王文岑醫師

OS OS - - OM combined OM combined meeting

meeting

報告者 報告者 : : 高郁勛 高郁勛 陳靜怡 陳靜怡

指導醫師 指導醫師 : : 黃逸岳醫師 黃逸岳醫師 陳玉昆醫師 陳玉昆醫師 王文岑醫師

王文岑醫師

報告日期 報告日期 : 95/12/21 : 95/12/21

General data General data

Name :

Name : 林 林 XX XX Sex :

Sex : 男 男

Age : 17 y/o Age : 17 y/o

Occupation: student Occupation: student

Native :

Native : 高雄縣 高雄縣 Attending V.S. : Attending V.S. : 黃逸岳醫師

黃逸岳醫師

First visit :95/09/19

First visit :95/09/19

Chief Complaint Chief Complaint

Painless swelling over upper left

Painless swelling over upper left gingiva gingiva for more than one week

for more than one week

Present Illness Present Illness

The 17 y/o male patient didn

The 17 y/o male patient didn ’ ’ t have t have

uncomfortable experience of oral cavity uncomfortable experience of oral cavity

before. On 95/09/16, his aunt found that a before. On 95/09/16, his aunt found that a

mass occupied on his upper left

mass occupied on his upper left gingiva gingiva . . The mass didn

The mass didn ’ ’ t make him painful or t make him painful or

uncomfortable. Then he was brought to uncomfortable. Then he was brought to XX XX 內兒科診所 內兒科診所 for help. After clinical for help. After clinical

examination, the doctor referred him to our examination, the doctor referred him to our

OPD for further treatment.

OPD for further treatment.

Past History Past History

Past Medical History Past Medical History

– – Enuresis with medication at our Urological Enuresis with medication at our Urological department for 5 years

department for 5 years

– – Depressive disorder with medication at our Depressive disorder with medication at our Psychological department for 2 years

Psychological department for 2 years – – Denied any other systemic disease Denied any other systemic disease – – Denied any drug or food allergy Denied any drug or food allergy

Past Dental History Past Dental History

– – OD, Endo OD, Endo

– – Experience to dental treatment: fair Experience to dental treatment: fair

Personal History Personal History

Personal hobbies:

Personal hobbies:

– – Alcohol： Alcohol ： ( ( - - ) Betel quid： ) Betel quid ： ( ( - - ) Cigarette： ) Cigarette ： ( ( - - ) )

Occupation: student Occupation: student

Education:

Education: 高二 高二 Marital status: ( Marital status: ( - - ) )

Economic state:

Economic state: 尚可 尚可

Psychic status: cooperative

Psychic status: cooperative

Family history Family history

Family support:

Family support:

– – 自 自 89 89 年起就住在兒童之家 年起就住在兒童之家 – – 姑姑平時也會照顧日常生活 姑姑平時也會照顧日常生活

Contributory to the problem: unknown Contributory to the problem: unknown

改嫁

P’t

Review of Systems Review of Systems

嘴巴 嘴巴 : : 牙齦流血 牙齦流血 ( ( 刷牙 刷牙 ) ) 呼吸道 呼吸道 : : 咳嗽 咳嗽 , , 痰 痰

腸胃道 腸胃道 : : 胃口不好 胃口不好 ( ( 不愛吃肉 不愛吃肉 ) ) 泌尿道 泌尿道 : : 夜尿 夜尿

No significant finding in other systemic No significant finding in other systemic

review

review

Physical Examination Physical Examination

Conscious: Clear Conscious: Clear

Vital sign:

Vital sign:

– – Pulse: 73/min Temp. : 36.4 Pulse: 73/min Temp. : 36.4 ° ° C C

Resp. Rate: 18/min B.P. : 104/61 mm/Hg Resp . Rate: 18/min B.P. : 104/61 mm/Hg

General appearance:

General appearance:

– – B.H. :171.5cm ; B.W. :49.5kg B.H. :171.5cm ; B.W. :49.5kg

Head and face: symmetric appearance

Head and face: symmetric appearance

Physical Examination Physical Examination

Eye: Eye:

– – Conjunctiva: not pale Conjunctiva: not pale – – Sclera: not Sclera: not icteric icteric

– – EOM: normal EOM: normal

Ear:

Ear: no hearing impairment no hearing impairment

Nose:

Nose: patent patent

Throat:

Throat: no discharge no discharge

Neck:

Neck: LAP( LAP( - - ) ; JVE( ) ; JVE( - - ) ; supple; free extension ) ; supple; free extension

Physical Examination Physical Examination

Chest:

Chest:

– – Symmetric expansion Symmetric expansion – – H.S. : no murmur, RHB H.S. : no murmur, RHB – – B.S. : clear B.S. : clear

Abdomen:

Abdomen:

– – Soft, no palpable mass Soft, no palpable mass

– – Normal active bowel sound Normal active bowel sound

Extremities:

Extremities: free extension, no pitting edema free extension, no pitting edema

Cranial nerve:

Cranial nerve: N.P. N.P.

