Odontogenic Myxoma

y is a tumor of the jaws which apparently arises from

the mesenchymal portion of the tooth germ, either dental papilla, the follicle or the periodontal ligament. y The Odontogenic Myxoma is a central lesion of the jaws which expands the bone and may cause destruction of the cortex.

Clinical Features
y occurs most frequently in the second or third decay of y y y y y

life, 23-30 years old. no particular sex predilection occurs most in mandibular area occasional occurs outside the tooth-bearing areas, several cases are in the condyle or neck of the condyle according to Thoma and Goldman, nearly every case was associated with missing or embedded teeth. pain or painless

Roentgenographic Feat res

y may present a mottled or honeycomabed appearance, while others may appear a destructive, expanding radiolucency which sometimes has a multilocular pattern. y displacement of the tooth by the tumor mass but root resorption is less frequent y invasion of the antrum occurs frequently in maxilla

Histologic Features
y made up of loosely arranged, spindle-shaped and stellate cells, many of which have long fibrillar processes that tend to intermesh. y According to Hodson and Prout, there is appearance of two acid mucopolysaccharides: relatively large quantities of hyaluronic acid and lesser amounts of chondroitin sulfate. This high hyaluronic acid component may be a significant factor in the neoplastic behavior of the tumor.

Treatment/ Prognosis
y surgical excision, followed by cautery. Extensive lesion may require resection to eradicate the tumor. Because of an often loose, gelatinous consistency, curettage may result in incomplete removal of the neoplasm. y the prognosis is good despite unpredictable recurrence.

Peria ical Cemental Dys lasia

y also known as Cementoma; Periapical Osteofibroma or Osteofibrosis; Cementifying Fibroma; Localized Fibroosteoma; Cementoblastoma; Periapical Fibrous Dysplasia y it is a lesion of rather common occurrence, some believe to a theory of its origin from odontogenic tissue, the cementum, while others believe that it represents only an unusualreaction of the periapical bone. It is not considered a neoplasm in usual sense of the term. y The term "cementoma" is a misnomer as the opacities are not cementum but bone; while they appear to arise from the teeth, the lesions apparently arise within bone instead.

Etiology
y unknown, although suggested to occur as a result of

mild chronic trauma, perhaps traumatogenic occlusion.

Clinical Features
y the lesion occurs in and near the periodontal ligament

around the apex of a tooth, usually mandibular incisor. y have multiple lesion, the cementoma involving the apices of several mandibular anterior teeth and bicuspid. y the lesions are invariably asymptomatic

Roentgenogra

ic Features

y The earliest stage or also known as Osteolytic stage is the formation of circumscribed area of periapical fibrosis accompanied by localized destruction of bone, that appears radiolucent. y The second stage or the Cementoblastic stage is the beginning of calcification in the radiolucent area of fibrosis. There is an increased of cementoblastic activity with the deposition of spicules of cementum or cementicles. y the third stage or so-called the Mature stage, in which an excessive amount of calcified material deposited in the focal area and appears a well defined radiopaque is usually bordered by a thin radiolucent line or band.

Osteolytic stage Shows a well circumscribed radiolucency in the apex

* Mature Stage (Left), Cementoblastic stage (Right) This pattern of radiopacities and radiolucencies around the apices of seemingly vital teeth is virtually diagnostic of osseous dysplasia (cementoma).

Treatment/ Prognosis
y Observation over several years is the main approach to

tracking the disease. The lesions should stabilize in size over time and subsequent biopsies and X-rays are used to ensure that these lesions are in benign. The pulp vitality test is also used to monitor the affected teeth to ensure that they remain healthy and to diagnose the disease correctly. If the lesions continue to grow, a dissection including removal of the tooth might be required. In severe cases, medication is used to prevent further calcification.

Central Cementifying Fibroma

y is a neoplasm of bone similar to the Central Ossifying

fibroma but the only difference is the end product: cementum in Central Cementifying Fibroma, on the other hand is bone.

Clinical Features
y occurs at any age, but more common in young and middleaged adults y the lesion is asymptomatic until there is formation of swelling and mild deformity, y displacement of teeth y relatively slow-growing tumor and may be present for some years before discovery y the cortical plates of bone and overlying mucosa or skin are almost invariably intact.

Roentgenogra

ic features

y the lesion is well circumscribed and

demarcated from surrounding bone y at early stage, the fibroma appears as a radiolucent with no evidence of internal radiopacities. As it matures, calcification increases, there is now appearance of radiopaque mass. y the central cementifying fibroma, central ossifying fibroma and central cemento-ossifying fibroma have a centrifugal growth pattern rather than a linear one. Therefore, these three grow by expansion equally in all direction and present a round tumor mass.

Histologic features
y Composed basically of many delicate interlacing

collagen fibers, seldom arranged discrete bundles, interspersed by large numbers of active, proliferating fibroblasts and cementoblasts. y presents many small foci of basophilic masses of cementum-like tissue.

Treatment/Prognosis
y excision followed

by diligent curettage of the wound y recurrence is rare