Osteomas of the craniofacial region. Review of 106 cases

Exploring the age and gender-based distribution of paranasal sinus osteomas using cone beam computed tomography: A retrospective cross-sectional study

Objective

The objective of this study is to explore the prevalence, size, location and radiographic features of osteomas in the paranasal sinuses using cone beam computed tomography imaging.

Study design

This study was planned as retrospective cross-sectional. 499 consecutive cone beam computed tomography scans obtained in a dentomaxillofacial radiology department for various dental indications. Statistical analysis of all data was done with SPSS version 22. Descriptive statistics and chi-square tests were used to determine the prevalence of categorical parameters.

Results

Osteoma was detected in 7 % (n = 35) of the 499 images analyzed. The age of the patients ranged from 6 to 96 years (mean 42.03 ± 18.70). No significant difference was found between the genders (p = 0.77). In terms of localization, it was significantly more common in the ethmoid sinuses (p < 0.01). Cortical type osteoma was observed the most frequently in the analyzed images (p < 0.01). The incidence of osteoma was not significant depending on age (p = 0.50).

Conclusion

Osteomas in the paranasal sinuses show a 7 % prevalence in CBCT images, with the ethmoid sinus being the most common site. The average size of osteomas was 3.43 ± 1.78 mm, predominantly cortical in type. These findings highlight the necessity for thorough examination of CBCT images by dentomaxillofacial radiologists to avoid overlooking osteomas.

Large Peripheral Osteomas and Dental Implants: A Case Report

Peripheral osteoma of the jaw is a rare, benign, slow-growing lesion, which usually appears as a unilateral, pedunculated, radiopaque mass protruding from the periphery and is generally solitary. Multiple osteomas without any syndromic involvement are rare. In the present case, a 75-year-old male patient underwent implant placement in the edentulous posterior ridges of the maxilla and mandible. Over 7 years, multiple masses gradually proliferated in the buccal bone of the implant in three different sextants of the posterior region, reaching a size of 2.0 cm. Clinically and radiologically, these lesions were presumed to be peripheral osteomas and were surgically removed because the large mass made self-performed oral hygiene and maintenance of peri-implant health difficult. The histopathological evaluation confirmed that peripheral osteomas were both compact and cancellous. The patient did not exhibit any other clinical manifestations of Gardner syndrome. Whether dental implant placement and loading are involved in the occurrence of peripheral osteomas is unclear, but they might have affected the consistent growth of the mass as a reactive mechanism. After resection, the functional abilities of chewing and self-cleansing significantly improved. No recurrence of peripheral osteoma was observed after 1 year of follow-up, and peri-implant health was well maintained. Within the limitations of the present case report, multiple peripheral osteomas can occur adjacent to dental implants without any syndromic issues, and a large mass of PO can harm peri-implant health which requires surgical removal. It is speculated that dental implants may be associated with the slow and consistent growth of PO.

A Unique Case of Supernumerary Teeth Erupting Inside a Maxillary Sinus Osteoma

Introduction: Ectopic foreign bodies in the maxillary sinus occur rarely. Ectopic tooth eruption rarely occurs in the orbit, nasal cavity, maxillary sinus, and elsewhere. Ectopic eruption of teeth in the maxillary sinus is most commonly associated with wisdom teeth and is rarely associated with supernumerary teeth. This rare phenomenon may be accompanied by chronic recurrent sinusitis with headaches and facial pain. However, fibro-osseous lesions in the paranasal sinuses are discovered incidentally on X-ray images and are often asymptomatic. Osteoma is the most common fibro-osseous lesion that develops in the paranasal and nasal sinuses. Osteomas rarely cause serious symptoms such as orbital lesions and intracranial invasion. Case Presentation: We report a rare case of exostosis containing supernumerary teeth within the maxillary sinus. A characteristic pedicled bone lesion with a clear border on computed tomography was the undefined orthopantomogram radiopacity in the maxillary sinus, and the lesion contained supernumerary teeth. As the patient had chronic nasal congestion, the tumor was surgically removed. Pathologically, the surgical specimen revealed an osteoma. The patient's symptoms of chronic sinusitis disappeared. Because the patient had no history of midface trauma or surgery, the supernumerary teeth were speculated to have migrated during a reactive osteogenic process caused by chronic sinusitis. Conclusions: A foreign body in the maxillary sinus can be easily diagnosed by computed tomography. Surgical removal is recommended if the foreign body is symptomatic or occupies more than half of the maxillary sinus. This can help resolve chronic sinusitis symptoms and prevent serious complications in the future.

Osteoma of the zygomatic bone from 16th century Sardinia (Italy) in the framework of a paleoepidemiological study

OBJECTIVE

The aim of this paper is to evaluate a case of osteoma of the zygomatic bone in a post-medieval individual in the context of a paleoepidemiological approach.

MATERIALS

Forty-five skulls from the plague cemetery of Alghero (Sardinia, Italy), dating back to the end of the 16th century, were evaluated for the presence of osteomata on the outer surface of the cranial vault and facial bones.

METHODS

Macroscopic examination was performed using standard anthropological methods. The bone presenting the lesion was submitted to radiological examination through cone beam; a 3D reconstruction was obtained with a surface 3D scanner.