Physical Examination Physical Examination

Mouth:

Mouth:

- - Teeth: Teeth:

Missing: 23 Missing: 23

Retained primary tooth: 63 Retained primary tooth: 63 O.D.: 16, 24, 26, 46

O.D.: 16, 24, 26, 46 Vitality test:

Vitality test:

-- 21, 24, 25: positive response21, 24, 25: positive response -- 22: negative22: negative

–– Occlusion:Occlusion:

Class I molar relation Class I molar relation Overbite: 2 mm ;

Overbite: 2 mm ; overjetoverjet: 2 mm: 2 mm

–– MMO:MMO: 51 mm ( from 11 to 41)51 mm ( from 11 to 41)

–– No No masticatorymasticatory muscle tendernessmuscle tenderness

Physical Examination Physical Examination

- - A swelling mass over A swelling mass over left side of maxilla

left side of maxilla

opposed to teeth 21~25:

opposed to teeth 21~25:

Buccal

Buccal gingivagingiva, vestibule , vestibule and palatal

and palatal gingivagingiva

Mucosa is intact, pink in Mucosa is intact, pink in color

color

No discharge from No discharge from gingiva

gingiva sulcussulcus Pain(

Pain(--), Tenderness(), Tenderness(--)) Firm in consistency Firm in consistency

No percussion pain of No percussion pain of teeth 21 to 25

teeth 21 to 25

Image finding

Image finding – – Skull PA and Skull PA and Lateral (95/10/05)

Lateral (95/10/05)

Image finding

Image finding – – Skull PA and Skull PA and Lateral (95/10/05)

Lateral (95/10/05)

Image finding

Image finding – – Water Water ’ ’ s view s view (95/10/05)

(95/10/05)

Image finding

Image finding – – Water Water ’ ’ s view s view (95/10/05)

(95/10/05)

Image finding

Image finding – – Panorex Panorex (95/09/19)

(95/09/19)

Image finding

Image finding – – Occlusal Occlusal film film (95/09/19)

(95/09/19)

Impression Impression

Dentigerous

Dentigerous cyst cyst Adenomatoid

Adenomatoid odontogenic odontogenic tumor tumor Keratocyst

Keratocyst Calcifying

Calcifying odontogenic odontogenic tumor tumor Unicystic

Unicystic ameloblastoma ameloblastoma

Incisional

Incisional biopsy biopsy

Aspiration: yellowish in Aspiration: yellowish in

color

color

Incisional

Incisional Biopsy Biopsy

No: KMUOP

No: KMUOP - - 06 06 - - 1864 1864 Date: 2006.09.19

Date: 2006.09.19

Specimen: 2 soft tissue fragments Specimen: 2 soft tissue fragments

Size: 1.0 x 0.7 x 0.3 cm Size: 1.0 x 0.7 x 0.3 cm

Color: Brownish Color: Brownish

Consistency: soft

Consistency: soft

HP Report

HP Report -- -- Incisional Incisional Dentigerous

Dentigerous cyst cyst

Bone, Maxilla, Impacted 23, Incision Bone, Maxilla, Impacted 23, Incision

Radiography

wall

Epi.

