Management of Peripheral Odontogenic Myxoma in a High-Risk Geriatric Patient

Odontogenic tumors such as peripheral odontogenic myxoma of the maxilla, although generally benign and slow-growing, still require surgical intervention to prevent functional and aesthetic disturbances. Surgical procedures in elderly patients with comorbidities (e.g., post-stroke patients) carry a higher risk of postoperative complications. A recent case report from RSUP Dr. Sardjito shows that with adequate preparation, excision and curettage surgery in a geriatric patient with controlled non-hemorrhagic stroke can be performed safely without serious complications during a six-month follow-up period. Nevertheless, potential risks must be carefully assessed and managed.

Case Overview

A study conducted by an FKG UGM student, Anik Khoiriyah, under the supervision of Dr. drg. Maria Goreti Widiastuti, Sp.BM(K), and drg. Cahya Yustisia Hasan, Sp.BM(K), examined a 74-year-old female patient with a history of controlled non-hemorrhagic stroke who presented with a painless gingival mass on the left maxilla for approximately three months. The lesion did not bleed easily but interfered with mastication. The lesion was diagnosed as peripheral odontogenic myxoma and treated with excision and curettage under general anesthesia. Comprehensive patient management included consultations with neurology and cardiology departments and co-management with geriatric services to minimize postoperative risks. Six months of follow-up showed a favorable prognosis: no complaints, no wound dehiscence, and no recurrence. 

Potential Postoperative Complications

Although no short-term complications were observed in this case, literature and clinical experience indicate that odontogenic tumor surgery—particularly in elderly patients with comorbidities—may be associated with several potential complications, including:

1. Intraoperative or postoperative bleeding, especially in patients taking antiplatelet or anticoagulant medications.
2. Surgical site or soft tissue infection, with increased risk in patients with poor hygiene, compromised immune status, or uncontrolled comorbidities.
3. Wound dehiscence, leading to pain, infection, and delayed healing.
4. Tumor recurrence, if excision or bone curettage is incomplete, although recurrence risk in this case was low.
5. Anesthesia-related complications, particularly in geriatric patients with comorbidities such as stroke, including cardiovascular, neurological, and drug interaction risks.
6. Aesthetic or functional problems, such as impaired oral mobility, pain, facial contour changes, or chewing difficulties due to tissue or structural damage.

Factors Influencing Complication Risk

Based on the case report and retrospective literature review:

• Patient preoperative condition (age, stroke history, cardiac and neurological status, nutritional status). 
• Current medications, particularly anticoagulants and cardiovascular drugs. 
• Surgical complexity (tumor location, size, bone involvement, proximity to vital structures).
• Quality of anesthesia care and perioperative monitoring.
• Postoperative wound care and follow-up.

Retrospective Case Analysis

In the reported case:

• No serious complications, infections, wound dehiscence, or recurrence were observed up to six months postoperatively. 
• Thorough preoperative preparation, including neurological and cardiological consultations and medication risk assessment, played a crucial role in preventing complications. 
• The favorable prognosis indicates that peripheral odontogenic tumor surgery can be safely performed in elderly patients with a history of stroke when risk factors are well controlled. 

Conclusions and Recommendations

• In elderly patients with a history of stroke, management of odontogenic tumors such as peripheral myxoma can be successfully performed without complications if perioperative preparation is optimal.
• Comprehensive preoperative evaluation, including interdisciplinary clinical consultation, medication management, and organ function assessment, is essential.
• Postoperative monitoring is critical, particularly in the short- and mid-term, to detect complications such as infection, wound dehiscence, or functional changes.
• Future research should include larger retrospective analyses with longer follow-up periods to better assess recurrence rates and long-term complications.

References
Anik Khoiriyah, Dr. drg. Maria Goreti Widiastuti, Sp.BM(K), drg. Cahya Yustisia Hasan, Sp.BM(K), Penatalaksanaan Miksoma Odontogenik Periferal Maksila Sinistra pada Penderita Geriatri Pasca Stroke Non Hemoragik dengan Anestesi Umum, https://journal.ugm.ac.id/mkgk/article/download/11982/8823

Penulis: Rizky B. Hendrawam | Foto: Freepik