RESULTS

Only one case of osteoma was observed in an adolescent aged 13-15 years, located on the right zygomatic bone. The lesion consisted of a rounded mass of 0.5 cm in diameter composed of compact bone, as also the radiographic study demonstrates. The prevalence of osteoma on the outer surface of the cranial vault and facial bones in the population of Alghero was 2.2 %.

CONCLUSIONS

This case offers the opportunity to enrich the knowledge about the presence of benign tumors among past populations and to evaluate this lesion in dry bone.

SIGNIFICANCE

This study provides paleoepidemiological data on the scarce area of benign tumors in paleo-oncology and presents the first documented osteoma of the zygomatic bone in paleopathology.

LIMITATION

Histological study was not performed for conservative issues.

SUGGESTIONS FOR FUTURE RESEARCH

Increasing the attention to benign tumors is essential to deepen our knowledge about paleoepidemiology of neoplastic lesions.

Prevalence of benign bone lesions of the lower extremity in the pediatric spinal disorders: a whole-body imaging study

There is a paucity of knowledge about benign bone lesions. The advances in imaging methods can screen bone lesions incidentally, and missing information can be provided. The aim of the study is to collect information about the prevalence and natural history of benign bone lesions with the use of whole-body biplanar slot-scanning imaging (EOS). EOS images acquired between 2015 and 2020 were retrospectively analyzed. Anatomical locations of lesions, number of lesions with polyostotic involvement and radiographic features of each were recorded. Fibrous lesions were further categorized according to the transition stages. The natural course was noted as remained in the same stage, progressed and disappeared during follow-up. A total of 1944 EOS images of 1378 (936 women and 442 men) patients were analyzed. The mean age was 12.3 (5-18) years. Bone lesions of the lower extremities were found in 278 scans (14.3%) of 196 (139 women and 57 men) patients (14.2%). Monostotic lesions were observed in 172 patients, and 24 had polyostotic lesions. The prevalence of lesions was 10.5%, 1.8%, 1.7%, 1.7% and 1.4‰ for fibrous cortical defect (FCD), nonossifying fibroma (NOF), osteochondroma, bone island and simple bone cyst, respectively. Among 145 FCDs, 55.2% of the lesions were stage A, 27.6% were stage B, 9.6% were stage C and 7.5% were stage D. EOS images acquired predominantly for spinal pathologies revealed a prevalence of 14% of benign bone tumors in the lower extremities. With the developments in imaging methods, the probability of encountering incidental lesion increases, and information about bone pathologies can be gathered.

Peripheral Osteoma of the Mandibular Condyle—Case Series

The purpose of this article is to present four new cases of peripheral osteoma of the mandibular condyle and the literature review. A retrospective study of files from our Department of Oral and Maxillofacial Surgery over the last 6 years revealed four cases of peripheral osteomas located in the area of the mandibular condyle. Diagnostic procedure included clinical, radiographic, and histologic criteria. Gardner’s syndrome was excluded from patient history and clinical evaluation. One patient had only an aesthetic disturbance, with facial swelling, and the other three patients presented disturbances of the mandibular function, including deviation during mouth opening along with malocclusion. Three of the patients were male and one was female; all were of middle age (45–65 years old). The proposed surgical treatment was accepted by half of the patients, while the remaining half declined the operation after a confirmation of the diagnosis. Peripheral osteomas of the maxillofacial region are uncommon, and some cases with multiple osteomas are related to Gardner’s syndrome. An osteoma of the mandibular condyle is very rare and surgical treatment is challenging for the surgeon with regards to the approach selection and the related complications. In the two cases that accepted the proposed surgical treatment, no recurrence and no complication was observed.

Recurrent CTNNB1 mutations in craniofacial osteomas

Osteoma is a benign bone forming tumor predominantly arising on the surface of craniofacial bones. While the vast majority of osteomas develops sporadically, a small subset of cases is associated with Gardner syndrome, a phenotypic variant of familial adenomatous polyposis caused by mutations in the APC gene resulting in aberrant activation of WNT/β-catenin signaling. In a sequencing analysis on a cohort of sporadic, non-syndromal osteomas, we identified hotspot mutations in the CTNNB1 gene (encoding β-catenin) in 22 of 36 cases (61.1%), harbouring allelic frequencies ranging from 0.04 to 0.53, with the known S45P variant representing the most frequent alteration. Based on NanoString multiplex expression profiling performed in a subset of cases, CTNNB1-mutated osteomas segregated in a defined "WNT-cluster", substantiating functionality of CTNNB1 mutations which are associated with β-catenin stabilization. Our findings for the first time convincingly show that osteomas represent genetically-driven neoplasms and provide evidence that aberrant WNT/β-catenin signaling plays a fundamental role in their pathogenesis, in line with the well-known function of WNT/β-catenin in osteogenesis. Our study contributes to a better understanding of the molecular pathogenesis underlying osteoma development and establishes a helpful diagnostic molecular marker for morphologically challenging cases.

