Surgical treatment of odontogenic myxoma

Clinicopathologic and imaging features of odontogenic myxomas: a multi-institutional study

PURPOSE

This study aims to report clinicopathologic and imaging features of odontogenic myxomas (OM), highlighting uncommon findings.

METHODS

Clinicopathologic and imaging data of OMs diagnosed in the five Brazilian diagnostic pathology centers were collected and analyzed.

RESULTS

The series comprised 42 females (68.9%) and 19 males (31.1%), with a 2.2:1 female-to-male ratio and a mean age of 34.5±15.4 years (range: 4-80). Clinically, most OMs presented as painless intraoral swelling (n = 36; 70.6%) in the mandible (n=37; 59.7%). Multilocular lesions (n=30; 83.3%) were more common than unilocular lesions (n=6; 16.7%). There was no statistically significant difference between the average size of unilocular and multilocular OMs (p=0.2431). The borders of OMs were mainly well-defined (n=24; 66.7%) with different degrees of cortication. Only seven tumors caused tooth resorption (15.9%), while 24 (54.5%) caused tooth displacement. Cortical bone perforation was observed in 12 (38.7%) cases. Morphologically, OMs were characterized mainly by stellate or spindle-shaped cells in a myxoid background (n=53; 85.5%). Surgical resection was the most common treatment modality (n=15; 65.2%), followed by conservative surgery (n=8; 34.8%). Outcomes were available in 20 cases (32.3%). Seven of these patients had local recurrence (35%). Enucleation was the treatment with the highest recurrence rate (4/7; 57.1%).

CONCLUSIONS

OM has a predilection for the posterior region of the jaws of female adults. Despite their bland morphological appearance, they displayed diverse imaging features. Clinicians must include the OM in the differential diagnosis of osteolytic lesions of the jaws. A long follow-up is needed to monitor possible recurrences.

Clinical Spectrum and Treatment of Odontogenic Myxoma: Analysis of 37 Cases

Background

Odontogenic myxoma is one of the benign mesenchymal odontogenic tumours with aggressive behaviour and showed slow and asymptomatic expansion, the second until the third decade of life is the most targeted age group. With high female preponderance, about the management, surgical management is the only option concerning this odontogenic pathology with a variety of treatment options. This study aims to analyse a series of 37 patients with odontogenic myxoma treated in a single institution.

Materials and method

In total, 37 patients with odontogenic myxoma were treated at KTDH in Sudan and were retrospectively reviewed. With the analysis of medical records of all patients diagnosed with odontogenic myxoma and the related variables, data were analysed using the SPSS statistical program (version 23).

Results

Most of the cases were females (26 patients 70.27%), and males were about (11 patients 29.73%). In most of the cases maxilla was affected more than the mandible (25 cases, 67.57%) mostly in its posterior segment (32 cases, 86.49). The most age group affected was the group of cases (0-20) which were about 18 cases (48.65%). In total, 35 of the cases noticed swelling (94.59%), while 14 noticed tooth mobility (37.84%) and paraesthesia was a positive finding in just one case (2.70%). In total, 12 patients (32.43%) had a positive history of tooth extraction related to the lesion, and recurrence was positive in (64, 86%).

Conclusion

Odontogenic myxoma is locally aggressive. There is no gold standard protocol for surgical treatment so choosing the most suitable and reliable treatment option relay on the operator taking into consideration the characteristic of each case and the recurrence rate with the associated postoperative impairments.

Unraveling the challenges in the diagnosis and management of desmoplastic fibroma of the mandible-a case report

Desmoplastic fibroma (DF) is an uncommon bone tumor that originates from the mesenchymal tissue and despite being benign, exhibits aggressive behavior locally. The following report describes the case of a 7-year-old boy with a rapidly enlarging swelling on the right side of the mandible. After a thorough clinical examination, radiographic imaging, and histopathological analysis, the diagnosis of DF was confirmed. Treatment planning was formulated considering both the tumor's tendency for local recurrence and the patient's well-being. Due to the patient's young age, segmental resection was not deemed appropriate, and an aggressive curettage and enucleation of the lesion followed by the bone graft was performed instead. The patient was kept under close follow-up for the first month of post-surgery and later reviewed after 3, 6, 9, and 12 months, respectively. Good bone healing was observed on radiographs. The patient did not show any signs of recurrence based on clinical or radiographic assessments and did not exhibit any neurosensory deficits as well.

