Recurrent myxoma of the zygoma: a case report.

There has been a great deal of controversy regarding the origin of myxomatous tumors.1,2 Virchow in 1863 coined the term myxoma for a group of tumors that had histologic resemblance to the mucinous substance of the umbilical cord.3 In 1948, Stout redefined the histologic criteria for myxomas as true neoplasms that do not metastasize and that exclude the presence of recognizable cellular components of other mesenchymal tissues, especially chondroblasts, lipoblasts, and rhabdomyoblasts. Myxoma is a tumor that can be found in heart, skin, subcutaneous tissue, and centrally in bone. Myxomas of the head and neck are rare tumors.4 Two forms can be identified: facial skeleton “bone” derived, which had been subdivided in the past into true osteogenic myxoma and odontogenic myxoma, and “soft tissue” derived from perioral soft tissue, parotid gland, ear, and larynx.5-7 In a recent immunohistochemical and ultrastructural study, Moshiri et al8 supported this notion of odontogenic origin by suggesting that fibroblasts that compose the tooth germ undergo modification to give rise to odontogenic myxoma. In contrast with this theory, Slootweg and Wittkampf9 showed that the matrix of myxomas of the jaw is entirely different from the extracellular matrix of normal dental tissue. In addition, myxomas may also develop in the sinonasal tract and other facial bones that originate from nonodontogenic mesenchyme. The presence of odontogenic epithelium is not necessary to make the diagnosis of myxoma of bone.10 In contrast to the findings of Slootweg and Wittkampf,9 McClure and Dahlin11 reviewed more than 600 bone tumors of patients at the Mayo Clinic and concluded that there were no true myxomas of bone except those found in the mandible and maxilla. Although no specific etiologic factors have been demonstrated, myxoma of the jaws is commonly accepted as an odontogenic tumor. Myxomas represent 3% to 6% of odontogenic tumors. They occur more often in the second and third decades of life with no gender predilection.12 The maxilla and mandible are equally involved in most series even though some authors found a higher incidence in the mandible.13 Radiographically, several radiolucent regions of varying sizes are present, which are septated by straight or curved bony trabeculae that form triangular or quadrangular compartments. Unilocular cysts have also been described. The radiographic margin of the tumor may be well or poorly defined, and the lesion may simulate ameloblastoma, central giant cell granuloma, or hemangioma.14,15 This tumor is benign but can be locally aggressive and rapidly growing and can be misdiagnosed as nonneoplastic. However, the tumors are neoplastic with potential for continued local growth and bone destruction.16,17 Most maxillary lesions are unilateral and do not cross the median palatal suture, whereas mandibular lesions do cross the midline. Myxomas of bone are rare tumors and present unique extirpative and reconstructive challenges. We present the case of a patient with recurrent orbitozygomaticomaxillary myxoma. *Formerly, Oral and Maxillofacial Fellow, Division of Plastic, Reconstructive and Maxillofacial Surgery, University of Pittsburgh, Pittsburgh, PA; Currently, Private Practice, Craniomaxillofacial Surgery Unit, Hospital Metropolitano, Valencia, Venezuela. †Formerly, Craniofacial Fellow, Division of Plastic, Reconstructive and Maxillofacial Surgery. University of Pittsburgh, Pittsburgh, PA; Currently, Assistant Professor of Surgery, Division of Plastic and Reconstructive Surgery, School of Medicine, University of California at Los Angeles, Los Angeles, CA. ‡Formerly, Head and Neck Pathology Fellow, Department of Pathology, University of Pittsburgh Medical Center, School of Medicine, Pittsburgh, PA; Currently, Assistant Professor of Phatology, Department of Phatology and Human Anatomy, Loma Linda University Medical Center, Loma Linda, CA. §Associate Professor of Oral and Maxillofacial Surgery, Division of Plastic, Reconstructive and Maxillofacial Surgery, Department of Surgery, University of Pittsburgh Medical Center, School of Medicine, Pittsburgh, PA. Address correspondence and reprint requests to Dr Landa: 6B Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15261; e-mail: leopoldolanda@hotmail.com © 2002 American Association of Oral and Maxillofacial Surgeons 0278-2391/02/6006-0019$35.00/0 doi:10.1053/joms.2002.33126