Possible Association Between Nickel and Multiple Osteomas of the Mandible in a Gir Bullock

A 10-year-old Gir bullock was presented with four contiguous hard nodular submucosal masses attached to the right rostral mandible. Overgrown masses were resected surgically and submitted for microstructural, elemental, and molecular spectroscopic analyses. An osteoma was diagnosed histopathologically. Elemental analysis by energy dispersive X-ray fluorescence spectroscopy revealed the presence of Ca, P, Sr, S, Zn, Cu, Ni, and Fe. Levels of the trace elements Fe, Zn, and Cu in the mandible mass were 2.39, 1.86, and 1.25 times higher, respectively, than those of normal bone. Nickel was detected in the mandible mass, but not in the normal bone. Molecular Fourier transform infrared spectroscopy confirmed the presence of inorganic ν₂ CO₃^2-, ν₃ PO₄^3-, and OH^- in addition to organic collagen amide B, amide I, amide II, and amide III chemical functional groups. Multiple osteomas of the mandible in humans are a feature of Gardner syndrome and have not been recognized in animals so far. This could be the first report of multiple osteomas of the mandible in a Gir bullock associated with nickel-induced epigenetic mutation.

Craniofacial Osteomas: From Diagnosis to Therapy

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.

Benign Bone-Forming Tumors

Benign bone-forming tumors comprise osteomas, osteoid osteomas, and osteoblastomas. Osteomas affect a wide age range and are usually discovered incidentally. They occur predominantly in the craniofacial skeleton and are classically composed of compact bone. Osteoid osteomas and osteoblastomas are painful lesions occurring in young patients. They are morphologically similar and characterized by FOS gene rearrangement and c-FOS expression at a protein level. Osteoid osteomas are usually smaller than 2 cm in maximum dimension with limited growth potential; osteoblastomas are larger than 2 cm and may be locally aggressive. Histologically both are composed of anastomosing trabeculae of woven bone.

Peripheral Osteoma of the Zygoma

ABSTRACT

Osteoma is a benign, slow growing lesion that consists of compact or cancellous bone. Three types of osteomas could be classified: the central osteoma arising from the endosteum, the peripheral osteoma from the periosteum, and the extraskeletal soft tissue osteoma. In the craniofacial region, peripheral osteomas of the zygoma are quite rare. A literature review identified 7 cases of zygomatic arch and 3 cases of zygomatic body. This is the first report of zygomatic osteoma that was endoscopically removed. This report presents a rare case of osteoma of the zygoma and its endoscopic approach. The authors were able to confirm that endoscopic approach of this zygomatic osteoma was safe and effective surgical choice.

Management of paranasal sinus osteomas: A comprehensive narrative review of the literature and an up-to-date grading system

BACKGROUND

Surgical excision represents the unequivocal treatment modality for symptomatic paranasal sinus osteomas. However, the optimal surgical approach and the extent of the surgery, as well as the management stance in the case of an asymptomatic tumor, remain controversial.

METHODS

The MeSH terms 'Osteoma', 'Nasal Cavity', and 'Paranasal Sinuses' were used to retrieve articles concerning the management of paranasal sinus osteomas that were published in the last 30 years, the vast majority of which comprised case reports of one or two cases. Original articles or large series of more than six cases were prioritized.

RESULTS

Our review summarizes previous findings and opinions relevant to the management of symptomatic and asymptomatic paranasal sinus osteomas. The recent shifts in trends of their management are thoroughly discussed. Currently, an extension of the lesion through the anterior frontal sinus wall; an erosion of the posterior wall of the frontal sinus; a far-anterior intraorbital extension; an attachment to the orbital roof beyond the midorbital point; and some patient-specific adverse anatomic variations that may restrict access, are considered strong contraindications to a purely endoscopic approach. On the grounds of this thorough review, a new grading system for frontal and frontoethmoidal osteomas is proposed to allow better conformity to recent advancements and current clinical, research, and educational needs.

CONCLUSION

Over the past 30 years, endoscopic techniques have emerged as the new standard of care for favorably located paranasal sinus osteomas. Nonetheless, open approaches remain indispensable for the management of the more perplexing cases of frontal sinus osteomas.

Practical Approach to Radiopaque Jaw Lesions

Radiopaque lesions of the jaw are myriad in type and occasionally protean in appearance. In turn, the radiologic analysis of these lesions requires a systematic approach and a broad consideration of clinical and imaging characteristics to enable reliable radiologic diagnosis. Initially categorizing lesions by attenuation pattern provides a practical framework for organizing radiopaque jaw lesions that also reflects important tissue characteristics. Specifically, the appearance of radiopaque lesions can be described as (a) densely sclerotic, (b) ground glass, or (c) mixed lytic-sclerotic, with each category representing a distinct although occasionally overlapping differential diagnosis. After characterizing attenuation pattern, the appreciation of other radiologic features, such as margin characteristics or relationship to teeth, as well as clinical features including demographics and symptoms, can aid in further narrowing the differential diagnosis and lend confidence to clinical decision making. The authors review the potential causes of a radiopaque jaw lesion, including pertinent clinical and radiologic features, and outline a simplified approach to its radiologic diagnosis, with a focus on cross-sectional CT. An invited commentary by Buch is available online. ^©RSNA, 2021.

