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Erupting complex odontoma
Erupting complex odontoma Background.—Odontomas are the most common type of odontogenic cyst. These are hamartomas composed of various dental tissues that grow slowly, are benign, and behave in a nonaggressive manner. Complex odontomas have calcified tissues present in an irregular mass that is mainly mature tubular dentin. Compound odontomas bear a superficial anatomic resemblance to rudimentary teeth. Odontoma eruption in the oral cavity is rare, and complex odontomas are less common than compound tumors. A complex odontoma was erupted in the right mandibular third molar area. Case Report.—Man, 23, came for treatment of a painful swelling on the right side of his lower jaw. The lesion had been present for 2 weeks. Gross facial asymmetry with diffuse smooth swelling in the right mandibular angle region was noted, with an apparent absence of the right mandibular third molar and a lesion in the alveolar mucosa that was exuding pus. Both the buccal and the lingual cortices were expanded and hard. Diagnostic considerations included pericoronal abscess and infected odontogenic cyst (dentigerous cyst) associated with an impacted third molar. Intraoral periapical and panoramic radiographs were scheduled, but the patient did not return for them. Eight months later, the patient reported with the same painful area, although the swelling was no greater than previously. On intraoral examination, a whitish yellow hard mass that resembled dentin and measured 3 cm mesiodistally and 2 cm buccolingually was found (Fig 2). The panoramic radiograph revealed a uniformly dense round radiopacity distal to the mandibular right second molar that was positioned over the coronal part of the mandibular right third molar. The molar had become displaced distoinferiorly (Fig 3). In the superior area the radiopacity erupted into the oral cavity. The rest of the lesion was surrounded by a uniform, well-defined radiolucent halo. An inferior displacement of the right mandibular canal was also noted. Infected erupting complex odontoma was diagnosed based on the clinical and radiographic findings. The patient was given general anesthesia, then the mass was accessed via an intraoral approach. The mass and the impacted tooth were excised. Histopathologic evaluation confirmed it was a complex odontoma. Discussion.—The patient had an infected mature complex odontoma that formed at the site of the mandibular
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right third molar and displaced the canal. Such lesions are often mistaken radiographically for other tumors. The eruption occurred quickly, which is unusual for oral odontomas.
Fig 2.—Clinical photograph showing the odontoma erupting in the oral cavity and impaction of the third molar. (Courtesy of Vengal M, Arora H, Ghosh S, et al: Large erupting complex odontoma: A case report. J Can Dent Assoc 73:169-172, 2007.)
Fig 3.—Panoramic radiograph showing the erupting odontoma and the impacted third molar, which was displaced to the distoinferior region of the angle of the mandible. (Courtesy of Vengal M, Arora H, Ghosh S, et al: Large erupting complex odontoma: A case report. J Can Dent Assoc 73:169-172, 2007.)
Clinical Significance.—While relatively common, the case of complex odontoma presented here is unique in its size of mass, the distortion it produced, and the rapidity of its onset.
Vengal M, Arora H, Ghosh S, et al: Large erupting complex odontoma: A case report. J Can Dent Assoc 73:169-172, 2007 Reprints available from M Vengal, Dept of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal, Karnataka – 576104, India; e-mail: [email protected]
Oral and Maxillofacial Surgery Aspiration of an impacted lower third molar Background.—Patients can aspirate teeth, dental prostheses, and other foreign bodies as a consequence of maxillofacial trauma or during dental treatment. The resulting symptoms range from minimal to life threatening. A highly unusual case of aspiration of an impacted mandibular third molar during surgical removal was reported. Case Report.—Man, 23, was seen for the surgical removal of a mesioangular, asymptomatic, partially impacted lower left third molar under local anesthesia. A bucco-distal triangular flap approach was used, with mesio-bucco-distal bone guttering and angular sectioning of the crown’s mesial half. A straight elevator was being used to elevate the tooth from the mesiobuccal direction when the patient’s gag reflex was stimulated. Initially stiffness was observed, then the elevated tooth was dramatically released and disappeared. The surgeon immediately searched the socket, soft tissues, suction apparatus, and surgical packs without finding the tooth. The patient had a very mild cough. He was unable to verify if the tooth had been swallowed or aspirated. The patient was referred for radiologic imaging to locate the tooth. Chest plain x-rays revealed a small radiopaque shadow in the right bronchial tree. Computed tomography of the chest showed a tooth shadow in the right bronchus, confirming that the tooth had been aspirated. The tooth was removed from the right middle bronchus using a hard bronchoscopy and general anesthesia. The patient was given preoperative steroids and antibiotics to address edema and infection. The patient’s recovery was without further incident. The cough resolved the day after the endoscopy.
