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Clinical Pathological Conference Compound Odontoma

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Clinical Pathological Conference Compound Odontoma Powered By Docstoc
					Clinical Pathological Conference---
       Compound Odontoma


   Wu Cheng-Hsien, Division of Oral & Maxillofacial Surgery,
   Department of Dentistry, V.G.H.-Taipei
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:
• Refer from LDC for removal of radiopaque lesion over
  R’t lower mandibular region.
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:
• General: DM(-) , HTN(-) , Heart disease (-)
• Allergies: food and drug(-)
• Trauma: significant injuries (-), blood transfusion (-)
Social and Personal History:
       Tobacco: Nil
       Alcohol: Nil
       Betel quid chewing: Nil
Family History:
• Family lipoma history , and now there is a lipoma over his right
  arm.
Review of Systems:
• No specific finding
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         Predominant   Predominant   Predominant   Predominant    Distinguishing
               gender        age           jaw           region         features
PCOD           F-80%         >30           Mandible      Tooth-         Vital teeth;
                                           90%           bearing area   circulra; size
                                                         (ant. mand.)   <1cm; well-
                                                                        defined with
                                                                        RL rim
Cementossi-    F             20s, 30s      Mand.         Premolar-      Circular; 2-
fying                                      70~80%        molar          5cm; well-
fibroma                                                                 defined;
                                                                        solitary
Odontoma       M~F           5-20          Maxilla 62%   Incisor;       RL+RO
compound                                                 canine
Odontoma       F-68%         5-20          Mandible      Molars         RL+RO
complex                                                                 ( patterless)
Ameloblastic   M-63%         5-20          Max.~mand.    Premolar-
fibroodonto-                                             molar
ma
AOT            F:M=2:1       16.5          Maxilla 65%   95% anterior   Pericoronal
                                                         of jaws        RL-75%;
                                                         65% in         often RO foci
                                                         canine area
COC            M~F           47%<31        Max.~mand.    75% anterior   Viscous
                                                         to 1st molar   yellow
                                                                        aspirate
CEOT           M~F           40,41         Mandible      1. Mandibu-    At least 52%
                                           68%           lar molar      associated
                                                         2. Maxillar    with
                                                         molar;mandi    unerupted
                                                         bular          teeth
                                                         premolar
                       Odontoma
• General features:
 Mixed odontogenic tumor; epithelial and mesenchymal origin
 A kind of harmatoma
• Etiology:
  Result from an extraneous bud of odontogenic epithelial cells
   from the dental lamina
• Epidemiology:
 The most common odontogenic tumor(67%); Compound>
   Complex(2:1)>      ameloblastic odontoma>     ameloblastic
   fibroodontoma
• Age:
 Occur in the 2nd decade of life (most common in childen and
  young adults)
• Sex:
  M~F (68% of the complex type occur in women)
• Site:
  Compound---incisor-canine area of the maxilla; Complex-- 1st
  and 2nd molar of the mandible
• Size: 1-3cm
• Progress: Non-aggressive
• Symptoms:
  Delayed eruption of permanent tooth
            Ameloblastic odontoma (AO;
              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 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