Multiple Miliary Osteoma Cutis of Face

Multiple miliary osteoma cutis is an uncommon condition presenting as multiple skin-colored papules of variable sizes on the face. A 48-year-old woman presented with multiple skin-colored hard papules on both cheeks. Examination revealed firm-to-hard dome-shaped asymptomatic papules in cluster over both cheeks. A punch biopsy was performed, which showed evidence of focal bony trabeculae with associated normal appendages. Few larger papules were incised and followed up with curettage of bony material and closed. All lesions could not be incised and removed because of large number of lesions in cluster.

Clinical implications, diagnosis, and treatment of a giant frontoethmoid osteoma

Osteomas are benign, asymptomatic fibro-osseous tumors that are most commonly observed in the paranasal sinuses and sometimes are found in imaging examinations that were taken for other reasons. Giant osteomas are rarely found in the frontal and ethmoid sinuses but, when they are, they may cause intracranial and orbital complications. The aims of this case report are to describe a frontoethmoid osteoma in a 40-year-old woman, discuss the characteristics of this lesion through cone beam computed tomography (CBCT) imaging, and review the options for treatment. A CBCT examination performed for the purpose of orthodontic diagnosis revealed the presence of a large, well-defined, lobular, hyperdense mass that occupied a sizeable area of the frontal sinus and extended to the ethmoid sinus. The patient did not report any pain. Based on the physical and imaging characteristics of the mass, the location and size of the lesion, and the patient's age, the diagnosis was a giant frontoethmoid osteoma. Due to its enhanced field of view, CBCT may enable earlier diagnosis of lesions that affect the maxillofacial region.

Pediatric Benign Paranasal Sinus Osteoneogenic Tumors: A Case Series and Systematic Review of Outcomes, Techniques, and a Multiportal Approach

BACKGROUND

Pediatric benign paranasal sinus osteoneogenic tumors have previously been difficult to treat due to the surgical constraints of the developing skull. Progression may lead to intracranial complications or orbital and optic nerve compression.

OBJECTIVE

To assess the presentation and management of benign paranasal sinus osteoneogenic tumors.

METHODS

Systematic review of the symptoms and surgical treatment of these lesions, and a case series of 2 adolescents with osteomas impinging on the orbit treated with a multiportal approach.

RESULTS

Forty-eight cases of osteomas, osteoblastoma, or osteoid osteomas were reviewed from 43 articles. The average age was 14 years, 67% of tumors were osteomas, and 48% were greater than 3 cm in longest dimension. Compared to osteoblastomas, osteomas had a greater male to female ratio (4.3:1; P = .02), presented at older age ( P = .03) with a smaller tumor burden ( P = .003), and had prior trauma or surgery ( P < .001). The ethmoid, frontal, maxillary, and sphenoid sinuses were affected in decreasing order of frequency. A purely endoscopic sinus surgery approach was taken in 31% of cases, open approach in 62% of cases, and combined approach in 7% of cases. Osteoblastoma patients had a 32% rate of recurrence, compared to only 3% among osteoma patients. On univariate logistics regression of patient demographics, tumor characteristics, and surgical approaches predictive of surgical outcomes, only tumor type was predictive of postoperative recurrence (odds ratio: 0.07; 95% confidence interval, 0.007-0.77; P = .029).

CONCLUSION

There was no association between surgical approach and postoperative complications or rate of recurrence. However, a transnasal and transorbital multiportal approach avoids facial incisions.

Basal Cell Carcinoma with Osteoma Cutis

Osteoma cutis is the formation of bone within the skin. It can present as either primary osteoma cutis or secondary osteoma cutis. Secondary osteoma cutis is more common and is associated with inflammatory, infectious, and neoplastic disorders, including basal cell carcinoma. A 79-year-old Caucasian man without underlying kidney disease or calcium abnormalities presented with a basal cell carcinoma with osteoma cutis on the chin. Basal cell carcinoma with osteoma cutis has seldom been described; however, the occurrence of this phenomenon may be more common than suggested by the currently published literature. The preferred treatment is surgical excision-with or without using Mohs micrographic technique. When the histopathologic examination reveals bone formation in the skin, clinicians should consider the possible presence of an adjacent malignancy, such as a basal cell carcinoma.

