Single Stage Management of Pediatric Odontogenic Myxoma With Left Extended Total Temporomandibular Joint Replacement

The treatment of peadiatric odontogenic myxoma (OM) can be challenging. The authors present an adolescent patient presenting with a left mandibular swelling and a lesion extending to the mandibular condyle. Biopsy confirmed OM and MDT discussion agreed for disarticulation resection with immediate reconstruction. Options for reconstruction included fibula free flap and extended total alloplastic TMJ replacement. Surgery was undertaken without complication and involved left mandibular disarticulation resection, extraction of associated teeth, extended TMJ replacement and block graft from the iliac crest. Margins were 0.5cm clear with no signs of recurrence over 3-year post surgery. Subsequent dental restoration with a single implant, avoiding the need for a free flap. OM recurrence rate can be up to 25%, and it is advised that patients with large lesions undergo resection, which can reduce this to 6%. The rapid recovery with immediate return of jaw function demonstrates the advantages of alloplastic reconstruction and this case clearly demonstrates the potential viability of using this technique for the management of OM in the adolescent patient and avoids any growth inhibitions from a free flap.