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Table of Contents
CASE REPORT
Year : 2020  |  Volume : 8  |  Issue : 4  |  Page : 106-108

Odontogenic myxoma of posterior maxilla: A case report with mini literature review


Department of Oral and Maxillofacial Surgery, MES Dental College, Perinthalmanna, Kerala, India

Date of Submission24-Aug-2020
Date of Acceptance15-Sep-2020
Date of Web Publication29-Dec-2020

Correspondence Address:
Dr. Sooraj Soman
Department of Oral and Maxillofacial Surgery, MES Dental College, Perinthalmanna, Malapuram 679321, Kerala.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INJO.INJO_36_20

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  Abstract 

Odontogenic myxoma is an uncommon, benign, locally invasive neoplasm with a high chance of recurrence. It is exclusively present in tooth-bearing areas of the jaws. Odontogenic myxoma commonly occurs in age groups ranging from 20 to 40 years with a female predilection, and the common site of occurrence is the posterior mandible. The purpose of this case report was to describe the unusual rare presentation of odontogenic myxoma of the posterior maxilla in a 16-year-old male patient, which was managed by surgical excision, peripheral ostectomy, and chemical cauterization

Keywords: Maxilla, odontogenic myxoma, odontogenic tumor


How to cite this article:
Soman S, Thulasi Das AD, Thomas AM, Thomas T. Odontogenic myxoma of posterior maxilla: A case report with mini literature review. Int J Oral Care Res 2020;8:106-8

How to cite this URL:
Soman S, Thulasi Das AD, Thomas AM, Thomas T. Odontogenic myxoma of posterior maxilla: A case report with mini literature review. Int J Oral Care Res [serial online] 2020 [cited 2021 Jan 24];8:106-8. Available from: https://www.ijocr.org/text.asp?2020/8/4/106/305357




  Introduction Top


Odontogenic myxoma (OM) of the bones of the jaw was first described by Goldman and Thoma in 1947. Myxomas of the soft tissue are frequent but intraosseous myxomas are rare and if seen its almost always found in jaws. OMs are tumors derived from embryonic mesenchymal elements of dental anlage such as dental papilla, follicle, or periodontal ligament.[1]

According to the World Health Organization, OM is classified as a benign tumor of ectomesenchymal origin with or without odontogenic epithelium. It is a locally invasive benign neoplasm, which does not show metastasis. It comprises 3%–6% of all tumors of odontogenic origin. OM usually occurs during the second and third decades of life. Females have a slight predilection over males (with a male-to-female ratio of 1:1.5). The mandibular sites are most often affected than maxilla and in mandible molar and ramus region are commonly involved, whereas in the case of maxilla, the most affected areas are premolar and first molar region.[2]

Depending on the pattern of differentiation of mesenchymal cells, the histological nature of the tumor varies. If myxomatous element predominates, then it is called odontogenic fibromyxoma, and if fibrous tissue predominates then odontogenic myxofibroma.[3]


  Case Report Top


A 16-year-old male patient reported to the Department of Oral and Maxillofacial Surgery with a mass on the right upper back tooth region and mild pain during chewing food since 3–4 months. Swelling increased gradually for 3 months. Patient gave history of mild pain, which was intermittent in nature, aggravated during mastication. He had a history of occasional bleeding from the site of interest during brushing. The patient’s medical and dental history was noncontributory. The patient was moderately built and well nourished. Solitary right submandibular lymph node of 3cm × 2cm in size was palpable and was slightly tender.

On clinical examination, a well-defined growth was noted in the right maxillary alveolar region, extending from distal aspect of 14–16 region with buccopalatal expansion of alveolar ridge involving the hard palate, 2cm short from midpalatine raphe. Size of swelling was about 4.5cm × 3cm, irregular in shape, noncompressible, and firm in consistency. The overlying mucosa was pink in color and hyper-keratinized due to chronic irritation of the opposing teeth. There was a displacement of right maxillary second premolar towards the buccal side [Figure 1].
Figure 1: Intraoral photograph showing the lesion

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Orthopantamogram and occlusal radiographs [Figure 2] were taken. Maxillary occlusal radiograph showed hazy radiolucency in the right posterior maxilla. A computed tomographic (CT) scan [Figure 2] revealed an osteolytic lesion of the right maxillary alveolus with expansion and thinning of the buccal and palatal cortex; it was also involving the maxillary antrum [Figure 3].
Figure 2: CT image (showing expansile lytic lesion)

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Figure 3: Excision of lesion

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Incisional biopsy was performed under local anesthesia, and the histopathological evaluation was suggestive of OM [Figure 4]. On the basis of the incisional biopsy report, progressive nature of the lesion, and cortical expansion, our treatment plan was wide local excision of the lesion followed by peripheral ostectomy and chemical cauterization with Carnoy’s solution.
Figure 4: Histopathology

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  Discussion Top


OM is a rare aggressive intraosseous benign tumor derived from mesenchymal elements of a developing tooth. Although it is a benign neoplasm, it may be infiltrative, aggressive, and may recur.[4] OM exclusively occurs in the jaw bones, consisting of 3%–6% of all odontogenic tumors. The tumor occurs across an age group that varies from 22.7 to 36.9 years. It is rare in children and adults who are over 50 years of age. There is a higher incidence of these tumors in women (64%–95%) than in men.

