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Radiographic Findings of Odontogenic Myxomas on Conventional Radiographs

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Radiographic Findings of Odontogenic Myxomas on Conventional Radiographs ANTICANCER RESEARCH 32: 2173-2178 (2012) Radiographic Findings of Odontogenic Myxomas on Conventional Radiographs REINHARD E. FRIEDRICH1, HANNA A. SCHEUER2, ANDREAS FUHRMANN3 JOZEF ZUSTIN4 and ALEXANDRE T. ASSAF1 1Oral and Maxillofacial Surgery, 2Orthodontics, 3Oral Radiology and 4Pathology, Eppendorf University Hospital, University of Hamburg, Germany Abstract. Odontogenic myxoma (OM) is a rare tumour debate (1, 2). The tumour consists of mesenchymal cells that arising in the jaws. The tumour is believed to be of are believed to be of odontogenic origin (3). A striking odontogenic origin due to the close relation to teeth. The argument in favour of odontogenic origin is the preferential radiographic appearance of OM is not specific and the location of OM in the dentoalveolar regions of the jaws (1- diagnosis is frequently unexpected following surgical removal 4). Most authors favour cells of the dental pulp or the of the lesion. The aim of this study was to analyse the periodontium as being the original tumour cell (1-3). radiographic appearance of OM on conventional radiographs. OM is rare. The relative frequency of OM in relation to This type of radiographic diagnosis is typically used by dental other odontogenic tumours varies considerably. OMs practitioners. Materials and Methods: We studied panoramic constitute 5% to more than 20% of odontogenic tumours (4-8). radiographs and plain skull radiographs of 14 patients Radiographic analysis is essential in the diagnosis of investigated over a period of 30 years (male: 3, female: 11; odontogenic tumours (1). Plain radiographs and orthopanto- age at time of diagnosis: 8 to 45 years, ≤16 years: 3). The mograms are the preferred screening modalities to identify maxilla was affected in five and the mandible in nine patients. pathologies of hard tissues in the dentoalveolar region (1-8). In each case, all tumour findings were restricted to one jaw. Radiographic findings in cases of OM often exhibit Results: Tumour size varied considerably. The largest tumours multilocular radiolucencies of approximately spherical shape were seen in the distal parts of the mandible and ramus. (1-4). The association of a bulb-like osteolytic lesion coined Displacement of teeth was a frequent finding (8 cases), but the terms ‘honeycomb’ and ‘soap-bubble’ like radiolucency as root resorption was rare (2 cases). Honeycomb appearance on a characteristic and the predominant radiological finding in plain radiographs was associated with the size of the lesion OM (2). However, OM shares this radiographic appearance and restricted to mandibular involvement. Conclusion: The with some other types of jaw tumour and tumour-like lesions, radiographic appearance of OM of the jaws varies preferentially ameloblastoma and keratocystic odontogenic considerably. Large lesions may exhibit characteristic tumour (9-13). Furthermore, unilocular lesions are as radiological signs of a slowly growing lesion. However, frequently found as multilocular osteolysis in OM (9), or may discrete displacement of teeth associated with a small be even the predominant feature in children (11). Recently, a osteolytic zone of the alveolar process between two teeth can classification of radiographic findings was presented based on be an OM. Careful interpretation of conventional radiographs conventional radiographs (13). The aim of this study was to is a must in identifying early lesions. add further data to the current literature, with emphasis on findings presented on conventional radiographs. Odontogenic myxoma (OM) is a benign neoplastic lesion of the jaws (1-4). The cellular origin of OM is still a matter of Materials and Methods We studied conventional radiographs of the jaws and skull of 14 patients with histologically proven diagnosis of OM that were Correspondence to: Professor Dr. R.E. Friedrich, Oral and Cranio- generated in a single institution over a period of 30 years. All Maxillofacial Surgery, Eppendorf University Hospital, University radiographs were derived from the archive of the Department of of Hamburg, Martinistr. 52, D-20246 Hamburg, Germany. Tel: +49 Oral Radiology, University Dental Clinic, Hamburg. We evaluated 40741053259, e-mail: [email protected] conventional radiographs of the following types: panoramic, anterior-posterior and lateral cephalograms, occlusal, Water’s Key Words: Odontogenic myxoma, conventional radiographs, projection, and conventional tomograms. In one case each, a cone orthopantomography, panoramic radiograph, odontogenic tumours. beam computed tomogram or a cranial computed tomogram were 0250-7005/2012 $2.00+.40 2173 ANTICANCER RESEARCH 32: 2173-2178 (2012) Table I. Radiological classification of jaw lesions in odontogenic myxoma depicted on conventional radiographs (13). 