Appropriate surgical margin for odontogenic myxoma: a review of 12 cases

doi:10.1016/j.oooo.2018.06.002

Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Volume 126, Issue 5, November 2018, Pages 404-408

https://doi.org/10.1016/j.oooo.2018.06.002 Get rights and content

Objective

Odontogenic myxoma (OM) is a rare benign tumor that is frequently nonencapsulated and invades the surrounding bone, resulting in a high risk of recurrence. However, the optimal surgical technique and appropriate surgical margin remains controversial. Here, we report our clinical investigation of 12 patients with OM diagnosed histopathologically.

Study Design

We retrospectively reviewed the records of 12 patients treated at our institution. Osteotomy or bone shaving with enucleation was generally performed with 5-mm bony margins from the radiologic extent of the tumor.

Results

One half of the cases occurred in the maxilla and the other half in the mandible. Treatment for maxillary OM was enucleation in 2 patients and maxillectomy in 4 patients. Treatment for mandibular OM was enucleation with shaving of the surrounding bone in 1 patient and segmental mandibulectomy in 5 patients. Radiographs of surgical specimen removed by segmental mandibulectomy indicated that the mean distance between the tumor and the margin was 5.4 (range 3.4–7.0) mm. Tumor recurrence was noted in 1 patient who had undergone enucleation alone.

Conclusion

The 1-cm surgical margin for OM, as reported conventionally, might not be necessary. A prospective study is needed to determine the appropriate surgical margin for OM.

Section snippets

MATERIAL AND METHODS

We retrospectively reviewed the records of 12 patients with a histologic diagnosis of OM treated at the Department of Oral and Maxillofacial Surgery, Tokyo Medical and Dental University, between April 2001 and March 2015. Clinical, radiologic, and histopathologic findings, treatment provided, and clinical course of these patients were evaluated. Osteotomy or bone shaving with enucleation was performed with 5-mm bony margins from the radiologic extent of the tumor based on the report that a 1-cm

Clinical characteristics

Six hundred and thirty-four patients with histopathologically diagnosed odontogenic tumors were treated at our institution during the study period. OM accounted for 1.9% of all cases of odontogenic tumors treated during this time. OM cases comprised 4 men and 8 women with a median age of 41.5 (range 27–65) years at the first visit (Table 1). These patients presented from 1 month to 10 years (median 2.5 years) after they first noticed symptoms or after the lesion had been identified at another

DISCUSSION

OM is a rare benign but locally aggressive tumor of the jaw. This tumor has been reported to account for 0.5–20% of all odontogenic tumors in adults and 8.5–11.6% of those in children.¹ There seems to be a regional difference in prevalence, in that OM is more common in African and Caucasian populations than in the population of the Far East.⁵ In this report, we describe 12 cases (1.9%) of OM out of 634 odontogenic tumors treated at our department over a period of 14 years.

Some studies have

REFERENCES (12)

SS Subramaniam et al.
Odontogenic myxoma in the paediatric patient: a review of eight cases
Int J Oral Maxillofac Surg
(2016)
TJ King et al.
Pediatric maxillary odontogenic myxoma: a report of 2 cases and review of management
J Oral Maxillofac Surg
(2008)
KH Lam et al.
Mandibular invasion in carcinoma of the lower alveolus
Am J Otolaryngol
(1999)
BW Rotenberg et al.
Myxomatous lesions of the maxilla in children: a case series and review of management
Int J Pediatr Otorhinolaryngol
(2004)
Y Leiser et al.
Odontogenic myxoma–a case series and review of the surgical management
J Craniomaxillofac Surg
(2009)
N Kumar et al.
Odontogenic myxoma
J Maxillofac Oral Surg
(2014)

There are more references available in the full text version of this article.

