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 Table of Contents  
CASE REPORT
Year : 2012  |  Volume : 3  |  Issue : 3  |  Page : 212-214

Odontogenic fibromyxoma of the maxilla


Department of Oral and Maxillofacial Surgery, AME'S Dental College Hospital and Research Centre, Raichur, Karnataka, India

Date of Web Publication19-Feb-2013

Correspondence Address:
Yadavalli Guruprasad
Department of Oral and Maxillofacial Surgery, AME'S Dental College Hospital and Research Centre, Raichur, Karnataka
India
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DOI: 10.4103/0976-433X.107406

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  Abstract 

Odontogenic fibromyxoma is a rare odontogenic tumor of mesenchymal origin. It is composed of large amounts of intercellular substance rich in acid mucopolysaccharides, making it locally very aggressive and with high recurrence rates following conservative excision. Its histological and radiological features make it difficult to differentiate from other odontogenic tumors and, occasionally, may be misinterpreted as a malignant lesion. Although the origin of a myxoma is still obscure, its origin from the dental follicle seems to be the most reasonable explanation. We report a case of odontogenic fibromyxoma of maxilla in a 32-year-old female patient.

Keywords: Benign, maxilla, odontogenic fibromyxoma, odontogenic tumor, radiolucency


How to cite this article:
Chauhan DS, Guruprasad Y. Odontogenic fibromyxoma of the maxilla . SRM J Res Dent Sci 2012;3:212-4

How to cite this URL:
Chauhan DS, Guruprasad Y. Odontogenic fibromyxoma of the maxilla . SRM J Res Dent Sci [serial online] 2012 [cited 2019 Jun 16];3:212-4. Available from: http://www.srmjrds.in/text.asp?2012/3/3/212/107406


  Introduction Top


Odontogenic myxoma is classified as a benign tumor of ectomesenchymal origin with or without odontogenic epithelium. Odontogenic myxoma usually occurs in the tooth-bearing areas. Therefore, it is supposed to be of tooth origin, and derived from the mesenchymal portion of a tooth germ most likely of the dental papilla. It has the potential for extensive bony destruction and extension into the surrounding structures. [1] Almost 75% of odontogenic myxoma occur in patients around 23-30 years of age, with a slight female predilection. Radiographically, majority of the cases present as expansile mass demonstrating multilocular radiolucency with or without scalloped borders, although some are unilocular. Rare cases present with a diffuse and mottled appearance, which can be mistaken for a malignant neoplasm. [2] Histopathologically, odontogenic myxoma is made up of loose and delicate fibrous connective tissue. The fibroblasts are stellate and are suspended in a delicate network of collagen fibrils. [2],[3] We report a case of odontogenic fibromyxoma of the maxilla in a 32-year-old female patient.


  Case Report Top


A 32-year-old female patient was referred to the Department of Oral and Maxillofacial Surgery for evaluation of an asymptomatic swelling in the right upper jaw since 6 months. The lesion had been slowly increasing in size since it was first noticed. There was no history of trauma, pain, paresthesia or lymphadenopathy. The lesion extended from the right canine to the first molar on the same side intraorally, and was soft in consistency on palpation [Figure 1]. Upper occlusal view radiograph showed well-circumscribed radiolucency in relation to upper right premolars and first molar, displacing the roots of the premolars [Figure 2]. Enucleation and aggressive curettage were done along with extraction of teeth 13, 14 and 15 under local anesthesia using an intraoral approach. The floor of the maxillary sinus was intact and aggressive curettage was carried out to avoid recurrence [Figure 3], [Figure 4], [Figure 5]. Histopathology revealed fibromyxomatic tissues consisting of bundle and round cells with blood vessels, and collagen fibers [Figure 6]. Postoperative follow-up was done for 1 year and no recurrence was observed; thereafter, the patient did not turn up for further follow-up.
Figure 1: Clinical appearance of the swelling on the right side intraorally

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Figure 2: Upper occlusal radiograph showing radiolucency in relation to right premolars and first molars

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Figure 3: Intraoperative photograph showing the lesion that is exposed using crevicular incision

