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Osteoma of the Jaw as First Clinical Sign of Gardner's Syndrome: The Experience of Two Italian Centers and Review. J Clin Med 2023; 12:jcm12041496. [PMID: 36836031 PMCID: PMC9963778 DOI: 10.3390/jcm12041496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/10/2023] [Accepted: 02/12/2023] [Indexed: 02/16/2023] Open
Abstract
Gardner's syndrome (GS) is a combination of polyposis, osteomas, fibromas, and sebaceous cysts. The aim of the study is to highlight whether maxillofacial osteoma could represent an early detection symptom of GS. Patients with suspected osteoma of the jaw underwent genetic and radiographical examinations. The database gathered 19 patients with oral osteoma that was histologically diagnosed; the whole sample was positive for APC gene mutation. Other cranial and peripheral locations were reported. Osteoma of the jaw is a crucial predictive factor of GS, and dentists and oral and maxillofacial surgeons must be aware of the importance of a timely diagnosis.
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Tarsitano A, Ricotta F, Spinnato P, Chiesa AM, Di Carlo M, Parmeggiani A, Miceli M, Facchini G. Craniofacial Osteomas: From Diagnosis to Therapy. J Clin Med 2021; 10:jcm10235584. [PMID: 34884284 PMCID: PMC8658100 DOI: 10.3390/jcm10235584] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/19/2021] [Accepted: 11/24/2021] [Indexed: 12/18/2022] Open
Abstract
An osteoma is a benign bone lesion with no clear pathogenesis, almost exclusive to the craniofacial area. Osteomas show very slow continuous growth, even in adulthood, unlike other bony lesions. Since these lesions are frequently asymptomatic, the diagnosis is usually made by plain radiography or by a computed tomography (CT) scan performed for other reasons. Rarely, the extensive growth could determine aesthetic or functional problems that vary according to different locations. Radiographically, osteomas appear as radiopaque lesions similar to bone cortex, and may determine bone expansion. Cone beam CT is the optimal imaging modality for assessing the relationship between osteomas and adjacent structures, and for surgical planning. The differential diagnosis includes several inflammatory and tumoral pathologies, but the typical craniofacial location may aid in the diagnosis. Due to the benign nature of osteomas, surgical treatment is limited to symptomatic lesions. Radical surgical resection is the gold standard therapy; it is based on a minimally invasive surgical approach with the aim of achieving an optimal cosmetic result. Reconstructive surgery for an osteoma is quite infrequent and reserved for patients with large central osteomas, such as big mandibular or maxillary lesions. In this regard, computer-assisted surgery guarantees better outcomes, providing the possibility of preoperative simulation of demolitive and reconstructive surgery.
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Affiliation(s)
- Achille Tarsitano
- Maxillofacial Surgery Unit, IRCCS Policlinico di S. Orsola, 40138 Bologna, Italy; (A.T.); (F.R.)
| | - Francesco Ricotta
- Maxillofacial Surgery Unit, IRCCS Policlinico di S. Orsola, 40138 Bologna, Italy; (A.T.); (F.R.)
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (P.S.); (A.M.C.); (M.D.C.); (M.M.); (G.F.)
| | - Anna Maria Chiesa
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (P.S.); (A.M.C.); (M.D.C.); (M.M.); (G.F.)
| | - Maddalena Di Carlo
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (P.S.); (A.M.C.); (M.D.C.); (M.M.); (G.F.)
| | - Anna Parmeggiani
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (P.S.); (A.M.C.); (M.D.C.); (M.M.); (G.F.)
- Correspondence: ; Tel.: +0039-05163-66273
| | - Marco Miceli
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (P.S.); (A.M.C.); (M.D.C.); (M.M.); (G.F.)
| | - Giancarlo Facchini
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (P.S.); (A.M.C.); (M.D.C.); (M.M.); (G.F.)
