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Compound Odontoma Removed by Endoscopic Intraoral Approach: Case Report

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Compound Odontoma Removed by Endoscopic Intraoral Approach: Case Report dentistry journal Case Report Compound Odontoma Removed by Endoscopic Intraoral Approach: Case Report Masakazu Hamada 1, Rena Okawa 2,* , Kyoko Nishiyama 1, Ryota Nomura 2, Narikazu Uzawa 1 and Kazuhiko Nakano 2 1 Department of Oral and Maxillofacial Surgery II, Osaka University Graduate School of Dentistry, Osaka 565-0871, Japan; [email protected] (M.H.); [email protected] (K.N.); [email protected] (N.U.) 2 Department of Pediatric Dentistry, Osaka University Graduate School of Dentistry, Osaka 565-0871, Japan; [email protected] (R.N.); [email protected] (K.N.) * Correspondence: [email protected] Abstract: A 12-year-old Japanese boy was referred to our hospital for evaluation of a radiopaque area on the left side of the mandible. Radiographic and computed tomographic examinations revealed a radiopaque lesion located on the lingual side, along with permanent tooth eruption. Several small tooth-like structures were noted within the lesion and the mandibular left second premolar was inclined in a mesial direction. An odontoma was clinically diagnosed and surgical removal by an endoscopic intraoral approach under general anesthesia was planned. Reports of oral surgery using an endoscopic approach have been presented, though none for an odontoma. With the expectation that removal of the odontoma would improve dentition in this case, we planned future management. A minimally invasive surgical removal procedure by an endoscopic intraoral approach from the Citation: Hamada, M.; Okawa, R.; lingual side was performed and good early recovery was noted. The resected tumor consisted Nishiyama, K.; Nomura, R.; Uzawa, of several small tooth-like structures. Histopathological diagnosis was a compound odontoma. N.; Nakano, K. Compound One-year follow-up findings showed that the post-surgical course was good. Odontoma Removed by Endoscopic Intraoral Approach: Case Report. Keywords: compound odontoma; odontogenic tumor; endoscopic intraoral approach Dent. J. 2021, 9, 81. https://doi.org/ 10.3390/dj9070081 Academic Editors: Gabriele Cervino 1. Introduction and Patrick R. Schmidlin Odontomas are one of the most common benign odontogenic tumors that occur in the jaw and are composed of enamel, dentin, cementum, and pulp tissue [1,2]. The 4th edition Received: 9 June 2021 of the World Health Organization’s Classification (WHO classification) of odontogenic Accepted: 5 July 2021 tumors published in January of 2017 divides these tumors into complex and compound Published: 7 July 2021 odontoma [3], which are usually asymptomatic lesions found incidentally during routine radiography [4]. Analyses of odontoma cases in Japan have shown that about half of the Publisher’s Note: MDPI stays neutral patients are between the ages of 10 and 19, with the detection rate for those under the age with regard to jurisdictional claims in published maps and institutional affil- of 10 reported to be about 10% [5,6]. If no effect on the dentition is observed, treatment may iations. be difficult depending on the site of occurrence. In recent years, endoscopes have come to be used in a variety of areas [7,8]. It has also been used in the field of oral surgery [9–13]. However, there are no reports of its use for odontomas. Here, we report a case of compound odontoma that developed in the mandible of a child and was removed from the lingual side by use of an endoscopic intraoral approach. Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. 2. Case Report This article is an open access article distributed under the terms and A 12-year-old boy was referred to the Department of Oral and Maxillofacial Surgery conditions of the Creative Commons at Osaka University Dental Hospital for evaluation of a radiopaque area on the left side of Attribution (CC BY) license (https:// the mandible. There was no special mention of systemic history and the patient reported creativecommons.org/licenses/by/ no symptoms in the affected area. An intraoral examination revealed no obvious gingi- 4.0/). val swelling around the left mandibular region (Figure1A), though the mandibular left Dent. J. 2021, 9, 81. https://doi.org/10.3390/dj9070081 https://www.mdpi.com/journal/dentistry Dent. J. 2021, 9, x FOR PEER REVIEW 2 of 6 Dent. J. 2021, 9, 81 2 of 6 gingival swelling around the left mandibular region (Figure 1A), though the mandibular secondleft second premolar premolar was was inclined inclined in a mesialin a mesial direction direction (Figure (Figure1B). Panoramic 1B). Panoramic and periapical and peri- radiographyapical radiography findings findings showed showed a radiopaque a radiopaque area around area the around root apices the root of theapices left of