and maxillofacial pathology has paramount importance in connecting basic science and clinical features; progress in this field will improve diagnosis and treatment. Although the prevalence of odontogenic tumors varies in different geographic sites, there are no reports in English on the relative frequency of odontogenic tumors in Iran. In the present 30-year retrospective study, the case records of all patients referred to the Mashhad Faculty of Dentistry during the period 1978-2008 were evaluated. Subsequently, all lesions diagnosed as odontogenic tumors were subjected to microscopic reevaluation. Data regarding sex, gender, location, and histopathology were gathered. Among 8,766 patients, only 165 odontogenic tumors (1.9%) were found, with a mean age of 26.3 years (range 6-81 years). One hundred and fifty-eight tumors were central with high frequency in the posterior region of both jaws especially in the mandible and seven were peripheral tumors, including five in the posterior mandible and two in anterior maxilla. Malignant transformation was seen in three cases as malignant ameloblastoma (1.8%). The most common tumor was ameloblastoma, followed by odontoma, odontogenic myxoma, and adenomatoid odontogenic tumor. Nevertheless, odontogenic tumors occurred more in females in the third decade with affinity for the posterior mandible in this study.     

Clinical and radiographic features of eosinophilic granuloma in the jaws: review of 41 lesions treated by surgery and low-dose radiotherapy

Eosinophilic granuloma within the jaws may radiographically mimic other benign odontogenic cysts and tumors, and different protocols have been suggested in the literature for treating eosinophilic granuloma of the jaws. Forty-one lesions of eosinophilic granuloma, diagnosed in 25 patients, were reviewed retrospectively, and data were collected regarding age, gender, ethnic origin, location, symptoms, clinical appearance, radiographic features, treatment, and recurrence. The lesions were found in youngsters (18.1 +/- 4.7 years of age), mostly in the posterior parts of the mandible, and the most common presenting symptom was pain (92%), often accompanied by swelling. Approximately one half of the lesions were radiographically well defined without ossification. All patients were treated by enucleation (with or without peripheral ostectomy) and radiotherapy; 7.3% lesions recurred during follow-up (9.3 +/- 4.6 years). In addition, the different treatments suggested in the literature for eosinophilic granuloma of the jaws were reviewed.     

Fibrolipomatous hamartoma in a patient with tuberous sclerosis: report of a case

Tuberous sclerosis is a rare congenital disorder with an incidence of 1 in 6000 births. The classic triad is seizure, mental deficiency, and angiofibromas. Orofacial manifestations include fibrous hyperplasia, hemangioma, bifid uvula, cleft lip and palate, macroglossia, high arched palate, and enamel defects. Benign tumors of the jaws including desmoplastic fibroma, calcifying odontogenic tumor, and odontogenic myxoma have been recently reported in tuberous sclerosis. This case report adds fibrolipomatous hamartoma of the mandible to this list.     

Asymptomatic expansion of the mandible

Frequently, the first noticeable sign of an odontogenic myxoma is a slowly enlarging, painless expansion of the jaw. Spreading, loosening, and migration of teeth in the area commonly occur. In the early stages, the tumor is asymptomatic, and detection is made only by routine radiographs. Clinicians should be aware of the radiographic changes caused by this benign odontogenic tumor, and include it in their differential consideration of lesions presenting such changes in the jaws. A typical case of a fairly large odontogenic myxoma has been presented. The clinical, radiographic, and histological presentations have been discussed. The tumor was treated by en bloc resection with immediate bone and nerve reconstruction. The patient responded well to therapy and no tumors were found at the 1 year follow-up examination.     

Recurrent central giant cell granuloma in the mandible: surgical treatment and dental implant restoration

Central giant cell granuloma is an uncommon benign intraosseus lesion of jaws. Traditional treatment has been local curettage, although aggressive sub-types have a high tendency to recur. This patient report describes a recurrent central giant cell granuloma involving the body of the mandible in a 48-year-old-woman. Initial treatment of lesion consisted of curettage and peripheral ostectomy. When recurrence was detected one year later, an en bloc resection and defect regeneration with a composite bone graft of autogenous bone, xenograft, and autologous platelet-rich plasma was carried out. Adequate new bone formation was observed during follow-up of 24 months. Two dental implants were placed, and implant-supported prosthesis was constructed, providing a satisfactory dental restoration.     

