Odontogenic Myxoma: A 23-Year Retrospective Series of 38 Cases

Rehabilitation of a patient with extensive odontogenic myxoma treated conservatively: A case report with 14 years of follow-up

Odontogenic myxoma is an odontogenic tumor of mesenchymal origin that presents locally invasive behavior. Its treatment is surgical, and the approach can be more conservative or radical. This article presents the rehabilitation of a patient with extensive odontogenic myxoma in the mandible treated conservatively with follow-up for 14 years. A 17-year-old male patient sought care with a painless swelling in the mandibular region causing facial asymmetry. Imaging exams showed a mixed image, with intralesional septa, involving the left anterior and posterior regions of the mandible with a small remaining basilar and lingual bone. An incisional biopsy was performed which confirmed the diagnosis of odontogenic myxoma. Due to the extent of the lesion, a conservative approach was chosen, with excision of the lesion and peripheral ostectomy, with recurrence of the lesion after 48 months, with a new approach being performed. After 14 years of follow-up, without further recurrence of the lesion, the patient was rehabilitated with dental implants and protocol-type prosthesis. Conservative treatment led to bone remodeling and enabled patient rehabilitation with oral implants and an implant-supported prosthesis. Thus, conservative treatment of odontogenic myxomas is a viable alternative for similar cases, and its longitudinal postoperative follow-up is essential. Key words:Conservative Treatment, Dental Implants, Myxoma; Oral Pathology, Oral Surgery.

Aggressive vascularized odontogenic myxoma. Case report and literature review

INTRODUCTION AND IMPORTANCE

Odontogenic myxoma (OM) is an infrequent benign mesenchymal odontogenic tumor of the jaws composed of rounded and angular cells dispersed in an abundant mucoid stroma. An aggressive and vascularized presentation is unusual.

CASE PRESENTATION

A 68-year-old woman was evaluated for a mass located under the palate and extended to the cheek. A large flattened mass covered the entire palate, except the left lateral dental arch, and extended to the cheek as a firmed 6 × 6 × 5 cm mass. An enhancement computed tomography and a magnetic resonance imaging revealed a large, heterogenous, expansive, 80 × 64 × 58 mm mass that destroyed the right maxilla and extended to the soft tissues of the cheek. Minimally invasive endovascular angiography and embolization was performed preoperatively. Through a modified Weber-Ferguson incision, a partial right lateral maxillectomy was performed, conserving the right nasal fossa and a left canine tooth, medially, and the floor of the orbit, upward. Pathology study reported an odontogenic myxoma with compromised margins but reexcision margins were negative. One year after surgery, there is no evidence of disease.

CLINICAL DISCUSSION

Pathological and radiological differential diagnosis that includes a large number of benign and malignant lesions are discussed. All authors agree that wide surgical excision is the treatment of choice.

CONCLUSIONS

Wide excision resulted in good functional and local control. Preoperative embolization is needed in case of a vascularized lesion. No immediate surgical reconstruction should be recommended to facilitate clinical surveillance and early recurrence detection.

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.

Odontogenic myxoma: A clinicopathological study over 15 years and immunohistochemical analysis

Objective

and rationale: Odontogenic myxoma is an uncommon odontogenic tumor with locally aggressive behavior. The clinicopathological studies of odontogenic myxoma in Asian countries are very limited and only few studies have investigated the immunohistochemical profiles of the tumor. This study aims to investigate the clinicopathological and immunohistochemical features of odontogenic myxoma at the Faculty of Dentistry, Mahidol University over a 15-year period.

Methods

Archives of our institute were reviewed. Cases diagnosed as odontogenic myxoma were retrieved. Demographic, clinical, radiographic, and histopathological features of these cases were analyzed. In addition, immunohistochemical markers including vimentin, Ki-67, Bcl-2, and CD117 were performed. The correlation between immunohistochemical profiles and clinicopathological characteristics was evaluated.

Results

Sixteen cases of odontogenic myxoma were discovered. Fourteen cases were central type while two cases were peripheral type. The mean age of patients was 34.6 years with male-to-female ratio of 1:2.2. Mandible (68.8 %) was more affected than the maxilla (31.2 %). Bony expansion or jaw swelling (43.8 %) was the most common clinical feature. Most cases (71.4 %) presented with multilocular radiolucency. Histopathologically, tumors show stellate and spindle-shaped cells in a myxoid stroma with varying amounts of collagen fiber. All cases were positive for vimentin and Bcl-2. Half of the cases showed positive for Ki-67. Mast cells were presented in most cases (75.0 %). A significant correlation was found between the immunoexpression level of Bcl-2 and border of lesion in radiograph (p = 0.024).

