Case Report
Odontogenic myxoma is an uncommon, benign neoplasm which occurs in the maxillofacial skeleton comprising 3-6% of all odontogenic tumors. It is slow growing but locally destructive having a tendency to occur in second to fourth decades of life with a slight female predilection. It is commonly seen in the mandibular posterior region. Clinically it presents as a slow growing asymptomatic swelling, however pain and paresthesia can occur in advanced stages.
30 year old female patient reported to the Department of Oral Medicine and Radiology with a chief complaint of swelling in the left middle third of face since 4 months. The swelling had gradually increased to the present size in the last 4 months and was associated with pain from the last 15 days.
On extraoral examination, there was a diffuse swelling measuring about 2x2 cms in the left maxillary region with obliteration of the left nasolabial fold. The skin over the swelling appeared normal and there was no local rise in temperature. On palpation, the swelling was firm to hard in consistency. Intraoral examination revealed a swelling obliterating the buccal vestibule extending from left upper canine to left upper first molar region. The swelling was also evident on the palate with similar extensions. The swelling was firm in consistency and tender on palpation. There was expansion of buccal cortical plate and egg shell crackling was evident in 25, 26 region. The associated teeth i.e 24, 25 were found to be grade I mobile and 26 was Grade II Mobile. Deep carious lesion was seen with 26, 27, 16 and 17. Based on the clinical features and history, provisional diagnosis of Radicular Cyst with 26 was given.
The patient was subjected to the following investigations: Aspiration was done and was found to be nonproductive. The patient was further subjected for radiographic investigations: Intraoral periapical (IOPA) radiograph w.r.t 24, 25, 26, 27. IOPA radiograph revealed displacement with 25, 26 and loss of lamina dura with 24, 25. Maxillary cross-sectional occlusal radiograph and orthopantomograph were also taken. The radiographs revealed an ill-defined mixed radiolucent–radiopaque lesion extending from distal aspect of 23 to mesial aspect of 27. Occlusal radiograph revealed expansion of the buccal cortical plate. Panoramic radiography also showed haziness in the left maxillary sinus. Incisional biopsy was performed and the specimen was sent for histopathological examination which revealed a partially encapsulated myxomatous area composed of dense collagen fibres with few calcified structures and islands of odontogenic epithelium suggestive of ODONTOGENIC FIBROMYXOMA.
Treatment: The tumor was surgically excised and segmental maxillectomy was carried out from 23-27 region. The excised specimen was sent for histopathological examination which confirmed the diagnosis of ODONTOGENIC FIBROMYXOMA. Thereafter, an obturator was fabricated to cover the surgical defect and help in feeding.
Comments
Post a Comment