Immediate reconstruction of a large mandibular defect of locally invasive benign lesions (a new method)

Locally invasive benign tumor and large lesions such as ameloblastoma, giant cell granuloma, odontogenic keratocyst, and odontogenic myxoma are a benign, invasive, lesions of the jaws that predominantly affects the mandible. Despite the benign nature of these lesions, there is a high rate of local recurrence after curettage, which usually requires resection. The traditional surgical approach for resection of these lesions, via either mandibulotomy or mandibulectomy is extraoral approach which is associated with significant functional and esthetic sequelae. A case series is presented here in which less invasive and intraoral approach. An intraoral approach provides wide and fast access to the mandible. This approach represents a less invasive alternative that provides access to the mandible for curative resection of benign tumors with minimal postoperative sequelae. At 5 years follow-up, there were minimal functional and esthetic defects.We explored the use of the less invasive and more esthetic incision as an approach to resection and reconstruction of the mandible. It is our belief that these concerns have been best addressed by the minimally invasive procedure used in this report. This approach resulted in a minimal esthetic and functional defect even though a massive mandibular resection was performed.     

Odontogenic myxoma in the pediatric patient: a literature review and case report

Odontogenic myxoma is a rare benign tumor of the jaws which, in most cases, grows slowly and asymptomatically. In general, the radiographic features are not pathognomonic of the lesion and the histologic characteristics are similar to the normal follicular and dental papilla tissue. Most reported cases involve noticeable expansile lesions in the jaws of individuals older than 10. The purpose of this report was to present the case of a maxillary odontogenic myxoma diagnosed in an asymptomatic 7-year-old girl on routine dental radiologic examination. The lesion's clinical, radiographic, and histological features and the treatment are discussed and compared to similar cases reported in the literature.     

Odontogenic tumors: a review of 319 cases in a Nigerian teaching hospital

OBJECTIVE: This study sought to determine the relative frequency of odontogenic tumors in a Nigerian population and to compare these data with previous reports. STUDY DESIGN: Records of patients seen at the Lagos University Teaching Hospital between January 1980 and December 2003, with histologic diagnosis of odontogenic tumors (based on World Health Organisation classification, 1992), were analyzed. RESULTS: Odontogenic tumors constituted 9.6% of all the biopsies of oral and jaw lesions seen within the period under study. Three hundred and eight (96.6%) were intraosseous, and 11 (3.4%) were peripheral (peripheral odontogenic fibroma=7; peripheral myxoma=3; peripheral ameloblastoma=1). The mean age of patients was 29.9+/-15.6 years (range, 4-85 years). Among these cases, 96.6% of the tumors were benign and 3.4% were malignant. Ameloblastoma with predilection for the mandible was the most frequent odontogenic tumor (63%), followed by adenomatoid odontogenic tumor (AOT) (7.5%), myxoma (6.5%), calcifying epithelial odontogenic cyst (5.3%), and odontogenic fibroma (5.3%). More cases of malignant odontogenic tumors were seen than cases of calcifying epithelial odontogenic tumor and odontomas. The mean ages of patients with AOT, ameloblastic fibroma, and odontoma were significantly lower than those with ameloblastoma ( P<.05). No significant difference was found between the mean ages of patients with benign odontogenic tumors and those with malignant odontogenic tumors ( P=.058). CONCLUSIONS: Odontogenic tumors, especially ameloblastoma, are not considered rare among Nigerians, whereas odontoma, regarded as the most frequent odontogenic tumor in North and South America, is rare.     

Odontogenic tumors in childhood: a retrospective study of 86 treated cases. Importance of a correct histopathologic diagnosis

The odontogenic tumors are an unusual group of lesions of the jaws derived from embryologic tooth-forming tissues and presenting in a large number of histologic patterns. More common in pediatric age and adolescence than in adult age, the odontogenic tumors can be observed casually or after the appearance of nonspecific symptoms. Because of their slow-growth tendency, usually they do not cause pain. The odontogenic tumors grow in the jaw, through the haversian system, without metastasis but with and high probability of relapse. A retrospective study of 86 cases treated between 1997 and 2005 is reported. The percent of diagnosed cases that were benign was 98.8%, and just one case of malign neoplasm is reported. The most frequent tumor accounted for in the reported sample was odontoma (39.5%) followed by odontogenic fibroma (12.8%). Ameloblastoma and myxoma showed the same incidence (11.6%). Early diagnosis, together with a correct histologic diagnosis, allows a preservative and effective surgical treatment and is necessary to reduce the risk of relapse.     

Peripheral Odontogenic Myxoma: A Review of the Literature and Report of Two Cases

Two cases of peripheral odontogenic myxoma with a verifiable location in gingival soft tissue and without bone involvement were compared with those reported in the literature. This study showed that they form a distinct albeit rare clinical entity with a potential to grow into large disfiguring lesions. The probability that small peripheral odontogenic myxomas are interpreted as edematous irritation fibromas may contribute to the small number of peripheral odontogenic myxomas recorded in the literature. The differential diagnosis of soft tissue myxoid proliferations is discussed.     