mandibu- the left larmandibular first premolar, first premolar, left mandibular left mandibular second premolar, second premolar, and left mandibular and left mandibular first premolar first (Figurepremolar1C,D). (Figure Computed 1C,D). Computed tomography tomography (CT) results (CT) showed results several showed small several tooth-like small struc-tooth- tureslike structures within the within lesion the located lesion located on the lingualon the lingual side (Figure side (Figure1E,F), and1E,F), an and odontoma an odontoma was clinicallywas clinically diagnosed. diagnosed. Figure 1. (A,B) Intraoral photographs takentaken atat thethe initialinitial visit.visit. ((C)) PanoramicPanoramic radiography,radiography, ((DD)) peri-per- iapical radiography, and (E) computed tomography images. (F) Three-dimensional construction of apical radiography, and (E) computed tomography images. (F) Three-dimensional construction of affected region. affected region. Dent.Dent. J.J. 20212021,, 99,, 81x FOR PEER REVIEW 33 of 66 Under general anesthesia, minimally invasive surgical removal withwith anan endoscopicendoscopic intraoral approachapproach from from the the lingual lingual side side was was performed performed (Figure (Figure2A–C). 2A–C). Since Since it was it was difficult diffi- tocult see to thesee lesionthe lesion directly directly or with or with a dental a dent mirroral mirror from from the lingualthe lingual side, side, we decidedwe decided to use to anuse endoscope an endoscope for for this this surgery. surgery. We We used used the the KARL KARL STORZ STORZ EndoskopeEndoskope (KARL(KARL STORZ, Tuttlingen, Germany). TheThe endoscopeendoscope waswas usedused to ensure that the lesion was removed. The resected tumor was found to consist of seve severalral small tooth-like structures (Figure 22D).D). In histopathologicalhistopathological analysis findings,findings, hematoxylin and eosineosin stainingstaining ofof thethe tooth-liketooth-like structures showed them to bebe composedcomposed ofof dentindentin andand cementumcementum withwith centrallycentrally locatedlocated loose fibrousfibrous tissue,tissue, consideredconsidered toto bebe pulppulp tissuetissue (Figure2 2E).E). Histopathological Histopathological diagnosis diagnosis was a compound odontoma.odontoma. Figure 2. (A,B) The endoscopeendoscope used in the surgery,surgery, ((CC)) IntraoperativeIntraoperative appearanceappearance afterafter removalremoval ofof tumor. (D) Excised surgical specimen showing tumor mass. (E) A histological examination of the tumor. (D) Excised surgical specimen showing tumor mass. (E) A histological examination of the specimen showed irregularly sized vascular spaces surrounded by dense connective tissue (H and specimen showed irregularly sized vascular spaces surrounded by dense connective tissue (H and E staining). E staining). Adjacent tooth roots showed no problems (Figure(Figure3 3A,B).A,B). OneOneyear yearafter afterremoval removalof of the odontoma, no recurrence was seen and though dentition improvement was expected, that was notnot notednoted (Figure(Figure3 3C).C). Furthermore, Furthermore,devitalization devitalization ofofpremolars, premolars, suchsuchas as root root resorption, toothtooth discoloration,discoloration, or or mobility, mobility, was was not not observed. observed. The The parents parents and and patient patient did notdid wishnot wish to continue to continue treatment treatment for dentition for dentition or occlusion or occlusion from from that that time. time. Dent.Dent. J. J.20212021, 9, ,9 x, 81FOR PEER REVIEW 4 of4 of6 6 FigureFigure 3. 3.(A)( PeriapicalA) Periapical and and(B) panoramic (B) panoramic radiography radiography images images after surger aftery surgeryobtained obtained at follow-up at follow-up examination. examination. (C) Pan- oramic(C) Panoramic radiography radiography image at image1-year atfollow-up. 1-year follow-up. 3.3. Discussion Discussion OdontomasOdontomas are are one one of of the the most most common common benign benign odontogenic odontogenic tumors tumors that that occur occur in in thethe jaw, jaw, and and can can be be divided divided into into complex complex an andd compound compound type type [1–3]. [1–3]. Among Among odontogenic odontogenic tumors,tumors, the the frequency frequency of ameloblastomasameloblastomas has has been been reported reported to to be be highest highest at 45.2%, at 45.2%, followed fol- lowedby odontomas by odontomas at 24.9%, at 24.9%, with thewith incidence the incidence rate of rate complex of complex odontoma odontoma 9.7% and9.7% that and of thatcomplex of complex odontoma odontoma 15.3% 15.3% [1]. These [1]. Thes tumorse tumors are usually are usually asymptomatic asymptomatic lesions lesions found foundincidentally incidentally during during a routine a routine radiography radiography examination, examination,
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