[Retrospective analysis of 273 benign fibro osseous lesionsin the sinus and maxillofacial region]

Objective:To compare and analyze the incidence, clinical features ,imaging features, the preoperative serum alkalinosis phosphatase (ALP) and recurrence rates of osteoma, ossifying fibroma (OF), and fibrous dysplasia (FD) in sinus and maxillofacial benign fibrosis (FOLS). Method: The 273 cases of FOLS with paranasal sinus and maxillofacial region in our hospital, among which there were 153 cases of osteoma, 44 cases of OF, and 76 cases of FD, were reviewed retrospectively and were follow-up for 6 months to 5 years. The incidence, gender, age, lesion location, preoperative serum ALP levels and recurrence rate of different lesions were analyzed and compared. Result:Most Osteoma occurred in paranasal sinus (72.5%),among which the most common part was ethmoid sinus (50.3%) and followed by the frontal sinus (22.1%),the ratio of female to male was 2:1,and there were 27 cases (17.7%) accompanied by sinusitis.None of the patients relapsed. Most OF occurred in the maxillofaCIal bone (65.9%) and most of the lesions were monostotic (75.0%).For those occurred in the paranasal sinuses,the ethmoid sinus (27.3%)were the most common part than others. The ratio of femal to male was almost 1∶1 and there were 12 cases (27.3%) accompanied by sinusitis. The recurrence rate of the OF was 13.6%.Most FD occured in maxillofacial bone (64.5%) were the monostotic form(64.5%) ,and in which the most common part was the maxilla (50.0%). While,most of those occurred in the paranasal sinuses were the polyostotic ones,and sphenoid sinus (34.2%) were the most common parts.The ratio of femal to male was almost 1∶1 and there were 10 cases (13.2%) accompanied by sinusitis. 12 cases relapsed (14.5%),and there were 9 cases (75.0%) acceptted the first surgery before the age of 20.The average age of onset among Osteoma［(40.7±14.55)y］,OF［(28.0±17.9)y］ and FD［(20.32±15.2)y］ were significant different (P<0.01).The preoperative serum ALP content among Osteoma［(68.3±24.1)U/L, OF(130.1±107.0) U/L and FD were (127.7±78.7) U/L significant different(P<0.01).Nevertheless,there were no differences of the preoperative serum ALP content between the monostotic and polyostotic in OF cases［(117.2±92.6) U/L,(168.7±140.1) U/L respectively,( P>0.01)］,as well as that between FD cases［(122.2±82.9) U/L, (137.7±70.7) U/L (P>0.01)］. Conclusion:The differences of the inCIdence,the age of onset,leision location,preoperative serum ALP content and reccurence rate among Osteoma,OF and FD are statistically significant.Surgery is the most effective treatment at present.

[Gardner syndrome with chronic osteomyelitis of the jaw: a case report]

Gardner syndrome is a rare autosomal dominant disease. Its symptoms include multiple intestinal polyps, soft tissue tumors, dental disorders, osteoma, and congenital hypertrophy of the retinal pigment epithelium. Here, we present a patient with Gardner syndrome and chronic osteomyelitis of the jaw to highlight the serious damage that can be caused by Gardner syndrome.

Osteoplastic Flap Without Obliteration: How I Do It

Background The osteoplastic flap provides access to pathology of the frontal sinus and is often performed with obliteration, which can result in significant long-term complications. Objective To describe the authors' approach to osteoplastic flap without obliteration. Methods Descriptive analysis. Results Osteoplastic flap without obliteration preserves frontal sinus function while permitting direct access to the frontal sinus. In this study, we demonstrate a combined nonobliterated approach, accessing the frontal sinus with a Draf III approach to remove a large frontal sinus osteoma. Conclusion The approach provides excellent exposure for large tumors not otherwise accessible via purely endoscopic procedures, permits improved surveillance, and minimizes long-term complications of obliterated sinuses.

Internal auditory canal exostosis: A technical case report

Background:

Exostoses of the internal auditory canal is a rare finding that may present with disabling symptoms of dizziness, hearing loss, and vestibular dysfunction based on the extent of cranial nerve compression. The purpose of this case report is to discuss the presentation and outcomes in a patient who presented with this disorder.