Histopathology

Diagnosis Diagnosis

Dentigerous

Dentigerous cyst over left side of maxilla cyst over left side of maxilla and impaction of tooth 23

and impaction of tooth 23

Enuresis with medication control Enuresis with medication control

Depressive disorder with medication Depressive disorder with medication

control

control

Oral and Maxillofacial Surgical Oral and Maxillofacial Surgical

Condition Condition

MMO: 51mm (from 11 to 41) MMO: 51mm (from 11 to 41) Airway: patent, no discharge Airway: patent, no discharge

Neck: Free extension, supple Neck: Free extension, supple

No teeth loosening No teeth loosening

– – Retained primary tooth 23 Retained primary tooth 23

Systemic problems:

Systemic problems:

– – Enuresis Enuresis

– – Depressive disorder Depressive disorder

Treatment Plan Treatment Plan

Pre Pre - - operation: operation:

–– Arrange Arrange endodonticendodontic treatment of tooth 22treatment of tooth 22

Operation plans:

Operation plans:

1.1. Decompression:Decompression:

Self care of decompression device Self care of decompression device Frequency of OPD follow up

Frequency of OPD follow up

2.2. EnucleationEnucleation + extraction of teeth 23 63 + bone graft+ extraction of teeth 23 63 + bone graft

Post operation:

Post operation:

–– Wound careWound care

–– Regular OPD follow upRegular OPD follow up

Treatment course Treatment course

Operation on 95/10/12:

Operation on 95/10/12:

–– MucoperiostealMucoperiosteal flap flap reflection

reflection

Bony perforation over 21 Bony perforation over 21 apical region (previous apical region (previous biopsy site)

biopsy site)

Labial cortical bone was Labial cortical bone was similar with eggshell in similar with eggshell in thickness

thickness

–– Increased the size of Increased the size of window (opposed to 22 window (opposed to 22

and 63) and 63)

Treatment course Treatment course

–– Incision the roof of the Incision the roof of the lesion

lesion ÆÆ sent for Hsent for H--P P examexam

–– Chemical cauterization via Chemical cauterization via soft tissue window

soft tissue window

4% phenol (2 minutes/time, 4% phenol (2 minutes/time, 3 times), then N/S irrigation 3 times), then N/S irrigation 95% alcohol (2 minutes/time, 95% alcohol (2 minutes/time, 2 times), then N/S irrigation 2 times), then N/S irrigation

–– Extraction of 63Extraction of 63

Treatment course Treatment course

–– Enucleated the main lesion Enucleated the main lesion and impacted 23

and impacted 23

No evidence of

No evidence of oro-oro-nasal nasal and and orooro-antral-antral

communication communication

Palatal mucosa was intact Palatal mucosa was intact

–– Placed Placed TriositeTriosite (artificial (artificial bone graft, 2ml/bottle, 4 bone graft, 2ml/bottle, 4 bottles) over the defect bottles) over the defect –– Suture the wound Suture the wound

Post Post - - operation operation panorex panorex (95/10/14)

(95/10/14)

Post Post - - operation operation panorex panorex (95/10/14)

(95/10/14)

Treatment course Treatment course

Post operation:

Post operation:

– – Wound condition: Wound condition:

No evidence of oozing No evidence of oozing

No evidence of discharge from nostril No evidence of discharge from nostril Mild to moderate swelling of left face Mild to moderate swelling of left face

– – Discharge from our ward on 10/17 (post Discharge from our ward on 10/17 (post - - op op 5th day)

5th day)

Treatment course Treatment course

OPD follow up:

OPD follow up:

–– On 95/11/20 (post operation On 95/11/20 (post operation 6 weeks) :

6 weeks) :

Little discharge from 21 22 Little discharge from 21 22 labial

labial gingivagingiva ÆÆ suspect suspect rejection of bone graft rejection of bone graft

–– N/S irrigation to wash the N/S irrigation to wash the infected bone graft

infected bone graft

–– No progress of graft No progress of graft

rejection during later F/U rejection during later F/U

Excisional

Excisional Biopsy Biopsy

No.: KMUOP

No.: KMUOP - - 06 06 - - 2044 2044 Date: 2006.10.12

Date: 2006.10.12 Specimen

Specimen

1. 1 Main lesion with tooth 23 1. 1 Main lesion with tooth 23

2. 1 Soft tissue fragment 2. 1 Soft tissue fragment

-- -- labeled as labeled as “ “ tissue before tissue before phenol treated

phenol treated ” ”