Evaluation of the Association between Paranasal Sinus Osteomas and Anatomic Variations Using Computed Tomography

Objective:

The pathogenesis of paranasal sinus osteoma (PSO) has not been fully elucidated. It is thought that both embryological and developmental factors play a role in the etiology. The aim of the present study was to investigate the association of frequency and localization of PSOs detected on computed tomography (CT) examination with osteoma presence.

Methods:

In this retrospective study conducted in December 2017 through March 2020 in Gaziosmanpaşa University Faculty of Medicine, images of a total of 18,867 patients who underwent paranasal sinus, maxillofacial CT and brain CT angiography were reviewed for the presence of PSOs. Sizes of PSOs and accompanying mucosal pathologies were identified. Associations between PSOs and paranasal sinus variations were evaluated statistically compared to the control group (200 patients without PSO).

Results:

A total of 176 patients (0.92%) were found to have PSO. Average age of the patients with PSO was 59.9 years (range: 18–93). PSOs were unilateral in 152 patients while 24 patients had multiple osteomas. Female/male ratio was 1.1/1. PSOs were most commonly located in the frontal sinuses. Frequencies of vertical concha bullosa, secondary middle turbinate, twisted uncinate, supraorbital ethmoid cell, intersinus septal cell, ethmoidomaxillary cell, Haller’s cell, frontal sinus hypoplasia and sphenoid sinus hypoplasia were significantly higher in the patient group compared to the control group.

Conclusion:

Higher or lower incidence rates of some anatomic variations in the patients with PSO could be explained by the possible effects of genetic and/or environmental factor. Additional studies are needed to evaluate these possible associations.

[A case of isolated sphenoid osteoma with suppurative sinusitis in a 15-year-old child]

Isolated sphenoid osteomas are very rare even in adults. There are extremely few publications on pediatric cases of sphenoid osteomas. This paper presents a case of isolated sphenoid osteoma combined with suppurative sphenoiditis in a 15-year-old patient. The child presented with persistent headache resistant to medical treatment. Endoscopic sphenotomy allowed both to remove osteoma and to relieve the symptoms of sinusitis. The presented case can be considered as the third detailed description of the sphenoid osteoma in children and the first demonstration of the effectiveness of the endoscopic approach for its removal.

A Novel Modification of the Sagittal Split Osteotomy as an Access Osteotomy

Pathologies present in the central zone of the mandible are difficult to access, primarily because of the presence of the inferior alveolar nerve (IAN) and the need to remove a large corticocancellous component to reach the area of interest. Many times, this bony window is replaced as a free graft and there is complete resorption in the long term or even rejection of the graft causing a bony defect which can weaken the mandible. Furthermore, the damage to the IAN is profound. To try and avoid these comorbidities the traditional sagittal split osteotomy was modified to access a central osteoma impinging on the IAN and the successful removal of the same without any comorbidities such as paraesthesia or loss of bone structure. We believe that this modification can be used for other scenarios such as benign cysts and difficult presentations of impacted teeth.

Benign connective and soft-tissue neoplasms of the oral and maxillofacial region: Cross-sectional study of 1066 histopathological specimens

BACKGROUND

Benign connective and soft-tissue neoplasms (CSTNs) are unusual in the head and neck region. The aim of the present study was to evaluate the demographic and clinicopathological features of these neoplasms.

METHODS

A cross-sectional study was conducted of cases diagnosed as benign CSTNs, with data collected from biopsy records. The chi-square test was used. A p-value <0.05 was considered indicative of statistical significance.

RESULTS

Among the 38 119 specimens, 1066 (2.79%) were benign CSTNs: 369 fibroblastic/myofibroblastic, 250 adipocytic, 179 vascular, 130 neural, 94 osseous/cartilaginous, 19 muscular, and two fibrohistiocytic. Most patients were female (62.8%) and white-skinned (45.8%). Mean age was 42 years. The tongue (25.2%) was the most affected site for extraosseous neoplasms.

CONCLUSION

This study had the largest sample of benign oral and maxillofacial CSTNs. Although these tumors have similar clinical features, the characterization and differentiation detailed here may help clinicians with regards to the correct diagnosis.

Microscopic and spectroscopic characterization of an extraskeletal intranasal osteoma in a Gir cow

This is probably the first report characterizing an extraskeletal intranasal osteoma in a Gir cow through scanning electron microscopy and various spectroscopic techniques. Nasal obstruction in a 10-year-old Gir cow is investigated in this study. Skull radiograph demonstrated 174.12 mm × 81.97 mm sized well-circumscribed radiodense mass within the left nasal passage. The intranasal mass was excised completely through a rhinotomy incision. Grossly, intranasal mass was nonhyperemic, rock-hard, and calcified, 174.12 mm × 81.97 mm in size, and 650 g of weight. Excised intranasal mass was investigated through histopathologic, scanning electron microscopic (SEM), energy-dispersive X-ray (EDX) spectroscopic, X-ray fluorescence (XRF) spectroscopic, microwave plasma-atomic energy spectroscopic (MPAES), and Fourier-transform infrared (FTIR) spectroscopic techniques. A native bone of age-matched Gir cow, collected from a cadaver, was taken as a control. Microscopically, structures similar to cortical bone randomly coexisted with trabecular bone were observed. The EDX analysis of the intranasal mass indicated mean Ca/P weight ratio of 1.88, close to Ca/P weight ratio of the control. The XRF analysis revealed the presence of Ca, P, Sr, S, Zn, Cu, Fe, and Ni in the intranasal mass. Additionally, Mn was noted by MPAES analysis. Hence, the XRF and MPAES analyses confirmed a similar elemental composition of the intranasal mass and control. FTIR spectroscopic study confirmed the presence of inorganic ν_1, ν₃ PO₄ ^3- , OH^- in addition to organic collagen amide A, amide B, amide I, amide II, and amide III chemical functional groups in the intranasal mass. These findings of the intranasal mass were consistent with an osteoma having similar elemental and molecular compositions with the native bone.

