Sequestrating giant complex odontoma: a case report and review of the literature

Abstract

Odontomas are the most common benign tumours of odontogenic origin. Due to their hamartomatous nature, they are usually asymptomatic but can cause impaction of one or more teeth. They consist microscopically of all the tissue types found in a developed tooth. We present a case of a large sequestrating complex odontoma resulting in facial asymmetry, cellulitis, pain and partial loss of function. This case has significance, as odontomas of this large size have rarely been reported.

Keywords: Complex odontoma; Hamartoma; Odontogenic; Radiographic features; Sequestration.

Fig. 1

Swelling with draining sinus and sub-mandibular cellulitis at the lower right mandibular border

Fig. 2

Intraoral view of the lesion

Fig. 3

Pre-operative panoramic radiograph 2008; the lesion has grown since 2004 and shows clearly a well-defined radiolucent rim which is the result of overlying infection

Fig. 4

Panoramic radiograph (2004); the extension of the radiopaque lesion into the ramus and the impacted first molar above the inferior border of the mandible is clearly visible. The lesion is surrounded by a radiolucent border, which seems to be more pronounced in the area of the ramus

Fig. 5

a Specimen sample of lesion. b Fractured impacted tooth after removal

Fig. 6

Panoramic radiograph after removal of BIPP

Fig. 7

Intra-oral view 3 months later—note the healing by secondary intention

Fig. 8

Micrograph shows a haphazard mixture of odontogenic hard tissue. Extensive necrosis and inflammation was present. (Histopathology, courtesy: Prof E. J. Raubenheimer)