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Yu D, Ng Cw B, Zhu H, Liu J, Lin Y. Bone and dental abnormalities as first signs of familial Gardner's syndrome in a Chinese family: a literature review and a case report. Med Sci (Paris) 2018; 34 Focus issue F1:20-25. [PMID: 30403170 DOI: 10.1051/medsci/201834f104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Gardner's syndrome (GS) is an autosomal dominant disease characterized by the presence of familial adenomatous polyposis (FAP) as well as extraintestinal manifestations such as osteomas, dental anomalies, epidermoid cysts and ocular abnormalities. These intestinal polyps carry a 100% risk of malignant change, so early diagnosis is crucial. As craniofacial osteomas and dental anomalies of GS usually precede gastrointestinal symptoms, otolaryngologists, oral surgeons and dentists play an important role in the diagnosis of GS. GS is extensively reported in literature in the Caucasian race but not in the Mongoloid race. We report a case of a 22-year-old patient with a manifestation of three features of GS - multiple osteomas, soft tissue tumors and dental anomalies in the craniofacial region, with no intestinal polyps at the time of reporting. A family pedigree with our patient as the proband was constructed and revealed 3 consecutive generations in his lineage with GS.
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Affiliation(s)
- Dan Yu
- M.S., D.D.S., Attending doctor, Department of Oral and Maxillofacial Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University. 79# Qingchun Road, Hangzhou 310003, People's Republic of China
| | - Benjamin Ng Cw
- B.D.S., Resident, Department of Oral and Maxillofacial Surgery, National Dental Centre Singapore. Second Hospital Avenue, 168938, Singapore
| | - Huiyong Zhu
- M.D., Ph.D., Professor, Department of Oral and Maxillofacial Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University. 79# Qingchun Road, Hangzhou 310003, People's Republic of China
| | - Jianhua Liu
- M.D., Ph.D., Professor and Chairman, Department of Oral and Maxillofacial Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University. 79# Qingchun Road, Hangzhou 310003, People's Republic of China
| | - Yi Lin
- M.S., D.D.S., Attending doctor, Department of Oral and Maxillofacial Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University. 79# Qingchun Road, Hangzhou 310003, People's Republic of China
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4
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Head and neck presentation of Gardner Syndrome: A pediatric case series. Int J Pediatr Otorhinolaryngol 2018; 110:31-33. [PMID: 29859582 DOI: 10.1016/j.ijporl.2018.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 11/23/2022]
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5
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Odes EJ, Delezene LK, Randolph-Quinney PS, Smilg JS, Augustine TN, Jakata K, Berger LR. A case of benign osteogenic tumour in Homo naledi: Evidence for peripheral osteoma in the U.W. 101-1142 mandible. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2018; 21:47-55. [PMID: 29778414 DOI: 10.1016/j.ijpp.2017.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 05/08/2017] [Accepted: 05/08/2017] [Indexed: 06/08/2023]
Abstract
The reported incidence of neoplasia in the extinct hominin record is rare. We describe here the first palaeopathological analysis of an osteogenic lesion in the extinct hominin Homo naledi from Dinaledi Cave (Rising Star), South Africa. The lesion presented as an irregular bony growth, found on the right lingual surface of the body of the adult mandible U.W. 101-1142. The growth was macroscopically evaluated and internally imaged using micro-focus x-ray computed tomography (μCT). A detailed description and differential diagnosis were undertaken using gross and micromorphology, and we conclude that the most probable diagnosis is peripheral osteoma - a benign osteogenic neoplasia. These tumours are cryptic in clinical expression, though they may present localised discomfort and swelling. It has been suggested that muscle traction may play a role in the development and expression of these tumours. The impact of this lesion on the individual affected is unknown. This study adds to the growing corpus of palaeopathological data from the South African fossil record, which suggests that the incidence of neoplastic disease in deep prehistory was more prevalent than traditionally accepted. The study also highlights the utility of micro-computed tomography in assisting accurate diagnoses of ancient pathologies.