Central compact osteoma of the mandible: case report featuring unusual radiographic and computed tomographic presentations and brief literature review

Central osteomas of the jaws have been infrequently reported, mostly presenting as a well-defined opacity on conventional radiography projections and as a hyperdensity on computed tomography scans. To increase the knowledge of the phenotypic expression of gnathic central osteomas, an unusual case has been described, including the clinical, radiographic, cone beam computed tomography (CBCT) and histopathologic findings. The lesion was initially discovered 4 years prior as an asymptomatic ovoid radiolucency in the posterior mandible. A 25-year-old female presented with a hyperdense expansile mass with a hypodense rim on a CBCT scan. The enucleated mass was diagnosed as a compact central osteoma. A literature search has identified 4 other cases with similar hypodense borders on CT scans. We propose that a subset of central osteomas should be considered in the differential diagnosis of osteopathologies of the jaws with hyperdense internal architecture and hypodense borders, as seen on CT images.

Giant osteomas: Clinical results and surgical approach from ophthalmic point of view

PURPOSE

To present clinical ocular manifestations, radiological features and surgical results of giant paranasal osteomas involving the orbit.

DESIGN

Retrospective, interventional, case series.

METHODS

The study included patients treated for giant paranasal osteoma involving the orbit. Total or subtotal excision of the tumor was performed via external approach. Clinical characteristics including presenting symptoms, radiologic investigation, histopathology and details of the surgery were recorded.

RESULTS

Of the six patients included; four were male and two were female. Mean age was 46.8 years (range 12-70 years). Five patients had unilateral, one patient had bileteral disease. The presenting complaints included complete (n = 2/6) or partial (n = 4/6) limitation of eye movements depending on the location and size of the tumor, diplopia (n = 5/6), vision loss (n = 2/6) exophthalmos (n = 6/6) and reduced pupillary light reflex (n = 2/6). The presumed origin of the tumor was frontoethmoidal region (n = 2/6), frontal sinus (n = 3/6) and ethmoid sinus (n = 1/6). Total resection was achieved in three of the patients whereas partial resection was achieved in remaining three patients due to risk of incremental neurological damage. Mild ptosis was observed in all patients during the postoperative period (temporary, n = 4; permanent, n = 2).

CONCLUSION

Despite the benign nature of osteomas, severe functional impairment including vision loss due to compression of the optic nerve and diplopia might occur in case of orbital involvement. Osteomas with an orbital extension > %50 of the bony orbit volume are more prone to cause irreversible visual loss. Surgical resection is still the mainstay of therapy.

Giant craniofacial osteoma with orbital invasion

Craniofacial osteomas, which involve orbits, can cause several problems, such as displacement of the globe, diplopia, and refractive changes. We report the case of a young man with diplopia and blurred vision, with a giant osteoma occupying right frontal and ethmoid sinuses, encroaching into his right orbit. The symptoms resolved 3 months after surgery. Our case highlights the successful surgery for a symptomatic craniofacial osteoma with orbital invasion.

Treatment of multiple craniofacial osteomas by endoscopic approach

Osteomas are benign osteogenic neoplasms that usually occur as solitary craniofacial lesions. Multiple osteomas are rare, particularly those that do not occur as part of an associated syndrome. We report a case of a 72-year-old woman who presented with multiple bony protrusions over the forehead and scalp. She denied any diagnosis of syndromes that are known to be associated with osteomas. Surgical excision was performed by endoscopically resecting more than 30 osteomas of the frontal and bilateral parietal bones. Compared with conventional surgical excision through a direct incision, endoscopic-assisted surgery is a simple and effective method for the treatment of multiple craniofacial osteomas and is associated with excellent cosmetic outcomes and no neurovascular complications.

Giant Osteomas: Optimizing Outcomes Through Virtual Planning; a Report of Two Cases and Review of the Literature

Osteomas are benign slow-growing tumors of compact or cancellous bone. They are often asymptomatic. However, a rare variety of "giant" osteomas exists, which can reach an impressive size, causing both functional and cosmetic concerns. The location and size of these lesions can make surgical intervention challenging. Here we present 2 cases of giant osteomas in which 3-dimensional planning was of great aid in optimizing functional and esthetic outcomes, and review the literature related to giant osteomas of the mandible.

