Clinical Pathological Conference--- Compound Odontoma Wu Cheng-Hsien, Division of Oral & Maxillofacial Surgery, Department of Dentistry, V.G.H.-Taipei

General Data: Name: 高 X X Chart No.: Ward No.: B108–16 Sex: Male Birthday: 74/02/08 Marital status: Single Date of admission: 89/06/19 Occupation: Student

Chief Complaint: Refer from LDC for removal of radiopaque lesion over R’t lower mandibular region. History of Present Illness: According to the statement of this 15 y/o boy, a few days ago, he went to LDC for regular dental check-up and scaling. The Dr. take the apical film & found this odontoma and suggested him to visit VGH OS OPD for help. So he admitted our ward B for surgery intervention for odontoma removal under GA.

Past Medical/Dental History: General: DM(-), HTN(-), Heart disease (-) Allergies: food and drug(-) Trauma: significant injuries (-), blood transfusion (-) Social and Personal History: Tobacco: Nil Alcohol: Nil Betel quid chewing: Nil Family History: Family lipoma history, and now there is a lipoma over his right arm. Review of Systems: No specific finding

OMS condition: Extraoral: No facial asymmetry No LAP Intraoral: retained deciduous tooth: 83 Pano. Finding: >Impaction:18,28,38,48 >A well-defined radiopaque-radiolucent lesion with radiolucent encapsulation about 1.5x1.5cm over apical area >33: ectopic eruption

Odontoma General features:General features: Mixed odontogenic tumor; epithelial and mesenchymal origin A kind of harmatoma Etiology:Etiology: Result from an extraneous bud of odontogenic epithelial cells from the dental lamina Epidemiology:Epidemiology: The most common odontogenic tumor(67%); Compound> Complex(2:1)> ameloblastic odontoma> ameloblastic fibroodontoma

Age:Age: Occur in the 2 nd decade of life (most common in childen and young adults) Sex:Sex: M~F (68% of the complex type occur in women) Site:Site: Compound---incisor-canine area of the maxilla; Complex-- 1 st and 2 nd molar of the mandible Size:Size: 1-3cm Progress:Progress: Non-aggressive Symptoms:Symptoms: Delayed eruption of permanent tooth

Ameloblastic odontoma (AO; odontoameloblastoma) Simultaneous occurence of an ameloblastoma and complex odontoma Clinical similarities to both the odontoma (age at time of diagnosis) and ameloblastoma (location, expansion and recurrent rate) aggressive; rare; benign More often in children early in the 2 nd decade of life; ♂ > ♀ ; mandible>maxilla Bony expansion; cortex destruction; teeth displacement; mild pain

Ameloblastic Fibroodontoma Contain cords & nests of odontogenic epithelium & some calcified odontogenic tissue in a myxomatous stroma benign, well-capsulated ♂ > ♀ ; most often in the first two decades of life mandible>maxilla; most in the premolar-molar area pericoronal to an imbedded tooth radiolucent-->radiolucent-radiopaque D.D.: COC; AOT; CEOT; odontoma Management: surgical enucleated