Central ossifying myxofibroma of the maxilla

CENTRAL

OSSIFYING

MYXOFIBROMA

OF

THE

MAXILLA

F

IBROMAS arising from within t,he mandible or maxilla are relatively rare. It is for that reason that t,his case is reported. According to Thornal and Stones,2 cent,ral fibromas may arise from the mesenchymal portion of the t,ooth germ or a periodontal membrane. According to Thornal central fibromas may also develop into cementotnas or ossifpin g fibromas depending on whether the cells comprising the tumor differentiate into ccmentoblasts or osteoblasts.

Ilistmy--,\

Negro

aged at tlw Dental (Xnic, Charity 4, I!JRL. Thv pati(lnt first, noticed :I lump in thus maxillary aspwt almut two ywrs prwiously. Thp lesion grew slowly

wonmn,

of New Orleans, on Aug. molar area on the boccal not painful.

@>iR. I.--Clinical

Case Report 27, was first Ron

appearance

of maxillary

About one month beforcb second bicuspid and the first The histopathologic examination

the

tumor with the bone in the bicuspid

obvious molar

bulging area.

of

the

Hospital left first and was

alveolar

anil

thcl patient \\-iLs swu at Charity Hospital the nvaxillary molar WPI’C cstractrd and a biopsy of the, tumor wxs doomed chronic inflammatory tissue.

left dons.

The opinions exprxssed in this articlr (lo not reflect the views of the 1Jnited States Naval Corps. *Assistant Pwfrssor of Oral Surgwy, Loyola School of Dentistry, New Orleans, La. (on military leave). Presently, Lieutenant (junior grade), Dental Corps, United States Naval Reserve; Oral Surgeon and Member of Maxillofacial Surgical Team, United States Naval Hospital. Camp Pendleton, Calif. **Associate Professor of Pathology, Loyola School of Dentistry, New Orleans, ~,a. Dental

914

CENTRAL

OSSIFYING

MYXOFIBROMA

OF

945

MAXILLA

Eza7nination.-Clinical examination of the oral cavity disclosed a large bulging mass about 3 cm. from the maxillary left first premolar to the left second molar (Fig. 1). The bulge was confined to the buccal aspect of the alveolar process. The mass was very hard indicating bone displacement. The mucosa covering the tumor was normal in color and texture, with no ulceration. Radiologic examination revealed extensive expansion and infiltration of the maxilla by a radiolucent process from the first bicuspid distally to the second molar and superiorly to the floor of the maxillary sinus (Figs. 2 and 3).

Fig. S.-Dental radiograph of the ossifying bony trabeculations within the involves the maxillary sinus.

Fig.

S.-An

occlusal

fllm

tumor lesion.

showing the The superior

was used for this projection lesion and the surrounding

areas of extension

which gives structures.

radiolucency and the of the lesion almost

another

perspective

of the

9 deep biopsy was done by reflecting a large, soft, tissue flap and removing some a representative piece of the white, of the paper thin bone over the tumor with a large curette; soft, homogenous tissue was sent to the pathology department for histopathologic examination. The diagnosis of central ossifying myxofibroma of the maxilla was returned. This diagnosis was compatible with the clinical history and appearance of a benign tumor. The lesion was slow growing and was confined within the bony cortices. If it had

946

it n

01 0

Fig.

4.

Fig.

5.

Fig.

6.

Figs. 4 na. The Fig. 6.osteocytt

in

:oi

diff

.te

CENTRAI,

OSSIFYING

been malignant in all probability bone cortex and mucosa covering they come in contact.

MYXOFIBROMA

there would it. Malignant

OF

947

MAXILLA

have been ulceration due to destruction tumors have no regard for tissues with

of the which

AistopathoZogy.-The tumor was composed of loosely arranged fibrocytes widely separated from one another in a mucoid stroma. Collagen fibers were present but they were In some sections of the tumor there widely separated and not hyalinized (Figs. 4 and 5). were bone trabeculae where the connective tissue cells had differentiated into osteocytes (Fig. 6). All cells were adult, well differentiated, and presented no evidence of malignancy. These findings are compatible with a diagnosis of ldrntral ossifying myofibroma. Treatment.Preoperative and Kline tests, trrramycin (500 procedure.

: A complete blood count, hemoglobin, clotting and bleeding time, Kahn and urinalysis were within normal limits. Prophylactic measures included mg. every 6 hours) whicah was start4 twrnty-four hours before the surgic*al

Operative : Operation was performed Aug. 14, 1951, under thesia. The upper left first bicuspid and second molar teeth were incision was made at the mesial point of the left cuspid tooth and The mucoperiosteum was reflected superiorly from the alveolar mass, The bulk of the bony covering was removed with a rongeur It was found that soft tissue was enucleated with currettes.

Fig.

tumor, sinus. volving remove,

7.-Postoperative

view

one teeth

month after surgery, had been removed

the with

nasal endotracheal anrsThen a vertical extracted. posterior to the tuberosity. bone to expose the bony forceps and the fibromatous during the removal of the

first premolar the tumor.

and

the

second

molar

while approximating the antral floor, a few small perforations had I)rc~ matle into the TO be as sure as possible that all remnants of tile tumor were removed, a slowly repear-shaped acrylic bur was used to cover the bony extensions of the mass and thus in addition to the tumor remnants, a small amount of contiguous bone. Gelfoam was laid over the small antral perforations and placed loosely into the bony defect as a space obliterator. The soft tissues were approximated ant1 closc~l with interrupted 000 black silk suture. Postoperative : The patient’s terramycin therapy was continued along with ice bags the first five hours to control swelling, sedation, analgesics, and forced fluids. There was no clinical evidence of hemorrhage through the antral perforations as indicated by the absence