Central osteoma of the maxilla with involvement of paranasal sinus

Osteoma is an osteoblastic benign tumor characterized by the proliferation of either compact or cancellous bone. In the jaws, the most of cases reported in the literature presented as peripheral solitary lesions, involving preferably the posterior region of the mandible. However, central osteomas are quite rare, especially in the maxillary bone. The purpose of this article was to present the clinical, radiographic, surgical, and histologic features of a solitary central osteoma of the maxilla with involvement of the paranasal sinus and to review the literature for central osteomas located in the jaws. Our clinical report participates to literature as the 12th case of central osteoma in the jaws and the fourth case in the maxillary bone.     

Solitary central osteoma of the jaws: a diagnostic dilemma

Osteomas are relatively rare benign osteogenic neoplasms, characterized by the proliferation of compact and/or cancellous bone. Osteomas can develop as peripheral (periosteal) masses attached to the cortical plates or as central lesions arising from endosteal bone surfaces. Although multiple osteomas of the jaws are a hallmark of Gardner syndrome (familial adenomatous polyposis), nonsyndromic cases are typically solitary. A search of the literature identified 91 well documented cases of solitary osteoma of the jaws published since 1955: 93.4% were peripheral and only 6.6% central, a ratio of 14:1 in favor of peripheral osteomas. Solitary central osteomas of the jaws seem to be very rare, with only 6 such cases reported since 1955. Adding the 4 new cases described here brings the total to 10 central osteomas, 30% occurring in the maxilla and 70% in the mandible. Whereas peripheral osteomas are fairly easy to diagnose, central osteomas pose a more challenging diagnostic problem and need to be differentiated from other similar lesions of the jaws, such as central ossifying fibroma, condensing osteitis, idiopathic osteosclerosis, osteoblastoma, cementoblastoma, and complex odontoma. With such a low number of cases of central osteoma reported, the objectives of the present report are to describe 4 new cases, analyze the clinical and radiographic characteristics, and discuss the features which distinguish these lesions from other similar lesions of the jaws.     

Peripheral Osteoma of the Body of Mandible: A Case Report

Osteoma is a slow growing benign tumor consisting of well differentiated compact or cancellous bone that increases in size by continuous growth. It can be of a central, peripheral, or extraskeletal type. The peripheral type arises from the periosteum and is rarely seen in mandible. Although completely curable with adequate surgical treatment, osteomas precede the clinical radiographic evidence of colonic polyposis/Gardner’s syndrome. Therefore they may be sensitive markers for the disease. Recurrence of peripheral osteoma after surgical excision is extremely rare. However it is appropriate to provide both clinical and radiographic follow up after surgical excision of peripheral osteoma. This article describes the case of a 45 year old male who presented with painless swelling of the right body of mandible and resultant cosmetic facial disfigurement and functional impairment.     

Osteoid osteoma associated with the teeth: unusual presentation

Osteoid osteoma is a rare benign osseous neoplasm which rarely affects the jaws. It is more common in long bones which can lead to postural scoliosis. The clinical characteristic feature of this tumour is the unexplained pain that is relieved by the intake of analgesics. Histologically it is characterized by the formation of central nidus with surrounding sclerotic bone. The diagnostic dilemma in this case report is aggravated by its unusual association with the teeth. The use of CT scanning is advised to distinguish from other odontogenic tumours. Treatment for this tumour is surgical removal or excisional biopsy to avoid recurrence and progression to malignant changes.     

Periosteal osteogenic sarcoma of the mandible

Periosteal osteosarcoma, a variant of juxtacortical osteosarcoma, is seldom seen in the jaws. The clinical, radiographic, and histopathologic features of a rare mandibular periosteal osteosarcoma presenting as a deep mass in the area of the parotid are reported. The clinicopathologic features that distinguish this lesion from the more common parosteal osteosarcoma are also discussed.     