Gross

Gross – – Main Lesion Main Lesion

Size

Size (Excluding tooth)(Excluding tooth):: -- 3.4x2.4x1.7 cm3.4x2.4x1.7 cm

Color Color

-- BrownishBrownish Consistency Consistency -- RubberyRubbery

Crown of tooth 23 Crown of tooth 23

---- surrounded by the surrounded by the lesion

lesion

Gross

Gross – – Hemisection Hemisection

Cystic

part Solid

mass

Tooth 23

Gross

Gross – – Hemisection Hemisection

Cystic part Cystic part 1.Dimension 1.Dimension

–– 2.0x1.8 cm2.0x1.8 cm 2.Color

2.Color –– BrownishBrownish 3.Consistency

3.Consistency –– RubberyRubbery 4.Content

4.Content –– a little brownish a little brownish fluid

fluid

„ Solid part 1.Dimension

– 1.5x1.0 cm 2.Color – White

3.Consistency – Firm

Gross

Gross – – 交界 交界 點 點

Capsule Cyst

and

Tumor Tumor

and Tooth Tooth and Cyst (CEJ)

Radiograph

Radiograph -- -- Gross Gross

Tumor

Slide

Slide -- -- Gross Gross

AOT

DC

Odontoma - like area AOT

DC

Microscope

Microscope – – 交 交 界點 界點

DC

AOT AOT

Tooth

DC

Tooth

Odontoma -like area

Possible Effect of Phenol Possible Effect of Phenol

No significant difference in microscopic No significant difference in microscopic

morphology morphology

Incision Before After

Final Diagnosis Final Diagnosis

Adenomatoid

Adenomatoid odontogenic odontogenic tumor arising tumor arising from

from dentigerous dentigerous cyst cyst (AOT ex DC)

(AOT ex DC)

Bone, Maxilla, Impacted 23, Bone, Maxilla, Impacted 23,

Enucleation

Enucleation

Discussion Discussion

Treatment methods of

Treatment methods of dentigerous dentigerous cyst: cyst:

–– EnucleationEnucleation and removal of associated toothand removal of associated tooth –– CurettageCurettage

–– MarsupializationMarsupialization // Decompression// Decompression

Possibility of eruption of associated tooth Possibility of eruption of associated tooth

Rare recurrence

Rare recurrence

Discussion Discussion

Management of surgical defect : Management of surgical defect :

– – Bone graft Bone graft

– – Packing with Packing with iodoform iodoform gauze gauze

Hemostasis Hemostasis

Decrease dead space Decrease dead space

Discussion Discussion

Cauterization agent:

Cauterization agent:

– – Local fixation of tissue Local fixation of tissue – – Ensures Ensures hemostasis hemostasis – – Carnoy’ Carnoy ’ s s solution: solution:

First suggested by Cutler and

First suggested by Cutler and ZollingerZollinger in 1933in 1933 Made up of:

Made up of:

–– Chloroform 3 mlChloroform 3 ml

–– Absolute alcohol 6 mlAbsolute alcohol 6 ml –– Glacial acetic acid 1 ml Glacial acetic acid 1 ml –– Ferric chloride 1 gmFerric chloride 1 gm

Discussion Discussion

Conventional method of using cauterization Conventional method of using cauterization agent:

agent:

–– Usually treat the bony defect of cystic lesion Usually treat the bony defect of cystic lesion afterafter enucleation

enucleation // excision// excision

–– Penetrate the cancellousPenetrate the cancellous bone to a depth of 1.5mmbone to a depth of 1.5mm

1.54mm after 5 minutes 1.54mm after 5 minutes 1.81mm after 1 hour 1.81mm after 1 hour

–– May impede bone healing and damage the vital May impede bone healing and damage the vital structure (neurovascular bundle, sinus membrane) structure (neurovascular bundle, sinus membrane) –– Before enucleationBefore enucleation, tends to damage the epithelial , tends to damage the epithelial

lining

lining ÆÆ affect to H-affect to H-P diagnosisP diagnosis

Discussion Discussion

The present case:

The present case:

– – Cauterization agent: 4% phenol Cauterization agent: 4% phenol – – Before Before enucleation enucleation : :

Destroy lining epithelium of cystic lesion Destroy lining epithelium of cystic lesion

–– Decrease possibility of recurrenceDecrease possibility of recurrence

Fibrous change of cyst wall

Fibrous change of cyst wall ÆÆ become dense in become dense in consistence

consistence

–– Easily excise the cystic lesion from the adjacent soft tissue Easily excise the cystic lesion from the adjacent soft tissue (sinus membrane, site of cystic perforation, neurovascular (sinus membrane, site of cystic perforation, neurovascular bundle)

bundle)

No harm to the bony surface and

No harm to the bony surface and neurovascular neurovascular bundle (mandible)

bundle (mandible)