Surgical management of odontogenic myxomas: A case series

INTRODUCTION

Odontogenic myxoma is a relatively rare bone tumor involving exclusively the jaws. Despite its benign nature, odontogenic myxoma can exhibit aggressive, locally invasiveness and has a high potential of recurrence. Surgical treatment can be conservative of radical. The choice of surgical procedure is controversial, and there are no established guidelines.

CASE SERIES PRESENTATION

We present a case series of three cases of odontogenic myxomas. This case series illustrates the variability of the radioclinical presentation of odontogenic myxoma and the resulting surgical management, ranging from simple enucleation to mandibular interruptive resection surgery with free flap reconstruction.

DISCUSSION AND CONCLUSION

Through this case series, we highlighted and described decision criteria contributing to treatment choice and summarized this in an algorithm. Radiological tumor characteristics and also patient specific factors such as age need to be considered to make a personalized decision to each patient.

A Case of Odontogenic Myxoma of the Mandible with Expansion to the Alveolar Crest – Comparison of Imaging Findings and Pathological Findings: A Case Report

Background:

An odontogenic myxoma is an intraosseous tumor characterized by stellate and spindle-shaped cells embedded in an abundant myxoid or mucoid extracellular matrix. We herein describe an odontogenic myxoma that expanded not only to the bone marrow but also to the outside of the alveolar bone. Diagnosis of an odontogenic myxoma in a tooth-deficient region by imaging findings alone was difficult because the positional relationship between the tumor and the tooth is unknown. Furthermore, some of these odontogenic myxomas reportedly show rapid growth.

Case Report:

Here, we present the case of a patient, a 44-year-old man, who had a hard, bone-like swelling on his right mandible molar region and mild paresthesia on his right cheek. An odontogenic myxoma and ameloblastoma were suspected based on the imaging findings; however, pathological examination of the biopsy led to a diagnosis of odontogenic myxoma. Right segmental mandibulectomy was performed, and there was no recurrence observed after surgery.

Conclusion:

To improve the accuracy of imaging diagnosis, it is important to compare the imaging findings with the pathological findings of the surgical specimen. This comparison in the present case revealed differences in the magnetic resonance imaging signal intensity in regions with different types of cell components.

Odontogenic myxoma with pain and uncommon histological feature in the mandible: A case report and review the literature

Odontogenic myxoma (OM) is a rare benign painless, slow-growing lesion with local aggressive behavior. Pain and sensory disturbance and fibro-osseous appearance in histopathology have been rarely reported in OM. The authors reported a 52-year-old male case presented with a large gingival mass around a mobile mandibular right first molar extended to the distal aspect of the third molar. Microscopic examination of the incisional and excisional biopsy revealed an OM with numerous newly formed bone or cementum-like material present throughout the specimen like those seen in fibro-osseous lesions. For avoiding to recurrence, a segmental mandibulectomy was performed and a metal plate was inserted to the right mandible defect under general anesthesia. Rehabilitation was completed with the placement of implants. We review and discuss about this variety.

Odontogenic myxoma of the anterior mandible: Case report of a rare entity and review of the literature

This report intends to compare classic presentations of odontogenic myxoma in contrast to our case. We also suggest a comprehensive evaluation of lesions and strongly advocate against premature treatments before reaching a definitive diagnosis.

Central Odontogenic Myxoma: A Radiographic Analysis

Objective

This study aimed to determine the radiographic characteristics of odontogenic myxomas (OMs) and their associations.

Materials and Methods

The study enrolled radiographs of patients taken between 2005 and 2019 with a confirmed histopathological diagnosis of central OM. OM radiographic features were evaluated, including location, border, locularity, involved area, the number of included teeth, root resorption, tooth displacement, bone expansion, bone perforation, and periosteal reaction. Fisher's exact test was used for statistical analysis.

