The Journal
Biological behaviour CEOTs are locally infiltrative tumours with a tendency to invade adjacent bone and cause displacement of teeth and resorption of roots . There have been a few reported cases of locally aggressive CEOT that either invaded into neighbouring structures like
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the maxillary sinus , caused cortical bone perforation or involved the surrounding soft tissue . In this reported case too , the buccal cortex was perforated and the mandibular canal breached in the premolar region , resulting in increased pressure on the nerve , possibly explaining sensory dysfunction along the course of the mental nerve . The presence of unilateral numbness of chin , urged us to rule out
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a metastatic focus . Usually benign , malignant transformation of CEOT has also found a rare mention in the literature . Less than 10 such
14 , 15 cases have been reported .
Radiologic features
• In the initial stage , it is totally radiolucent , mimicing a dentigerous cyst , especially when associated with an impacted tooth .
• In the second stage , scattered cacifications are seen within the radiolucency , presenting as
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“ snow driven ” picture .
• Final stages are associated with osseous destructuction and tumoral calcification giving it
8 a “ honey comb appearance .
Treatment and recurrence rate Treatment options range from simple enucleation and curettage to radical excisions like hemimandibulectomy or maxillectomy . However , the tumour is generally recommended to be excised with 1 cm bony linear margins and appropriate attention to soft tissue anatomic barriers . Recurrence rate ranges from 14-
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20 % . A minimum follow up period of 5 years is recommended .
Conclusion
Since this tumour is usually slow growing and painless , most patients are seen when the tumour is large with expansion of the buccal cortex exhibiting facial asymmetry . However , if presented at its early stages , conservative management offers good prognosis . Early reporting and awareness is the key to effective management with minimal patient morbidity .
Pathogenesis There is no consensus regarding the degree of differentiation of the odontogenic epithelium that gives rise to this tumour . Most authors believe the tumour cells to originate from stratum intermedium due to morphological similarities with the normal cells of this layer . However , the occurrence of the extraosseous variant and almost half of the cases not seen in association with an unerupted tooth suggest other sources such as the rests of dental lamina
10 or basal cells of the oral epithelium .
10 3 40 Vol . 12 No . 23 May-August Sept-Dec 2016