Case Description:

A 19-year-old female presented to the neurotologist with left ear discomfort, pain with left lateral gaze, and dizziness. She underwent extensive evaluation including audiometric testing, videonystagmography, and neuroimaging, which confirmed left auditory and vestibular hypofunction and compression of the contents of the internal auditory canal from the exostosis. After extensive counseling, the patient elected to undergo a suboccipital craniectomy to remove the internal auditory canal exostosis. She experienced complete resolution of symptoms.

Conclusions:

Exostoses of the internal auditory canal, although rare, can present with severe symptoms of dizziness, hearing loss, and vestibular hypofunction based on the extent of cranial nerve compression. Imaging, particularly with thin-cut computed tomography, is invaluable in making the correct diagnosis. Severe cases can be treated successfully with surgery with minimal or no complications and excellent outcome.

Fibro-Osseous Lesions of the Skull Base in the Pediatric Population

Fibro-osseous lesions of the skull base include a variety of lesions with different biologic behavior. The most common lesions include fibrous dysplasia, osteoma, aneurysmal bone cyst, and juvenile ossifying fibroma. The diagnosis can usually be established with radiographic imaging. In the absence of symptoms, slow-growing lesions can often be observed. When surgery is indicated for relief of symptoms, endoscopic endonasal techniques are well suited for all age groups.

Arthroscopic Excision of Osteoid Osteoma of the Femoral Neck

Osteoid osteoma (OO) is a benign, solitary bone tumor of the long bones of the lower limbs and accounts for 10% to 12% of all benign bone. However, an OO of the femoral neck is extremely rare and difficult to treat. Arthroscopic excision of OO of the femoral neck has many advantages. We report a 15-year-old patient with OO of the femoral neck which was treated with arthroscopic excision. The clinical and radiographic findings along with the surgical management of the lesion are presented. The pain disappeared immediately after the operation. At the 14 months' followup, the patient was pain free, and there was no evidence of recurrence.

Osteoma with actinomycosis in a nasal cavity: A case report

RATIONALE

Osteoma with actinomycosis is a very rare disease in the nasal cavity.

PATIENT CONCERNS

We report a case of a 17-year-old female student who presented with nasal obstruction and rhinorrhea for 6 months.

DIAGNOSES

The preoperative finding was osteoma covered with yellowish polypoid material.

INTERVENTIONS

We performed endoscopic sinus surgery, which included excision of the tumor and medication with oral penicillin for 8 weeks.

OUTCOMES

Postoperative recovery was uneventful. There was no evidence of tumor recurrence during the 1-year period after surgery.

CONCLUSION

Anaerobic conditions as a result of allergic rhinitis and narrowed nasal cavity because of osteoma can be the cause of formation of actinomycosis. Clinicians should note that osteoma with actinomycosis can be treated with surgical removal of the tumor and short-term antibiotic therapy.

Types of orbital osteoma - A descriptive analysis

AIMS

This study describes different types of orbital osteoma based on clinical per-operative morphology and radiological findings to facilitate communication between ophthalmologists and surgical management for a better patient outcome.

MATERIALS AND METHODS

The study was conducted in the Orbit and Oculoplastics Department of Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan, from July 1, 2001 to June 30, 2014. A retrospective analysis of 520 diagnosed orbital tumours who presented to us was carried out and the prevalence of orbital osteoma was determined. The sampling technique was non-randomized sampling. Based on the clinical morphology observed during surgical intervention as well as the radiological findings of the orbital osteoma, a simple yet useful description of orbital osteoma was introduced.

RESULTS

The retrospective analysis of 520 diagnosed orbital tumours revealed a prevalence of 2.3% (n = 12) of orbital osteoma. Based on our observation of the 12 (n = 12) cases of orbital osteoma, we have classified orbital osteoma into a combination of seven types: "sessile" or broad-based osteoma; "pedunculated" or mushroom osteoma with a thin cylindrical stalk of origin; "dumb-bell"-shaped osteoma with the simultaneous presence in orbital and adjoining sinus/nasal cavity; "wrapped" osteoma, covered by a thin cartilaginous layer; "naked" osteoma, without any such covering; "homogenous" or uniformly dense osteoma; and "heterogeneous", soft-dense osteoma with varying areas of density.

CONCLUSION

This study attempts to introduce a simple description of different types of orbital osteoma based on clinical per-operative morphology and radiological findings for the first time to facilitate the surgical removal of orbital osteoma.

