Complex odontomas are rare benign jaw neoplasms. generally small and asymptomatic. We present an unusual case of a giant complex odontoma which completely filled the maxillary antrum, resulting in elevation of the orbit and facial asymmetry

Altini, M.

Glass, R.B.J.

Hurtzanu, Y.

Kassner, G.

Mendelsohn, Dianne B.

English

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704 SA MEDICAL JOURNAL VOLUME 63 30 APRIL 1983Giant complex odontoma of themaxillary antrumA case reportDIANNE B. MENDELSOHN, Y. HERTZANU, R. B. J. GLASS, G. KASSNER,M. ALTINISummaryComplex odontomas are rare benign jaw neoplasms.generally small and asymptomatic. We present anunusual case of a giant complex odontoma whichcompletely filled the maxillary antrum, resulting inelevation of the orbit and facial asymmetry.S Air Med J 1983: 63: 704-706.An odontoma is a hamartoma ofodontogenic tissue composed ofdentine and enamel in which pulp and cementum are also pre-sent. According to Gorlin I odontomas may be classified as fol-lows: (I) ameloblastic odontoma (odonto-ameloblastoma); (il)ameloblastic dentinosarcoma; (iil) complex odontoma; and (iv)compound odontoma.The complex and compound odontomas together represent[he most common odontogenic tumours. The complex odon-toma appears to be less common than the compound odontomabut far more prevalent than the ameloblastic odontoma.Case reportA 9-year-old boy presented with a history of longstanding nasalobstruction and purulent nasal discharge. He also reported se-veral episodes of epistaxis.Marked facial asymmetry due to elevation of the right eye andswelling over the right maxilla was noted. The right lateral nasalwall was medially displaced and the hard palate was depressed on[he right side. There was a gap in the dentition with an absentright upper premolar tooth. Sensation in the cheek was intact.No other abnormalities were noted.Routine paranasal sinus radiographs showed the presence ofalarge calcified expansile mass involving the entire right maxillaryantrum (Fig. I). Frontal tomography showed a tooth in thesuperior aspect of the mass. A thin radiolucent band surroundedthe tumour (Fig. 2).Departments of Diagnostic Radiology and Otolaryngology,Johannesburg Hospital and University of the Witwaters-rand, JohannesburgDIANNE B. ME TDELSOHN, .\1.8. BCH. FF.RAD (0.) IS A.)Y. HERTZANU, .\\.D. YASSI)R. B. J. GLASS, .\\.B. 8.CH.G. KASSNER, .\\.B. BCH., F.es IS.A)Department of Oral Pathology, School of Pathology, Uni-versity of the Witwatersrand, and South African Institute forMedical Research, JohannesburgM. ALTIN I, 8.D.S., .\\.DE:\T.Date: received; 13 July 19 2.Reprint reque~t~ to: Or D. B..\\endebohn, Dept of Diagno~[ic Radiology, Johanne~burgHo.. pital. Jubilee Road, Parkrown, 2193 RSA.Fig. 1. Occipitomental and lateral sinus radiographs showing alarge calcified mass filling and expanding the entire right maxil-lary antrum.Fig. 2. Frontal tomogram clearly demonstrating complete tumourreplacement of the maxillary antrum. Note marked elevation ofthe orbital floor and encroachment onto the right nasal cavity. Anormal molar tooth has been displaced from the alveolar marginand abuts the orbital floor (arrowed). A well-defined radiolucentband surrounds the tumour.Surgery was performed via a Caldwell-Luc approach to theright maxillary antrum. An irregular hard tumour was removedpiecemeal from the sinus.Fig. 3. The lesion is well encapsulated and consists of sheets ofdentine (D), enamel (E), cementum and pulp arranged in ahaphazard fashion (H and E x 40).SA MEDIESE TYDSKRIF DEEL 63 30 APRIL 1983 705The surgical specimen consisted of one piece of hard tissuemeasuring 4,5 x 4 x 2,5 cm and twelve smaller pieces of hardtissue, the largest measuring I x I x I cm. Histological examina-tion of decalcified sections showed an encapsulated lesion con-sisting predominantly of dentine but containing significantamounts of enamel, cementum and pulp (Fig. 3). Reducedenamel epithelium could also be seen in some areas. The varioustooth components were arranged in a totally haphazard fashion,having no specific relationship to one another. The enamel hadfor the most part dissolved in the