Benign osteoblastoma of the mandible

A rare case of benign osteoblastoma involving the mandible is presented. This neoplasm can easily be confused with other bening or malignant lesions of the jaws. The differential diagnosis can be made only by histopathologic examination. The lesion usually does not recur after complete excision.     

Modified surgical approach for removal of an ivory osteoma in the paranasal sinus. A case report

Osteomas are benign tumors that consist mainly of mature compact or cancellous bone. The most common site in maxillofacial complex is the mandible, particularly the angle, followed by sinuses. The authors report a case of an ivory osteoma of the paranasal sinus in a 16 year-old male patient. The lesion was located in the left paranasal sinus (frontal, ethmoidal and maxillary), obstructing the nasolacrimal duct, resulting in dacryocystitis and frontal mucocele. The ethmoid and orbital portions were approached and excised through a Weber-Ferguson incision and maxillary osteotomy was carried out to remove the ivory osteoma, considering its location in the central and deep region of the face. After tumor removal and drainage of frontal and ethmoidal sinuses, the bone flap was repositioned using titanium microplates and screws. Soft tissue was then sutured. The patient was seen again at 3 weeks, 3 months and 2 years after surgery. Overall, he showed a good recovery and wound healing. A multispeciality team approach is advisable in such cases if radical excision is necessary. A craniofacial approach made radical single stage excision of this multicompartmental ivory osteoma possible with an uneventful postoperative period.     

Endoscopic resection of forehead osteomas

BACKGROUND: Endoscopic brow lift has become widely accepted as a procedure for restoring a youthful brow. Sometimes, a patient seeking a solution for rejuvenation of the upper third of the face may present other problems such as a forehead lesion. The authors describe their clinical experience in surgical endoscopic excision of forehead osteomas. PATIENTS AND METHODS: In nine patients with a forehead osteoma, seeking for a solution in rejuvenating the upper third of the face, we performed a combination of endoscopic brow lift and endoscopic excision of the forehead osteoma. We also performed an endoscopic excision of a forehead osteoma in two patients that did not request any additional aesthetic face procedure. RESULTS: No complication and no recurrence have been reported. The aesthetic result satisfied the patients. CONCLUSIONS: Endoscopic resection of a forehead osteoma offers sufficient, effective and safe access for dissection and suspension of the tissues released. It offers a superbly hidden scar and is well appreciated by the patients.     

Giant mandibular condyle osteoma

Osteomas are benign tumors composed of mature compact or cancellous bone. They represent an uncommon lesion that occurs mainly in craniofacial complex bones. In jaws, they can appear on the bone surface as a polypoid or sessile mass, characterizing a peripheral osteoma (PO), or can be a lesion in the medullar space, then it is called central osteoma. In view of the scarcely reported cases about POs, this article presents a case of PO of the maxillofacial area that was surgically resected using hemicoronal approach.     

Huge osteoma of the mandible: report of case.

A review of the literature on osteoma of the jaws as well as its relationship to Gardner syndrome was presented. A case report of a compact or ivory osteoma that had been slowly enlarging for a minimum of eight years was described. The one-year postoperative examination has shown no discernible resumption of growth.     

Peripheral osteoma in a young patient: a marker for precancerous condition?

Osteoma is a benign osteogenic tumor arising from the proliferation of cancellous or compact bone. The osteoma can be central, peripheral, or of an extraskeletal type. Peripheral type of osteoma is most common in the lower jaws, which occurs at the surface of the cortical bone and is sessile or pedicled. The overall incidence of osteoma is low, affecting 0.01-0.04% of the population; osteomas comprise 12.1% of benign bone tumors and 2.9% of all bone tumors. Most of the osteomas occurring in the mandible are dense osteomas, and the cancellous osteoma is comparatively rare. Maxillofacial osteoma associated with cutaneous sebaceous cysts, multiple supernumerary teeth, and colorectal polyposis is known as Gardener's syndrome. However, in some cases, maxillofacial osteomas with multiple impacted and supernumerary teeth are not accompanied by a fixed complex of symptoms. We report one such case in a 15-year-old female patient.     