Clinical Features Clinical Features

DCDC AOTAOT This caseThis case Incidence

Incidence ^20%20%

(jaw cyst) (jaw cyst)

3~7%3~7%

(odontogenic(odontogenic tumor)tumor)

XX

AgeAge ^1010--3030

(wide range) (wide range)

10-10-1919

(69%) (69%)

1717

Gender

Gender ^MaleMale

(slight) (slight)

Female Female

(F:M=2:1) (F:M=2:1)

MaleMale

SiteSite ^{MdMd 8, Mx8, Mx 33 MxMx ant. (3)ant. (3) Tooth 23Tooth 23} Symptom

Symptom AsymptomaticAsymptomatic AsymptomaticAsymptomatic AsymptomaticAsymptomatic XX--rayray ^{UnilocularUnilocular R/LR/L}

Surrounding Surrounding Unerupted

Unerupted toothtooth

Unilocular

Unilocular R/LR/L Unerupted

Unerupted tooth, tooth, 75%75%

Calcification, Calcification,

33%~66%

33%~66%

Unilocular

Unilocular R/LR/L Impacted 23 Impacted 23

DC: dentigrous cyst; AOT: adenomatoid odontogenic tumor; R/L: radiolucency

Dentigerous

Dentigerous Cyst Cyst

Pathogenesis Pathogenesis

-- -- uncertain, fluid accumulation uncertain, fluid accumulation between

between REE REE and tooth crown and tooth crown Transformation of

Transformation of odontogenic odontogenic epithelial lining

epithelial lining

-- -- genesis: unknown genesis: unknown

-- -- incidence: rare incidence: rare

Lesions Arising From Lesions Arising From

Dentigerous

Dentigerous cyst cyst

Non Non - - aggressive benign tumor aggressive benign tumor -- -- AOT AOT

Aggressive benign tumor Aggressive benign tumor -- -- Mural Mural ameloblastoma ameloblastoma

Malignant tumor Malignant tumor

-- -- Squamous Squamous cell carcinoma cell carcinoma Mucoepidermoid

Mucoepidermoid carcinoma carcinoma

cells in the lining of DC)

AOT Ex DC in Literatures AOT Ex DC in Literatures

Bravo et al, 2005

Bravo et al, 2005 Takahashi et al, 2001Takahashi et al, 2001 This caseThis case

AgeAge 1414 MM Mx, 23Mx, 23

Swelling with sharp Swelling with sharp

painpain Unilocular

Unilocular R/L, 23 R/L, 23 crown surrounded crown surrounded Expanding to sinus Expanding to sinus

2222 1717

Gender

Gender MM MM

SiteSite Mx, 28Mx, 28 Mx, 23Mx, 23 Symptom

Symptom Painless swelling, Painless swelling, nasal obstruction nasal obstruction

Painless swelling Painless swelling

XX--rayray ^{UnilocularUnilocular R/L , 28 R/L , 28}

surrounded surrounded

Unilocular

Unilocular R/L, 23 R/L, 23 crown surrounded crown surrounded

Other

Other Expanding to sinusExpanding to sinus //

„ Total 6 cases

Vallejo et al, 1998: 12 y/o male; Warter et al, 1990: 8 y/o male Tajima et al, 1992; 1988, J Philipp Dent Assoc.

Other Lesions Associated Other Lesions Associated

with AOT with AOT

COC: 2 cases

COC: 2 cases CEOT: 24 casesCEOT: 24 cases

Duration

Duration 2 months2 months //

CaseCase ZeitounZeitoun et al, 1996et al, 1996 Miyake et al, 1996Miyake et al, 1996

AgeAge 3535 MM MdMd ant.ant.

Painless swelling with Painless swelling with

sharp pain sharp pain Unilocular

Unilocular R/L with B/L R/L with B/L bony expansion and

bony expansion and areas areas of calcification

of calcification

1616 Gender

Gender FF

SiteSite Mx, 21Mx, 21

Symptom

Symptom Painless swelling, nasal Painless swelling, nasal obstruction

obstruction

X-X-rayray ^{UnilocularUnilocularR/L , 28 R/L , 28}

surrounded surrounded

Pathogenesis of AOT Pathogenesis of AOT

Origin Origin

1. Remnants of Dental lamina or 1. Remnants of Dental lamina or

epithelial rests epithelial rests

2. Enamel organ epithelium(REE) 2. Enamel organ epithelium(REE)

Nature Nature 1. An

1. An odontogenic odontogenic tumor tumor

2. A benign, non

2. A benign, non - - invasive hamartoma invasive hamartoma, , not a true

not a true neoplasm neoplasm

WHO Classification WHO Classification

A mixed

A mixed odontogenic odontogenic neoplasm neoplasm

-- -- an epithelial tumor with an inductive an epithelial tumor with an inductive effect on the