Results

Significant associations were found between the OM border and the affected jaw (p=0.036), locularity (p=0.036), involved areas (p=0.009), and bone perforation (p=0.036). OMs with an ill-defined border were associated with maxillary lesions, multilocularity, dentate areas, and cortical bone perforation. The number of included teeth (2 or fewer or 3 or more) was significantly associated with locularity (p=0.010), involved area (p=0.045), and bone expansion (p=0.010). Larger OMs including 3 or more teeth, were associated with a multilocular appearance, dentate areas, and bone expansion.

Conclusion

The border of OM and the number of included teeth are related to other radiographic appearances. Understanding these relationships could help in treatment decisions and help better understand the nature of OM.

The use of Three-Dimensional Printed Technology for Mandibular Reconstruction in a Rare Case of Giant Odontogenic Myxofibroma

ABSTRACT

Odontogenic myxofibroma is a benign odontogenic tumor of mesenchymal tissue that generally originates from the mandible. It is an extremely rare tumor accounting for approximately 2% of all odontogenic tumors. In this report, the authors presented a giant right mandibular mass that extends to the angle of the mandible and displacing the tongue laterally caused significant malocclusion, pain, and impaired oral intake. The tumoral involvement of the mandibula required a partial mandibulectomy with the resection of right mandibular ramus, body, and bilateral parasymphysis. Right mandibular condyle was preserved. The mandibular defect was reconstructed with a fibula free flap. Three-dimensional printed maxillofacial bone model of the patient was used as contour modeling and guide. Histopathologic examination confirmed the diagnosis as odontogenic myxofibroma.The purpose of the report is to present a very rare case of odontogenic myxofibroma and its general characteristics, radiological features, differential diagnosis, surgical management, and the use of three-dimensional printing technology in the field of mandibular reconstruction.

Role of Carnoy's solution as treatment adjunct in jaw lesions other than odontogenic keratocyst: a systematic review

Carnoy's solution (CS) is routinely used as adjuvant therapy in the management of odontogenic keratocyst (OKC) and a few other benign lesions. The purpose of this study was to explore the evidence of its application and efficacy in benign lesions other than OKC. We have systematically reviewed published articles to identify the evidence of CS in benign jaw lesions other than OKC following the PRISMA guidelines. The search was conducted in PubMed, Google Scholar, Semantic Scholar, and Cochrane Library database, to find relevant articles from 1980 to March 2020. Finally, 39 studies were analysed in this review. It included studies where CS was used as an adjunct for the benign lesion of the jaw and followed for a minimum of 6 months. Thirty-nine studies with 11 different types of lesion were reported where CS was used as an adjuvant and application time was restricted to 3-5minutes. Recurrence were reported only in ameloblastoma cases [unicystic=10.98% (10/91), mixed=18.18% (26/143)]. Meta-analysis was not possible as all studies were non-controlled in nature. Based on the available data, there was no strong evidence for the use of CS as an adjuvant in the benign lesion of the jaw. Prospective and randomised control studies are recommended for the best stratification for the use of CS.

Multidisciplinary Approach to Rehabilitation after Tumor Resective Jaw Surgery: A 9-Year Follow-Up

A 36-year-old male patient presented at the Department of Maxillofacial Surgery, University Hospital Clinic Zagreb in December 2010 due to a swelling of the left body of the mandible that was noticed 4 months earlier. The patient was referred regarding an atypical clinical and radiological finding in the form of a multicystic appearance in the corpus of the left mandible and teeth mobility in the same region. A probatory biopsy was performed under local anesthesia and sent for histopathologic examination which reported odontogenic myxoma. The tumor was removed with a marginal resection of the mandible from the left first incisor to the left second molar. Two years after surgery, in January 2013, the patient was referred to the oral surgeons for implant-prosthodontic rehabilitation. Two narrow implants were placed at positions 32 and 36, and three months afterwards, implant-retained denture was made using locator connections to compensate lost teeth and to correct the ratio of soft tissues and facial contours. The patient was followed-up for 9 years without any functional and aesthetic problems. Loosing function and aesthetic morbidity, after radical surgical treatment, often have compromised the quality of life of this group of patients. It is important to highlight the need for multidisciplinary collaboration for the complete rehabilitation of the patient after surgical oncology of the maxillofacial region.