It begins as a slow-growing tumor but can reach a huge size with massive cortical bone expansion and destruction of bone, implying its infiltrative behavior. OM in most of the cases presents as an asymptomatic swelling and can grow to considerable dimensions before diagnosis. It rarely presents with pain unless the lesion invades into the surrounding structures and results in neurological signs.[5]

OM of the maxilla may be asymptomatic or it can present as heaviness, swelling of cheek or palate, malocclusion, or loosening of teeth. Displacement of teeth has been reported in 9.5% of the cases. When the maxillary sinus is involved, OM often fills the entire antrum, palate, orbit, and nasal cavity. In severe cases, the presenting symptoms may be a nasal obstruction or exophthalmos.[6]

Radiographic appearances of OM may range from unilocular to multilocular radiolucency including honeycomb, soap bubble, and tennis racket patterns.[7] The tennis racket pattern is seen where the bony septae appears as triangular, square or rectangular compartments with very fine trabeculation within them. It is the most common radiographic appearance of OM.[8]

The aggressive nature of OM is well discussed in the literature. It is now well-established that for the management of OM a surgical excision is the treatment of choice. Recommended therapy varies from curettage to radical excision. Complete surgical removal can be difficult as the lesion is not encapsulated especially in the maxilla. The infiltration of myxomatous tissue into the adjacent cancellous spaces, close proximity of vital structures, and more complex anatomy makes the surgical treatment tedious.[9]

The high rate of recurrence of myxomas ranges from 10% to 33% with an average of 25%. The prime cause for recurrence is thought to be related to incomplete removal rather than the intrinsic biologic behavior of the tumor.

Although there are few studies regarding this, radiotherapy and chemotherapy appear to be ineffective in controlling the recurrent lesions. It is suggested that patients should be followed up closely for at least 2 years because this is the most likely time for recurrence.[10]


  Conclusion Top


Considering the unspecific nature of the myxomatous tumors, a sound anatomical knowledge with systematic clinical and histopathological investigations are required for proper diagnosis and management of OMs.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.



 
  References Top

1.
Abiose BO, Ajagbe HA, Thomas O Fibromyxomas of the jaws: A study of 10 cases. Br J Oral Maxillofac Surg 1987;25:415-21  Back to cited text no. 1
    
2.
Simon EN, Merkx MA, Vuhahula E, Ngassapa D, Stoelinga PJ Odontogenic myxoma: A clinicopathological study of 33 cases. Int J Oral Maxillofac Surg 2004;33:333-7.  Back to cited text no. 2
    
3.
Reichart PA, Philipsen HP Odontogenictumors and allied lesions. Illinois, IL: Quintessence Publishing; 2004.  Back to cited text no. 3
    
4.
Ashoka CA Odontogenic myxoma of mandible: Report of a rare case with review of literature. IOSR J Dent Med Sci 2016;15:35-40.  Back to cited text no. 4
    
5.
Vasudevan V, Das UM, Manjunath V, Bavle RM, Sudhakar M, Kumar N, et al. Odontogenic myxoma of the maxilla: A report of unusual pediatric case. Int J Clincal Pediatr Dent 2011;4:264-8.  Back to cited text no. 5
    
6.
Kawase-koga Y, Saijo H, Hoshi K, Takato T, Mori Y Surgical management of odontogenic myxoma: A case report and review of the literature. BioMed Cent Res Notes 2014;7:1-7.  Back to cited text no. 6
    
7.
Gupta S, Grover N, Kadam A, Gupta S, Sah K, Sunitha JD Odontogenic myxoma. Natl J Maxillofac Surg 2013;4:81-3.  Back to cited text no. 7
    
8.
Wood NK, Goaz PW Differential Diagnosis of Oral Lesions. St Louis, MO: Mosby; 1987. p. 543-5.  Back to cited text no. 8
    
9.
Leiser Y, Abu-El-Naaj I, Peled M Odontogenic myxoma: A case series and review of the surgical management. J Craniomaxillofac Surg 2009;37:206-9.  Back to cited text no. 9
    
10.
Hamama J, Khalfi L, Fiqhi K, EL Khatib K Odontogenic myxoma of maxilla: Conservative or radical surgery?. Res Rep Oral Maxillofac Surg 2018;2:004.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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