Case Report

Odontogenic
Myxoma of the
Mandible

By :
I Gusti Ayu Dwi Susantini

Scientific Advisor :
Dr. I Gde Ardika Nuaba Sp.T.H.T.K.L (K) FICS
MYXOMA
– Benign, slow growing and locally aggressive
mesenchymal neoplasm
– Stout (1948) :
1. exclude presence of celluler component such as
chondroblasts, lipoblasts, rhabdomyoblast
2. Growing infiltratively and expansively
3. Do not metastasize
– Can be found in skin, subcutaneuous tissue, heart,
and bone
MYXOMA

Myxoma of the
Head and Neck
Osteogenic
Myxoma
Facial bone

Odontogenic
Myxoma
Facial soft
tissue
 Odontogenic Myxoma

Definition: WHO Characteristic: Etiology:

Non-encapsulated benign Asymptomatic Missing and
odontogenic tumor of lesion, infiltrative unerupted teeth
ectomesenchimal origin, growth, locally and presence of
consists of rounded and invasive and odontogenic
aggresive, no epithelium
angular cell that lie in
metastase,
abundant mucoid stroma,
originate from dental
papilla, follicle or
periodontal ligament
 Rare cases
3-6% of all odontogenic tumors
EPIDEMIOLOGY Prevalence in Asia, Europe and America :
0,5%-17,7%

Second to third decades of life

Female have predilection over male  1,5 :1

Found in almost any area of the jaw

Mandible more commonly affected than
maxilla
7
Macroscopic Appearance

• Appear as a grayish white mass

• Nodular heterogenous mass of
variable consistency, with a
glistening gelatinous cut surface
• Uncapsulated and poorly
demarcated from surrounding
tissue
Microscopic Appearance
 DIAGNOSIS

Anamnesis Physical Examination Supporting Examination

Clinical
May or may not be symptomatic
Symptom
Swelling
Painless, paresthesia
Facial deformity/asymmetry
Slow growing mass with late appearing
symptom  late to seek the treatment
 DIAGNOSIS
Anamnesis Physical Examination Supporting Examination

Extra oral examination:

• Swelling
• On palpation the swelling no tenderness,
hard with areas with firmness, no fluctuation,
localized

Intra oral examination:

• Swelling of the mucosa and gingiva
• Local invasion at the site of tumor and
surrounding structure
• Tooth mobility
• Root resorption
• Invasion of the sinus maxilla
 DIAGNOSIS
Anamnesis Physical Examination Supporting Examination

Radiological appearance
• Unilocular or multilocular radiolucent
• Soap bubble appearance, honey comb
ammpearance or tennis racket
 DIAGNOSIS
Anamnesis Physical Examination Supporting Examination

CT Finding
• Can help to detect bone involvement and surrounding
soft tissue structure.
• a solid osteolytic part of mass and size of mass with
contrast, bone expansion, cortical bone thinning, soft
tissue mass with bone destruction

HISTOPATHOLOGY
• Stellate shaped cells with few collagen fibrils and
cappilaries
 MANAGEMENT

SURGICAL

• Enucleation
• Curretage
• Marginal resection
• Segmental or Block resection
• Radical resection
• Radical resection with reconstruction
CASE REPORT
21

Identity
Name : DAE
Age : 23 y.o
Sex : Female
Adress : NTT
 Patient came to the ENT Policlinic
CLINICAL Sanglah General Hospital September, 12
th2017, with chief complaint painless
HISTORY
swelling of the left side of the face since
the last 1 year.

The swelling was small iniatially and

growth slowly to its current size. There
was no history of pain, no difficulty in
eating, or swallowing. There was no
dental history.
PHYSICAL ▪Vital Sign :
EXAMINATION ▪BP : 130/80 mmHg
▪Respiratory : 24 x/minute
▪Pulse : 88 x/minute
▪Temperature : 360C
 ENT Examination:
PHYSICAL
EXAMINATION
▪Ear : within normal limit
▪Nose : within normal limit
▪Throat : within normal limit
PHYSICAL
EXAMINATION

Extra oral examination :

 Diffused swelling in left mandible, firm and no

tender on palpation, approximately 12 cmx12 cm

in size
 The lesion cause asymmetry of the face

Intra oral examination :