Mandibular odontogenic myxoma in a paediatric patient

Odontogenic myxoma (OM) are benign, locally aggressive tumours that are rarely found in the paediatric maxillofacial region. OMs derive from mesenchymal odontogenic tissue. We describe the management of a 3-year-old girl who presented with a large right-sided mandibular lesion. Her treatment included conservative excision, curettage and peripheral ostectomy. A literature review was performed which calls into question the dogmatic practice of resection with 1 to 1.5 cm margins. Treatment approaches to the OM could potentially be altered in the paediatric patient.

Reconstruction of Mandibular Defects With Bone Marrow-Derived Stem Cells in Odontogenic Myxoma

Odontogenic myxoma is a benign tumor, mostly located in the mandible. It shows locally aggressive behavior and requires surgical removal. Common treatment options for reconstructing the bone defects are immediate or delayed autologous bone graft or free flap. In this article, the authors present the successful reconstruction with autogenous bone graft and autologous human bone marrow mesenchymal stem, followed by distraction osteogenesis, dental implant placement and prosthodontic restoration in the mandibular defect.

Odontogenic Myxoma: Systematic review and bias analysis

BACKGROUND

Odontogenic myxoma (OM) is a rare neoplasm, which originates from odontogenic ectomesenchyme. There is no study in the literature that analyses the best standards for OM diagnosis and how the treatment modalities may influence the recurrence rates.

OBJECTIVE

To evaluate the best standards for odontogenic myxoma (OM) diagnosis and treatment, and how these may influence the recurrence rates.

STUDY DESIGN

Two independent researchers performed a systematic review in many databases. Fifty-two eligible studies were included for qualitative analysis. Bias analysis was conducted according to Oxford Centre for Evidence-Based Medicine.

RESULTS

A total of 1363 OM cases were reported on, and female gender with average age of 27 years is the most common patient profile. Conventional microscopic findings were observed in 93.43% of the reported cases. In 57.49% of the cases, multilocular radiographic appearance was present, followed by unilocular appearance (32.87%). Posterior mandible was the site with the major prevalence, while surgical resection was the most common treatment modality, followed by enucleation. Recurrence rates for both treatment modalities were approximately close (13.04% and 25.0%, respectively).

CONCLUSION

The correct diagnosis of OM relies on the association of clinical, radiographic and microscopic findings. About imaging examinations, panoramic radiography and computed tomography are sufficient for the evaluation of OM. Recurrence rates were closely among the two most used surgery treatments. So according to some clinical-radiological aspects, conservative surgery may be preferred than aggressive surgery modalities.

Recurrence rate of odontogenic myxoma after different treatments: a systematic review

Our aim was to establish the recurrence rate of odontogenic myxoma after different treatments. Our search covered papers from 1972-2017 from different sources. The papers were evaluated and critically appraised by two independent investigators. The recurrence rate and 95% CI were calculated in relation to each specific treatment, and the chi squared test was calculated to find out if there was any significant difference in the recurrence rate between conservative treatment and resection. The overall recurrence rate was 5 of 39 patients (13%) during a mean follow up period of 10 years. With conservative treatment the recurrence rate was 4/22 (19%) (mean follow up 11 years) and after resection it was 1/17 (6%) (mean follow up nine years). Maxillary lesions were more likely to recur than mandibular ones. Quality of life variables such as disfigurement and neural deficit were more common after resection than with conservative treatment. The frequency of recurrence was relatively low over 10 years' follow up, irrespective of whether resection or a more conservative approach was used, despite being slightly lower (as might be expected) after resection. Conservative treatment should be considered first to avoid resection-associated morbidity and the effect on the quality of life. Maxillary lesions have more room to spread before they are clinically evident, making them difficult to treat optimally and contributing to the recurrence rate.

Odontogenic myxomas: what is the ideal treatment?

There is no consensus regarding the ideal treatment for odontogenic myxomas, an odontogenic mesenchymal neoplasm. Various authors have suggested en bloc resection due to a concern regarding inadequate clearance while others have suggested more conservative treatment. We present a case managed by buccal cortical resection and an iliac crest bone graft. The patient had no recurrence for over 7 years.

