Myxoma of the jaw

Odontogenic myxomas in the Hong Kong Chinese: clinico-radiological presentation and systematic review

AIM

The aim of this study was to determine the clinical and radiological presentation on plain films of central odontogenic myxomas (OM) in the Hong Kong Chinese and compare them to other reported series by a systematic review (SR).

METHODS

The study had two elements, that of a complete series of all OMs presenting at a major Chinese maxillofacial surgical unit and a SR. The files of the Department of Oral and Maxillofacial Surgery of the University of Hong Kong between 1989 and 2000 were reviewed for OM cases. The relevant literature was identified by electronic databases, review of citation lists and handsearching of key journals. The principal selection criterion was that the study should represent a complete collection of cases.

RESULTS

The SR revealed that only a quarter of the reports provided any quantitative radiological details. Just under half of the included reports provided the relative period prevalence of OMs compared to other odontogenic tumours, but these reports almost completely excluded consideration not only of the radiology but also specific clinical details. Furthermore, they did not report of recurrence data, an important feature of the OM. Most of the most recent reports were concerned with relative period prevalence. The relative period prevalence and 'number of OMs per hospital per year' of studies separated by two or more decades in Hong Kong and Nigeria indicate an increase in the number of lesions diagnosed as OMs. The 10 Hong Kong cases were broadly consistent with the predilections for females and the mandible of other reports. The mean age at first presentation in the present report is 36.9, older than the other reports. Most lesions are large, affecting both posterior and anterior quadrants. They appear to be larger than those in many other reports. Two of the OMs are accompanied by histories of recent rapid growth. Tooth displacement and root resorption are more frequently observed in OMs in the present study. Although all OMs in the present study are still being followed up after surgery, none have recurred.

CONCLUSION

Although the presentation of larger lesions in the older Chinese could in part be explained by attitudes rooted in traditional medicine in spite of the widespread availability of modern medical care in Hong Kong, there is a history of recent rapid growth in at least two cases. An emphasis by recent reports on the OMs' relative period prevalence of concurrent odontogenic lesions, has omitted recording the radiology and the specific clinical details usually required for diagnosis.,

Clinical and radiological features of odontogenic myxoma of the jaws

OBJECTIVES

To analyse critically the clinical and radiological features of odontogenic myxoma.

METHODS

The clinical features of 164 cases of odontogenic myxoma (two new and 162 from the literature) and the radiological features of 96 cases (two new and 94 from the literature) were analysed.

RESULTS

Most of the tumors (75%) were diagnosed in the 2nd to 4th decades. The male to female ratio was 1:1.5. Tumors were located in the mandible in two-thirds and in the maxilla one-third of cases. A multilocular appearance was observed in 55% and unilocular in 36%; 9% were not loculated. There was a statistically significant correlation (P < 0.000) between the size of the lesion and its locularity with the larger lesions more likely to be multilocular. Only 5% of the tumors were associated with an unerupted tooth.

CONCLUSIONS

Odontogenic myxoma has a variable clinical and radiological appearance and it should be considered in the differential diagnosis of radiolucent and mixed radiolucent-radiopaque lesions of both jaws in all age groups.

Myxoma of the maxilla: a case with extremely aggressive biologic behavior

BACKGROUND

Osseous "bone-derived" myxoma is a benign, slow-growing, locally invasive tumor that is found exclusively in the facial skeleton. Although recurrence is frequent, uncontrolled growth is not classic.

METHODS AND RESULTS

We report the case of a patient with myxoma of the maxilla in which the growth of the myxoma was so invasive that it resulted in destruction and deformation of the facial skeleton even after repeated resections. Eventually, destruction and infiltration of the skull base with a fatal outcome was the result.

CONCLUSIONS

This case of locally aggressive myxoma of the maxilla illustrates the need for a correct primary treatment of this benign tumor. Although complete resection may result in a significant functional and aesthetic mutilation, incomplete primary removal results in high recurrence rates. Therefore, a radical primary resection of the tumor with maximal preservation of surrounding anatomic structures is necessary. Follow-up should be meticulous and based upon regular clinical and radiographic examinations.

Don't confuse dental soft tissues with odontogenic tumors

Surgical pathologists are cautioned against the misinterpretation of immature dental tissues (dental papillae and follicles) and dental pulp as odontogenic tumors, especially odontogenic myxomas and fibromas. The close histologic similarity of the immature tissues to tumors may require a clinical-radiologic correlation with the histopathologic specimen in order to distinguish the locally aggressive tumors from innocuous dental tissues.