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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 31  |  Issue : 1  |  Page : 70-73

Odontogenic myxoma involving maxilla: A case report


1 Department of Oral Medicine and Radiology, Sarjug Dental College and Hospital, Darbhanga, India
2 Department of Oral and Maxillofacial Surgery, Sarjug Dental College and Hospital, Darbhanga, India
3 Department of Public Health Dentistry, Dr. B. R. Ambedkar Institute of Dental Sciences and Hospital, Patna, Bihar, India

Date of Submission14-Oct-2018
Date of Acceptance28-Nov-2018
Date of Web Publication23-Apr-2019

Correspondence Address:
Dr. Abhijeet Alok
Department of Oral Medicine and Radiology, Sarjug Dental College and Hospital, Hospital Road, Laheriasarai, Darbhanga, Bihar-846 003
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.jiaomr_173_18

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   Abstract 


Odontogenic myxoma is a rare benign odontogenic tumor of the oral cavity which is locally aggressive and non metastasizing. The mandible is more commonly involved than maxilla. It usually presents as a painless swelling in second to third decade of life. Radiographically, it can be unilocular or multilocular, so the diagnosis is not easy many times. It poses a diagnostic and therapeutic challenge because of its morphology and biologic behavior. We represent a case of 35-year-old female who had an asymptomatic swelling in maxillary right region since 7 months.

Keywords: Benign, maxilla, maxillary sinus, odontogenic tumor, odontogenic myxoma


How to cite this article:
Alok A, Hasan K, Singh S, Bhattacharya PT. Odontogenic myxoma involving maxilla: A case report. J Indian Acad Oral Med Radiol 2019;31:70-3

How to cite this URL:
Alok A, Hasan K, Singh S, Bhattacharya PT. Odontogenic myxoma involving maxilla: A case report. J Indian Acad Oral Med Radiol [serial online] 2019 [cited 2019 Dec 14];31:70-3. Available from: http://www.jiaomr.in/text.asp?2019/31/1/70/256892




   Introduction Top


In 1947, Odontogenic myxoma was first described by Goldman and Thoma.[1] Virchow coined the term “myxoma.”[2] Odontogenic myxomas are uncommon, accounting for only 3–6% of odontogenic tumors. They are benign, intraosseous neoplasms that arise from Odontogenic ectomesenchyme and resemble the mesenchymal portion of the dental papilla.[3] Odontogenic myxoma is a locally invasive benign neoplasm. The invasiveness could be attributed to its nonencapsulated nature and tendency to infiltrate the surrounding cancellous bone. The tumor may be encountered in almost any areas of jaws, and the mandible is involved more commonly than the maxilla. Odontogenic myxoma manifests as a slow-growing tumor with the capability of reaching to a considerable size with no significant signs and symptoms.[4] We present a similar case of odontogenic myxoma infiltrating the right maxillary sinus in a middle-aged female without any alarming symptoms.


   Case Report Top


A 35-year-old female patient reported to the Department of Oral Medicine and Radiology with a chief complaint of swelling in upper right facial region since 7 months. History of present illness revealed that patient was apparently asymptomatic 7 months back before swelling appeared in the maxillary right region. Initially swelling was smaller in size but it gradually increased to present size. There had been no increase in size of swelling since 2 months [Figure 1]. There was no history of paresthesia, pus discharge, and trauma. Difficulty in breathing was present. Her past medical, dental, and family history was noncontributory. Extraoral examination revealed a diffused swelling in maxillary right region. Superior-inferiorly, swelling extended 1 cm from corner of mouth to inner canthus of eye on the right side. Anterior-posteriorly, swelling extended 3 cm from the tragus of ear till the midline of dorsum of nose. There was deviation of nasolabial angle and nasolabial fold was raised. The overlying skin was of normal color. On palpation, it was nontender, firm in consistency, and there was no local rise in temperature. On intraoral examination, an oval swelling of roughly 2 × 5 cm in diameter was noted on the palatal side in maxillary right region extending from 13 to 18 regions. It involved whole palatal region till midline. There was vestibular obliteration with respect to 14, 15,16,17, and 18 regions. On palpation, swelling was nontender, firm in consistency, and not associated with any discharge. There was no displacement and mobility of teeth in the maxillary right region [Figure 2]. On the basis of history and clinical findings, a provisional diagnosis of fibro-osseous lesion in the maxillary right region was given. Differential diagnosis of minor salivary gland tumor, ameloblastoma, and odontogenic myxoma was considered.
Figure 1: Extraoral image of patient showing swelling and loss of nasolabial fold