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.

Image segmentation-based volume approximation-volume as a factor in the clinical management of osteolytic jaw lesions

OBJECTIVE

Size characterization of osteolytic jaw lesions (OJL), in particular of neoplastic nature, is heterogeneously performed and lacks standardization in the medical literature and clinical practice. An OJL's volume holds promise as a surrogate for treatment response and prognosis. We comparatively evaluate various methods for size characterization of odontogenic OJLs.

METHODS

We retrospectively performed semiautomatic image segmentation of CBCT data sets for volume approximation of neoplastic (51) and non-neoplastic odontogenic OJLs (100). We assessed the three greatest orthogonal diameters and calculated the volume using the cuboid- and ellipsoid-formula. Image segmentation was carried out using ITK-SNAP. Image segmentation-based volume approximation served as reference. Intra- and inter-rater variability were evaluated at hand of Bland-Altman-Analysis and dice similarity coefficient (DSC).

RESULTS

Concerning the intrarater variability, we found the DSC to be highest for image segmentation-based volume approximation, simultaneously showing the tightest limits of agreement and greatest reliability. The cuboid formula showed consistent overestimation of the lesion's volume with a percent mean difference of -52 % (upper and lower limits of agreement +8.57 %  and -112.63%, respectively). In mean, the ellipsoid formula underestimated the lesion's volume by 10.1% (upper and lower limits of agreement +76.8%  and -56.6%, respectively). Inter rater variability was higher for formula-based volume approximation. Volume and multilocularity (p = 0.001) correlate with aggressiveness and growth potential.

CONCLUSIONS

Segmentation-based volume approximation holds great promise for patient individualized treatment planning and clinical management. The data suggest that maximum tumour diameter-based size characterization, especially the cuboid-formula and the maximum diameter alone, should not be recommended.

Appropriate surgical margin for odontogenic myxoma: a review of 12 cases

OBJECTIVE

Odontogenic myxoma (OM) is a rare benign tumor that is frequently nonencapsulated and invades the surrounding bone, resulting in a high risk of recurrence. However, the optimal surgical technique and appropriate surgical margin remains controversial. Here, we report our clinical investigation of 12 patients with OM diagnosed histopathologically.

STUDY DESIGN

We retrospectively reviewed the records of 12 patients treated at our institution. Osteotomy or bone shaving with enucleation was generally performed with 5-mm bony margins from the radiologic extent of the tumor.

RESULTS

One half of the cases occurred in the maxilla and the other half in the mandible. Treatment for maxillary OM was enucleation in 2 patients and maxillectomy in 4 patients. Treatment for mandibular OM was enucleation with shaving of the surrounding bone in 1 patient and segmental mandibulectomy in 5 patients. Radiographs of surgical specimen removed by segmental mandibulectomy indicated that the mean distance between the tumor and the margin was 5.4 (range 3.4-7.0) mm. Tumor recurrence was noted in 1 patient who had undergone enucleation alone.

CONCLUSION

The 1-cm surgical margin for OM, as reported conventionally, might not be necessary. A prospective study is needed to determine the appropriate surgical margin for OM.

Odontogenic myxoma: A causality dilemma - Report of a nonpareil case and review of literature

Odontogenic myxoma is a benign locally aggressive neoplasm with a sparse prevalence and incertitude histogenesis. They constitute 3%-6% of odontogenic tumors in gnathic bones. It is ubiquitously seen between vicenarian to early quadragenarian group with female proclivity and fondness to the mandibular jaws. They are silent lesions clinically and show myxoid stroma amidst fibrous background. This report highlights central odontogenic myxoma in a 43-year-old male patient and focuses on concepts, differential diagnosis, molecular concepts and treatment aspect.

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.

Odontogenic myxoma: A 63-year retrospective multicenter study of 85 cases in a Brazil population and a review of 999 cases from literature

BACKGROUND

Odontogenic myxoma (OM) is an uncommon neoplasm of the jaws. Considering the importance of defining the relative incidence and demographic profile of these lesions in South America, the aim of this study was to analyze the clinical and imagiological features of OM from three South American oral pathology services and to discuss these findings in light of the literature.

