Pre-surgical 3D navigation and stereolithographic surgical implant guides in the management of an odontogenic myxoma involving the maxillary sinus

Background: Odontogenic myxomas are benign but locally invasive and aggressive tumours originated in primordial mesenchymal odontogenic tissues, which do not metastasize. They present slow growth and are usually asymptomatic. They can cause tooth shifting, root resorption and cortical perforation. Radiographically, they are observed as unilocular or multilocular radiolucid lesions with well-defined borders and fine bony trabeculae, often described as ‘soap bubble’ or ‘sunray-like’. The treatment of choice is the surgical resection with safety margins, which may imply large resections, affecting aesthetics and function.

Methods/case report: 36 year old female, presenting an odontogenic myxoma with a 7-year evolution, compromising maxilla (crossing the midline), maxillary sinus and lateral wall of the nose cavity on the right side. Pre-surgical 3D navigation and stereolihtographic models were used to plan a hemi-maxillectomy, involving the resection of the anterior sinus wall, lateral wall of the nose cavity, maxilla and all upper teeth on the right side, including the contralateral central and lateral incisors, considering safety margins. Given the large resection, involving loss of facial and labial support, loss of teeth and an open rinolalia, the inmediate instalation of oseointegrated implants was planned previously, using a stereolithographic surgical implant guide (Simplant, Materialise) fabricated based on the pre-surgical navigation. The installation of one cygomatic and two standard dental implants permited the confection and attachment of a provisory prosthesis, recovering facial and labial support and improving phonetics and aesthetics.

Conclusions: Computer-assisted 3D navigation and stereolithographic implant guides are valuable clinical tools to improve the accuracy of maxillofacial and implant surgery, reducing psychological impact of large resections and prosthetic rehabilitation time. They also reduce surgical time and eliminate subsequent implant surgery, providing short-term aesthetic results, thus improving the patients psychological state, restoring function and aesthetics in less time.

Key words : odontogenic myxoma; pre-surgical navigation; implants

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Jan 21, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Pre-surgical 3D navigation and stereolithographic surgical implant guides in the management of an odontogenic myxoma involving the maxillary sinus
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