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Tumor Discovery Odontogenic myxofibroma arising in a child with long-term follow-up

(55.3%), which is consistent with previous reports. adult cases, conservative treatment was applied in only
4,8
However, among children ≤10 years of age, 5 (62.5%) 20 cases (52.6%), suggesting that conservative surgery
were boys and 3 (37.5%) were girls, highlighting a slight was more commonly performed in children than in
preponderance of male patients. In general, the lesions adults. In this case study, we performed enucleation and
invade into the alveolar bone and are often accompanied curettage, considering the site of origin, age, growth, and
by root resorption and deviation of adjacent teeth. Only post-operative appearance. The patient had been well
three cases (6.5%), including our own, were reported to without recurrence for 14 years since the surgery. Until
be localized in the mandibular angle and not associated now, there have been no functional or aesthetic issues
with teeth. reported by the patient.

Differential diagnoses include ameloblastoma, myxoid Odontogenic myxofibromas may show invasive growth
nerve sheath tumors, chondromyxoid fibroma, low- into bone, and there are reports of recurrence in 9.5% of
grade myxofibrosarcoma, and osteosarcoma. Among patients over 3 years of follow-up. In children, 20% of
9
8,52
them, differentiation from malignancy is of significant myxomas and myxofibromas in patients under 16 years
clinical relevance. The radiographic and CT findings in of age recurred within 1 year after surgery. There were
7
myxofibromas are often uni- or multi-locular radiolucent no reports of recurrence among the 46 Japanese cases we
images showing unclear borders, and the cortical bone analyzed. However, the mean post-operative observation
around the lesion is usually bulging and thinning. period of the 45 patients, excluding our own case, was only
47
In the present case, the radiographic and CT images 2 years and 3 months (ranging from 5 months to 7 years),
showed a unilocular radiolucent image with unclear
borders accompanied by cortical bone resorption and and data on post-operative observation period were not
protrusion. This finding was similar to the characteristic described for 10 cases. In addition, the follow-up period
of osteosarcoma of the jaw, such as osteoid protrusion of the six pediatric cases ranged from 8 months to 7 years,
(spicula) and reactive trabecular bone formation (sun-ray and none of the cases had a long-term follow-up period
image), which made differentiation difficult. In some cases as long as 14 years like ours. Thus, the actual recurrence
6
of osteosarcoma of the jawbone, radiographic findings rate of odontogenic myxofibromas in the long term is
have shown a radiolucent image with a clear border, such unknown. A large-scale study of the long-term prognosis
as a cyst, which reportedly hampered differentiation from should be conducted to investigate the appropriateness
benign diseases. 48,49 Therefore, making a careful diagnosis of conservative surgery. In addition, given that studying
is critical. post-operative growth is taken into account in pediatric
cases, we consider that long-term follow-up is necessary
Radical resection or conservative surgery is the most
common method of treatment, and Meleti et al. stated to evaluate the functional and esthetic effect of the
8
procedure.
that the rates were 26.09% and 73.91%, respectively. In
the present analysis of 46 cases in Japan, radical resection 4. Conclusion
was performed in 12 cases (26.1%) and conservative
surgery in 28 cases (60.9%), with the approach unknown We report a case of odontogenic myxofibroma that arose
in 6 cases (13.0%), a trend similar to that reported in in the mandibular angle of a pediatric patient with a long-
Europe and the US. There are differences of opinion term follow-up of more than 14 years. The occurrence of
8
concerning the selection of surgical procedure, with odontogenic myxofibromas in the jawbone of children
53
some reports supporting the choice of radical resection has been rarely reported. This case report and literature
in cases of large lesions or recurrence, considering the statistics will provide helpful information for the diagnosis
local invasiveness of the tumor. 1,50,51 However, extensive and determining treatment strategies for odontogenic
jaw resection in children may induce aesthetic issues myxofibroma in children with growth process.
and psychological suffering due to hindered growth
of the maxillofacial region and a deformed facial Acknowledgments
appearance. Therefore, it is suggested that benign None.
mandibular tumors in young patients first be treated
with enucleation and curettage, even if the tumor is Funding
large enough to be considered for jaw resection. In fact,
in the eight pediatric cases ≤10 years of age assessed in None.
this analysis, enucleation and curettage or enucleation Conflict of interest
and fenestration were selected, and conservative surgery
was performed in 100% of these cases. In contrast, in 38 The authors declare no conflicts of interest.

Volume 3 Issue 1 (2024) 8 https://doi.org/10.36922/td.2096