Odontogenic myxoma containing osteocement-like spheroid bodies: report of a case with an unusual histopathological feature

The odontogenic myxoma is a rare, benign, but locally invasive tumour of the jaws. Radiographically, it is a bone destroying lesion and has ill-defined borders. Histological characteristics are spindle and stellate-shaped tumour cells and a distinct myxomatous stroma. Bony islands that represent residual trabeculae are found scattered throughout the lesion. This report describes a case of odontogenic myxoma that shows diffusely dispersed osteocement-like spherular calcified bodies, unlike residual bone trabeculae, and discusses its differential diagnosis.     

Condyloma acuminatum associated with odontogenic myxoma: a case report

Condylomata acuminatum is a sexually transmitted infectious disease caused by human papiloma virus on the skin. The transmission is mainly by close contact with infected person and autoinoculation. In oral cavity the condition manifests as soft pink nodules which proliferate and coalesce rapidly to form diffuse papillomatous clusters of varying size. Odontogenic myxoma is a rare tumor of jaws which occurs in the tooth-bearing areas of the mandible and maxilla. It is an uncommon, benign, but locally aggressive neoplasm. This case report highlights a 17-year-old girl with two lesions in oral cavity with soft tissue growth on the palate which has been diagnosed as Condyloma Acuminatum, treated by surgical excision and a large swelling on the right side of the mandible in the same patient diagnosed as odontogenic myxoma where marginal resection was performed.     

Peripheral odontogenic myxoma located on the maxillary gingiva: report of a case and review of the literature

BACKGROUND: Odontogenic myxoma is a rare, benign neoplasm and is often located in the maxillofacial region centrally most common in the mandible. Soft tissue localization that can be classified as a peripheral myxoma is rarely seen than the central localization. Peripheral myxoma is slowly growing and less aggressive compared to the central myxoma and has a low recurrence rate. CASE REPORT: In this presentation, the patient with a peripheral odontogenic myxoma of the posterior maxillary gingiva was presented with histological findings following surgery, and the clinical differences and characteristics of the various types of myxomas were discussed by a review of the literature.     

Peripheral epithelial odontogenic tumors: a review

Peripheral (extraosseous or soft tissue) odontogenic tumors are rare lesions that occur in the soft tissue overlying the tooth-bearing areas of the mandible and the maxilla. A review of the English-language literature revealed only 48 well-documented cases of peripheral epithelial odontogenic tumors. Thirty-two were peripheral ameloblastomas; six were peripheral adenomatoid odontogenic tumors; nine were peripheral calcifying epithelial odontogenic tumors; and one was a peripheral squamous odontogenic tumor. An additional four cases were reported as peripheral ameloblastomas in extragingival locations, but their odontogenic origin is debatable. Although the peripheral ameloblastoma is histologically similar to its central counterpart, it differs in its clinical features and biologic behavior. It does not exhibit an aggressive, destructive behavior and does not invade the underlying bone. Conservative excision of the tumor with minimal but adequate margins is the treatment of choice and recurrences are uncommon. This benign biologic behavior appears to be true also for lesions diagnosed as peripheral calcifying epithelial odontogenic tumors and undoubtedly is true for the peripheral adenomatoid odontogenic tumors.     

Peripheral ameloblastic fibroma of the maxilla: report of a case and review of the literature

Peripheral odontogenic lesions are considered to be rare within the classification of odontogenic tumors. Also referred to as extraosseous or soft tissue odontogenic tumors, peripheral odontogenic tumors share the same histopathologic characteristics of their central or intraosseous counterparts. Ameloblastic fibroma is a rare odontogenic tumor that arises from both odontogenic epithelium and connective tissue. Only 2 cases of peripheral ameloblastic fibroma have been reported in the English-language literature, one of which did not show the classic features of an ameloblastic fibroma. In this report, we describe a rare case of a peripheral ameloblastic fibroma in the maxilla of a 3-year-old girl.     

Advanced central myxoma of the jaws in Nigeria. Clinical features, treatment and pathogenesis

18 advanced cases of myxoma of the jaws are described. These had a typical age, sex and site distribution and characteristic clinical and radiographic features. Surgical treatment was radical as benefits large, poorly defined tumours, but there was no evidence that these were aggressive lesions. It is argued that the designation of myxoma as an odontogenic tumour is uncertain though not excluded. Attention is drawn to evidence that many myxomas of the jaws may be examples of myxomatous degeneration in other neoplasms.