CASE REPORT Usefulness of cone beam computed tomography for odontogenic myxoma M Araki* ,1,2 , S Kameoka 1 , N Mastumoto 3,4 and K Komiyama 3,4 1 Department of Oral and Maxillofacial Radiology, Nihon University School of Dentistry, Tokyo, Japan; 2 Division of Advanced Dental Treatment, Dental Research Center, Nihon University School of Dentistry, Tokyo, Japan; 3 Department of Pathology, Nihon University School of Dentistry, Tokyo, Japan; 4 Division of Bio-defence, Dental Research Center, Nihon University School of Dentistry, Tokyo, Japan A case of odontogenic myxoma is reported as showing a cyst-like pattern with a partially thick but vague and unclear radiopaque border between the left mandibular second premolar and first molar on rotational panoramic radiography. Internal structure of the lesion displayed radiolucency with a sparse and coarse trabecular pattern. No expansion of bucco-lingual cortical bone was apparent. The radiographic pattern of odontogenic myxoma did not resemble a tennis racket-like or straight, curved and coarse septal appearance on panoramic radiography, but characteristic findings were noted on cone beam CT. Cone beam CT may prove extremely useful in clarifying detailed internal structure and the state of margins. Dentomaxillofacial Radiology (2007) 36, 423–427. doi: 10.1259/dmfr/85361774 Keywords: odontogenic myxoma; rotational panoramic radiography; cone beam computed tomography; cyst-like pattern Introduction Odontogenic myxoma in the jaws is infrequent, accounting for only 3–6% of odontogenic tumours. 1 Generally, odontogenic myxoma is not encapsulated and tends to infiltrate the surrounding bone trabecular space. Aspects of the lesion can look somewhat like a malignant tumour rather than a benign tumour. Thunthy 2 stated that, radio- graphically, the multilocular compartments of odontogenic myxoma differ from those of other lesions in that the compartments tend to be angular and may be separated by straight septa forming either square, rectangular, or triangular spaces. However, the radiographic pattern of odontogenic myxoma is usually seen as fine and straight septa along the margin. Such odontogenic myxomas actually display a variant pattern on radiography, and great care is thus needed for differential diagnosis. A case is reported herein of odontogenic myxoma showing a cyst-like pattern with a partially thick but vague and unclear radiopaque border between the left mandibular second premolar and first molar on rotational panoramic radiography. The difficulties and requirements for differential diagnosis are discussed along with the clinical applications of limited cone beam CT. Case report A 30-year-old man was referred to Nihon University Dental Hospital for detailed examination of a radiolucent lesion displacing the root between the left mandibular second premolar and first molar on rotational panoramic radiogra- phy. The patient had not noticed any swelling or pain in the left buccal gingiva before visiting a dental office for dental treatment. Medical and family history revealed nothing of note. On intraoral examination, the gingiva was normal in colour and no subjective symptoms were present. An electrical dental pulp test revealed that the left mandibular second premolar and first molar were both vital. Clinical laboratory examination yielded normal findings. On radiological examination, rotational panoramic radiography on the first visit showed a cyst-like lesion with a partially thick but vague and unclear radiopaque border between the left mandibular second premolar and first molar, extending from the alveolar ridge to the upper border of the mandibular canal (Figure 1). In particular, the inner side of the border was vague and fusing into the inner structure of the lesion, and the lower margin displayed a weak, scalloped pattern. Internally, the lesion exhibited a sparse and coarse trabecular pattern. Tooth roots of the left mandibular second premolar and first molar were diver- gent. Periapical radiography showed neither a multilocular pattern with straight, sharp septa, nor invasion of bone *Correspondence to: M Araki, Department of Radiology, Nihon University School of Dentistry, 1-8-13 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8310, Japan; E-mail: [email protected] Received 6 June 2006; revised 3 October 2006; accepted 3 November 2006 Dentomaxillofacial Radiology (2007) 36, Dentomaxillofacial Radiology (2007) 36, 423–427 q 2007 The British Institute of Radiology http://dmfr.birjournals.org
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