A 12-year-old woman was referred to the Department of Oral and Maxillofacial Surgery due to a delay in eruption of the lower incisors and permanent canine on the right side that was detected during treatment.
She also reported occasional pain and swelling of the gum.
Personal history included focal epilepsy and no allergies.
On physical examination, absence of right lower canines and facial expressions was detected, as well as a slight bulging of the buccal cortical bone of the mandible in that location.
Radiographic tests included an orthopantomography and periapical radiograph, which showed an intraosseous cystic lesion measuring 20 x 30 mm and showing well-defined margins with some radiopaque images inside.
In addition, within the cyst, some radiopaque structures similar to a tooth could be identified along with a lateral displacement of the roots of teeth without apical resorption.
With the diagnosis of suspected mandibular compound odontoma, the patient underwent surgery with local anesthesia, although the cyst could not be completely removed due to lack of cooperation by the patient.
Therefore, a second surgery under general anesthesia was performed in the Ambulatory Surgery Unit, with complete removal of the tumor followed by curettage of the surgical bed.
Histological analysis revealed a compound odontoma with areas of proliferating amel cells.
Microscopically, a proliferation in nests and bands of palisade odontogenic epithelium along with stellate cells located in the center of the nests could be observed.
The stroma of the epithelial nests showed areas of fibromyxoid tissue and collagen zones with abundant cement deposits surrounded by fibroblasts and remains attached to dental enamel.
Therefore, periodic controls were performed by clinical examination and CT controls without evidence of recurrence after 24 months of evolution.
