Large complex composite odontoma

LARGE

COMPLEX

COMPOSITE

ODONTOMA

Report of a Case G. T. Simon, L.D.S., S.M.F.,” Vellow, South India

rind Kichard

Department of Den.tal and Oral Swgwy,

Christian

G. Topazian,

B.A., D.D.S.,“’

zHeaical College and Hospital

are tumors of odontogenic origin in which dentine and enamel are by epithelial and mesenchymal cells. Histodifferentiation of the ameloblasts and odontoblasts is normal but, because of poor morphodifferentiation, their end products arc characterized by bizarre structural arrangements. Two common kinds of odontoma, which are called composite because of the presence of more than one tissue type, may be distinguished1 : DONTOMAS

0 produced

1. Compound composite odontomas. These are odontomas in which the enamel and dentine are laid down in such a manner that the structures bear considerable anatomic resemblance to normal teeth, except that they are often smaller than typical teeth. 3. Complex composite odontomas. These are odontomas in which the calcified dental tissues are essentially an irregular mass bearing little morphologic similarity to even rudimentary teeth. Large complex authors.2, 3 The possibility of large odontomas mize the possibility

‘composite

odontomas

have

been

reported

by

several

that pathologic fracture may occur at the time of removal must be considered. Precautions should be taken to miniof fracture and to treat the fracture, should it occur.

CASE REPORT A 30-year-old South Indian man was seen in the Department of Dental and Surgery, Christian Medical College Hospital, on July 6, 1960, complaining of a swelling the ramus of the right mandible with a discharging sinus near the angle.

Oral over

History of Presed Illness.-The patient had noticed a small swelling around the lower right third molar six months previously. Initially the swelling was not tender. It gradually increased in size until the entire ascending ramus was involved. Three months later the swelling became painful. At that time the patient was treated at a hospital, where fifteen injections (the nature of which is not known) resulted in moderate relief of pain and re Shortly after completion of the series of injections, the duction in the size of the swelling. *Demonstrator in Dental Surmx~. **Assistant Professor of Dental Surgery. 911

!)I?

SI.1JOS

.\SI)

'l'Ol'.\%f.\.\

,.",lJZl &,*I. \ss&~:.,. PI,.>

welling reCurred. The paticnr \!il:: giv<,Il furl11(-1 ~II,J,s,.~ 1~~18.1,~ :, I,ri\.:d*: i,,:rG,lit ior)fi). i81i!. lhc: pailL and swelling vorltinuc*~l ilwtr:tltvl. >\ rlloutll bcforc he ,‘ar,,i’ to tIci* i’hriStiurl Mc~cliv:~t (‘
Fig.

1.

Fig.

2.

oblique roentgenogram of the right mandible, disclosing a large Fig. l.- -Lateral The tumor is in close relation most of the ascending ramus. paqu e maSS occupying third molar. There is evidence of infection about the margins roots of the erupted turn0 1‘. roentgenogram of the mandible, disclosing a large discrete Fig. 2.- -Posteroanterior

t’,”tdio-

Of ::: tu1

Th6 ? s mall Fig. 3.- -Lateral aspect of the gross specimen, which weighed 20 grams. Of the contained soft tissue and communicated with the interior open] ings on the surface defect resulted from removal of a piece of tumor for biops Y. turn0 1‘. The wedge-shaped

Fig.

Y. These proba tbly

site r)f pathol~ TX it’ bontx. upicd almost. thirll molar.

LARGE

COMPLEX

COMPOSITE Fig.

defect

ODONTOMA

915

6.

Fig. 7. six months postoperatively. 6.-Lateral oblique roentgenogram taken is almost completely Alled with bone. with little evidence of fracture. Fig. 7.-Posteroanterior roentgenopram of the mandible showing obliteration defect on the right six months after operation.

Fig.

bony

The

bony of

the

Impression

: Complex composite odontoma. Course.-There was moderate smelling of the tissues over the operative site. This gradually decreased after the third day. On the day following the operation intermaxillary elastics were placed for fixation and immobilization. The drainage tube was removed after forty-eight hours, and the sutures were removed on the fifth postoperative day. On the seventh postoperative day the elastics were replaced with wire, dietary instructions were given, and the patient was discharged with instructions to visit the outpatient clinic \I-eekly. Roentgenograms taken on July 21, 1960, disclosed the fragments at the fracture site in good position, with the teeth wired in occlusion (Fig. 5). Eight weeks after the pat.ient’s discharge from the hospital the intermaxillary wires were removed. One lvcek later function was found to be good, with no evidence of rualoc-

Postoperative

elusion.

The patient was seen again disclosed almost complete filling-in

on Jan. 12, 1961. of the defect with

Rocntgcuograms

bone (Figs.

taken

6 anti 7 ).

on

that

date

KEFERENCES

A\ Textbook of Oral Pathology, Phila, 1%‘. G., Hine, N. K., and Levy, H. M.: delphia, 1958, TV. R. Saunders Company, p. 199. 2. Thoma, K. H.: Oral Surgery, ed. 2, St. Louis, 1952, The C. V. Nosby (‘ompany, p. 13.?7. lhe Maxilla and Mnxillarp 3. Christensen, R. IV:.: Complex Composite Odontoma involving Sinus, ORAL SURG., ORAL MED. & ORAT, PATH. 9: 1136, 1936. 1. Shafer,