Air-blocking ablation of osteoid osteoma; a technical note

Osteoid osteoma accounts for approximately 10-12% of all benign bone tumors. Surgery was the treatment of choice for osteoid osteomas until percutaneous radiofrequency ablation (RFA) was introduced in 1992. Although RFA is generally considered curative in the treatment of osteoid osteoma, disease recurrence after ablation has been reported. We report a case in which RFA was delayed by the presence air surrounding the ablation probe. In this case, ablation could only be performed after the probe was removed and saline was injected through the introducer needle to displace the air. Air is reported to decrease radiofrequency energy transmission; a simple measure like injecting saline through an introducer could prevent such a complication. We also suggest that partial air in the ablation bed surrounding the ablation probe could decrease the energy transmission and may be one of the causes of early recurrences. Saline injection could be helpful in providing a more reliable environment for ablation.

A nasal osteoma with an acute course in a Japanese Black heifer

A 14-month-old Japanese Black heifer presented with unilateral epistaxis and mild swelling of the right face. Radiography revealed a mass with increased radiopacity on the right side of the nasal bridge, extending to the left side. Intranasal endoscopy confirmed a large tumor-like structure protruding into the nasal cavity. Following euthanasia, cranial computed tomography (CT) was performed, revealing a tumor 24.3 × 17.5 × 14.8 cm in size. The tumor occupied the entire right nasal cavity and the frontal and sphenoid sinuses. Histopathological examination revealed that the tumor consisted of well-differentiated trabecular bones and loose connective tissue. Based on these findings, a diagnosis of osteoma was established. This report describes a case of osteoma with an acute course in a Japanese Black heifer.

Frontal sinus osteoma with pneumocephalus: A rare cause of progressive hemiparesis

Osteomas of paranasal sinuses are common benign tumors and are diagnosed incidentally. However, osteomas complicated by pneumocephalus with air fluid level presenting with progressive hemiparesis is rare. Here, we present a case report of a 22-year-old male who presented with left-sided progressive hemiparesis with history of generalized headache since 2 years.

Subtrochanteric osteoid osteoma: A misdiagnosed case complicated by a hip fracture

A 34-year-old man with a subtrochanteric osteoid osteoma localized to the lateral cortex of the left femur is reported. The patient presented with mild spontaneous pain of the lateral thigh and knee. He refused a radiographic examination and was treated as a greater trochanteric pain syndrome for 9 months. He was then admitted with a transcervical fracture of the neck of the left femur after a fall from standing height. The fracture was fixed with 3 cannulated screws and healed uneventfully. His symptoms worsened after the first postoperative year. Eighteen months postoperatively the pain was dull, worsening at night, and relieved only with anti-inflammatory drugs, and he had a limp. New radiographs and tomograms were indicative of a lateral subtrochanteric osteoid osteoma with a subperiosteal localization. The lesion was treated successfully with surgical excision of a piece of reactive bone including the nidus.

Surgical case of intracranial osteoma arising from the falx

Intracranial osteomas completely unrelated to osseous tissues are extremely rare. In the present study, the case of a 40-year-old female who presented with persistent headache is reported. Computed tomography (CT) and bone window CT revealed an ossified lesion in the frontal area. Fast imaging employing steady-state acquisition (FIESTA)/CT venography fusion imaging demonstrated that the mass was located just below the superior sagittal sinus and cortical veins, and had adhered partially to these veins. Surgery achieved complete tumor removal with preservation of the cortical veins and superior sagittal sinus. The histological examination findings were compatible with osteoma. The present postoperative course was uneventful. The present rare case of intracranial osteoma originating from the falx was successfully treated surgically. Preoperative FIESTA/CT venography fusion imaging was very useful to demonstrate adhesion between the tumor mass and the superior sagittal sinus and cortical veins.

Cancellous osteoma of maxilla: A rare case report

Osteoma is a slow growing benign tumor result from either cancellous or compact bone proliferation. Osteoma of the jaws may arise from the surface of the bone as a sessile mass located either peripherally or endosteally. This paper presents a rare case report of peripheral cancellous osteoma, involving the buccal cortical plate and alveolar process of the right maxilla of a 37-year-old female patient.

Osteoma and Ectopic Tooth of the Left Maxillary Sinus: A Unique Coexistence

BACKGROUND

Ectopic eruption of a tooth or osteoma rarely occurs within the maxillary sinus. Coexistence of these two rare entities in the maxillary sinus has never been reported in the English literature.