Maxillary sinus osteoma: A case report and literature review

This case report describes a rare presentation of an osteoma in the maxillary sinus picked up from an incidental finding on an orthopantomogram that was obtained to inform orthodontic treatment. While orthodontists principally use this radiograph to assess the developing dentition, aid treatment planning and monitor treatment, several peripheral anatomical sites are evident on this radiograph. We review the literature in relation to osteomas presenting in the craniofacial area along with its management. We provide examples of common radiopaque lesions along with their radiographic features that dental healthcare clinicians may encounter.

Nasal Bone Osteoma Approach

Osteoma is a benign osteogenic lesion that arises most frequently in the craniomaxillofacial region. Rarely, it can appear on the outer side of nasal bone and cause aesthetic problems. The authors present an unusual case of outer side nasal bone osteoma with a brief review of its main clinical presentations, diagnostic studies, and treatment options.

A Sizeable Solitary Pedunculated Peripheral Osteoma of the Hard Palate: A Case Report

Osteomas are benign, slow growing, usually sessile osteogenic tumors of unknown etiology. They arise from proliferation of either cancellous or compact bone. They can be central, peripheral or extra-skeletal based on their origin from endosteum, periosteum or extra-skeletal soft tissue respectively. They are commonly found in the skull and facial bones, the most common site in the maxillofacial region being paranasal sinuses. Among the jaw bones the most common site is the mandible. The hard palate is a rare site for such osteomas with a very few cases reported in literature. We report a case of large pedunculated peripheral osteoma of the hard palate in a 38 year old male. The tumor was excised with no recurrence after 3 years followup.

Peripheral osteoma of the nasal bone after laser treatment: A case report

INTRODUCTION

Peripheral osteoma, which arises from the periosteum, commonly develops in the head and neck region and is found frequently in the mandible, maxilla, and paranasal sinuses. However, osteoma of the face, especially from the nasal bone, is quite rare.

PATIENT CONCERNS

A 34-year-old female visited our outpatient department with a small mass on the nose. She had n laser treatment of nevus at the same spot 14 years before, and it had enlarged slowly since 10 years before.

DIAGOSIS

Computed tomography scan revealed a 0.7 × 0.5 cm sized radio-opaque tumor of the nasal bone.

INTERVENTIONS

Under general anesthesia, surgical excision was performed through a transcolumellar and infracartilaginous incision. The excised tumor was a 0.7 × 0.5 cm sized hard mass.

OUTCOMES

Biopsy confirmed it as a peripheral osteoma. After tumor removal, structural stability of nasal framework including bone and cartilage was maintained, and symmetry of the nasal dorsum was acquired.

CONCLUSION

Chronic osteoma can compress the abutting structures. In the case of the nose, either structural instability or asymmetry can occur. By applying open rhinoplasty techniques, postoperative scars could be hidden and additional correction of the affected structure could be carried out if necessary. As a result, the surgeon can achieve the functional and esthetic outcomes simultaneously.

Surgical Treatment of Paranasal Sinus Osteomas: A Single Center Experience of 58 Cases

OBJECTIVES

Osteomas are osseous tumors that primarily occur at the skull, in particular the paranasal sinus system. Surgical tumor resection is the "gold standard" treatment in symptomatic osteomas. The aim of this study was to investigate the use of surgical approaches (endoscopic, open, combined) and to provide a step-by-step approach for patients' management.

METHODS

Fifty-eight patients (31 m, 27 f, 42.1 ± 15.3 years) that were treated between 2001 and 2015 at our department were included in this retrospective, single center study.

RESULTS

In almost half of cases (n = 28, 48.3%) endoscopic, endonasal approaches were used for tumor resection while open (n = 11, 19%) or combined (n = 19, 32.8%) approaches were used in the rest of the cohort. Open or combined approaches were applied in patients suffering from osteomas localized in the maxillary or frontal sinuses only.

CONCLUSION

Beside interviews, clinical examination, nasal endoscopy, and computed tomography are crucial for diagnosis of paranasal sinus osteomas. Magnet resonance imaging can be useful in extensive pathologies. The preoperative selection of the optimal approach for osteoma resection might be most challenging in patients' management. Although useful recommendations regarding the use of surgical approaches have been published, technical requirements and surgical experience of surgeons have to be considered in the limitations of endoscopic approaches. If there are doubts about the resectability of an osteoma by an endoscopic approach, the surgical procedure may be started endoscopically, and, if necessary, it can be combined with an external approach.

LEVEL OF EVIDENCE

IV Laryngoscope, 130:2105-2113, 2020.

Surgical Management of the Peripheral Osteoma of the Zygomatic Arch: A Case Report and Literature Review

An osteoma is a benign, slow-growing, osteogenic neoplasm with a low recurrence rate that is typically characterized by the proliferation of a compact or cancellous bone. It can be peripheral, central, or extraskeletal. Usually asymptomatic, peripheral osteomas in the maxillofacial region commonly arise in the paranasal sinuses and mandible and rarely occur in the zygomatic arch, with only six previously documented cases in the literature. Here, we present the management of a solitary peripheral osteoma of the right zygomatic arch in a 72-year-old woman and a review of the literature.