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Affiliation(s)
- Edward J Odes
- School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand Medical School, Parktown, Johannesburg, 2193, South Africa; Evolutionary Studies Institute, University of the Witwatersrand, Johannesburg, South Africa.
| | - Lucas K Delezene
- Evolutionary Studies Institute, University of the Witwatersrand, Johannesburg, South Africa; Department of Anthropology, University of Arkansas, Fayetteville, United States
| | - Patrick S Randolph-Quinney
- School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand Medical School, Parktown, Johannesburg, 2193, South Africa; Evolutionary Studies Institute, University of the Witwatersrand, Johannesburg, South Africa; School of Forensic and Applied Sciences, University of Central Lancashire, Preston, PR1 2HE, UK.
| | - Jacqueline S Smilg
- School of Radiation Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Radiology, Charlotte Maxeke Academic Hospital, Johannesburg, South Africa
| | - Tanya N Augustine
- School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand Medical School, Parktown, Johannesburg, 2193, South Africa
| | - Kudakwashe Jakata
- Evolutionary Studies Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Lee R Berger
- Evolutionary Studies Institute, University of the Witwatersrand, Johannesburg, South Africa
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Tarim Ertas E, Yırcalı Atıcı M, Sözen E. Can careful dental and radiographic examination provide life-saving information? Early diagnosis of Gardner syndrome based on dentomaxillary findings. Oral Radiol 2016. [DOI: 10.1007/s11282-016-0235-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Platzek I, Schubert M, Sieron D, Laniado M. Mandibular tori as an incidental finding in MRI. Acta Radiol Short Rep 2014; 3:2047981614522790. [PMID: 24778803 PMCID: PMC4001434 DOI: 10.1177/2047981614522790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 12/25/2013] [Indexed: 11/16/2022] Open
Abstract
Tori (singular: torus) are among the most common benign jaw lesions. The magnetic resonance imaging (MRI) characteristics have not been reported yet. We present a 72-year-old patient with mandibular tori, which were detected as an incidental finding on MRI and provide an overview of the imaging features of tori.
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Affiliation(s)
- Ivan Platzek
- Department of Radiology, Dresden University Hospital, Dresden, Germany
| | - Marika Schubert
- Department of Maxillofacial Surgery, Dresden University Hospital, Dresden, Germany
| | - Dominik Sieron
- Department of Radiology, District Hospital of Orthopedics and Trauma Surgery, Piekary Śląskie, Poland
| | - Michael Laniado
- Department of Radiology, Dresden University Hospital, Dresden, Germany
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Additional Detection of Multiple Osteomas in a Patient with Gardner's Syndrome by Bone SPECT/CT. Nucl Med Mol Imaging 2013; 47:297-8. [PMID: 24900131 DOI: 10.1007/s13139-013-0225-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 07/28/2013] [Accepted: 08/07/2013] [Indexed: 10/26/2022] Open
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Georgalas C, Goudakos J, Fokkens WJ. Osteoma of the skull base and sinuses. Otolaryngol Clin North Am 2012; 44:875-90, vii. [PMID: 21819877 DOI: 10.1016/j.otc.2011.06.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Osteomata of the frontal and ethmoid sinuses have traditionally been surgically removed via external approaches. However, endoscopic techniques have increasingly been used for the surgical management of selected cases. Advances in visualization and instrumentation, as well as the excellent access provided by the Draf type 3 procedure, expanded the reach of endoscopes. We describe current limits of endoscopic approaches in the removal of osteomata from the frontal sinus and our algorithms for their management. We believe that the vast majority of frontal sinus osteomata can be managed endoscopically, and that only significant anterior or extreme infero-lateral extension constitute major limiting factors.
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Affiliation(s)
- Christos Georgalas
- Department of Otolaryngology, Endoscopic Skull Base Centre, Academic Medical Centre, Amsterdam, Meibergdreef 9, 1105 AZ, The Netherlands.
