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Clinical Pathological Conference---Clinical Pathological Conference---Compound OdontomaCompound Odontoma
Wu Cheng-Hsien, Division of Oral & Maxillofacial Surgery, Department of Dentistry, V.G.H.-Taipei
General Data:General Data:• Name: 高 X X • Chart No.: 2935590-6• Ward No.: B108–16 • Sex: Male• Birthday: 74/02/08 • Marital status: Single• Date of admission: 89/06/19 • Occupation: Student
Chief Complaint:Chief Complaint:
• Refer from LDC for removal of radiopaque lesion over R’t lower mandibular region.
History of Present Illness:History of Present Illness: • According to the statement of this 15 y/o boy, a few
days ago , he went to LDC for regular dental check-up and scaling. The Dr. take the apical film & found this odontoma and suggested him to visit VGH OS OPD for help. So he admitted our ward B108-16 for surgery intervention for odontoma removal under GA.
Past Medical/Dental History:Past Medical/Dental History:• General: DM(-) , HTN(-) , Heart disease (-)• Allergies: food and drug(-)• Trauma: significant injuries (-), blood transfusion (-)
Social and Personal History:Social and Personal History:Tobacco: NilAlcohol: NilBetel quid chewing: Nil
Family History:Family History:
• Family lipoma history , and now there is a lipoma over his right arm.
Review of Systems:Review of Systems:• No specific finding
OMS condition:OMS condition:• Extraoral: No facial asymmetry No LAP• Intraoral: retained deciduous tooth: 83• Pano. Finding: >Impaction:18,28,38,48 >A well-defined radiopaque-radiolucent lesion
with radiolucent encapsulation about 1.5x1.5cm over 42-45 apical area
>33: ectopic eruption
Mixed Radiolucent-Radiopaque Lesions
Entity Predominantgender
Predominantage
Predominantjaw
Predominantregion
Distinguishingfeatures
PCOD F-80% >30 Mandible90%
Tooth-bearing area(ant. mand.)
Vital teeth;circulra; size<1cm; well-defined withRL rim
Cementossi-fyingfibroma
F 20s, 30s Mand.70~80%
Premolar-molar
Circular; 2-5cm; well-defined;solitary
Odontomacompound
M~F 5-20 Maxilla 62% Incisor;canine
RL+RO
Odontomacomplex
F-68% 5-20 Mandible Molars RL+RO( patterless)
Ameloblasticfibroodonto-ma
M-63% 5-20 Max.~mand. Premolar-molar
AOT F:M=2:1 16.5 Maxilla 65% 95% anteriorof jaws65% incanine area
PericoronalRL-75%;often RO foci
COC M~F 47%<31 Max.~mand. 75% anteriorto 1st molar
Viscousyellowaspirate
CEOT M~F 40,41 Mandible68%
1. Mandibu-lar molar2. Maxillarmolar;mandibularpremolar
At least 52%associatedwithuneruptedteeth
Odontoma Odontoma
• General features:General features: Mixed odontogenic tumor; epithelial and mesenchymal origin
A kind of harmatoma • Etiology:Etiology: Result from an extraneous bud of odontogenic epithelial cells
from the dental lamina• Epidemiology:Epidemiology: The most common odontogenic tumor(67%); Compound>
Complex(2:1)> ameloblastic odontoma> ameloblastic fibroodontoma
• Age:Age: Occur in the 2nd decade of life (most common in childen and
young adults)
• Sex:Sex: M~F (68% of the complex type occur in women)
• Site:Site: Compound---incisor-canine area of the maxilla; Complex-- 1st
and 2nd molar of the mandible
• Size: Size: 1-3cm
• Progress: Progress: Non-aggressive
• Symptoms:Symptoms:
Delayed eruption of permanent tooth
Ameloblastic odontoma (AO; Ameloblastic odontoma (AO; odontoameloblastoma)odontoameloblastoma)
• Simultaneous occurence of an ameloblastoma and complex odontoma
• Clinical similarities to both the odontoma (age at time of diagnosis) and ameloblastoma (location, expansion and recurrent rate)
• aggressive; rare; benign• More often in children early in the 2nd decade of life; ♂>♀;
mandible>maxilla• Bony expansion; cortex destruction; teeth displacement; mild
pain
Ameloblastic FibroodontomaAmeloblastic Fibroodontoma
• Contain cords & nests of odontogenic epithelium & some calcified odontogenic tissue in a myxomatous stroma
• benign, well-capsulated• ♂>♀; most often in the first two decades of life• mandible>maxilla; most in the premolar-molar area• pericoronal to an imbedded tooth• radiolucent-->radiolucent-radiopaque• D.D.: COC; AOT; CEOT; odontoma• Management: surgical enucleated