decalcification process leavingonly empty enamel spaces (Fig. 4), but some enamel matrixcould be seen in parts. The dentine was mainly tubular in type,but extensive areas of atubular dentine could also be seen (Fig.5). There was no inflammation or evidence of malignancy. Thehistological features were those of a complex odontoma.Fig. 4. Most of the enamel has dissolved in the decalcificationprocess, leaving predominantly empty spaces. Odontogenicepithelium is clearly seen (arrowed) (H and E x 64).The patient has had no recurrence of the tumour or sinusitisduring a follow-up period of 21/ 2 years. The facial asymmetryhas almost completely disappeared.DiscussionOdontomas may develop from the enamel organ or the dentallamina, either in place of a normal tooth or a supernumerarylamina or even in association with the follicle of an uneruptedtooth. 2 The aetiology is unknown but there is some evidence infavour of a genetic basis for odontomas. 3 In contrast to com-pound odontomas the complex odontoma reflects poor dentaldifferentiation, bearing no resemblance to teeth. It presents as an706 SA MEDICAL JOURNAL VOLUME 63 30 APRIL 1983Fig. 5. Dentinal tubules can be seen (D). Remnants of organicmatrix of enamel (arrowed) have persisted in parts (H and E x100).amorphous calcified expansile mass which may be confined tothe alveolus or may expand to fill the maxillary sinus. Microsco-pically, complex odontomas appear to consist mainly ofcalcifieddental tissues haphazardly distributed with no semblance ofindividual tooth form, surrounded by a fibrous capsule.4Complex odontomas most commonly occur in the second tothird decades of life but have been known to occur at any age. 5There is no sex predilection.G,7 They are more common in themandible than in the maxilla, usually occurring in the mandibu-lar premolar-molar area. 7Complex odontomas are usually small, produce few clinicalsigns and symptoms, and are usually discovered on routinedental radiographs. They could be suspected because of failureof a tooth to erupt. When they occur in the ma.xilla they tend topush the floor of the antrum upwards and bulge into the antralcavity.s Occasionally they may be large and may expand and thinout cortical bone, resulting in facial asymmetry.Radiographically, a complex odontoma appearsas an irregularmass ofcalcified tissue surrounded by a well-defined radiolucentband. The differential diagnosis of the complex odontomashould include cementifying or ossifying fibromas, adenomatoidodontogenic tumours, calcifying odontogenic cysts, peri-apicalcemental dysplasia and calcifying epithelial odontogenic tu-mours. A clue to the diagnosis of complex odontomas is theirtendency to be associated with unerupted molar teeth. 7Since they do not recur, treatment is by surgical removal.When small they shell out easily owing to the presence of asurrounding capsule. However, when large and irregular in out-line they must be sectioned and removed, otherwise a fracture ofthe containing bone may result. 9REFERENCESI. Gorlin RI. Odontogenic tumors. In: Gorlin RI, Goldman HM, eds. Thomas'Oral Pathology. 6lh ed. SI Louis: CV Mosby, 1970: 481-501.2. Calon RB, Fla G, Marble HB jun, Topazian RG. Complex odontoma in lhemaxillary sinus. Oral SlIrg 1973; 36: 658-662.3. Hilchin AD. The aeliology of lhe calcified composile OOOOlomas. Br Dent J1971; 130: 475-482.4. Robbins SL. Pathology. 3rd ed. Philadelphia: WB Saunders, 1969:786.5. Minderjahn A. Incidence and clinical differenrialion of odonrogenic lumours.J Maxillo/aeSllrg 1979; 7: 142-150.6. Dodd GO, Iing B. Radiology 0/ the Nose, Paranasal Sinllses and Nasopharynx.Bahimore: Williams & Wilkins, 1977: 205.7. Goaz PW, While Se. Oral Radiology: Principles and Interpretation. SI Louis:CV Masby, 1982: 463-468.8. Samuel E, Lloyd GAS. Clinical Radiology 0/ the Ear, Nose and Throat. 2nd ed.London: HK Lewis, 1978: 88-89.9. Archer WHo A Manllal o/Oral SlIrgery. 2nd ed. Philadelphia: WB Saunders,1956: 364-367.

Giant complex odontoma of the maxillary antrum

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Giant complex odontoma of the maxillary antrum

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