Advertisement

Oral and Maxillofacial Surgery

, Volume 14, Issue 4, pp 247–252 | Cite as

Two-stage surgical removal of large complex odontoma

  • Bruno Ramos Chrcanovic
  • Filipe Jaeger
  • Belini Freire-Maia
Case Report

Abstract

Purpose

The surgical treatment of a large complex odontoma in the mandibular angle is reported. Four possible surgical approaches to remove a benign tumor in the mandibular angle are discussed.

Patient

A two-stage surgical treatment was chosen; first, removing most part of the lesion and preserving the second molar, decreasing the risk of a pathological mandibular fracture. A maxillo-mandibular fixation for a period of 4 weeks was used. The patient was oriented to maintain a soft diet. The second surgical stage occurred 3 months after the first one due to the significant bone consolidation observed, reducing the possibility of a mandibular fracture. The remaining lesion and the second molar were then completely removed.

Conclusions

This case demonstrates the value of the tridimensional computed tomography in treatment planning prior to any definitive surgery. A computed tomography should be made in every case of intraosseous lesion in order to establish the intraosseous extent of the tumor, cortical perforation, and soft tissue involvement for precise guidance for the surgical planning. It is recommended that the surgeon considers excision by an intraoral, lingual approach when indicated, and in two stages, when an extremely thin mandibular base is present.