METHODS

Data regarding age, gender, anatomic site, and imagiological features from 85 cases of OM were collected. Additionally, we did a review of OM studies published in three electronic databases.

RESULTS

Among 63 450 oral biopsies, 1178 (1.85%) were odontogenic tumors (World Health Organization - 2017), of which 85 (7.21%) met the criteria of OM. The mean age was 30.7 years (range: 10-61 years; SD: 12.22). Forty-five (52.9%) cases occurred in females and 40 (47.1%) in males (ratio: 1:1.12). Maxilla was affected in 44 cases (53%) and mandible in 39 (47%). Of the 41 informed cases (48.2%), all of them were radiolucent lesions. The literature review indicated a majority of mean ages in third decade and a predilection for females, mandible, and multilocular radiolucent lesions.

CONCLUSIONS

The features of OM samples have strong similarity to that reported in studies from other continents. It is possible to infer that geographic variation does not help to explain some differences observed in the clinical features of OM.

Clinicopathologic analysis of 14 cases of odontogenic myxoma and review of the literature

Background

Odontogenic myxoma is a rare benign neoplasm that originates from odontogenic ectomesenchyme. There is no standard of care and recurrences are frequent after conservative surgical procedures.

Material and Methods

A retrospective study conducted at a single cancer center, with analysis of medical records of all patients diagnosed with odontogenic myxoma from 1980 to 2010, along with a literature review.

Results

There were 14 patients with diagnosis of odontogenic myxoma (OM). Most patients were female (78.6%) and Caucasian (100%), with ages ranging from 7 to 51 years (21.6 ± 11.6 years). The time period between the first symptom and first consultation ranged from 0 to 60 months (19.4 ± 19.97 months). The most frequent complaints were increased local volume or failure to tooth eruption. The most common tumor site was the mandible (11 cases, 78.5%). About radiological findings, most lesions were multilocular (9 cases, 64.3%) and with imprecise limits (12 cases, 85.7%). Surgery was performed in all cases and curettage was the most applied technique (10 cases, 71.4%). Three patients underwent mandibulectomy and complex reconstructions including iliac crest microvascular flap. Three patients had postoperative complications and 4 had local recurrences of the tumor. The follow up time ranged from 12 to 216 months (112 ± 70.8 months). All patients are without clinical and radiographic evidence of disease.

Conclusions

OM is a locally aggressive and rare tumor. There is no gold standard surgical management and the therapeutic decision should be individualized taking into account the characteristics and extension of the tumor.

Key words:Mandible, myxoma, odontogenic, odontogenic tumor.

Central odontogenic fibromyxoma of mandible: an aggressive odontogenic pathology

Myxoma of the jaws which was first described by Thoma and Goldman in 1947 is a rare neoplasm and its rate of prevalence and incidence is not available. Myxoma term, according to 1992 WHO classification, is used along with odontogenic myxoma (OM) and myxofibroma. There are two forms of myxomas or fibromyxomas that are recognised in head and neck region: one is derived from the facial skeleton and the other is derived from the soft tissue. Most of the OM are located intraosseously, but peripheral ones are also recognised. OM behaves differently from myxomatous tumours of long bones, which recur more often and may transform into malignancy. A majority of these lesions occur between 2nd and 4th decade. In the pathogenesis of OM, dental papilla, dental follicle and periodontal ligament tissues have been implicated as possible 'germ centres'. This case describes an uncommon finding of central odontogenic fibromyxoma, throwing light on its epidemiology, clinical, histopathology, molecular and treatment aspects.

Odontogenic myxoma in the paediatric patient: a review of eight cases

Paediatric odontogenic myxoma (OM) is a rare pathological condition in the oral and maxillofacial region. There has been much debate in the literature regarding the preferred method of treatment; however due to the rare nature of this disease, definitive algorithms of management are yet to be determined. A case series of eight paediatric patients with OM is presented. Six of the lesions were in the maxilla and two were mandibular lesions. The patients were aged between 2 and 18 years. Treatment ranged from excision and the application of Carnoy's solution to segmental resection and reconstruction. From this case series it can be seen that even in situations where treatment was limited to excision and the application of Carnoy's solution, no recurrences occurred. As such the present authors favour an initially more conservative approach to the management of these lesions where possible and reserving conventional resective treatment for recurrences, lesions causing pathological fracture, and those in regions that are difficult to access.

