Clinical Pathological Conference--Compound Odontoma

Wu Cheng-Hsien, Division of Oral & Maxillofacial Surgery,

Department of Dentistry, V.G.H.-Taipei

General Data:

Name: X X
Chart No.: 2935590-6
Ward No.: B10816
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 Rt 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
gender
F-80%

Predominant
age
>30

Predominant
jaw
Mandible
90%

Predominant
region
Toothbearing area
(ant. mand.)

Cementossifying
fibroma

20s, 30s

Mand.
70~80%

Premolarmolar

Odontoma
compound
Odontoma
complex
Ameloblastic
fibroodontoma
AOT

M~F

5-20

Maxilla 62%

F-68%

5-20

Mandible

Incisor;
canine
Molars

M-63%

5-20

Max.~mand.

Premolarmolar

F:M=2:1

16.5

Maxilla 65%

COC

M~F

47%<31

Max.~mand.

95% anterior
of jaws
65% in
canine area
75% anterior
to 1st molar

CEOT

M~F

40,41

Mandible
68%

PCOD

1. Mandibular molar
2. Maxillar
molar;mandi
bular
premolar

Distinguishing
features

Vital teeth;
circulra; size
<1cm; welldefined with
RL rim
Circular; 25cm; welldefined;
solitary
RL+RO
RL+RO
( patterless)

Pericoronal
RL-75%;
often RO foci
Viscous
yellow
aspirate
At least 52%
associated
with
unerupted
teeth

Odontoma
General features:
Mixed odontogenic tumor; epithelial and mesenchymal origin
of harmatoma

A kind

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-- 1 st 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 2 nd 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