| Odontogenic myxoma | |
|---|---|
| Specialty | Dentistry |
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]
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]
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]
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]