Treatment of a calcifying epithelial odontogenic tumour with tube decompression: a case report

doi:10.1016/j.bjoms.2018.11.008

British Journal of Oral and Maxillofacial Surgery

Volume 56, Issue 10, December 2018, Pages 979-981

https://doi.org/10.1016/j.bjoms.2018.11.008 Get rights and content

Abstract

Conservative treatment of odontogenic tumours with decompression or marsupialisation is not common, but can be done successfully in those with a cystic pattern. We present a calcifying epithelial odontogenic tumour that was treated by tube decompression and subsequent enucleation.

Introduction

Calcifying epithelial odontogenic tumour is a relatively rare lesion that is seen predominantly in the mandible.¹ It is characterised by secretion of an odontogenic amyloid protein into the stroma, and over time, this protein will gradually become calcified.¹ Small tumours are managed conservatively with curettage and enucleation (with the removal of the thin layer of bone surrounding the lesion).² however, advanced surgical approaches such as segmental and marginal resections are used in larger and more aggressive lesions.³

We report a case of a calcifying epithelial odontogenic tumour that was treated with decompression, with a saline cuff used as a tube for irrigation.

Section snippets

Case report

A 35-year-old man was referred to the clinic for a routine oral examination. Panoramic radiographs showed a multilocular, radiolucent lesion in the left molar region that involved the roots of all the molar teeth with mandibular cortical expansion (Fig. 1). His medical history was not helpful.

The third molar was extracted and an incisional biopsy specimen taken under local anaesthesia (articaine hydrochloride 40 mg/ml, adrenaline hydrochloride 0.012 mg/ml). The length of a saline cuff (Fig. 2)

Discussion

Cystic epithelium may be the primary characteristic and main histological component of a calcifying epithelial odontogenic tumour, which presents as a unilocular cystic lesion on radiography.⁴ Azevedo et al⁵ reported that three of their 19 cases showed cystic epithelium associated with the solid tumour. It is debatable whether the growth of the lesion shows a cystic pattern, or if cystic degeneration occurs in the tumour when the proliferation reaches a peak level.⁴ In our patient there was a

Conflict of interest

We have no conflicts of interest.

Ethics statement/confirmation of patient’s permisson

No ethics approval was needed.The patient’s written permission was obtained.

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There are more references available in the full text version of this article.

Cited by (5)

A custom-made removable appliance for the decompression of odontogenic cysts fabricated using a digital workflow
2022, Journal of Dentistry
Citation Excerpt :
Castro-Núñez et al. described an innovative method for applying negative pressure during the decompression of odontogenic cysts [19]. Urethral catheters, intravenous administration sets, nasogastric tubes, Luer syringes, dual nasal trumpet stents, and saline cuffs may also be converted for decompression [20–25]. Orthodontic brackets may be used to attach the tube to neighboring teeth [26].
This case series aimed to assess the feasibility of a custom-made decompression appliance fabricated using a digital workflow to decompress odontogenic cysts. Additionally, the treated cysts were assessed for volumetric changes.
A three-dimensional (3D) reconstruction software (CoDiagnostiX version 10.4) was used to obtain the master cast STL (Standard Tessellation Language) file by placing a customized virtual implant to create a recess for the tube of the decompression device. The decompression appliance was planned using Dental Wings Open Software (DWOS). Following rapid prototyping, the tube of the appliance was perforated using round burs. In cases where the appliances were designed to replace teeth, denture teeth were added using the conventional workflow. The appliances were delivered on the day of the cystostomy. Following decompression, cyst enucleation was performed. Cyst volume was assessed by manual segmentation of pre- and post-operative cone-beam computed tomography (CBCT) reconstructions using slice-by-slice boundary drawing with a scissors tool in the 3DSlicer 4.10.2 software. Percentage of volume reduction was calculated as follows: volume reduction/pre-operative volume × 100.
Six odontogenic cysts in six patients (5 male, 1 female; age 40 years, range: 15–49 years) with a pre- and post-operative cyst volume of 5597 ± 3983 mm³ and 2330 ± 1860 mm³ respectively (p < 0.05) were treated. Percentage of volume reduction was 58.84 ± 13.22 % following a 6-month-long decompression period.
The digital workflow described in this case series enables the delivery of decompression appliances at the time of cystostomy, thus effectively reducing the volume of odontogenic cysts. The resulting bone formation established a safe zone around the anatomical landmarks; therefore, during enucleation surgery, complications to these landmarks can be avoided.
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Enucleation is the dissection of an intraosseous cavity [19], having an esthetic priority, as radical treatment may result in significant esthetic, functional, and psychological sequelae that necessitate a reconstruction procedure to restore the patient’s quality of life [1]. Gülşen et al. [20] reported a case of a calcifying epithelial odontogenic tumour that was treated successfully with decompression, accompanied with a saline cuff as a tube for irrigation. A surgical stent is a device used to apply pressure on the soft tissues to facilitate healing and prevent cicatrization or collapse by providing support for the anastomosed structures [21].
Ameloblastoma is a benign neoplasm of odontogenic origin with local invasive characteristics and a high recurrence rate. It compromised 1% of the jaw's cysts and tumors with only 10–15% in children.
A 14-year-old boy sought treatment for a painless swelling involving the right side of the face started one year ago. The intra-oral examination displayed a firm mass associated with 46, 47 teeth, and the angle of the mandible. The radiographic examination revealed a large well-defined homogeneous radiolucency extending from the 46 region to involve the angle and extending towards the coronoid and condylar processes. An incisional biopsy confirmed the diagnosis of unicystic ameloblastoma. Treatment was planned according to the patient’s age: Phase I: Surgical enucleation. Phase II: Construction and insertion of a surgical stent. Phase III: Construction of a transitional acrylic Kennedy class II partial denture. Phase IV: the patient is scheduled for a definitive implant-supported prosthesis at 18 years old.
The management of ameloblastoma is influenced by the age of the patient, the extension, duration, and position of the lesion, and the histopathological variants. Several authors recommended enucleation as a conservative treatment approach to eliminate the esthetical, functional, and psychological squeals associated with the radical approach. The use of a surgical stent protects the enucleated cavity and promote tissue healing.
Enucleation and subsequent surgical stent not only eliminates the disease, but also preserves the bone structure, prevents the facial disfigurement, and significantly improve the patient’s esthetic, mastication, oral health, and quality of life.
Conservative treatment of a unicystic ameloblastoma by marsupialization with a favorable response: A case report and review of the literature
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Two-dimensional change in the cystic defects after decompression and enucleation of jaw cysts-A comparative study
2021, Annals of Maxillofacial Surgery
Conservative decompression management with functional appliance in pediatric plexiform ameloblastoma
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Short communicationTreatment of a calcifying epithelial odontogenic tumour with tube decompression: a case report

Abstract

Introduction

Section snippets

Case report

Discussion

Conflict of interest

Ethics statement/confirmation of patient’s permisson

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Oral Surg Oral Med Oral Pathol Oral Radiol

Am J Orthod Dentofacial Orthop

J Oral Maxillofac Surg

Br J Oral Maxillofac Surg

Short communication
Treatment of a calcifying epithelial odontogenic tumour with tube decompression: a case report