Mandibular Condyle Osteoma

Background:

Osteoma is a benign tumor composed of both cortical and cancellous bones that increase in size with continuous formation of bone. The pathogenesis is unknown. Osteomas can cause symptoms depending on their location and size. They can be asymptomatic or symptomatic, with trismus, limitation of mouth opening, and progressive malocclusion with facial asymmetry and can be painful.

Aim:

The aim of this paper is to report an unusual case of osteoma in the mandibular condylar neck and review the cases of mandibular condyle osteomas that have been reported in the last 15 years.

Conclusions:

Only a few cases involving the temporomandibular joint have been reported. We report an unusual case of osteoma in the mandibular condylar neck causing restricted mouth opening in addition to pain. Complete surgical excision in symptomatic cases is the therapy of choice with a low recurrence rate.

Central Osteoma of Maxilla Associated with an Impacted Tooth: Report of a Rare Case with Literature Review

Osteomas are benign osteogenic neoplasms caused by proliferation of mature compact or cancellous bone. Clinically they may be classified as peripheral, central or extraskeletal. Osteomas usually involve the craniofacial region with mandible being the most common site. Central osteoma of the jaws is a very rare entity with only 13 cases reported in the literature till date of which only five cases occurred in the maxilla. Here we present a case of a large central osteoma of anterior maxilla associated with an impacted tooth, the first of its kind and a review of literature.

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.

Large Paediatric Central Osteoma with Osteoblastoma-Like Features in the Mandible

The diagnosis of osteomas in the paediatric population can pose a challenge to pathologists in excluding malignant bony tumours. We present the case of a 10-year old male presenting with a large left mandibular radiopaque lesion. This paper discusses the case of a central osteoma with osteoblastoma-like features, literature review, differential diagnosis of radiopaque lesions of the maxilla and mandible as well as a detailed discussion of the pathology of the lesion. Although similar lesions have been described in the sino-orbital region, this is believed to be the first report of this pathological entity in the mandible.

Osteoid Osteoma of the Mandibular Condyle: A Diagnostic Dilemma

Osteoma is benign osteogenic lesions characterized by proliferation of either cancellous or compact bone and can be central, peripheral, or extraskeletal. The most common site is in the skull. When affecting the facial bones, they are frequently found in the mandible, the most common locations being the posterior lingual surface and the mandible angle area. Here, we are presenting a rare case of osteoid osteoma of the mandibular condyle causing facial deformity in a 21-year-old male patient. On investigation, orthopantomogram revealed a solitary ill-defined homogeneous mixed radiopaque-radiolucency with a thin sclerotic border on the left mandibular condyle, cone-beam computed tomography showed a solitary irregular bony multilobulated overgrowth and the fusion imaging of positron emission tomography–computed tomography showed lobulated protuberance along medial margin of the left mandibular condyle with methylene diphosphonate bone scan showed well defined focal increased tracer uptake. The left side condylectomy was performed followed by shaving of inferior border with modified condyle formation by sliding osteotomy. Secondary surgery for correction of occlusion was done, and the patient was advised for orthodontic correction. The present case showed no recurrence after 18 months of follow-up.

Post-Traumatic Peripheral Giant Osteoma in the Frontal Bone

Osteomas are benign, slow-growing tumors that most frequently occur in the craniomaxillofacial region. These tumors are mostly asymptomatic and are generally found incidentally. A giant osteoma is generally considered to be greater than 30 mm in diameter or 110 g in weight. A 35-year-old female presented to us with complaints of a firm mass that showed continuous growth on the forehead following trauma. A hairline incision was made to expose the osteoma. Biopsy of the tumor confirmed a osteoma. There were no complications after surgery. Postoperative computed tomography revealed that the tumor was completely removed. Because a peripheral giant osteoma of the frontal bone with a history of trauma is a rare finding, thorough history-taking, physical examination, and preoperative imaging tests are needed for patients with a history of trauma to rule out a giant osteoma.

Giant Peripheral Temporomandibular Osteoma With Immediate Reconstruction of Mandible

Osteoma is a benign osteogenic tumor, which is characterized the slow-growing proliferation of compact or cancellous bone. The etiology of the lesion is not well established. Among the hypotheses, the following are related: a traumatic factor, infectious processes, or true neoplasm due to the origin of cartilaginous cells. It can present at any age, usually in young adult individuals, with equal prevalence in both sexes. The clinical characteristics of the peripheral osteoma are represented by slow asymptomatic growth, which leads to swelling and, thus, facial asymmetry. When it is related to the mandibular condyle, this growth can cause functional impairment, such as malocclusion, temporomandibular joint dysfunction, and even limited mouth-opening owing to ankylosis.

Multiple Peripheral Osteomas Related to Frontal Exposure by Bicoronal Incision

Osteoma of the skull is a benign slow-growing osteogenic lesion typically composed of well-differentiated mature bone tissue. It is characterized by the proliferation of compact or cancellous bone and is found almost exclusively in the head and neck region. Central, peripheral, and extraskeletal are the major variants of craniofacial osteomas. Trauma, inflammation, developmental disorders, and genetic defects are considered their etiologic factors. Paranasal sinuses, especially frontal and ethmoidal sinuses, are the favorite locations of peripheral craniofacial osteomas.Peripheral osteomas are usually benign, innocuous lesions, but their size, prominence, and visibility on the face necessitate a surgical intervention.The authors describe a rare patient in whom multiple osteomsas were located in the frontal area likely related to an exposure of the site by bicoronal incision made 10 years earlier.