Odontogenic myxoma of the maxilla: surgical management and case report

BACKGROUND

Odontogenic myxoma is a benign odontogenic tumour of the jaw [1]. This tumour often presents as an asymptomatic expansile lesion without sensory nerve changes [2]. It is thought to arise from mesenchymal origin with cells of microscopic similarity to dental pulp and follicle [3]. Radiographically it presents most often as a multiloculated radiolucency [2]. It is a locally aggressive lesion which may require extensive treatment to prevent recurrence.

METHOD

The authors present the case of a 13-year-old boy with an extensive lesion in the maxilla.

CONCLUSION

We discuss various treatment approaches for management of this tumour.

Odontogenic Myxoma in Children: A Case Report and Literature Review

Benign odontogenic lesions are rare entities but are very important due to their locally aggressive nature. Odontogenic myxoma is even rarer in children than in adults. There is no evidence in the literature in regard to the best treatment approach, in terms of conservative or aggressive surgery, for this type of tumor. This paper reports a case of odontogenic myxoma in a child treated with a compromised approach through bone osteotomies and a review of the literature about this disease, especially in pediatric patients.

Surgical and prosthetic management of maxillary odontogenic myxoma

Odontogenic myxomas are uncommon tumors of comprising of 3% of all the tumors of odontogenic origin. They usually occur during the second and third decades of life and are more commonly seen in females. The current case report sheds light upon the surgical treatment of a myxoma of odontogenic origin in posterior maxilla of a young female patient. Prosthodontic rehabilitation stages are also briefly described following complete healing of the lesion after surgery.

Facial dysmorphology and odontogenic tumor development associated with inborn errors of metabolism: a case report

PURPOSE

Inborn errors of metabolism (IEMs) are genetic disorders that alter normal physiologic functioning. Deficiency of 3-methylcrotonyl-coenzyme A carboxylase is one such IEM that can lead to major episodes of metabolic dysfunction. Certain IEMs are associated with characteristic congenital dysmorphic facial features. This can be problematic, because these dysmorphisms can mask underlying tumor growth. Literature is lacking on a causal relation between IEM and odontogenic tumor development.

MATERIALS AND METHODS

This case was explained in detail and a review of the literature was undertaken. PubMed was used to search for articles involving surgical management of odontogenic myxoma (OM) and associations between odontogenic tumors and IEM.

RESULTS

It was determined that the development of odontogenic tumors, specifically OM, is associated with IEMs. These tumors can easily be overlooked as a common dysmorphic feature of an IEM.

CONCLUSION

IEMs lead to major metabolic disturbances and, thus, can alter the cellular microenvironment. Hypothetically, these alterations can lead to the development of odontogenic tumors. With the diagnosis of IEM becoming more common owing to improved newborn screening, careful attention should be given to these patients because of the possibility that dysmorphologic facial features could be masking underlying tumor growth.

An aggressive odontogenic myxoma of the maxilla

Odontogenic myxoma (OM) is a relatively rare benign odontogenic tumor of mesenchymal origin. OM is more common in the mandible than in the maxilla. It is an asymptomatic lesion that shows an infiltrative growth pattern. When the maxillary sinus is involved, it often fills the entire antrum. Odontogenic tumors are uncommon in the maxillary molar area, which often leads to diagnostic dilemma as this region of the maxilla is in the vicinity of vital structures, and radiographic overlapping of structures is always present. We present a similar case of a 17-year-old male patient who reported with a swelling in the left maxilla that infiltrated the maxillary sinus in a short duration of time.

A large odontogenic myxoma of the bilateral maxillae: A case report

Odontogenic myxomas (OMs) are benign mesenchymal locally aggressive neoplasms of the jaw bone. Although OMs predominantly involve the mandible, maxillary tumors are usually more aggressive than mandibular tumors. The present study describes the case of a 37-year-old male with a large odontogenic myxoma of the bilateral maxillae, which caused a defect in the right skull base bone. The tumor was successfully removed through radical resection of the hard tissue and local resection around the envelope of the soft tissue. The tumor exhibited no recurrence. However, the current methods for bilateral maxillary reconstruction to restore the maxillary buttress and achieve an optimal aesthetic appearance are complicated due to the lack of suitable conditions for oral rehabilitation with good dentition.