Discussion.—In this unusual case, the patient experienced a sudden gag reflex provoked by the suction tip during elevation of the tooth to be removed. Transient apnea and immediate closure of the glottis occurred, followed by laryngeal opening to permit inspiration. The tooth was simultaneously forced through the opened larynx and into the right bronchus. The patient suffered only a mild cough as a result. Other patients have developed severe airway compromise or total obstruction when the foreign body is larger. Radiographic assessment was helpful in diagnosing aspiration, but computed tomography confirmed the tooth’s presence in the right bronchus.
Clinical Significance.—Whenever an avulsed or extracted tooth, or part of a tooth, cannot be found, suspect aspiration or ingestion. Early diagnosis and management are essential. Bronchoscopy would be the favored method of removal.
Elgazzar RF, Abdelhady AI, Sadakah AA: Aspiration of an impacted lower third molar during its surgical removal under local anesthesia. Int J Oral Maxillofac Surg 36:362-364, 2007 Reprints available from RF Elgazzar, Dept of Oral and Maxillofacial Surgery, College of Dentistry, King Faisal Univ, Dammam, PB 1982, PC 31441, KSA, Saudi Arabia; fax: 966 3857 2624; e-mail: reda_ [email protected], [email protected]
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Dental Abstracts
right third molar and displaced the canal. Such lesions are often mistaken radiographically for other tumors. The eruption occurred quickly, which is unusual for oral odontomas.
Fig 2.—Clinical photograph showing the odontoma erupting in the oral cavity and impaction of the third molar. (Courtesy of Vengal M, Arora H, Ghosh S, et al: Large erupting complex odontoma: A case report. J Can Dent Assoc 73:169-172, 2007.)
Fig 3.—Panoramic radiograph showing the erupting odontoma and the impacted third molar, which was displaced to the distoinferior region of the angle of the mandible. (Courtesy of Vengal M, Arora H, Ghosh S, et al: Large erupting complex odontoma: A case report. J Can Dent Assoc 73:169-172, 2007.)
Clinical Significance.—While relatively common, the case of complex odontoma presented here is unique in its size of mass, the distortion it produced, and the rapidity of its onset.
Vengal M, Arora H, Ghosh S, et al: Large erupting complex odontoma: A case report. J Can Dent Assoc 73:169-172, 2007 Reprints available from M Vengal, Dept of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal, Karnataka – 576104, India; e-mail: [email protected]
Oral and Maxillofacial Surgery Aspiration of an impacted lower third molar Background.—Patients can aspirate teeth, dental prostheses, and other foreign bodies as a consequence of maxillofacial trauma or during dental treatment. The resulting symptoms range from minimal to life threatening. A highly unusual case of aspiration of an impacted mandibular third molar during surgical removal was reported. Case Report.—Man, 23, was seen for the surgical removal of a mesioangular, asymptomatic, partially impacted lower left third molar under local anesthesia. A bucco-distal triangular flap approach was used, with mesio-bucco-distal bone guttering and angular sectioning of the crown’s mesial half. A straight elevator was being used to elevate the tooth from the mesiobuccal direction when the patient’s gag reflex was stimulated. Initially stiffness was observed, then the elevated tooth was dramatically released and disappeared. The surgeon immediately searched the socket, soft tissues, suction apparatus, and surgical packs without finding the tooth. The patient had a very mild cough. He was unable to verify if the tooth had been swallowed or aspirated. The patient was referred for radiologic imaging to locate the tooth. Chest plain x-rays revealed a small radiopaque shadow in the right bronchial tree. Computed tomography of the chest showed a tooth shadow in the right bronchus, confirming that the tooth had been aspirated. The tooth was removed from the right middle bronchus using a hard bronchoscopy and general anesthesia. The patient was given preoperative steroids and antibiotics to address edema and infection. The patient’s recovery was without further incident. The cough resolved the day after the endoscopy.
Discussion.—In this unusual case, the patient experienced a sudden gag reflex provoked by the suction tip during elevation of the tooth to be removed. Transient apnea and immediate closure of the glottis occurred, followed by laryngeal opening to permit inspiration. The tooth was simultaneously forced through the opened larynx and into the right bronchus. The patient suffered only a mild cough as a result. Other patients have developed severe airway compromise or total obstruction when the foreign body is larger. Radiographic assessment was helpful in diagnosing aspiration, but computed tomography confirmed the tooth’s presence in the right bronchus.
Clinical Significance.—Whenever an avulsed or extracted tooth, or part of a tooth, cannot be found, suspect aspiration or ingestion. Early diagnosis and management are essential. Bronchoscopy would be the favored method of removal.
Elgazzar RF, Abdelhady AI, Sadakah AA: Aspiration of an impacted lower third molar during its surgical removal under local anesthesia. Int J Oral Maxillofac Surg 36:362-364, 2007 Reprints available from RF Elgazzar, Dept of Oral and Maxillofacial Surgery, College of Dentistry, King Faisal Univ, Dammam, PB 1982, PC 31441, KSA, Saudi Arabia; fax: 966 3857 2624; e-mail: reda_ [email protected], [email protected]
Volume 53
Issue 1
2008
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