effect on the odontogenic odontogenic ectomesenchyme

ectomesenchyme

AOT infrequently produce

AOT infrequently produce dentinoid dentinoid

material and rarely enamel matrix

material and rarely enamel matrix

Classification of AOT Classification of AOT

Central

Central – – 96% 96%

1. Follicular 1. Follicular

(F) 73%

(F) 73%

-- -- This case This case

2. 2. Extrafolloicular Extrafolloicular (E) (E) Peripheral (P)

Peripheral (P) – – 4% 4%

Gingiva

Gingiva

Predilections of AOT Predilections of AOT

Age Age – – second decade, 69% second decade, 69%

Gender

Gender – – female, 1.9:1 female, 1.9:1 1. Race

1. Race – – Asian, 3:1 Asian, 3:1 2. Type

2. Type – – Peripheral, 14:1 Peripheral, 14:1 Site

Site – – Mx Mx ant., 2.1:1(Mx:Md) ant., 2.1:1(Mx:Md) Unerupted

Unerupted tooth tooth -- -- Canine Canine

Differential Diagnosis of AOT Differential Diagnosis of AOT

Follicular type Follicular type

---- dentigerousdentigerous cyst cyst

Extrafollicular

Extrafollicular typetype

---- radicularradicular cyst, lateral cyst, lateral periodontal cyst, etc.

periodontal cyst, etc.

Peripheral type Peripheral type

gingival fibrous lesions, ex:

gingival fibrous lesions, ex:

fibroma

fibroma, , epulisepulis. .

Differences In Radiograph Differences In Radiograph

“ “ Snowflake Snowflake ” ” appearance appearance -- -- foci of foci of

calcification, calcification,

33%~66%

33%~66%

May extend

May extend apically apically past the CEJ in

past the CEJ in follicular type follicular type

CEJ

Histological Features Histological Features

Duct-Duct-like structurelike structure ---- odontogenicodontogenic originorigin

“Tumor droplets“Tumor droplets”” in the central of the rosette or in the central of the rosette or swirled structure

swirled structure

–– eosinophiliceosinophilic amorphous hyaline material,amorphous hyaline material, 1. 1. AmyloidAmyloid--likelike

2. Enamel matrix or

2. Enamel matrix or dentinoiddentinoid materialmaterial

Calcification Calcification

Immunohistochemical

Immunohistochemical Stains Stains

Enamel proteins Enamel proteins

-- -- amelogenin amelogenin , , enamelin enamelin Cytokeratin

Cytokeratin 1. CK 14

1. CK 14 -- -- dental epithelium (+) dental epithelium (+) 2. CK 8, 10, 18

2. CK 8, 10, 18 – – dental epithelium ( dental epithelium ( - - ) ) 3. CK19

3. CK19 – – preameloblast preameloblast (+), (+), secreting

secreting ameloblast ameloblast (+) (+)

Results In Literatures Results In Literatures

Murata et al, 2000 Murata et al, 2000

1. Positive of tall columnar cells of 1. Positive of tall columnar cells of

duct duct - - like structures and tumor like structures and tumor droplets

droplets Æ Æ ameloblast ameloblast origin origin 2. Negative of calcifications

2. Negative of calcifications Æ Æ dystrophic degeneration dystrophic degeneration Leon et al, 2005

Leon et al, 2005

CK14 (+), CK19 (+), CK8, 10, 18 (

CK14 (+), CK19 (+), CK8, 10, 18 ( - - ), ),

Æ Æ probable origin: REE probable origin: REE

Conclusion Conclusion

AOT ex DC AOT ex DC

– – probably the same origin: REE probably the same origin: REE AOT : epithelial

AOT : epithelial odontogenic odontogenic tumor

tumor

Should view as tumor Should view as tumor treatment

treatment – – enucleation enucleation prognosis

prognosis – – good good recurrence

recurrence – – rare (0.2%) rare (0.2%) Phenol

Phenol – – no effect on no effect on histopathological histopathological examination

examination