Diagnosis.—Odontomas are often only diagnosed after removal. When attended with suppuration, the condition has been mistaken for disease of the jaw. Fibrous odontomas have been mistaken for sarcoma, and portions of the maxilla removed unnecessarily. Any circumscribed tumour of the jaw, particularly when met with in a young adult, should suggest the possibility of an odontoma. Skiagrams often give useful information both for diagnosis and for treatment.
Treatment.—The solid varieties of odontoma can usually be shelled out after dividing the overlying soft parts. In the follicular variety, it is usually sufficient to excise a portion of the wall, scrape out the interior, and remove any tooth that may be present. The cavity is then packed and allowed to heal from the bottom.
Fibroma.—A fibroma is a tumour composed of fibrous connective tissue. A distinction may be made between the soft fibroma, which is comparatively rich in cells and blood vessels, and in which the fibres are arranged loosely; and the hard fibroma, which is composed of closely packed bundles of fibres often arranged in a concentric fashion around the blood vessels. The cut surface of the soft fibroma presents a pinkish-white, fleshy appearance, resembling the slowly growing forms of sarcoma; that of a hard fibroma presents a dry, glistening appearance, aptly compared to watered silk. The soft variety grows much more rapidly than the hard. In certain fibromas—in those, for example, which grow from the periosteum of the base of the skull and project into the naso-pharynx—the blood vessels are dilated into sinuses and have no proper sheaths; they therefore tend to remain open when divided, and to bleed excessively. Transition forms between soft fibroma and sarcoma are met with, so that in operating for their removal it is safer to take away the capsule along with the tumour, and the patient should be kept under observation in view of the risk of recurrence.
The skin—especially the skin of the buttock—is one of the favourite seats of fibroma, and it may occur in a multiple form. It is met with also in the subcutaneous and intermuscular cellular tissue, and in the abdominal wall, where it sometimes attains considerable dimensions. Various forms of fibroma are met with in the mamma and are described with diseases of that organ. The fibrous overgrowths in the skin, known as keloid and molluscum fibrosum, and those met with in the sheaths of nerves, are described elsewhere. Fibroid tumours of the uterus are described with myoma.
Diffuse fibroma or Fibromatosis, analogous to lipomatosis, is met with in the connective tissue of the skin and sheaths of nerves, and constitutes one form of neuro-fibromatosis; a similar change is also met with in the stomach and colon.
Fig. 53.—Myeloma of Shaft of Humerus, causing pathological fracture. (Mr. J. W. Struthers' case.)
(The unusual site of the tumour is to be noted.)
Myxoma.—A myxoma is composed of tissue of a soft gelatinous, semifluid consistence. The pure myxoma is extremely rare, and clinically resembles the lipoma. Myxomatous tissue is, however, frequently found in other connective-tissue tumours as a result of degeneration, for example, in cartilaginous tumours and in sarcomas. Myxomatous tissue is also a prominent constituent of the “innocent parotid tumour.” Mucous polypus of the nose, which is often described as a myxoma, is merely a pendulous process of œdematous mucous membrane.