CASE REPORT

Herein, we present a 21 year-old male patient with osteoma and ectopic tooth in the left maxillary sinus treated with the removal of the ectopic tooth by endoscopic sinus surgery and excision of the osteoma by the Caldwell-Luc procedure.

CONCLUSION

Unique coexistence of two different entities in the maxillary sinus is most likely due to pediatric facial trauma. Pediatric patients with maxillofacial trauma should be carefully watched for dental injury both clinically and radiologically.

Lingual Osseous Choristoma

An osseous choristoma is a rare benign lesion consisting of normal bone tissue; it is seen in abnormal locations. It is most often seen in the posterior 1/3 of the tongue in the head. Its etiopatogenesis is controversial, and till date, less than 100 cases have been reported in the literature. Although a lingual osseous choristoma is asymptomatic, in some patients, symptoms such as swelling sensation in the throat, globus pharyngeus, dysphagia, retching, nausea, and sore throat have been reported. In this article, a 41-year-old female patient admitted to our clinic with throat pain and globus pharyngeus who underwent an excision from the region of radix lingua and the result of histopathological examination was reported as "osseous choristoma" was presented and related literature is reviewed.

Single-staged resections and 3D reconstructions of the nasion, glabella, medial orbital wall, and frontal sinus and bone: Long-term outcome and review of the literature

BACKGROUND

Aesthetic facial appearance following neurosurgical ablation of frontal fossa tumors is a primary concern for patients and neurosurgeons alike. Craniofacial reconstruction procedures have drastically evolved since the development of three-dimensional computed tomography imaging and computer-assisted programming. Traditionally, two-stage approaches for resection and reconstruction were used; however, these two-stage approaches have many complications including cerebrospinal fluid leaks, necrosis, and pneumocephalus.

CASE DESCRIPTION

We present two successful cases of single-stage osteoma resection and craniofacial reconstruction in a 26-year-old female and 65-year-old male. The biopolymer implants were preselected and contoured based on imaging prior to surgery. The ideal selection of appropriate flaps for reconstruction was imperative. The flaps were well vascularized and included a pedicle for easy translocation. Using a titanium mesh biopolymer implant for reconstruction in conjunction with a forehead flap proved advantageous, and the benefits of single-stage approaches were apparent. The patients recovered quickly after the surgery with complete resection of the osteoma and good aesthetic appearance. The flap adhered to the biopolymer implant, and the cosmetic appearance years after surgery remained decent. The gap between the bone and implant was less than 2 mm. The patients are highly satisfied with the symmetrical appearance of the reconstruction.

CONCLUSIONS

Advances in technology are allowing neurosurgeons unprecedented opportunities to design complex yet feasible single-stage craniofacial reconstructions that improve a patient's quality of life by enhancing facial contours, aesthetics, and symmetry.

Bilateral external ear canal osteomas - discussion on a clinical case

Osteomas of the external ear are uncommon benign tumors that need to be differentiated from the external ear canal exostoses, bony proliferations that are linked mainly to cold-water exposure. Clinical manifestations vary from no symptoms to recurrent local infections and external ear cholesteatoma. Objective: presenting a rare case that we did not find described in the published literature. A patient with multiple long-term asymptomatic osteomas of both external ear canals presented to our department. Material: Data recorded from the patient's medical record was reviewed and analyzed. Surgery was performed and histology confirmed the presumptive diagnosis. Results: There was a discrepancy between the local severity of the disease, with a complete obstruction of his ear canals, and the long-term disease-free status of the patient. Conclusion: We hypothesized about the etiology of these multiple bilateral osteomas of the EAC, in light of the clinical and surgical findings.

99mTc-methylene diphosphonate single-photon emission computed tomography/computed tomography improves the diagnostic accuracy of osteoid osteoma

We present a case of a 17-year-old football player who had previously received multiple facet joint injections for presumed secondary osteoarthritis. ⁹⁹mTc-methylene diphosphonate single-photon emission computed tomography/computed tomography imaging of the cervical spine demonstrated focal increased radiopharmaceutical activity in the right C2 lamina, which was associated with an osteolytic lesion with a central irregular sclerotic nidus. Surgical pathology confirmed an osteoid osteoma.