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.

Young adult with Gorham's disease presenting in an emergency department: a case report

Introduction

Gorham’s disease is a very rare musculoskeletal disorder characterized by progressive resorption of one or more skeletal bones. Most of the 200 cases reported earlier are diagnosed before the age of 40 years. Due to rarity, the diagnosis of Gorham’s disease in the Emergency Department may be very difficult.

Case presentation

We report a case of Gorham’s disease. A 23-year old Caucasian man presented to the Emergency Department with a significant loss of power and sensation of the lower limbs and lower torso. Clinical examination, computed tomography, and magnetic resonance imaging revealed resorption of the ribs and vertebrae, severe kyphosis, and spinal stenosis in the thoracic area. The patient underwent several surgical procedures, including spondylodesis and decompression, and made a good initial recovery. Biopsy confirmed the diagnosis of Gorham’s disease.

Conclusion

We present a young man with Gorham’s disease visiting the Emergency Department. After the proper diagnosis and treatment, our patient had good outcome, although the etiology of this rare disease is uncertain.

Gorham's disease: treatment with an autologous iliac bone graft and a reverse total shoulder arthroplasty

Background

Gorham’s disease (GSD) is a rare osteolytic disease with unclear etiology, and no known prevention or effective treatment. Here we report a new surgical treatment for a case of GSD in September 2017.

Case presentation

We report GSD in a 52-year-old woman. She had disappearance of her humeral head and a defect of the glenoid bone in her left shoulder joint, which were serious obstacles to joint function. We used an autologous iliac bone graft to repair the glenoid bone defect and a reverse total shoulder arthroplasty. After surgery, humeral osteolysis did not continue, and her shoulder function recovered well.

Conclusions

This case suggests that autologous bone grafting can still be used to treat GSD despite it being an osteolytic disease. The successful treatment suggests that this method could be used for GSD in other bones.

Gorham's disease of the mandible: radiological features

The most conspicuous element of Gorham's disease is its radiographic features, wherein massive disappearance of the mandible is observed. We report a case of an adolescent boy with massive osteolysis of the mandible in whom the diagnosis of Gorham's disease was made. A 14-year-old boy was referred to the Department of Oral and Maxillofacial Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, for the management of a massive mandibular deformity. He was diagnosed with a hemangioma-like lesion at 1 year of age. The disease had progressed for an unknown number of years. Plain X-rays and computed tomography images were examined for reconstructive surgery planning. Gorham's disease is self-limiting, but has catastrophic results. The role of imaging is huge, particularly for reconstructive surgery planning.

Gorham's Disease of the Maxilla and Mandible With Distinctive Cone Beam Computerized Tomographic Features

Gorham's disease is a rare and atypical disorder epitomized by progressive osteolysis of bone with eventual total disappearance of bone. The etiology is poorly understood with variable clinical presentation. Most times it is initially misdiagnosed as temporomandibular joint dysfunction, periodontal disease or odontogenic tumors clinically and radiographically in routine dental practice. Radiographic examination, such as Cone Beam Computerized Tomography (CBCT) play a vital role in diagnosing such disorder resulting in disappearance of the involved bone entirely, which is a definitive distinguishing feature of this condition. Regarding the rarity of the condition, the current study presents a case of Gorham's disease with distinctive clinical, radiological, and histological, features involving maxilla and mandible.

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

Vanishing bone disease (VBD) is a rare disease of unknown etiology which is characterised by progressive replacement of bony framework by proliferation of endothelial lined lymphatic vessels. It has been given numerous names like massive osteolysis, Gorham's disease, phantom bone disease, and progressive osteolysis. It has no age, sex or race predilection. It may involve single or multiple bones and spread of the disease does not respect the relevant joint as boundary. The first report of the disease was published around two decades back but the mysterious nature of its etiology and ideal management strategy has still not been completely unfolded. The disease may functionally or aesthetically effect the patient and also has the potential to be life threatening. The first case of VBD in maxillofacial region was reported by Romer in 1924, Handbuch der speziellen pathologischen Anatomie and histology, Springer, Berlin. Since then, there have been few case reports of the same in maxillofacial region. We present a review of cases of VBD in maxillofacial region reported in literature along with our experience of a case.

Surgical Treatment of Gorham's Disease with Massive Osteolysis of the Skull and Cervical Spine: A Case Report and Review of Literature

Gorham's disease is a rare disorder of unknown etiology and variable clinical presentation and is characterized by the proliferation of lymphatic vessels associated with massive regional osteolysis. Although 10 cases involving the skull and cervical spine have been reported in the literature, little is available concerning the surgical treatment of either atlantoaxial dislocation or basilar impression. Most cases have experienced universally unsuccessful treatment with bone grafts, which have led to dissolution. This case report describes the clinical course, and radiotherapeutic, medical, and surgical treatment for Gorham's disease with basilar impression and massive osteolysis of the skull and upper cervical spine. The case of a 27-year-old man with progressive massive osteolysis of the skull and cervical spine is reported. Multiple surgical treatments to decompress the spinal cord and stabilize the skull and upper cervical spine with autologous fibular grafts were performed in order to prevent the progression of atlantoaxial dislocation and basilar impression. Pathologically, radiotherapy failed to show any effect. The efficacy of antiresorptive therapy with bisphosphonates could not be confirmed either clinically or radiologically. Although solid bone fusion was not obtained, the patient has achieved a satisfactory functional outcome and remains completely active after repeated surgeries. Surgical treatment is extremely difficult in cases of Gorham's disease involving the skull and upper cervical spine. Fibular bone grafts seem to show resistance to erosion to osteolytic tissue.

Bone loss in Gorham's disease: A case study

In this study, a rare disease with characteristics of spontaneous osteolysis of the bone is reported. The patient was an eight-year-old male, who was admitted with shortness of breath. The absence of the right clavicle was identified by radiography. However, the change to the right clavicle was not malignant, as indicated by bone scanography. The biopsy of the right cervical rib revealed a number of vascular fibrous tissues and vessels distending and shunting together; however, no cell proliferation was observed. In addition, no acid-fast bacillia or malignant cells were detected in the sample of pleural effusion from the patient. Low hemoglobin (93 g/l) and a slight elevation of alkaline phosphatase levels (133 U/l) were observed; however, the other laboratory examination results were normal. The follow-up investigation and radiotherapy results indicated that the osteolysis of the skull and the other portion of bone had not worsened. Although it has been reported that >15% of patients succumb to this disease, the patient reported in the current study was in a relatively stable condition.