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Figure 4: Intraoperative photograph showing surgical cavity after excision and curettage

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Figure 5: The surgical specimen after excision

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Figure 6: Histopathological picture showing fibromyxomatic tissues consisting of bundle and round cells with blood vessels and collagen fibers (H and E, ×40)

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  Discussion Top


Odontogenic fibromyxoma is a mesodermal tumor representing only about 3-6% of the odontogenic tumors. It is a rare, locally aggressive, non-metastasizing tumor. It commonly occurs in the second and third decades of life, and the mandible is involved more commonly than the maxilla. [2],[3] The lesion often grows without symptoms and presents as a painless swelling. The radiographic features are variable, and the diagnosis is therefore not easy. Odontogenic fibromyxomas are diagnosed with radiological, histological and histochemical investigations. The radiological investigation reveals homogenous radiolucencies or sclerotic trabeculations with variable appearances, like "honeycomb," "soap bubble" and "tennis racket." [4] In the case discussed, the lesion appeared as a large radiolucent area with no trabeculations. Radiological examination plays a crucial role in the differential diagnosis of myxomas/fibromyxomas and also between benign myxomas and malignant neoplasms with myxomatous tissue. Based on the radiographic feature, site and consistency of the lesion, the differential diagnosis of odontogenic myxoma, mural ameloblastoma and infected odontogenic cyst were given. [4],[5],[6] The treatment of the fibromyxoma is surgical, and involves enucleation and curettage. [4],[7] The avoidance of recurrence is strongly related to the complete resection of the lesion. The patient should be monitored for at least 2 years after the surgical intervention due to the higher rate of recurrence during this period. [8],[9]


  Conclusion Top


In conclusion, the maxilla is a rare location of a fibromyxoma. Its management is surgical, and ranges from enucleation and curettage to complete resection and peripheral osteotomy according to its size. Patients must be monitored for at least 2 years postoperatively in order to diagnose possible recurrence.

 
  References Top

1.Kaffe I, Noor H, Buchner A. Clinical and radiological features of odontogenicmyxoma of the jaws. Dentomaxillofac Radiol 1997;26:299-303.  Back to cited text no. 1
    
2.Chuchurru JA, Luberti R, Cornicelli JC, Dominguez FV. Myxoma of the mandible with unusual radiographic appearance. J Oral Maxillofac Surg 1985;43:987-90.  Back to cited text no. 2
    
3.Asaumi J, Konouchi H, Hisatomi M, Kishi K. Odontogenic myxoma of maxillary sinus: CT and MR - pathologic correlation. Eur J Radiol 2001;37:1-4.  Back to cited text no. 3
    
4.Peltola J, Magnusson B, Happonen RP, Borrman H. Odontogenic myxoma: A radiographic study of 21 tumours. Br J Oral Maxillofac Surg 1994;32:298-302.  Back to cited text no. 4
    
5.Frezzini C, Maglione M, Rizzardi C, Melato M. Odontogenic myxoma recurring after 11 years: Case reportand observations on this unusual neoplasm. Minerva Stomatol 2003;52:247-51.  Back to cited text no. 5
    
6.Chen CT, Chen YR, Lai JP, Tung TC. Maxillary myxoma treated with wide resection and immediate reconstruction: A case report. Ann Plast Surg 1997;39:87-93.  Back to cited text no. 6
    
7.Kumar N, Jain S, Gupta S. Maxillary odontogenic myxoma: A diagnostic pitfall on aspiration cytology. Diagn Cytopathol 2002;27:111-4.  Back to cited text no. 7
    
8.Keszler A, Dominguez FV, Giannunzio G. Myxoma in childhood: An analysis of 10 cases. J Oral Maxillofac Surg 1995;53:518-21.  Back to cited text no. 8
    
9.Fenton S, Slooturg PJ, Dunnehier EA, Mouritis MP. Odontogenic myxoma in a 17 month-old child: A case report. J Oral Maxillofac Surg 2003;61:734-6.  Back to cited text no. 9
    


    Figures

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



 

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Abstract
Introduction
Case Report
Discussion
Conclusion
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