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International Poster Journal of Dentistry and Oral Medicine
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Int Poster J Dent Oral Med 12 (2010), No. 3     15. Sep. 2010

Int Poster J Dent Oral Med 2010, Vol 12 No 3, Poster 500

An unusual presentation of the myxoma of maxilla

Language: English
 

Authors:
Dr Rashmi Dhale, Assoc. Prof. Dr Mangesh Phadnaik,
Government Dental College & Hospital, Maharashtra University of Health Sciences, Aurangabad, India

Date/Event/Venue:
November 18th, 2008
33rd National Conference of Indian Society of Periodontology
Chandigarh, India
 

Introduction

Myxoma is a benign, but locally aggressive and rare skeletal neoplasm. It was first described by Thoma and Goldman in 1947. The lesion is defined by the World Health Organization (WHO) as a locally invasive neoplasm consisting of rounded and angular cells lying in an abundant stroma. Kim et al. (2002) reported two cases in mandible & maxilla each. Aquilino et al. (2005) has also reported a case of maxillary myxoma. This neoplasm probably arises from the primitive mesenchymal structures of a developing tooth including the dental follicle, the dental papilla or even the periodontal ligament and therefore is of interest for the periodontist. It is mostly located intraosseously and may cause cortical expansion. Usually occurring in second and fourth decades of life, it has a male: female ratio of 1: 1.6. It has a 2: 1 predilection for occurrence in the mandible rather than the maxilla, most of those occur in premolar and molar areas. Radiographically, the lesion appears as unilocular or multilocular radiolucency with or without wispy trabeculae. Complete surgical excision of the defect is advocated for smaller lesions. If removed incompletely the recurrence rate is up to 33%. The present case was a distinct presentation of maxillary myxoma occurring in its anterior region, perforating the bony cortex, in a male patient. He was managed conservatively with esthetic restoration.
 

Objectives

A painless gingival swelling in a 38 year old male patient since 16 months.
 

Material and Methods

Case presentation: A 38 years male, with gradually enlarging, painless gingival swelling since 16 months. On examination the lesion was localized to the buccal gingiva of tooth # 12 & 13, pink, firm, sessile, 2.5 cm x 2.5 cm in size. Tooth # 12 was grade II mobile. The associated teeth were vital. He had a 12 months old IOPA radiograph of the same lesion showing, unilocular radiolucency between teeth # 12 & 13.
Radiographic examination: Fresh IOPA radiograph was taken, it was showing unilocular radiolucency between the roots of tooth #12 & 13. Bone exhibiting wispy trabecular pattern. Borders of the lesion were well defined. The occlusal radiograph of maxilla showed limited palatal extension of the lesion and displacement of tooth # 12 & 13.
Incisional biopsy: Gross examination of gelatinous specimen revealed a glistening, homogenous cut surface with well delineated capsule. Microscopically, it showed myxomatous tissue immediately beneath the epithelium giving a false impression of a peripheral myxomatous lesion.
Surgical procedure: Under all aseptic precautions, under local anesthesia the lesion was excised en masse and the defect curetted. The tooth # 12 was extracted. The defect was then filled with Hydroxyapatite bone graft and covered with upper lip pedicle flap. The periodontal dressing was applied.
Histopathologic examination: Low magnification view revealed bony spicules overlying the myxomatous tissue at certain areas, which indicated its intraosseous origin. At higher magnification, it showed loosely arranged, evenly dispersed spindle shaped cells with lightly eosinophilic cytoplasm in mucoid rich matrix.

Fig 1: Clinical appearance of lesion Fig 2: IOPA radiograph of lesion
Fig 3: Occlusal radiograph of lesion Fig 4: Incisional biopsy
Fig 5: Microscopic examination Fig 6: Surgical site preparation
Fig 7: Placement of wide incision Fig 8: Tooth #12 and lesion removed
Fig 9: Defect thoroughly curetted Fig 10: Upper lip pedicle flap raised
Fig 11: Defect filled with Hydroxyapatite Fig 12: Lip pedicle flap sutured
Fig 13: Periodontal dressing applied Fig 14: Low magnification view
 
Fig 15: High magnification view
 
 

Results

An uneventfully healed operated site with a well accepted flap. No signs of recurrence till date. The prosthesis restored the esthetics of the patient.

Fig 16: Healing after 12 months Fig 17: After prosthetic restoration
 

Conclusions

Myxoma is benign, locally aggressive lesion, rare in skeleton. Kim et al. (2002) reported two cases in mandible & maxilla each. Aquilino et al. (2005) has reported a case of maxillary myxoma. The lesion presented also occurred in the maxilla in the anterior region. Myxoma usually spreads within marrow causing cortical expansion. Unlike this the myxoma described here has perforated the cortex instead of only expansion. The clinical suspicion and early diagnosis has led to prompt management of the disease & proper esthetic restoration; thus avoiding a disfiguring surgery, had the lesion been discovered at a later stage.
Every gingival enlargement should be viewed with a high degree of clinical suspicion for early diagnosis of an aggressive lesion beneath an indolent looking swelling. This may lead to offering the patient a conservative surgery with esthetic restoration rather than disfigurement due to an extensive surgery later.
 

Literature

  1. Aquilino RN, Tuji FM, Eid NLM et al. Odontogenic myxoma in the maxilla: A case report. Oral oncology EXTRA. 2006 (42) 133-136.
  2. Kim JY, Park GM, Cho BH. el al. Korean J Oral Maxillofac Radiol. 2002 (32) 231-4.
  3. Noffke CEE, Raubenheimer EJ , Chabikuli NJ. et al. Odontogenic myxoma: review of the literature & report of 30 cases from South Africa. Oral Surg Oral Med Oral pathol Oral Radiol Endod. 2007 (104) 101-9.
  4. Reichart P, Philipsen H. Odontogenic tumors & allied lesions. Quintesence publishing co. 2004.
     

Abbreviations

WHO - World Health Organization
IOPA - Intra Oral Peri Apical
 

This Poster was submitted by Dr Rashmi Dhale.
 

Correspondence address:
Dr Rashmi Dhale
F-2 Surabhi Apartment, Plot No. 9A
Hill Road, Gandhinagar
Nagpur 440010
Maharashtra, India