 A firm, non tender swelling in left buccal and

gingiva, extending from superior to the inferior

border.
 There was displacement or resorption of any

tooth in the mandible

Radiologic
Examination solid mass in the left
mandibular area
(CT Scan) measuring 12.6 cm x
12 cm which extends
to the left maxilla and
to the left maxillary
sinus and destroys
the maxillary and left
mandibular os which
gives a stinging
contrast, very likely
the possibility of a
malignancy
 Fine Neddle Aspiration Biopsy (FNAB)
(20 September 2017)
SUPPORTING
EXAMINATION  Soft tissue tumor with atypical round
cell and myxoid tumor

Open Biopsy in region mandibular

sinistra (October, 9 th 2017)
 showed myxoid matrix impression of
the myxoma lesion
DIAGNOSIS
Anamnesis Phisical
Examination
Supporting
Examination

Myxoma of the Mandible S

MANAGEMENT
October 20 th 2017 :

1. TRACHESOSTOMY PRIMER
2. RADICAL HEMI MANDIBULECTOMY
SINISTRA
3. RECONSTRUCTION WITH MEANS
FREE FIBULAR FLAP BY PLASTIC
SURGEON
Radical Hemi mandibulectomy S

Intra operatif findings:

Grayish mass is homogeneous

glossy, its consistency solid with
slippery surface with a size of
15 cm x 9 cm.
 Vascularized Free Fibular Flap (VFFF)

● Radical surgical resection of mandibular odontogenic

myxoma with primary reconstruction must be the treatment
of choice
● The use of VFFF ia an optimum method for mandibular
reconstruction
 • Post-operative patient used Naso Gastric
Post Tube (NGT) for nutritional intake.
Operation • Patients were treated temporarily in an
intensive room
• Given antibiotic and analgetic
• Wound care

• NG tube is removed 2 weeks later and

trachesostomy cannula was released
• November 9 th 2017  patient allowed
hospital discharge
 HISTOPATHOLOGY FINDING

Microscopic appearance  showing the proliferation of neoplastic cells arranged

randomly in the myxsoid matrix with several stellate, spindle and round shaped
cell

The hitomorphological conclusions  odontogenic myxoma

 FOLLOW UP

November 16 th 2017 November 24 th 2017 January 10 th 2018

Moderate oedem, facial

region present moderate attached internal No oedem, facial region
asymmetry, surgical fixation miniplate of the present symmetry
wound doest not show left mandible, the
clinical infection, suture position are suffiecient
are removed
 DISSCUSION
Case Literature

• The usual age incidence OM

Female, 23 y.o is between 10-50 y.o
• Mean age range 22,7-36,9
year
• Sex predilection-mainly
female predominance
• Ajike et al  ratio F: M= 2,4:1
• Nofke et al  ratio F: M= 3:1
 DISSCUSION
Case Literature

Predilection of OM more common

Site of lesion : mandible S in the mandible
• Simon et al mandible (75%)
and maxilla (25%)
• Friedriech et al mandible
(64%) and 36% maxilla
Most often found in the
mandibular premolar area
 DISSCUSION
Case Literature

Halfpenny and Gonzales et al

Clinical Finding : painless asymptomatic swelling and can
swelling in left side face, grow to considerable dimension
on palpation no tender. before diagnosis, as was seen in
our cases
Swelling has reached a large
size before the patient is aware OM may become symptomatic
of his presence and seeking
because of expansion of lesion
treatment
 DISSCUSION
Case Literature

Conventional radiography (-) Conventional Radiological of OM :

-Unilocular or multilocular radiolucent
CT finding : -honey comb, soap bable, tenis racket
solid mass in the left mandibular, apperance
12.6 cm x 12 in size cm which
extends to the left maxilla and to Asaumi et al  based on CT seen as
the left maxillary sinus and 1) osteolytic expansile lesion
destroys the os left mandibular 2) Bony expansion
3) Thinning of cortical bone and also
destruction of bone
 DISSCUSION
Case Literature
Surgery is mainstay of treatment
• Buffano et al and Ayranci et al :
Management : enucleation and curettage when
Radical hemi mandibulectomy lesion less than 3 cm in size and
sinistra with reconstruction with segmental or radical resection with
means free fibular flap by reconstruction when lesion were
plastic surgeon larger
• Lu muzio et al and Zanetti et al a
reccurence rate 10-30% has been
reported after enucleation and
curettage
• Radical resection approach with
reconstruction is an optional
therapy that can adequately cover
all lesions and also to prevent
recurrence.
 Conclussion

• F, 23 y.o who had an

odontogenic myxoma located
in the mandible sinistra.
• Patient underwent radical
hemimandibulectomy and
reconstruction with free fibular
flap
• A follow up period is clearly
necessary. Recommanded
should be followed for 2 years
after surgery.
THANK YOU