Palatal lymphangioma: a case report

Lymphangioma is a rare, congenital benign tumor involving vascular malformation, with a great potential for recurrence. It appears during the early years of life and therefore is highly common among children. We report here a five-year-old patient with a simple lymphngioma. The mother of the child reported she had noted the lesion in the palate after an injury in the area with a pen. The recommended treatment was surgical excision since this was a small and well-delimited lesion. Periodic clinical controls for 18 months showed that mucosa presented normal characteristics, with no signs of recurrence.     

Regression of a lesion resembling pyogenic granuloma after endodontic treatment

A rare case of regression of a lesion resembling pyogenic granuloma after endodontic treatment of a maxillary lateral incisor in a 16-year-old female patient is reported. After clinical and radiographic examination, the maxillary right lateral incisor was endodontically treated in two visits. At the second visit, clinical regression of the exophytic lesion was evident and the size of this lesion had been greatly decreased, so was not biopsied. After 3 weeks, the exophytic lesion had totally disappeared. This case report indicates that surgical excision of exophytic lesions resembling pyogenic granuloma is not necessary in all situations.     

Submandibular osseous choristoma.

PURPOSE: Osseous choristoma is a rare, benign lesion of the oral cavity and is usually found in the tongue. It presents as a tumour-like mass of normal bony structure with mature cells in an abnormal position. The object of this paper is to report one case of osseous choristoma. PATIENT: A 32-year-old male presented with a lesion in the submandibular region, which was treated by excision. After 28 months of follow-up there was no recurrence. CONCLUSION: Upon reviewing the English literature, no previous case of an osseous choristoma located in the submandibular region has been found. Extended clinical and radiographic follow-up is necessary after surgical excision of an osseous choristoma, despite its benign nature.     

Benign osteoblastoma of the mandible. A clinical-pathologic review and report of a case.

Benign osteoblastoma is an uncommon, solitary, osteoid and bone-producing tumor which is characterized by prevalent active osteoblasts and rich vascularized delicate fibrous stroma, previously regarded as malignant. The term benign osteoblastoma was recently proposed by different authors to separate this lesion from other solitary benign bone tumors. It most often involves long bones and vertebral column and other bones, and also occurs in jaw bones. There is a close histopathologic similarity between benign osteoblastoma and osteoid osteoma; consequently, much debate about them exists. Benign osteoblastoma has a good prognosis and is best treated by curettage or conservative surgical excision. Recurrence is rare. Because of its rarity in jaw bones, one case of benign osteoblastoma of the mandible is reported.     

Hemophilic pseudotumors of the mandible.

Three patients with hemophilic pseudotumors of the mandible were described and the treatment of the lesions was discussed. Surgical intervention, accompanied by adequate clotting factor replacement, was used in all three cases with satisfactory results. Pseudotumors of the jaws are a rare but serious complication of hemophilia. The cause of the mandibular lesion can be intraosseous hemorrhage, soft tissue hemorrhage with periosteal stripping and subperiosteal hematoma formation, or a combination of these factors. Surgical management with adequate replacement of clotting factor and the use of EACA is an effective method of treatment.     

