Surgical management of an erupted complex odontoma occupying maxillary sinus

Abstract

The occurrence of complex odontomas is not considered to be rare in the jaws. But the occurence of large odontomas obscuring the maxillary sinus, or erupting into the oral cavity are considered to be rare. The prognosis is good with surgical excision and recurrence is nil. Most of the times the surgical site can be closed primarily, but sometimes requires local flaps to achieve tension free closure. Here, we report such a case treated by surgical excision trans orally followed soft tissue defect reconstruction with pedicled palatal island flap.

Multiple Extensive Complex Odontomas of the Jaws

“…The list of clinical differential diagnosis for complex odontoma includes adenomatoid odontogenic tumor, cementifying or ossifying fibroma, calcifying odontogenic cysts, calcifying epithelial odontogenic tumor and periapical cemental dysplasia [7]. Ameloblastic odontoma and ameloblastic fibroodontoma greatly resemble odontoma especially on radiograph [5].…”

“…Thoma and Goldman in 1946 classified them as follows: Geminated composite odontomes, compound composite odontomes, complex composite odontomes, dilated and cystic odontomes [2,7]. In 1937, H.M. Worth grouped them as epithelial odontomes arising from dental epithelium (dentigerous cyst, dental cyst or multilocular cyst) and composite odontomes arising from the dental epithelium and dental mesoblestic tissues (complex, compound, geminated and dilated) [7]. Hybrid odontoma, a new variant has also been quoted in literature [2].…”

“…To the best of our knowledge, a total number of 21 cases of erupted odontomas have been reported in English literature, 10 of these being of compound variety and 11 of complex type. The reason for this type of behavior could possibly be due to the eruptive forces of the apparently impacted teeth and in cases of absence of teeth, may also be due to the resorption of alveolar ridge exposing the tumor, sequestration of overlying bone, remodelling of alveolar bone in case of young adults or reactive type of growth of the capsule around odontoma in elderly patients [7]. Erupted odontomas frequently result in pain and swelling followed by malocclusion with recurrent infections [1].…”

“…The odontoma is a tumor of unknown etiology [6]. However, it has been attributed to different pathological conditions such as local trauma, inflammatory and/or infectious processes, mature ameloblasts, cell rests of Serres (dental lamina remnants), odontoblastic hyperactivity or due to hereditary anomalies like Gardener's syndrome and Hermann's syndrome, and alterations in genetic component responsible for controlling dental development [7,8]. They are formed due to budding of extra odontogenic epithelial cells originating from the dental lamina.…”

“…Based on location, odontomas have been classified as central or intraosseous, peripheral or extraosseous and erupted types [3,7]. The 2005 WHO classification of odontogenic tumors classifies odontomas as compound odontoma, complex and ameloblastic fibro-odontoma [2,8].…”