Keywords

Odontogenic tumors Complex odontoma Computed tomography 

References

  1. 1.
    Gomel M, Seçkin T (1989) An erupted odontoma. Case report. J Oral Maxillofac Surg 47:999–1000CrossRefPubMedGoogle Scholar
  2. 2.
    Ragalli CC, Ferreria JL, Blasco F (2000) Large erupting complex odontoma. Int J Oral Maxillofac Surg 29:373–374CrossRefPubMedGoogle Scholar
  3. 3.
    Patiño Illa C, Berini Aytés L, Sánchez Garcés MA, Gay Escoda C (1995) Odontomas complejos y compuestos: Análisis de 47 casos. Arch Odontoestomatol 11:423–429Google Scholar
  4. 4.
    Kaneko M, Fukunda M, Savo T, Ohnishi T, Hosokawa V (1998) Microradiographic and microscopic investigation of a rare case of complex odontoma. Oral Surg Oral Med Oral Pathol Oral Radial Endo 86:131–134CrossRefGoogle Scholar
  5. 5.
    Amado Cuesta S, Gargallo Albiol J, Berini Aytes L, Gay Escoda C (2003) Review of 61 cases of odontoma. Presentation of erupted complex odontoma. Med Oral 8:366–373PubMedGoogle Scholar
  6. 6.
    Kaugars GE, Miller ME, Abbey LM (1989) Odontomas. Oral Surg Oral Med Oral Pathol 67:172–176CrossRefPubMedGoogle Scholar
  7. 7.
    Owens BM, Schulman NJ, Mincer HH, Turner IE, Oliver FM (1997) Dental odontomas: a retrospective study of 104 cases. J Clin Pediatr Dent 21:261–264PubMedGoogle Scholar
  8. 8.
    Chang JY, Wang JT, Wang YP, Liu BY, Sun A, Chiar CP (2003) Odontoma: a clinicopathological study of 81 cases. J Formos Med Assoc 102:876–882PubMedGoogle Scholar
  9. 9.
    Philipsen HP, Reichart PA, Praetorius F (1997) Mixed odontogenic tumours and odontomas. Considerations on interrelationship. Review of the literature and presentation of 134 new cases of odontomas. Oral Oncol 33:86–99CrossRefPubMedGoogle Scholar
  10. 10.
    Hisatomi M, Asaumi JI, Konouchi Honda Y, Wakasa T, Kishi K (2002) A case of complex odontoma associated with an impacted lower deciduous second molar and analysis of 107 odontomas. Oral Dis 8:100–105CrossRefPubMedGoogle Scholar
  11. 11.
    Widad FA, Putrus ST (1985) Erupted odontoma. Oral Surg Oral Med Oral Pathol 59:225–226CrossRefGoogle Scholar
  12. 12.
    López-Areal L, Silvestre Donat F, Gil Lozano J (1992) Compound odontoma erupting in the mouth: 4-year follow-up of a clinical case. J Oral Pathol Med 21:285–288CrossRefPubMedGoogle Scholar
  13. 13.
    Morning P (1980) Impacted teeth in relation to odontoma. Int J Oral Surg 9:81–91CrossRefPubMedGoogle Scholar
  14. 14.
    Junquera L, de Vincente JC, Roig P, Olay S, Rodriguez-Recio O (2005) Intraosseous odontoma erupted into the oral cavity: an unusual pathology. Med Oral Patol Oral Cir Bucal 10:248–251PubMedGoogle Scholar
  15. 15.
    Mild Y, Iwaya N, Hirota M, Yamada N, Aisaki K, Sato J, Ishii T, Iwanari G, Mikyake M, Kudo I, Komiya K (1999) Clinicopathological studies of odontoma in 47 patients. J Oral Sci 41:173–176Google Scholar
  16. 16.
    Ide F, Shimoyama T, Horie N (2000) Gingival peripheral odontoma in an adult: case report. J Periodontol 71:830–832CrossRefPubMedGoogle Scholar
  17. 17.
    Singer SR, Mupparapu M, Milles M, Rinaggio J, Pisano D, Quaranta P (2007) Unusually large complex odontoma in maxillary sinus associated with unerupted tooth. Report of case and review of literature. N Y State Dent J 73:51–53PubMedGoogle Scholar
  18. 18.
    Bodin I, Julin P, Thomsson M (1984) Odontomas and their pathological sequels. Dentomaxillofac Radiol 12:109–114Google Scholar
  19. 19.
    Piattelli A, Perfetti G, Carrano A (1996) Complex odontoma as a periapical and interradicular radiopacity in a primary molar. J Endod 22:561–563CrossRefPubMedGoogle Scholar
  20. 20.
    Neville BW, Damm DD, Allen CM, Bouquet JE (2002) Bone pathology. In: Neville BW, Damm DD, Allen CM, Bouquet JE (eds) Oral and Maxillofacial Pathology, 3rd edn. Saunders, Philadelphia, pp 660–664Google Scholar
  21. 21.
    Mupparapu M, Singer SR, Rinaggio J (2004) Complex odontoma of unusual size involving the maxillary sinus: report of a case and review of CT and histopathologic features. Quintessence Int 35:641–645PubMedGoogle Scholar
  22. 22.
    Frame JW (1986) Surgical excision of a large complex composite odontoma of the mandible. Br J Oral Maxillofac Surg 24:47–51CrossRefPubMedGoogle Scholar
  23. 23.
    Laskin DM (1989) Discussion—surgical management of a large complex mandibular odontoma by unilateral sagittal split. J Oral Maxillofac Surg 47:183–184CrossRefGoogle Scholar
  24. 24.
    Wong GB (1989) Surgical management of a large complex mandibular odontoma by unilateral sagittal split osteotomy. J Oral Maxillofac Surg 47:179–182CrossRefPubMedGoogle Scholar
  25. 25.
    Liposky RE (1980) Decortication and bone replacement technique for the treatment of a large mandibular cyst. J Oral Surg 38:42–45PubMedGoogle Scholar
  26. 26.
    Kuramochi MM, Vanti LA, Berenguel IA, Pereira WL, Zangrando D (2006) Acesso Extra-Oral para Reconstrução Primária em Odontoma Complexo raro em mandíbula. Rev Port Estomatol Cir Maxilofac 47:35–40Google Scholar
  27. 27.
    Blinder D, Peleg M, Taicher S (1993) Surgical considerations in cases of large mandibular odontomas located in the mandibular angle. Int J Oral Maxillofac Surg 22:163–165CrossRefPubMedGoogle Scholar
  28. 28.
    Or S, Kisnisci R (1987) Complex odontoma of the mandible. Report of a case. Quintessence Int 18:159–161PubMedGoogle Scholar
  29. 29.
    Killey HC, Kay LW (1966) Large complex composite odontomas of the jaws. Int Surg 46:103–107PubMedGoogle Scholar
  30. 30.
    Hisatomi M, Asaumi J, Konouchi H, Yanagi Y, Matsuzaki H, Kishi K (2003) Comparison of radiographic and MRI features of a root-diverging odontogenic myxoma, with discussion of the differential diagnosis of lesions likely to move roots. Oral Dis 9:152–157CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Bruno Ramos Chrcanovic
    • 1
  • Filipe Jaeger
    • 2
  • Belini Freire-Maia
    • 3
    • 4
  1. 1.Belo Horizonte, MG-CEPBrazil
  2. 2.Nova LimaBrazil
  3. 3.Belo Horizonte, MG-CEPBrazil
  4. 4.Department of Oral and Maxillofacial Surgery, School of DentistryPontifícia Universidade Católica de Minas GeraisBelo HorizonteBrazil

Personalised recommendations