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.

Prognostic evaluation of preserving palatal mucosa after resection of maxillary myxoma: 10 years' follow-up

OBJECTIVES

This study was carried out to assess the clinical and radiological outcomes of preserving palatal mucosa after resection of odontogenic maxillary myxomas.

STUDY DESIGN

Fifteen patients (9 females and 6 males) with odontogenic maxillary myxomas participated in this study. Their ages ranged between 22 and 40 years. They were diagnosed as having myxomas by clinical and computed tomographic examinations as well as by performing biopsies on them. All lesions were treated by maxillary resection with preserving palatal mucosa. After surgery, the resultant surgical defects were followed up for 10 years.

RESULTS

No clinical or radiological evidence of recurrence was observed after 20 years' follow-up. The healing process was rapidly progressing without any serious complications. However, 6 patients complained of sore areas in their palatal mucosa because of the acrylic stents. They were successfully treated with mouthwash, anti-inflammatory drugs, and relief of the acrylic stents. After surgery, numbness of the upper lip was observed in all cases; however, it improved gradually in 5 patients over a period of 2 years. Computed tomographic scan of the surgical sites has shown incomplete filling of the resultant surgical defects. Constantly, there was empty space beneath the orbital floor in all computed tomographic images.

CONCLUSIONS

Maxillary resection with preserving palatal mucosa is a recommended treatment modality for odontogenic maxillary myxomas as it minimizes the unpleasant sequelae after surgery without recurrence. However, this technique should be restricted only to the cases having intact palatal bone.

Unusual presentation of localized gingival enlargement associated with a slow-growing odontogenic myxoma

Unusual presentation of localized gingival enlargement associated with a subjacent tumoural pathology is reported. The patient was a 55-year-old black male, whose chief complaint was a progressive gingival overgrowth for more than ten years, in the buccal area of the anterior left mandible. According to the clinical features and the radiological diagnosis of odontogenic keratocyst, a conservative surgery with enucleation and curettage was performed. Tissue submitted for histopathological analysis rendered the diagnosis of odontogenic myxoma. After 12-month of follow-up, no evidence of recurrence was found. Clinicians should be cautious when facing any gingival enlargement to avoid diagnostic pitfalls and to indicate the appropriate treatment.

The orosomucoid 1 protein (α1 acid glycoprotein) is overexpressed in odontogenic myxoma

BACKGROUND

Odontogenic myxoma (OM) is a benign, but locally invasive, neoplasm occurring in the jaws. However, the molecules implicated in its development are unknown. OM as well as Dental Follicle (DF), an odontogenic tissue surrounding the enamel organ, is derived from ectomesenchymal/mesencyhmal elements. To identify some protein that could participate in the development of this neoplasm, total proteins from OM were separated by two-dimensional electrophoresis and the profiles were compared with those obtained from DF, used as a control.

RESULTS

We identified eight proteins with differential expression; two of them were downregulated and six upregulated in OM. A spot consistently overexpressed in odontogenic myxoma, with a molecular weight of 44-kDa and a pI of 3.5 was identified as the orosomucoid 1 protein. Western blot experiments confirmed the overexpression of this protein in odontogenic myxoma and immunohistochemical assays showed that this protein was mainly located in the cytoplasm of stellate and spindle-shaped cells of this neoplasm.

CONCLUSION

Orosomucoid 1, which belongs to a group of acute-phase proteins, may play a role in the modulation of the immune system and possibly it influences the development of OM.

Odontogenic myxoma with diffuse calcifications: a case report and review of the literature

This is a case report of an unusual odontogenic myxoma with calcifications, one of three reported in the literature. It had a typical radiographic appearance although it presented in an older patient. The presence of osteo-cementum-like calcification raises other differential diagnoses but does not in and of itself mitigate the diagnosis. The patient has not shown recurrence 14 months after resection and 11 months after reconstruction and continues to be closely monitored.