Conclusions

This study contributes to better understanding of the characteristics of odontogenic myxoma. Clinicians and pathologists should be aware of odontogenic myxoma, as its clinical and histopathological features may overlap with other tumors. The expression of Bcl-2 and presence of mast cell in this tumor may relate to its growth and aggressiveness. Despite its benign nature, odontogenic myxoma exhibits high recurrence, especially in lesion managed conservatively.

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.

Clival intraosseous myxoma treated with an endoscopic endonasal approach: illustrative case

BACKGROUND

Solitary lesions of the clivus, especially nonchordomatous ones, are exceptionally rare pathologies representing only 0.1%-0.2% of intracranial tumors that may present diagnostic and therapeutic challenges. Intraosseous myxomas are benign tumors arising from mesenchymal cells with an unknown pathophysiology.

OBSERVATIONS

In this article, a 15-year-old male with clival intraosseous myxoma who was treated via an endoscopic endonasal surgical approach is presented. The patient became symptomatic after a baseball struck his head, leading to throbbing headaches and visual difficulties for tracking objects. Examination noted diplopia, cranial nerve VI palsy, and ptosis. After imaging revealed a tumor extending to the left cavernous sinus with bulging of the dorsal clivus against the basilar artery/ventral pons, resection was performed. Postoperatively, the patient noted ocular motility and alignment improvement without further complications.

LESSONS

Clival masses present with symptoms from compromised neurovascular structures including visual disturbances and trigeminal sensory deficits. Given the rarity of these entities, patients may postpone further treatment until workup; this patient was misdiagnosed for possible concussion until several weeks passed. A PubMed database review of cranial myxoma cases was conducted to identify solitary clival intraosseous myxoma cases. This case is one of the few in which this pathology was treated through an endoscopic endonasal operative approach without complications, demonstrating its safety and effectiveness.

Diode laser on excision of giant peripheral odontogenic myxoma: a rare case report and literature review

It was to report a rare case of peripheral odontogenic myxoma removed with high-power diode laser and to do an extensive review of studies of odontogenic cysts and tumors treated with high-power laser (HPL). This is a rare case of a 63-year-old male patient with a peripheral odontogenic myxoma measuring approximately 10 cm in the attached gingiva region of tooth 16 removed with a high-power diode laser (808 nm, 3 W, in continuous mode, under constant suction, with 400-µm optical fiber). A literature review was also carried out looking for articles that involved the use of HPL in the treatment of odontogenic cysts and tumors, without restriction of year or language. In the present case, there was no need for suturing, no postoperative discomfort, and minimal bleeding during the procedure. In a 12-month follow-up period, there were no signs of recurrence. Only two cases of intra-osseous odontogenic myxomas treated with HPL and 10 cases involving other odontogenic cysts and tumors were found. All studies showing HPL to be effective in treating these lesions. Despite the different types of lasers used and different parameters, it is observed that lasers are effective in the treatment of odontogenic lesions.

Pediatric Odontogenic Myxoma: A Case Report and a Systematic Review of the Literature

Purpose:

Odontogenic myxoma (OM) is a benign, locally invasive odontogenic tumor, which has been historically treated with en bloc resection to prevent recurrence. In pediatric patients en bloc resection is associated with significant morbidity in relation to growth, function, cosmesis, and the associated risks of radical surgery.

Methods:

This research aims to present an up-to-date series of OM in pediatric patients (0-3 years), to evaluate treatment approaches and recurrence in this population, and provide treatment recommendations through the presentation of a case report in a 15-month-old child and a systematic review of the literature. MEDLINE (PubMed), Scopus, Science Direct, Google Scholar, and Cochrane Database of Systematic Reviews were searched in August 2021 in accordance with the PRISMA guidelines.

Results:

In total 53 patients were identified with OM. Pediatric OM occurs more frequently in males, in the maxilla, presenting most commonly with swelling, with a mean duration of onset of 9 weeks (6-12 weeks, 95% CI). The rates of recurrence in OM were low (5/53, 9%) with no recurrences in patients treated with enucleation with peripheral ostectomy or adjunctive procedures including cryotherapy or Carnoy’s solution, indicating that they can be used successful as first line treatment, reducing patient morbidity.

Conclusion:

Pediatric odontogenic myxoma occurs most frequently in males, within the maxilla and can be treated successfully with conservative surgical management with enucleation, peripheral ostectomy with the application of Carnoy’s solution or Cryotherapy, reducing patient morbidity. Patients should be followed up clinically and radiographically to monitor for recurrence, which primarily occurs within the first 12 months of treatment.

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.