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Fiani N, Arzi B, Johnson EG, Murphy B, Verstraete FJM. Osteoma of the oral and maxillofacial regions in cats: 7 cases (1999–2009). J Am Vet Med Assoc 2011; 238:1470-5. [DOI: 10.2460/javma.238.11.1470] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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11
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Transmigration of impacted canines: prevalence, management and implications on tooth structure and pulp vitality of adjacent teeth. Clin Oral Investig 2011; 16:625-32. [PMID: 21448635 DOI: 10.1007/s00784-011-0545-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 03/09/2011] [Indexed: 01/11/2023]
Abstract
The aim of this study was to estimate the prevalence of transmigrant canines in a sample of panoramic radiographs of a random Greek population, to classify them and evaluate clinically and radiographically all the implications for adjacent teeth. Panoramic radiographs of 3,586 patients retrieved from eight private practices between 1998 and 2009, were examined. Panoramic radiographs with extracted canines were not included in this study. An impacted canine was considered to be transmigrant when at least part of its length had crossed the midline. Six radiographs exhibited transmigrant canines (0.17% of the total sample of panoramic radiographs), of which four were mandibular and two maxillary. Canine transmigration is a rare phenomenon in Greek population. The impact of transmigrant canines on adjacent teeth varied from inclination, calcific metamorphosis and root resorption to no effect. Orthodontic therapy was the treatment of choice for two of the cases, while in the remaining cases the patients were scheduled for periodic recalls. Clinical and radiographic evaluation and early diagnosis are crucial aids in proper treatment planning.
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Kamel SG, Kau CH, Wong ME, Kennedy JW, English JD. The role of Cone beam CT in the evaluation and management of a family with Gardner's syndrome. J Craniomaxillofac Surg 2009; 37:461-8. [PMID: 19674914 DOI: 10.1016/j.jcms.2009.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 06/01/2009] [Accepted: 06/05/2009] [Indexed: 01/05/2023] Open
Abstract
Gardner's syndrome (GS) is a hereditary autosomal dominant disease of the colon that presents with extra-colonic manifestations such as osteomas, skin lesions and dental abnormalities. Osteomas are commonly found in the skull, jaws and the paranasal sinuses. We present a family of four sisters affected with GS with a wide range of anomalies. The role of Cone beam computed tomography (CBCT) in the early detection and evaluation of osteomas and dental anomalies with precise assessment of their relationship to adjacent anatomic structures is described here in detail. The careful interpretation of CBCT may be of a great value in surgical and orthodontic treatment planning in the presence of jaw lesions. Management of dental problems in GS may be challenging due to the presence of odontomas and increased bone density. A multidisciplinary approach in the management of GS can achieve the best treatment results.
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Affiliation(s)
- Sherif Galal Kamel
- 3D Imaging Facility, University of Texas Health Science Center at Houston, TX, USA
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Huber MA. Gastrointestinal illnesses and their effects on the oral cavity. Oral Maxillofac Surg Clin North Am 2008; 20:625-34. [PMID: 18940628 DOI: 10.1016/j.coms.2008.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Many disease processes affecting the gastrointestinal (GI) tract may cause observable changes to the oral cavity. In fact, oral cavity changes may represent the first clinical manifestation of an underlying GI condition. Recognition and appropriate referral of a possible GI condition contribute to overall health and wellness in patients. Some of the more important GI conditions that may manifest oral cavity involvement include: reflux disorders, inherited GI polyposis syndromes, and inflammatory bowel disease. This article briefly reviews the aforementioned topics.
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Affiliation(s)
- Michaell A Huber
- Division of Oral Medicine, Department of Dental Diagnostic Science, University of Texas Health Science Center, Mail Code 7919, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA.
