A Giant Posterior Maxillary Intra-Sinusal Complex Odontoma: A Clinical Case

Abstract

Odontomas are the most common odontogenic neoplasms. They are generally small and asymptomatic. This article presents an unusual case of a giant maxillary complex odontoma, which obscured a part of the maxillary antrum and impacted a tooth. This was discovered during an episode of maxillofacial cellulitis. In this case, surgical excision of the lesion was performed under general anesthesia, and the closure was performed with a fat pad pedicled flap. A brief review of the literature was performed to analyze the characteristics of this clinical entity and their implication in the treatment.

Keywords: complex odontoma; computed tomography; impacted teeth; odontogenic tumors; oroantral communication.

Figure 1. (A) Clinical appearance after biopsy. CT scan in the (B) coronal and (C) axial sections of the hyperdense mass, which found a 33 x 23 x 21 mm right intra-sinusal encysted bone density mass with inclusion of the probable teeth 17 and 18. (D) Panoramic radiograph on the day of the first consultation showing an inhomogeneous radiopaque image surrounded by a radiolucent halo at the level of the tuberosity and the right maxillary sinus.

Figure 2. A conservative exeresis of the lesion was made with intra-oral access. (A) Identification of the lesion. (B) Fragmented odontoma. (C) Overview of the buccal-sinusal communication. (D) Pedicled buccal fat pad flap.

Figure 3. (A) Clinical appearance six weeks after surgery showing mucosal healing and bucco-sinusal closure. (B) Dental panoramic six weeks after surgery showing the beginning of bone healing.