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The fibrous odontoma is the result of an overgrowth of fibrous tissue surrounding the tooth sac, which encapsulates the tooth and prevents its eruption. The thickened tooth sac is usually mistaken for a fibrous tumour, until, after removal, the tooth is recognised in its interior. Composite Odontoma.
CLASSIFICATION OF TUMOURS: I. Connective-tissue tumours: Innocent: Lipoma, Xanthoma, Chondroma, Osteoma, Odontoma, Fibroma, Myxoma, Endothelioma, etc.; Malignant: Sarcoma II. Epithelial tumours: Innocent: Papilloma, Adenoma, Cystic Adenoma; Malignant: Epithelioma, Glandular Cancer, Rodent Cancer, Melanotic Cancer III. Dermoids IV. Teratoma.
Many examples of this variety of odontoma, growing in the nasal cavity or in the maxillary sinus, have been erroneously regarded as osteomas even after removal. On section, the tumour is usually laminated, and is seen to consist mainly of dentine with a partial covering of enamel and cement. Diagnosis. Odontomas are often only diagnosed after removal.
There then succeeds, usually between the twentieth and twenty-fifth years, an eruptive stage, which is often attended with suppuration, and this may be the means of drawing attention to the tumour. Following Bland Sutton, several varieties of odontoma may be distinguished according to the part of the tooth-germ concerned in their formation.
The epithelial odontoma is derived from persistent portions of the epithelium of the enamel organ, and constitutes a multilocular cystic tumour which is chiefly met with in the mandible. The cystic spaces of the tumour contain a brownish glairy fluid. These tumours have been described by Eve under the name of multilocular cystic epithelial tumours of the jaw.
When attended with suppuration, the condition has been mistaken for disease of the jaw. Fibrous odontomas have been mistaken for sarcoma, and portions of the maxilla removed unnecessarily. Any circumscribed tumour of the jaw, particularly when met with in a young adult, should suggest the possibility of an odontoma. Skiagrams often give useful information both for diagnosis and for treatment.
The follicular odontoma, also known as a dentigerous cyst, is derived from the distension of a tooth follicle. It constitutes a cyst containing a viscid fluid, and an imperfectly formed tooth is often found embedded in its wall. The cyst usually forms in relation to one of the permanent molars, and may attain considerable dimensions.
Treatment. The solid varieties of odontoma can usually be shelled out after dividing the overlying soft parts. In the follicular variety, it is usually sufficient to excise a portion of the wall, scrape out the interior, and remove any tooth that may be present. The cavity is then packed and allowed to heal from the bottom. #Fibroma.# A fibroma is a tumour composed of fibrous connective tissue.
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