Cited by (15)

Surgical management of odontogenic myxomas: A case series
2023, International Journal of Surgery Case Reports
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.
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.
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.
A case of dentinogenic ghost cell tumor of the mandible with a review of the literature
2023, Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology
Dentinogenic ghost cell tumors (DGCTs) are a rare type of benign odontogenic tumor with formation of ghost cells and dentinoid. We report a 52-year-old woman with a DGCT. There was buccolingual thickening of the left mandible intraorally, with mobile teeth #33–#37, and non-vital teeth #33–#35. Imaging was performed, followed by an incisional biopsy, which suggested an odontogenic tumor without signs of malignancy, histologically. Segmental mandibulectomy was performed with extraction of tooth #31 and reconstruction with a titanium plate. No recurrence occurred in the 2-year follow-up. Histologically, dentinoid was formed adjacent to the ameloblastoma-like neoplastic odontogenic epithelium, with clusters of ghost cells. Tumor cells stained positive for cytokeratin-14 and cytokeratin-19. Nuclear accumulation of β-catenin was observed in some tumor cells. The tumor was histologically diagnosed as a DGCT with tumor-free surgical margins.
Odontogenic myxoma of the maxilla: A rare case report and review of the literature
2022, Annals of Medicine and Surgery
Citation Excerpt :
Radical surgical resection includes a 1.5–2 cm of healthy bone margin, to reduce the risk of recurrence [7]. Some authors, however, have suggested that a margin of healthy bone tissue might not be necessary to avoid recurrence [30]. Conservative treatment by enucleation and curettage is recommended for tumors with a diameter less than 3 cm, but since myxomas are not encapsulated and tend to infiltrate the surrounding bone, a more extensive resection than curettage and peripheral osteotomy is often required for larger lesions [6,8,10].
Odontogenic myxoma (OM) is an uncommon benign odontogenic tumor arising from the jaw bone. The diagnosis poses a challenge because its clinical features overlap with those of other benign and malignant neoplasms. Although surgery is usually the choice treatment, there is still some controversy concerning surgical techniques and proper indications.
We present the unusual case of an odontogenic myxoma involving the maxilla, diagnosed in a 31 years old patient presenting to our department for facial swelling through computed imaging and pathological analysis. After careful consideration, the patient was treated with conservative surgery, with a satisfying end result.
Because of its slow growth, odontogenic myxoma is often asymptomatic. The diagnosis is based on clinical, radiological and histological caracteristics. Complete surgical excision is the treatment of choice, but it can be challenging because of the tumor's indistinct margins.
Though there are still no clear guidelines for the management of OM in the head and neck region, the general consensus is that the surgical excision should be complete, and patients treated in a conservative manner should benefit from regular follow-ups.
Conservative surgical treatment of odontogenic myxoma with preservation of the inferior alveolar nerve
2022, Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology
Citation Excerpt :
Several reports recommend radical methods that ensure a safety margin of ≥1 cm around the tumor [3,6,10,14,15]. In our previous clinical investigation of patients with OM, we observed a mean distance of 5.4 mm (range, 3.4–7.0 mm) between the tumor and the bone margin using radiographs of surgical specimen in segmental mandibulectomy cases; notably, no recurrent cases were observed [16]. Therefore, we reported that the conventional safety margin of ≥1 cm for OM, a benign tumor, might not be necessary.
Owing to a high recurrence rate, radical jaw resection is regarded as the first choice of treatment for odontogenic myxoma. However, there have been several reports on the effectiveness of conservative surgical treatment preserving inferior alveolar nerve for odontogenic myxoma of the mandible. A 37-year-old woman presented with a complaint of pain around her mandibular left third molar. Odontogenic myxoma was diagnosed by using biopsy. The tumor occupied a part of the cortical bone and contained the inferior alveolar nerve. We performed enucleation and curettage, which preserved the inferior alveolar nerve. Ten years after the treatment, there were no symptoms of recurrence or nerve paralysis. Here, we discuss the conservative treatment of odontogenic myxoma, focusing on inferior alveolar nerve preservation.
Navigation-assisted transoral resection of a large maxillary odontogenic myxofibroma using rigid endoscopy
2020, Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology
Citation Excerpt :
