Removal of a Complex Odontoma within a Dentigerous Cyst

Resident: Swan

Article Title: Large Erupting Complex Odontoma in a Dentigerous Cyst Removed by a Piecemeal Resection

Authors: Biocic, et al.

Journal: Pediatric Dentistry 32:3, June 2010

Article Type: Case Report

Main Topic: Odontomas

Odontomas in general:

These lesions are the most common Odontogenic Tumor in European, North American, and South American populations. Compound odontomas are more common than complex. Complex typically occur in the posterior mandible, while compound usually present in the antetior maxilla. They typically cause no clinical symptoms and are found during routine radiographic examination. They are often associated with failed eruption of permanent and, rarely, primary teeth. Radiographically, odontomas present as well-defined radiopacities within the bone with a peripheral radiolucent zone representing the follicle. Occasionally, they are associated with a dentigerous cyst. This is a case report of such a scenario.

Case Report:

A 10 year old otherwise healthy patient presented to the authors' clinic in Croatia with painful swelling of the right mandible and cheek that had lasted one week. The mother reported previous swellings of a similar nature, that all spontaneously went away. On extraoral examination, the patient presented with facial asymmetry and a soft painful swelling at the angle of the mandible, extending up to the right cheek. Lymphadenopathy was also observed in the area. Intraorally there was an oral mucosal defect distal to #30 resembling exposed alveolar bone or tooth remnants. The buccal and lingual cortical plates were distended, and the pano showed a large (5X3 cm), nonuniform, radiopaque mass surrounded by an unevenly wide radiolucent zone surrounding the entire mass. In the lower distal portion of the mass, a tooth bud of a developing lower second molar was observed.

And here it is:

Laboratory findings were within normal limits, however, alkaline phosphatase was elevated. A biopsy performed under general anesthesia revealed a complex odontoma and an inflamed dentigerous cyst.

Definitive surgical treatment (also performed under general anesthesia):

The lesion was removed via piecemeal resection. The lower part of the tumor was removed together with the cyst. The buccal cortex and inferior mandular border were preserved, but the mass destroyed the lingual cortex. A suction drain was placed and secured in the lower vestibule and the flap was replaced. When the drain was empty 3 days postoperatively, it was removed. Recovery was uneventful and the patient showed no signs of recurrence 2 years later.

Discussion:

This is a case report of a situation that occurs very infrequently: A complex odontoma associated with a dentigerous cyst, with the odontoma erupting into the oral cavity. The surgeons had 4 options for its removal:

1. segmental resection of the mandible with subsequent reconstruction

2. sagital split osteotomy

3. two stage removal

4. separation with a bur, with subsequent piecemeal resection of the odontoma and cyst

The authors chose option 4 and obtained a great result.

Much love from Utah.