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Figure 2: Intraoral image of patient showing intraoral swelling

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The investigations which were done included computed tomography (CT) examination of maxillofacial region, fine-needle aspiration cytology (FNAC), blood investigations, and biopsy of lesion. CT (coronal section) showed expansile mass in the right maxilla, which completely obliterated the maxillary antrum as well as the right side of nasal cavity compressing the lateral nasal wall presented with deviated septum invading the inferior and middle nasal meatus [Figure 3]. It extends superiorly from right floor of orbit involving the nasal bone on right side till floor of the nasal cavity inferiorly. Anterior-posteriorly, it extends fromsuperior and middle nasal turbinate till the maxillary sinus posteriorly. FNAC was done to rule out any odontogenic cysts. Result of FNAC was negative. Blood investigations were found to be within normal limits. Incisional biopsy revealed haphazardly arranged stellate, spindle-shaped, and round cells in an abundant, loose myxoid stroma with only a few collagen fibrils. This histopathology report was suggestive of odontogenic myxoma. Surgical resection of tumor was done under local anesthesia via vestibular approach. After asepsis, local anesthesia which included both infra orbital nerve block, greater palatine nerve block, and nasopalatine nerve block was given. Vestibular incision was given which extended from left canine to right first molar region. Full-thickness flap was reflected to expose the lesion [Figure 4], [Figure 5], [Figure 6]. Osteotomy was performed with the help of surgical bur and nasal pack was given for 5 days. Closure of wound was done by simple interrupted sutures. The excised lesion was again sent for histopathological examination. The second histopathological report was consistent with the first report. Hence, the final diagnosis of odontogenic myxoma of maxillary right region was arrived [Figure 7].
Figure 3: CT image of patient (coronal view) revealing large expansile lesion on right maxillary region

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Figure 4: Intraoral image showing vestibular incision from left canine to right first molar

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Figure 5: Image showing surgical excision of lesion

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Figure 6: Image of excised specimen shows gelatinous mass

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Figure 7: Histopathologic image of odontogenic myxoma

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   Discussion Top


The most common synonyms for odontogenic myxoma include myxoma, myxofibroma, and fibromyxoma. The two forms of odontogenic myxomas have been identified:(1) Facial bone-derived myxoma which can be subdivided into true osteogenic myxoma and odontogenic myxoma and (2) soft-tissue derived myxoma.[5] Although the lesion can occur at any age, more than half arise in individuals between 10 and 30 years of age. Odontogenic myxoma rarely occurs before age 10 or after age 50. Odontogenic myxomas occur more commonly in mandible compared to maxilla with the ratio of 3:1. In the mandible, odontogenic myxoma occurs in the premolar and molar areas and only rarely in the ramus and condyle. Myxomas in the maxilla usually involve the alveolar process in the premolar and molar regions, zygomatic process, and are more invasive as seen in our case. Smaller lesions may be asymptomatic and are discovered only during radiographic examination. Larger lesions are often associated with painless expansion of the involved bone. In some instances, clinical growth of the tumor may be rapid, which is probably related to the accumulation of myxoid ground substance in the tumor. Displacement and mobility of teeth in the affected region is a relatively common finding. However, in the current case this was not noted. Radiographically, it may be unilocular or multilocular. The lesion is usually well-defined andmay have corticated and noncorticated margin. Most often margins are poorly defined, particularly in the maxilla. When it occurs pericoronally with an impacted tooth, an odontogenic myxoma may have cyst-like unilocular outline, although most have a mixed radiolucent-radiopaque internal pattern. Residual bone trapped within the tumor remodels into curved and straight, coarse, or fine septa. The presence of these septa gives the tumor a multilocular appearance. A characteristic septum identified with this tumor is a straight, thin-etched septum. These septa have been described as “tennis racket” or stepladder-like pattern. Worth was the first person who coined term tennis racket to this multilocular pattern.[6] Root resorption may or may not be seen. Odontogenic myxoma frequently scallops between the roots of adjacent teeth.[7] The odontogenic myxoma expands the cortical plates, showing as a smooth enlargement of the alveolar bone and basal bone. Sometimes, it perforates the cortical plate and produces a bosselated appearance. The expanding tumor is soft on palpation when the plates are destroyed and gives an impression of fluctuance whereas in our case the integrity of cortical plates was maintained.

