ODONTOGENIC MYXOMA: CLINICAL AND RADIOGRAPHIC CHARACTERISTICS OF TWO CASES

Abstract

Odontogenic myxoma (OM) is a benign, slow-growing neoplasm of ectomesenchymal origin. The radiological features are variable including unilocular or multilocular radiolucency with a well-defined or diffuse border, making the differential diagnosis difficult. These facts pose potential challenges in reaching the correct diagnosis only with radiographic examinations. In this article, two cases of OM are presented and the varied clinical and radiological features and difficulties in differential diagnosis are discussed together with the application of computed tomography (CT) and cone beam computed tomography (CBCT). The presented cases are a 33-year-old female patient with the complaints of migration and mobility of maxillary left premolar teeth and a 30-year-old-male patient with the complaint of a firm, non-tender, fixed mass in the mandibular right posterior region. Periapical, panoramic, and CT/CBCT images revealed the presence of multilocular hypodense lesions with or without hyperdense foci in the relevant areas, and divergence and mobility of the associated teeth were also observed. Excisional biopsy and histopathological examination exhibited the definitive diagnosis of OM. Three-dimensional advanced imaging techniques such as CT and CBCT differ from two-dimensional periapical and panoramic radiographs in that they can demonstrate more characteristic radiographic findings and clearly display the tumour in three-dimensional accuracy and perspective. Therefore, the use of advanced imaging techniques is recommended as a useful tool in the diagnostic process of OM in order to display the borders and to help in investigation of the internal structure of the tumour.

Keywords

• odontogenic myxoma
• diagnosis
• panoramic radiography
• computed tomography
• cone beam computed tomography

References

1. 1. Simon EN, Merkx MA, Vuhahula E, Ngassapa D, Stoelinga PJ: Odontogenic myxoma: a clinicopathological study of 33 cases. Int J Oral Maxillofac Surg 2004;33:333-337.
2. 2. Li TJ, Sun LS, Luo HY: Odontogenic myxoma: a clinicopathologic study of 25 cases. Arch Pathol Lab Med 2006;130:1799-1806.
3. 3. Sivakumar G, Kavitha B, Saraswathi TR, Sivapathasundharam B: Odontogenic myxoma of maxilla. Indian J Dent Res 2008;19:62-65.
4. 4. Boffano P, Gallesio C, Barreca A, Bianchi FA, Garzino‑Demo P, Roccia F: Surgical treatment of odontogenic myxoma. J Craniofac Surg 2011;22:982‑987.
5. 5. Shah A, Lone P, Latoo S, Ahmed I, Malik A, Hassan S, Naik A, Rashid RU: Odontogenic myxoma of the maxilla: A report of a rare case and review on histogenetic and diagnostic concepts. Natl J Maxillofac Surg 2011;2:189-195.
6. 6. Vasconcelos ACU, Silveira FM, Gomes APN, Tarquinio SBC, Sobral APV, de Arruda JAA, da Silva LP, da Silveira MMF, Barbosa LF, Kato CNAO, Jaeger F, da Silva TA, Mesquita RA: Odontogenic myxoma: A 63-year retrospective multicenter study of 85 cases in a Brazil population and a review of 999 cases from literature. J Oral Pathol Med 2018;47:71-77.
7. 7. Araki M, Kameoka S, Matsumoto N, Komiyama K: Usefulness of cone beam computed tomography for odontogenic myxoma. Dentomaxillofac Radiol 2007;36:423-427.
8. 8. Limdiwala P, Shah J: Odontogenic myxoma of maxilla: A review discussion with two case reports. Contemp Clin Dent 2015;6:131-136.

