Odontogenic myxoma

Odontogenic myxoma
SpecialtyDentistry

The odontogenic myxoma is an uncommon benign odontogenic tumor arising from embryonic connective tissue associated with tooth formation.[1] As a myxoma, this tumor consists mainly of spindle shaped cells and scattered collagen fibers distributed through a loose, mucoid material.[2]

Signs and symptoms

Odontogenic myxomas have been found in patients ranging in age between 2 and 50 years, however, they are most commonly diagnosed in young adults (specifically between 25 and 35 years of age).[3][4] The mandible is more likely to be affected than the maxilla.[5] Odontogenic myxomas usually present with bone expansion, asymptomatic cortical perforation, and a multilocular appearance.[5] The region between the molar and premolar is the site of the most common occurrence for multilocular lesions[4] while the anterior portion of the mouth favors a smaller, unilocular variety.[3]

Patients afflicted with an odontogenic myxoma generally notice a painless, slowly enlarging expansion of the jaw with possible tooth loosening or displacement.[3] As the tumor expands, it frequently infiltrates adjacent structures. Maxillary lesions frequently enter the sinuses while mandibular tumors often extend into the ramus.[1]

Diagnosis

Radiographically, odontogenic myxomas appear most commonly as multilocular radiolucencies with ill-defined borders,[5] though unilocular cyst-like tumors can occur, especially when associated with impacted teeth or when discovered in childhood.[4][6] Ideally, the septa that cause the multilocular feature are thin and straight, producing a tennis racket or stepladder pattern. In reality, the majority of the septa visible in the tumor are curved and coarse, causing a "soap bubble" or "honeycomb" appearance, though locating one or two straight septa can aide in the diagnosis of this tumor.[1][6]

Treatment

Small unilocular lesions have been successfully treated with enucleation and curettage followed by chemical bone cautery. Multilocular tumors exhibit a 25% recurrence rate and, therefore, must be treated more aggressively. In the case of a multilocular myxoma, resection of the tumor with a generous portion of surrounding bone is required. Tumor enucleation followed by peripheral osteotomy should be considered as the first therapeutic choice.[5] Because of the gelatinous nature of the tumor, it is crucial for the surgeon to remove the lesion intact so as to further reduce the risk of recurrence.[1][3]

References

  1. ^ a b c d Sapp, J. Philip., Lewis R. Eversole, and George P. Wysocki. Contemporary Oral and Maxillofacial Pathology. 2nd ed. St. Louis, MO: Mosby, 2002. 152-53.
  2. ^ Cawson, R. A., and E. W. Odell. Cawson's Essentials of Oral Pathology and Oral Medicine. 8th ed. Edinburgh: Churchill Livingstone, 2008. 145-46.
  3. ^ a b c d Wood, Norman K., Paul W. Goaz, and Norman K. Wood. Differential Diagnosis of Oral and Maxillofacial Lesions. 5th ed. St. Louis: Mosby, 1997. 342-43.
  4. ^ a b c McDonald, Ralph E., David R. Avery, and Jeffrey A. Dean. Dentistry for the Child and Adolescent. 8th ed. St. Louis, MO: Mosby, 2004. 163-64.
  5. ^ a b c d Chrcanovic, Bruno R.; Gomez, Ricardo S. (April 2019). "Odontogenic myxoma: An updated analysis of 1,692 cases reported in the literature". Oral Diseases. 25 (3): 676–683. doi:10.1111/odi.12875. ISSN 1354-523X.
  6. ^ a b White, Stuart C., and M. J. Pharoah. Oral Radiology: Principles and Interpretation. 6th ed. St. Louis, MO: Mosby/Elsevier, 2009. 385-87.
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