1. Definition of the lesion’s border Description of radiological appearance Well-defined Clear border of the lesion, corticated or sclerotic margin Poorly defined Border of the lesion identifiable, but corticated margin is absent Diffuse No margin distinguishable, indistinct transition zone between lesion and unaffected bone 2. Type of lesion Description of radiological appearance Unilocular (Type I) Single discrete radiolucent cavity Multilocular (Type II) Two or more compartments with multiple interlaced and interrupted osseous trabeculae Alveolar bone involvement (Type III) Small lesion affecting the alveolar bone and showing bone resorption Maxillary sinus involvement (Type IV) Defined by radiologically proven growth into the sinus Osteolytic destruction (Type V) Large radiolucent area with irregular borders (‘moth-eaten’ margins), cortical erosion and rarely seen interlaced and interrupted osseous trabeculae Combination of osteolytic Onion-like, agglomerated radiopaque features, ‘sunray’-appearence destruction and osteogenesis (Type VI) additionally available for analysis of the lesion. The classification Table II. Distribution of odontogenic myxoma according to age and sex of radiological findings in OM proposed by Zhang et al. (13) was (N=14). applied in this study (Table I). Gender Results Age range (years) Male Female Total The maxilla was affected in five and the mandible in nine 0-9 1 0 1 patients (35.7% vs. 64.3%). In each case, all tumour findings 10-19 0 3 3 20-29 1 2 3 were single and restricted to one jaw (males: 3, females: 11). 30-39 1 4 5 Biographic data related to diagnosis are: age at time of 40-49 0 2 2 diagnosis: 8 to 45 years, mean: 26.5 years, males: 8-36 years >50 0 0 0 (mean: 22.6 years), females: 10-45 years (mean: 27.5 years), patients younger than 10 years: 1 (7.1%), younger than 20 Total 3 11 14 years: 4 (28.5%) (Table II). Tumour size and shape varied considerably. The largest tumours were seen in the distal parts of the mandible and ramus. Displacement of teeth was a frequent finding (8 cases), but root resorption was rare (2 cases). Honeycomb or soap- Discussion bubble appearance was obviously associated with the size of the lesion and restricted to mandibular involvement. The This study confirms the large variability of OM on plain radiological classification of lesions according to Zhang et al. radiographs. A classification of OM is desirable (8-10). (13) resulted in matching the findings to more than one type of However, the radiological findings showed noteworthy lesion in almost every case (Table III). Although the overlaps between distinct radiological categories. Therefore, impressive variety of radiological findings hampered a distinct a typing of radiological features in OM appears to be of allocation of findings to a single type of lesion, the lesions limited value when only plain radiographs of the jaws are shared some findings that are represented in the numerical available for analysis. On the other hand, the numerical code of the classification. The results are summarized in coding of radiological findings may be of value in Tables II and III and illustrated in Figures 1 and 2. epidemiological studies. 2174 Friedrich et al: Radiographic Findings in Odontogenic Myxoma Table III. Radiological findings in odontogenic myxomas. Typing of lesions according to Zhang et al. (13). Case Gender Age Osseous lesion Teeth (years) Jaw Topography/extension Classified appearance (type) Borders Root Root displacement resorption 1 M 8 Mandible Tooth 85 to mid-ramus Multilocular (soap bubble-like), (II, III) Well + – 2 F 45 Mandible Tooth 35 to mid-ramus Multilocular (soap bubble-like) (II, III) Poor – – 3 F 22 Mandible Teeth 33-37 (from alveolar Multilocular (II, III) Well + + limbus to the basal cortex) 4 F 25 Mandible Teeth 32-33 (alveolar process) Unilocular (I, III) Well + – 5 M 24 Maxilla Left tuber Tuber (IV) Poor – – 6 F 34 Maxilla Teeth 23-25 (alveolar process) Unilocular (I, III) Poor – – 7 F 35 Mandible Teeth 32-33 (alveolar process) Unilocular (I) Well + – 8 F 43 Maxilla Teeth 11-13 (periapical lesion) Unilocular (I, III) Well + – 9 F 30 Mandible Teeth 45-46 (alveolar process) Unilocular (I, III) Poor + + 10 F 17 Mandible Tooth 36 – mid ramus Multilocular (soap bubble-like) (II) Well – – 11 M 36 Mandible Toothless region 46-47 (large Unilocular (I) Well – – osteolysis extending to basal cortex) 12 F 36 Maxilla Tooth 28 (Osteolytic Tuber Region) Unilocular, irregular borders (I, III) Poor – – 13 F 10 Maxilla Teeth 21-26, (displaced canine inside Unilocular (with septa on the maxillary sinus) computed tomogram) (I, IV, VI) Poor + – 14 F 16 Mandible Teeth 32-33 (alveolar process) Unilocular (I, III) Well + – Although rarely diagnosed, knowledge about OM is reported to be diagnosed in
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