Calcifying epithelial odontogenic (Pindborg) tumor. A clinical case

Calcifying epithelial odontogenic tumor (CEOT), Pindborg tumor, is a rare benign odontogenic neoplasm representing about 0.4-3% of all odontogenic tumors. This tumor more frequently affects adults in an age range of 20-60 years, with a peak of incidence between 40 and 60 years. About 190 cases of CEOT have been reported in the dental literature. Fifty-two percent of cases of CEOT is associated with a tooth impacted and/or displaced by the tumor. The primary CEOT has a recurrence rate of 10-15%, after total excision, and its malignant transformation is a very rare occurrence. The authors report a case of primary intra-osseous CEOT, embedding the mandibular right second molar, in a 24 year-old male. Radiographs showed a well-defined unilocular osteolytic lesion, swelling and reabsorbing the mandible and displacing the inferior alveolar nerve. It was possible to perform conservative surgical treatment consisting of the enucleation of the tumor together with a portion of tumor-free bone cavity margin and the debridement of the inferior alveolar neuro-vascular bundle, which was surrounded by a tumor capsule-like structure. The postoperative histological examination of the tumor revealed typical benign features. The differential diagnosis and work-up of the tumor treatment are discussed in relation with its histological typing and localization in the jaws.     

Effects of palatine bone denudation repair with periosteal graft on maxillary growth: An experimental study in rats

BackgroundThe long-term goal of cleft palate repair is to provide normal maxillary growth and speech capacity. However, most surgical repairs of cleft palate result in areas of bone denudation on lateral aspects of the hard palate. It is widely acknowledged that palatal bone denudation and subsequent scar contracture resulting from cleft palate surgery can inhibit maxillary growth.MethodThis study is designed to investigate the effect of the periosteum on growth patterns of the maxilla. A total of 32 three-week-old Sprague-Dawley rats were randomly divided into a control group and three experimental groups: a mucosa excision group, a mucosa-periosteum excision group and a periosteal graft group. Nine weeks postoperatively the skulls were prepared for study and palatal widths and lengths were determined. The experimental groups were investigated for various histological changes.ResultsThere was no statistically significant difference for the maxillary measurements (palatal width and length) between the mucosa excision group and the periosteal graft group when compared with the control group. However, the mucosa-periosteum excision group compared to the control indicated a statistically significant decrease in the same measurements. There was also a statistically significant difference for the maxillary measurements between the periosteal graft group and the mucosa-periosteum excision group.It was demonstrated histologically that the density of the Sharpey's fibres and periodontal scar tissue showed a slight increase in the mucosa excision group and the periosteal graft group compared with the control group. In the mucosa-periosteum excision group, the density increased significantly as expected.ConclusionsAll of these findings testify that retaining the periosteum or replacement with a periosteum graft after surgery can prevent the inhibition of maxillary growth.     

Primary extracranial meningioma of the mandible: A report of 2 cases and a review of the literature

Three cases of primary extracranial meningioma arising in the jaws have been reported in the English-language literature. The purpose of this report is to document 2 additional cases that arose in the mandible. Both cases occurred in women and appeared as radiolucent lesions. Microscopic examination revealed an unencapsulated tumor composed of uniform spindle-shaped cells arranged in whorls and interconnecting fascicles. Occasional nuclear pseudoinclusions and psammoma bodies were identified. The tumor cells demonstrated immunohistochemical reactivity for epithelial membrane antigen and vimentin. Both cases were treated by surgical excision. Based on previously published examples in the jaws, these neoplasms do not appear to be aggressive.     

Peripheral osteoma of the mandible: case report and review of the literature.

BACKGROUND: Osteoma is a benign often asymptomatic neoplasm, consisting of well-differentiated mature bone. This paper reports a case of peripheral osteoma located in the anterior mandibular region and provides a review of the literature about this lesion in the jaws. PATIENT AND METHODS: A 43-year-old white woman presented with a swelling in the left mandible of 7 years duration. The English literature was reviewed over the past 76 years and data about location, histopathology and number of the peripheral osteomas, sex, and age of the patients were evaluated. RESULTS: Data analysis showed 69 well-documented cases of peripheral osteoma. Peripheral osteomas are more frequent in the mandible than the maxilla and the cancellous type was most frequent; males and females are equally affected in the mandible; the age range was 9-85 years. CONCLUSION: The peripheral type of osteoma is most common in the lower jaws, occurs at the surface of the cortical bone and is sessile or pedicled.