Condyloma acuminatum associated with odontogenic myxoma: a case report

Long-Term Follow-Up after Conservative Surgical Treatment of Odontogenic Myxoma: A Case Report and Literature Review

Odontogenic myxoma (OM) is a relatively rare, benign odontogenic tumor with locally aggressive behavior, but it is a nonmetastasizing neoplasm of the jaw bones. Although radical resection with an appropriate surgical margin is recommended, emerging evidence has suggested that a more conservative approach will result in acceptable recurrence rates with less morbidity if careful long-term follow-up is provided. A 56-year-old Japanese man with odontogenic myxoma of the left mandible was conservatively treated by surgical enucleation and curettage because he desired functional and cosmetic preservation. During a follow-up period of 100 months, the patient has remained clinically and radiologically free of recurrence. As far as we can ascertain, 20 reports published after 1990 described 37 patients with mandibular OM that had been treated by conservative surgery. Tumors recurred during a mean follow-up of 49.2 ± 42.8 months in 7 (18.9%) patients, and only one of five patients who were followed up for over 100 months developed recurrence. The rate of recurrence decreased from 24.0% to 8.3% when follow-up exceeded 60 months. Although enucleation and curettage have proven effective, the risk of recurrence remains considerable and long-term follow-up is indispensable. More evidence of long-term outcomes after conservative surgery for OM is needed.

Size distribution and clinicoradiological signs of aggressiveness in odontogenic myxoma-three-dimensional analysis and systematic review

OBJECTIVES

Therapeutic assessment of odontogenic myxoma (OM) is poorly standardized. Unidimensional size criteria have shown to be unreliable in therapeutic decision-making. We evaluate the size distribution of OM and scan for associated clinicoradiological signs of aggressiveness. Additionally, we evaluate three-dimensional size delineation of OM aiming to improve future therapeutic assessment of this destructive neoplasm.

METHODS

Primarily, we reviewed the database "PubMed" for data concerning the size of OMs as radiologically determined. Afterwards, the impact of age, sex, locularity and location on the size was investigated by χ² test, Student's t-test and regression analysis. Furthermore, we statistically evaluated the impact of size on the occurrence of clinicoradiological signs of aggressiveness. Secondly, we approximated the volume of five unpublished cases of OM by semi-automatic image segmentation of cone-beam CT images.

RESULTS

Multilocular OMs were significantly larger than unilocular ones (p < 0.002). Age (0.042) and multilocularity (<0.002) significantly impacted size. Size was significantly associated with cortical perforation (0.032) and multilocularity (<0.002), further regression analysis revealed tooth resorption (0.019), cortical perforation (0.005) and multilocularity (<0.002) as significant predictors of size. Employing the volume as a mean of comparison, we found that the biggest OM (38.42 ml; multilocular) was 124 times larger than the smallest (0.31 ml; unilocular). However, using the maximum diameter (cm) as a surrogate for size, the biggest lesion (6.3) was only 5.25 times larger than the smallest (1.2).

CONCLUSIONS

Locularity and volumetric size characterization might help in therapeutic decision-making and could help to improve our understanding of OM.

Surgical management of odontogenic myxoma: a case report and review of the literature

BACKGROUND

Odontogenic myxoma is a benign odontogenic tumor with locally aggressive behavior, and is relatively rare in the oral cavity. There are currently no clear surgical management guidelines for odontogenic myxoma, and a variety of approaches may be used. This study evaluated the literature concerning the surgical management of odontogenic myxoma, and reports the long-term outcome of a case managed by using a more conservative surgical approach.

CASE PRESENTATION

We managed a 40-year-old Japanese man with odontogenic myxoma in the right mandible by enucleation and curettage, a relatively conservative approach that has proved to have been justified by a lack of recurrence over 10 years. Our strategy was compared with others reported in the literature, which was identified by a PubMed search using the term "odontogenic myxoma". Articles without full text or with missing data were excluded. The age and sex of patients, the tumor location (maxilla/mandible), treatment (conservative/radical), recurrence, and follow-up period were compared in the reported cases that we evaluated. From the initial 211 studies identified, 20 studies qualified as mandibular cases of odontogenic myxoma. Recurrence was reported in three cases that had been treated with a more conservative surgical approach.

CONCLUSIONS

Enucleation and curettage has proved an effective approach in several cases in ours there has been no recurrence more than 10 years after surgery but the risk of recurrence appears to be higher. We discuss the important factors that must be considered when determining the correct management approach to odontogenic myxoma.