On gross examination, odontogenic myxoma appears as a grayish white, nodular heterogenous mass of characteristically mucoid, white gelatinous slimy material, and sometimes covered by eggshell patches of bone. Clinical and radiographic differential diagnosis of odontogenic myxoma may include ameloblastoma, central giant cell granuloma, odontogenic keratocyst, central hemangiomas, cherubism, giant cell lesion of hyperparathyroidism, aneurysmal bone cyst, fibrous dysplasia, and odontogenic cysts [Table 1].[8],[9],[10],[11]
Table 1: Differential diagnosis of odontogenic myxoma

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Odontogenic myxomas does not respond to radiation. So the most common treatment modality used is surgical resection of lesion. Small myxomas are generally treated by curettage. Large myxomas are treated by resection with a generous amount of surrounding bone to ensure removal of myxomatous tumor that infiltrates the surrounding bone. In 25% of cases, odontogenic myxoma reoccurs.[12] Long-term follow-up is required in patients in which conservative approach was chosen as treatment modality.


   Conclusion Top


Owing to its unspecific nature, odontogenic myxomas should be diagnosed after thorough history, proper clinical, radiographic evaluation, and histopathological examinations. With proper treatment, prognosis of odontogenic myxoma is good. Patient should be kept under follow-up for few years owing to high recurrence rate.

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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Gupta S, Grover N, Kadam A, Gupta S, Sah K, Sunitha JD. Odontogenicmyxoma. Natl J Maxillofac Surg 2013;4:81-3.  Back to cited text no. 1
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2.
Gonzalez-Garcia R, Rodriguez-Campo FJ, Naval Gias L, Munoz-Guerra MF, Sastre-Perez J, Diaz-Gonzalez FJ. Mandibular odontogenicmyxoma. Reconstructive considerations by means of the vascularized fibular free flap. Med Oral Patol Oral Cir Bucal 2006;11:E531-5.  Back to cited text no. 2
    
3.
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Ayranci F, Omezli M, Rastgeldi O, Duman A. Odontogenic myxoma located in the mandible: A case report. Middle Black Sea J Health Sci 2015;1:25-8.  Back to cited text no. 4
    
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6.
Chrcanovic BR, do Amaral MB, MarigoHDA, Freire-Maia B. An expanded odontogenicmyxoma in maxilla. Stomatologija 2010;12:122-8.  Back to cited text no. 6
    
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Halfpenny W, Verey A, Bardsley V. Myxomaof mandibular condyle: A case report and review of literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90:348-53.  Back to cited text no. 7
    
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Alok A, Panat SR, Singh ID, Singh S. Nonsyndromic multiple keratocystodontogenic tumor: A rare case report. J Indian Acad Oral Med Radiol 2015;27:264-7.  Back to cited text no. 8
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Alok A, Singh ID, Singh S, Kishore M. Central giant cell granuloma: A report of 2 cases and review of literature. J Indian Acad Oral Med Radiol 2015;27:156-9.  Back to cited text no. 9
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Choudhary A, Saxena T, Upadhyay N, Alok A. Aneurysmal bone cyst: A rare case report. J Dent Sci Oral Rehab 2012;3:34-6.  Back to cited text no. 10
    
11.
Cankaya AB, Erdem MA, Bilgic B, Firat D. Myxofibroma of the maxilla, current concepts, and differential diagnosis. J Dent Sci 2017;4:417-20.  Back to cited text no. 11
    
12.
Leiser Y, Abu-El-Naaj I, Peled M. Odontogenicmyxoma: Acase series and review of the surgical management. J Craniomaxillofac Surg 2009;37:206-9.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
 
 
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