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Genetic Disorders and Bone Affecting the Craniofacial Skeleton. Oral Maxillofac Surg Clin North Am 2007; 19:467-74, v. [DOI: 10.1016/j.coms.2007.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Fonseca LC, Kodama NK, Nunes FCF, Maciel PH, Fonseca FA, Roitberg M, de Oliveira JX, Cavalcanti MGP. Radiographic assessment of Gardner's syndrome. Dentomaxillofac Radiol 2007; 36:121-4. [PMID: 17403893 DOI: 10.1259/dmfr/18554322] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The detection of osteomas in the maxillofacial region may be the initial clinical finding in Gardner's syndrome (GS). The most common location of osteomas is in the skull, but the lesion can also occur in the jaws. We present a case of a 47 year old male patient with GS who was referred for radiological evaluation. Extraoral examination revealed an epidermoid cyst and the patient had a history of intestinal polyps. A panoramic radiograph demonstrated numerous osteomas and diffuse sclerosis of the mandible, and compound odontomas with impacted teeth. CT scan allowed the localization and extension of the osteomas, and showed other sites in the maxillofacial region as well. CT images also revealed a different behaviour of osteoma, invading the mandibular canal.
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Affiliation(s)
- L C Fonseca
- Department of Radiology, College of Dentistry, University of São Paulo, São Paulo, Brazil
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Parkins GEA, Armah G, Ampofo P. Tumours and tumour-like lesions of the lower face at Korle Bu Teaching Hospital, Ghana--an eight year study. World J Surg Oncol 2007; 5:48. [PMID: 17484780 PMCID: PMC1885260 DOI: 10.1186/1477-7819-5-48] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Accepted: 05/07/2007] [Indexed: 11/21/2022] Open
Abstract
Background The oro-facial region including the jawbones, the maxilla and mandible and related tissues can be the site of a multitude of neoplastic conditions. These tumours have a predilection for the entire facial region; however, odontogenic tumours tend to affect the mandible more than the maxilla, especially, in West African children. We report results from a retrospective study spanning eight years on the frequency, clinical presentation, sites and character of lower face tumours seen in the main referral hospital in Ghana. Patients and methods Records of consecutive patients of all age and sex seen by the first author's team at the Department of Oral and Maxillofacial Surgery, Korle-Bu Teaching Hospital with tumours affecting the lower part of the face from January 1996 to December 2003 were retrieved, coded and entered into a database. The data were then analyzed by age, sex, presenting signs and symptoms, site of lesion, and their histology. Results A total of 394 patients with oro-facial swellings were retrieved from the registry out of which 210 had lower face tumour and tumour-like lesions. The complete data set was obtained for 171 patients, comprising 99 (58%) males and 72 (42%) females. The most common clinical presenting features were mandibular facial swelling (63%), intra-oral swelling (55%), pain (41%) and ulceration (29%). The tumours were predominantly found in the right (43%), anterior (19%) and left (18%) aspects of the lower face. The remainder making up 20% were found in the floor of the mouth, tongue and lips. Seventy eight (45.6%) of the patients presented with lesions that were classified as malignant of which 54 (62%) were diagnosed as squamous cell carcinoma (SCC). Sixty-two (36.3%) had benign odontogenic tumours and thirty-one (18.1%) had non-odontogenic tumour-like lesions. Fifty-four (62%) of malignant tumours were squamous cell carcinoma; 58 (93.6%) of the benign odontogenic tumours were classified as ameloblastoma. The mean age at presentation of all lesions was 40.4 years with over 50% of benign lesions in patients aged between 11 and 30 years. Malignant tumours were more commonly detected in patients between 41 and 70 years (63%). Conclusion Tumours and tumour-like lesions of the lower face comprising the mandible, tongue and adjacent structures are a diverse group of neoplasm and are seen commonly in practice of Maxillofacial surgery. Both malignant and benign tumours are seen in the Ghanaian population. In the present study, SCC and ameloblastoma were the commonest malignant and benign odontogenic tumours seen respectively; the two representing more than 65% of all tumours.
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Affiliation(s)
- Grace EA Parkins
- Department of Oral and Maxillofacial Surgery, University of Ghana Dental School, College of Health Sciences, Korle-Bu, Accra, Ghana
| | - George Armah
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Patrick Ampofo
- Department of Oral and Maxillofacial Surgery, University of Ghana Dental School, College of Health Sciences, Korle-Bu, Accra, Ghana
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