9. 9. Wang K, Guo W, You M, Liu L, Tang B, Zheng G: Characteristic features of the odontogenic myxoma on cone beam computed tomography. Dentomaxillofac Radiol 2017;46:20160232.
10. 10. Thoma KH, Goldman HM: Central myxoma of the jaw. Oral Surg Oral Med Oral Pathol 1947;33:532-540.
11. 11. Barnes L, Eveson JW, Reichart P, Sidransky D: Pathology and Genetics of Head and Neck Tumours; in Kleihues P, Sobin LH (EDS): World Health Organization classification of tumours. Lyon, France: IARC Press, 2005, vol 9, pp 296-300.
12. 12. Noffke CE, Raubenheimer EJ, Chabikuli NJ, Bouckaert MM: Odontogenic myxoma: review of the literature and report of 30 cases from South Africa. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104:101-109.
13. 13. Martínez-Mata G, Mosqueda-Taylor A, Carlos-Bregni R, de Almeida OP, Contreras-Vidaurre E, Vargas PA, Cano-Valdéz AM, Domínguez-Malagón H: Odontogenic myxoma: clinico-pathological, immunohistochemical and ultrastructural findings of a multicentric series. Oral Oncol 2008;44:601-607.
14. 14. Anyanechi CE, Saheeb BD: The clinical presentation of odontogenic myxoma of the jaws: a 22-year retrospective analysis. J Clin Exp Oncol 2017;6:5.
15. 15. Barros RE, Dominguez FV, Cabrini RL: Myxoma of the jaws. Oral Surg Oral Med Oral Pathol 1969;27:225-236.
16. 16. Rotenberg BW, Daniel SJ, Nish IA, Ngan BY, Forte V: Myxomatous lesions of the maxilla in children: a case series and review of management. Int J Pediatr Otorhinolaryngol 2004;68:1251-1256.
17. 17. Kaffe I, Naor H, Buchner A: Clinical and radiological features of odontogenic myxoma of the jaws. Dentomaxillofac Radiol 1997;26:299-303.
18. 18. Lu Y, Xuan M, Takata T, Wang C, He Z, Zhou Z, Mock D, Nikai H: Odontogenic tumors. A demographic study of 759 cases in a Chinese population. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;86:707-714.
19. 19. Zhang J, Wang H, He X, Niu Y, Li X: Radiographic examination of 41 cases of odontogenic myxomas on the basis of conventional radiographs. Dentomaxillofac Radiol 2007;36:160-167.
20. 20. Shivashankara C, Nidoni M, Patil S, Shashikala KT: Odontogenic myxoma: A review with report of an uncommon case with recurrence in the mandible of a teenage male. Saudi Dent J 2017;29:93-101.
21. 21. Kauke M, Safi AF, Kreppel M, Grandoch A, Nickenig HJ, Zöller JE, Dreiseidler T: Size distribution and clinicoradiological signs of aggressiveness in odontogenic myxoma-three-dimensional analysis and systematic review. Dentomaxillofac Radiol 2018;47:20170262.
22. 22. 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.
23. 23. MacDonald-Jankowski DS, Yeung R, Lee KM, Li TK: Odontogenic myxomas in the Hong Kong Chinese: clinico-radiological presentation and systematic review. Dentomaxillofac Radiol 2002;31:71-83.
24. 24. Koseki T, Kobayashi K, Hashimoto K, Ariji Y, Tsuchimochi M, Toyama M, Araki M, Igarashi C, Koseki Y, Ariji E: Computed tomography of odontogenic myxoma. Dentomaxillofac Radiol 2003;32:160-165.
25. 25. Dabbaghi A, Nikkerdar N, Bayati S, Golshah A: Rare appearance of an odontogenic myxoma in cone-beam computed tomography: a case report. J Dent Res Dent Clin Dent Prospects 2016;10:65-68.
26. 26. Simon EN, Merkx MA, Vuhahula E, Ngassapa D, Stoelinga PJ: A 4-year prospective study on epidemiology and clinicopathological presentation of odontogenic tumors in Tanzania. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;99:598-602.
27. 27. Kawai T, Murakami S, Nishiyama H, Kishino M, Sakuda M, Fuchihata H: Diagnostic imaging for a case of maxillary myxoma with a review of the magnetic resonance images of myxoid lesions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;84:449-454.
28. 28. MacDonald-Jankowski DS, Yeung RW, Li T, Lee KM: Computed tomography of odontogenic myxoma. Clin Radiol 2004;59:281-287.