Management and Recurrence of Intra-osseous Odontogenic Myxoma: Systematic Review and Individual Participant Data...

The objective of this systematic review with individual participant data (IPD) meta-analysis evaluated treatment outcomes of intraosseous odontogenic myxoma (OM) across different surgical modalities, focusing on recurrence rate associated with each approach. Secondary objectives included synthesizing epidemiological, clinical, radiographic, and histopathologic variables of prognostic significance to provide an evidence base for optimizing surgical decision-making and postoperative surveillance strategies. This study was conducted per PRISMA guidelines, and registered in the PROSPERO. A systematic search was conducted across MEDLINE, Embase, Scopus, and Web of Science databases for English-language articles published from January 1950 to present. Eligibility criteria included human subjects with a confirmed diagnosis of intraosseous OM, odontogenic myxofibroma, or odontogenic fibromyxoma. Two reviewers independently performed study selection, data extraction, and risk of bias assessment using the Joanna Briggs Institute tools. This study utilized IPD analysis rather than aggregate effect-size meta-analysis. Statistical analyses involved descriptive statistics, comparative tests, and logistic regression to estimate odds ratios (OR) for potential prognostic factors. Eighty-three studies comprising 187 patients were included. The population predominantly consisted of OM, followed by odontogenic myxofibroma and odontogenic fibromyxoma. The overall recurrence rate was 14.4%. The analysis showed a significant difference in outcomes between treatment modalities. Surgical resection demonstrated a 5.5% recurrence rate, while conservative management with and without additional modalities (peripheral ostectomy and/or chemical cauterization) showed 14.3 and 25.3% recurrence, respectively (p = 0.001, OR [95% CI] = 0.17 [0.06 - 0.48]). Age, sex, tumor location, and histopathologic subtype did not show statistically significant associations with recurrence. However, age less than 15 years, tumor size larger than 6 cm, and multilocular radiographic patterns demonstrated a trend toward higher recurrence risk (OR [95% CI] = 1.90 [0.76-4.77], 1.70 [0.14-20.42], and 1.42 [0.58-3.45], respectively). Surgical resection provides significantly superior disease control for intraosseous OM compared to conservative management. While histopathological subtypes do not influence prognosis, clinical features such as large tumor size and multilocular presentation, suggest a need for more aggressive intervention. Due to potential confounding by indication, results are associative rather than casual. Nevertheless, the high recurrence risk in conservative therapies necessitates rigorous, extended, long-term radiographic surveillance for non-radical approaches.