Clinically, odontogenic myxoma is characterized by slow growth and bony invasion, resulting in a painless facial deformity [3,8–10]. Although the only treatment available for odontogenic myxoma is surgery, there is no consensus regarding the best surgical technique for odontogenic myxoma [8,9,11,12]. This report describes the case of a 36-year-old man with a maxillary odontogenic myxofibroma that was resected transorally by navigation-assisted surgery and by using a rigid endoscopy and discusses the usefulness of this system for the surgery of maxillary benign tumors.
Odontogenic myxoma/myxofibroma is a rare, benign tumor that is frequently nonencapsulated and invades the surrounding bone, resulting in a high risk of recurrence. Here, we report a case of a navigation-assisted transoral resection of a large maxillary odontogenic myxofibroma by using a rigid endoscopy. A 36-year-old Caucasian man was referred to our department with a suspected tumor of the left maxillary sinus in April 2017. Computed tomography (CT) revealed that the lesion measured approximately 55 × 35 × 35 mm and occupied the left maxillary sinus with invasion into the left nasal cavity. The bone surrounding the lesion, including alveolar bone, was thinning, and some calcified structures similar to the septal wall were recognized within the lesion. A biopsy was performed, and histopathological examination was consistent with odontogenic myxoma. In October 2017, the tumor was transorally excised through navigation-assisted surgery and by using a rigid endoscopy under general anesthesia. There has been no evidence of recurrence for 2.5 years postoperatively. Our patient’s treatment course demonstrates two important considerations for future treatment. First, through the simultaneous use of a surgical navigation system and rigid endoscopy, surgical removal was performed safely. This is of note particularly with regard to our ability to both distinguish calcification in the benign tumor from the posterior wall of the maxillary sinus and to perform antrostomy of the ethmoidal cells. Second, the use of these systems together allowed for the surgery to be minimally invasive, and Weber Ferguson incisions were avoided.
Primordial odontogenic tumour: A systematic review of the common but also unusual features of this novel entity
2020, Journal of Stomatology, Oral and Maxillofacial Surgery
Citation Excerpt :
The aim of this systematic review is to update all available data on POT published in the literature and to identify those features of the neoplasm that require further investigation in future studies. It is fundamental that clinicians worldwide increase their awareness of the existence of this neoplasm in the pediatric population since it can be surgically enucleated without the use of more aggressive approaches, such as those required for ameloblastoma or odontogenic myxoma [8,9]. This study followed the guidelines of the PRISMA statement [10].
Primordial odontogenic tumour (POT) is a novel entity that was described in 2014 and that is included in the group of benign mixed epithelial and mesenchymal odontogenic tumours. In recent years, several papers have added new cases with some clinical and histopathological aspects that slightly differ from those described in the original report. The aim of this systematic review is to update all available data on POT published in the literature and to identify those features of the neoplasm that require further investigation.
A systematic review of literature was conducted using PubMed, Embase, Web of Science and Scopus. Additional sources were also checked. Publications reporting cases with enough clinicopathological information were included, without any time or language restrictions. Histopathological or radiological studies were considered for qualitative analysis.
A total of 30 publications were included. Seventeen papers were used for quantitative analysis while 13 papers were used only for qualitative analysis. A total of 18 cases of POT were identified. Some clinical, radiographic, histopathological and therapeutic features were common in all reported cases, while other aspects of the neoplasm were inconsistent through published cases. This inconsistency was particularly remarkable when dealing with the histopathological features of the neoplasm.
Some issues about POT remain unclear and deserve to be clarified by future reports. The description of the odontogenic epithelium covering the ectomesenchyme is often contradictory, while it remains debatable whether peripheral ameloblastic epithelial islands or hard dental tissue deposition can occasionally occur within the tumour.

View all citing articles on Scopus

: Declarations of interest: none

View full text

Oral and Maxillofacial SurgeryAppropriate surgical margin for odontogenic myxoma: a review of 12 cases

Objective

Study Design

Results

Conclusion

Section snippets

MATERIAL AND METHODS

Clinical characteristics

DISCUSSION

Int J Oral Maxillofac Surg

J Oral Maxillofac Surg

Am J Otolaryngol

Int J Pediatr Otorhinolaryngol

J Craniomaxillofac Surg

Odontogenic myxoma

J Maxillofac Oral Surg

Oral and Maxillofacial Surgery
Appropriate surgical margin for odontogenic myxoma: a review of 12 cases