Management of Large Odontoma in Mandible: A Rare Case Report
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Abstract
Odontomas are considered to be developmental anomalies (hamartomas), rather than true neoplasm, composing of both epithelial cells and mesenchymal dental hard tissues. The prevalence is up to 20.1 %, regarded as the second most common tumor occurring in the oral cavity. Based on pathological conditions, Odontomas are classified into two types, compound odontomas and complex odontomas. This study investigates the case of a 19-year-old Thai female who was referred to the department of oral and maxillofacial surgery at Chiangmai University and presented with a swollen right cheek that happened gradually. Without any symptoms, the tumor was accidentally detected from a radiograph during orthodontic treatment in a private clinic. The patient’s past medical history showed no underlying disease or drug allergy. The clinical examination revealed facial asymmetry with swelling present on the right buccal area, normal skin texture, no tenderness, and no abnormal sensation. Intraorally, a bony-hard swelling of the right mandible from distal of the mandibular right second molar to the ramus of mandible, mandibular right third molar was clinical missing.
The panoramic radiograph exhibited a unilocular nonhomologous radiopaque lesion with a well-defined margin, and the lesion expanded its border to the right mandible. The inferior alveolar canal and the mandibular right third molar were displaced inferiorly to the inferior border of the mandible. An incisional biopsy was performed under local anesthesia and the diagnosis showed it was complex odontoma. The Odontoma was enucleated by extraoral approach. After the lesion had been removed, internal fixation was done using a reconstruction plate.The patient had no pain or postoperative paresthesia during a 12-month follow-up period. Removing the reconstruction plate was carried out 18 months after the surgery. The patient was sent back to continue orthodontic treatment. In conclusion, this case is a rare incidence of large Odontomas at the right angle of the mandible. Despite their large size, conservative treatment with reconstruction plate to prevent pathologic fracture yielded satisfactory results, consistent with other studies in previous literature.
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References
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