Peripheral Solitary Osteoma of the Zygomatic Arch: A Case Report and Literature Review

Osteoma is a benign slow-growing osteogenic neoplasm commonly occurring in the craniofacial skeleton, characterized by the proliferation of compact and/or cancellous bone. Osteomas may be peripheral, central, or extraskeletal. Peripheral osteomas arise from the periosteum and are quite uncommon in the jaw bones. The exact aetiology and pathogenesis of peripheral osteoma are unknown. Clinically, peripheral osteomas are usually asymptomatic, but depending on the location and size of the lesion, it may cause swelling, pain, esthetic disfigurement and functional impairment. On radiological imaging, a peripheral osteoma appears often as well-circumscribed, round to oval, pedunculated radiopaque mass attached to the cortex by a broad base or a pedicle. Asymptomatic osteomas are treated conservatively, while surgical excision is indicated when the lesion is symptomatic, actively growing, or for cosmetic reasons. Histologically, osteomas are composed of a normal-appearing, dense mass of lamellar bone. Recurrence of peripheral osteoma after surgical removal is extremely rare and there are no reports of malignant transformation. A review of the literature disclosed only 7 well-documented cases of peripheral osteoma located at the zygomatic bone. The purpose of this article is to present the clinical, radiographic, surgical and histological features of a solitary peripheral osteoma of the left zygomatic arch in a 55-year-old woman and to review the literature about this uncommon pathologic entity.

Peripheral osteoma in an unusual location on the mandible

Osteoma is a benign, slow-growing, painless, discrete lesion which is characterised with the proliferation of a compact or cancellous bone. Osteomas are rare on the jaws. Lesions of the mandible developed most often in the condyle, angle and margin. Osteoma developed on the genial tubercle area had only been reported in one case. A 50-year-old female patient has been admitted to our department with the symptom of a hard mass under the chin area. In extra-oral and radiographic examinations, a 1×1 cm size, round, palpable, immobile, radiopaque mass has been determined on the genial tubercle area. The lesion has been completely removed under local anaesthesia by extra-oral approach. Her recovery period was uneventful. Osteoma diagnosis was confirmed with histopathological examination. There is no recurrence at 3-year follow-up. The purpose of this case report is to present a peripheral osteoma case that occurred in the genial tubercle area which is an unusual place.

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.

Solitary central osteoma of mandible in a geriatric patient: Report and review

Solitary central osteomas of jaw are extremely rare lesions with only few previously documented cases. This paper reports a case of large solitary central osteoma involving mandible symphysis- parasymphysis region in an elderly female patient. A brief review of similar cases reported in the literature is also provided in this paper.

KEY WORDS

Osteomas, osteogenic,bone, tumor, jaw, mandible.

Peripheral osteoma of the hard palate: a rare case report and literature review

Osteomas are benign osteogenic tumors that are composed of cancellous or compact bone. They are usually sessile tumours composed of dense sclerotic, well-formed bone projecting out from the cortical surface. They commonly occur in skull and facial bones, however, excluding the maxillary sinuses, the maxilla is a rare site for osteomas. Therefore, we aim to present a case of maxillary osteoma in a 19-year-old male patient and to provide an overview of current literature on the diagnostic options and treatment modalities. To best of our knowledge, in the English literature, this is the seventh reported case of maxillary osteoma which is located on the hard palate.

The Analysis of Patients Operated for Frontal Sinus Osteomas

Objective

Paranasal sinus osteomas are benign tumors that are smooth-walled, slow-growing, and induced by bone tissue. Although their most common localization is the frontal sinus, some osteomas are seen in the ethmoid, maxillary, and sphenoid sinuses. Frontal sinus osteomas are often asymptomatic; however, when they become symptomatic, headache is the most common complaint. In this study, we aimed to analyze the postoperative results of patients who were diagnosed with frontal sinus osteoma and were operated with appropriate surgical techniques.

Methods

We retrospectively evaluated 14 patients who were diagnosed with frontal sinus osteoma and were operated in our department between March 2009 and July 2014. The following parameters were analyzed: patients' age and gender, complaints at the time of admission to our clinic, pathological findings from physically examination, tumor features observed in preoperative paranasal sinus computed tomography (size and localization), surgical methods applied, intra- and postoperative complications, and recurrence rates. All patients preoperatively provided informed consent.

Results

Of the 14 patients, 7 were males and 7 were females, with a mean age of 40.57 years. A total of 11 (79%) osteomas were located within the frontal sinus and 3 (21%) within the frontal recess. External surgical approach was performed to 11 patients, endoscopic approach was performed to 2 patients and external and endoscopic approach was performed to 1 patient together.

Conclusion

Although the preferred surgical method in frontal sinus osteoma depends depended on size and localization of tumors, experience of surgeon is also important. Although the external surgical approach is appropriate for large and laterally localized osteomas, the endoscopic approach is appropriate for small and inferomedially localized osteomas. In both surgical approaches the site of origin should be drilled.