"Vanishing Bone Disease" in Maxillofacial Region: A Review and Our Experience

Vanishing the Existence of the Mandible?

Phantom bone disease, also known as Gorham's disease, is a rare disorder characterized by the progressive destruction of one or more skeletal bones. Commonly involved bones are the upper and lower extremities. Very few cases have been reported in the maxillofacial region with unilateral mandible being commonly involved. This case, to our knowledge, is the third case of Gorham's disease involving the whole length of the mandible in a 55-year-old female with a brief discussion on its clinical, radiographic, and histopathological presentation and treatment options.

Diagnostic Dilemma of Vanishing Bone Disease - A Case Report and Review of Literature

Rationale

Vanishing bone disease (VBD) is a rare bone disorder in which progressive osteolysis may lead to complete disappearance of involved bones. The diagnosis of this disease requires a high degree of clinical suspicion. We present a case of progressive osteolysis of mandible in a patient.

Patient Concerns

The patient had been without definitive diagnosis and treatment for over a year.

Diagnosis

Diagnosis was made by exclusion of genetic, traumatic, inflammatory, infective, endocrine and neoplastic aetiologies and by carefully correlating clinical, imaging and histopathological findings of the patient.

Treatment

Segmental resection of the advancing edge of the lesion was carried out.

Outcome

The patient is disease free, with no evidence of further osteolysis, after six months of follow-up.

Take-Away Lessons

This article describes the exclusion-based approach adopted to diagnose a case of VBD, aiming to standardise a workup for the diagnosis.

Radiographic extent of maxillofacial Gorham's disease and its impact on recurrence: A systematic review

OBJECTIVE

This systematic review assessed the radiographic extent of maxillofacial Gorham's disease and its impact on recurrence.

STUDY DESIGN

PubMed and Cochrane databases were searched. The key words were (Gorham Disease OR Vanishing Bone Disease OR Gorham Stout Syndrome) AND (Jaw OR Maxilla OR Mandible OR Maxillofacial).

RESULTS

Forty-one cases from 39 articles were included. Based on radiographic extent, the lesions were classified as large or small. Most cases occurred in the mandible (24), followed by a combination of maxilla and/or mandible and other bones (12), both mandible and maxilla (3), and maxilla only (2). Only mandibular cases were analyzed for radiographic extent. Of the 24 mandibular lesions, 16 were large and 8 were small. Nine of the large lesions occurred in the young age group with 2 recurrences, followed by 5 in the middle-aged group with 1 recurrence. Small lesions were nearly equally distributed over the age groups, with 2 recurrences in the middle-aged group and 1 recurrence in the adult age group. Age, sex, and lesion size had no significant effect on recurrence.

CONCLUSIONS

Radiographic extent of the lesion does not impact recurrence, suggesting a possible existence of aggressive and nonaggressive variants of maxillofacial Gorham's disease.

Vanishing bone disease: An enigma

Vanishing bone disease is a rare clinical entity with unknown etiology. This disease affects individual irrespective of age or sex. Various names have been used in the literature to describe this condition such as Gorham's disease, phantom bone disease, massive osteolysis, disappearing bone disease and acute spontaneous absorption of bone. The pathogenesis is unknown and the treatment still remains controversial. Considering the rarity of the disease, we report here an interesting and unique case of massive osteolysis of the lower jaw that affected the mandibular basal and alveolar bone. The diagnoses lead on the association of clinical, radiological and histological features.