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CASE REPORT
Year : 2012  |  Volume : 30  |  Issue : 1  |  Page : 74-77
 

Peripheral osteoma in a young patient: A marker for precancerous condition?


1 Department of Pedodontics and Preventive Dentistry, HP Government Dental College, Shimla, Himachal Pradesh, India
2 Department of Oral Pathology and Microbiology, HP Government Dental College, Shimla, Himachal Pradesh, India
3 HP Government Dental College, Shimla, Himachal Pradesh, India

Date of Web Publication3-May-2012

Correspondence Address:
P Singhal
Department of Pedodontics and Preventive Dentistry, HP Government Dental College, Shimla, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.95588

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   Abstract 

Osteoma is a benign osteogenic tumor arising from the proliferation of cancellous or compact bone. The osteoma can be central, peripheral, or of an extraskeletal type. Peripheral type of osteoma is most common in the lower jaws, which occurs at the surface of the cortical bone and is sessile or pedicled. The overall incidence of osteoma is low, affecting 0.01-0.04% of the population; osteomas comprise 12.1% of benign bone tumors and 2.9% of all bone tumors. Most of the osteomas occurring in the mandible are dense osteomas, and the cancellous osteoma is comparatively rare. Maxillofacial osteoma associated with cutaneous sebaceous cysts, multiple supernumerary teeth, and colorectal polyposis is known as Gardener's syndrome. However, in some cases, maxillofacial osteomas with multiple impacted and supernumerary teeth are not accompanied by a fixed complex of symptoms. We report one such case in a 15-year-old female patient.


Keywords: Gardener′s Syndrome, impacted teeth, osteoma


How to cite this article:
Singhal P, Singhal A, Ram R, Gupta R. Peripheral osteoma in a young patient: A marker for precancerous condition?. J Indian Soc Pedod Prev Dent 2012;30:74-7

How to cite this URL:
Singhal P, Singhal A, Ram R, Gupta R. Peripheral osteoma in a young patient: A marker for precancerous condition?. J Indian Soc Pedod Prev Dent [serial online] 2012 [cited 2019 Jul 19];30:74-7. Available from: http://www.jisppd.com/text.asp?2012/30/1/74/95588



   Introduction Top


Osteomas are bosselated, round to oval, sessile, benign tumors that are composed of mature compact or cancellous bone. The osteoma can be central, peripheral, or of an extraskeletal type. The central osteoma arises from the endosteum, the peripheral osteoma from the periosteum, and the extraskeletal soft tissue osteoma usually develops within muscle. Osteomas are essentially restricted to the craniofacial skeleton and rarely, if ever, are diagnosed in other bones. [1] A peripheral osteoma occurs most frequently in the paranasal sinuses. Other locations include the orbital wall, temporal bone, pterygoid processes, external ear canal, and mandible. [2],[3],[4],[5] In the mandible, dense peripheral osteoma is most commonly found and the cancellous osteoma is comparatively rare. [6] A solitary peripheral osteoma of the jaw bones is quite rare, involving the mandible more often than the maxilla. [2],[3] It has been reported that males and females are equally affected without predisposition for any age. [7] Peripheral osteomas are slow-growing lesions, and clinically they usually remain asymptomatic. However, when they reach a large size, they can produce swelling and asymmetry. [8] Patients with osteomas should be evaluated for Gardner's syndrome (GS). This syndrome is an autosomal dominant disease characterized by colorectal polyposis, multiple osteomas, cutaneous sebaceous cysts, and multiple impacted or supernumerary teeth. The early detection of GS is extremely important because patients can develop colorectal adenocarcinoma. [9] The maxillofacial features of the syndrome can appear many years before the intestinal polyposis, so dentists should be familiar with the significance of GS as a pre-cancerous condition. [9] The purpose of this report is to present a bilateral peripheral osteoma in the mandible with multiple impacted and a supernumerary tooth in a 15-year-old female patient.


   Case Report Top


A 15-year-old female patient reported with a complaint of slowly enlarging swelling in the right lower jaw for the last 1½ years [Figure 1]. There was no associated pain with the lesion, and the patient did not have problem with mouth opening or chewing. She had no history of previous facial trauma, and her medical history was not contributory. Clinical examination revealed extraoral swelling on the right side of the lower jaw; it was oval, non-tender, immobile, and bony hard on palpation. Size of the swelling was approximately 2 × 2 cm. A similar non-tender, small, bony hard swelling was also present medially below the angle of the left mandible. Intraorally, the swelling was palpable in buccal vestibule in relation to tooth no. 46. Teeth 13, 14, 23, 25, 34, 35 were clinically missing, 53 was retained, root stumps of 46 were present, and 36 was carious. On radiographic examination, orthopantomogram (OPG) revealed impacted 13, 14, 23, 25, 34, 35, and a supernumerary tooth in relation to the root stumps of 46 [Figure 2]. An oval, well-defined, radiopaque mass was present on the lower border of body of the right mandible. Another small radiopaque mass was also seen on the left mandibular angle region [Figure 3]. The lesion was provisionally diagnosed as osteoma. Endoscopy of the patient was done to rule out the presence of intestinal polyps. The patient was prepared for surgery. Under local anesthesia, both the bony masses were excised and the specimen was sent for microscopic examination. Postoperative recovery was uneventful. Histopathologic examination revealed that the specimen mostly consisted of cancellous bone with interspersed loose connective tissue containing few capillaries, confirming the diagnosis of peripheral osteoma [Figure 4]. Post-surgical follow-up is being carried out periodically.
Figure 1: Swelling present on the right side of the face

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Figure 2: OPG shows multiple impacted and supernumerary teeth

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Figure 3: Lateral oblique showing bilateral mandibular osteomas

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Figure 4: Histopathologic slide showing bony tissue

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   Discussion Top


As noted in the literature, Peripheral Osteoma of the jawbones is quite rare. These lesions are more frequent in the mandible than in the maxilla. Sayan et al. reported finding 22.85% of the lesions in the mandible and 14.28% in the maxilla in their study; [3] also, Kaplan et al. reported that 81.3% of cases occurred in the mandible. [10] Bilateral osteoma's real prevalence is not known. These lesions usually appear as unilateral, pedunculated, mushroom-like masses. In the mandible, the most common sites are the angle and lower border of the body lingually. [11]

The exact etiology and pathogenesis of peripheral osteoma is unknown; however, neoplastic and reactive causes have been suggested as possible etiologic factors. Some investigators consider it a true neoplasm, while others classify it as a developmental anomaly. [3] The possibility of a reactive mechanism, triggered by trauma or infection, has also been suggested because peripheral osteomas are generally located on the lower border or buccal aspect of the mandible, which are areas susceptible to trauma. [10],[12] It is possible that muscle traction (i.e., masseter, medial pterygoid, temporalis) plays a role in the development of peripheral osteomas. [13] However, in the present case, we have no information on the possible cause because there is no history of previous trauma. But the root stump of badly carious tooth was present in relation to osteoma of the right side and a grossly carious tooth was present on the left side. Clinically, peripheral osteoma appears as a unilateral and well-circumscribed mass, ranging from 10 to 40 mm in diameter, [7],[13] being bilateral and approximately 18 mm on the right side and 15 mm on the left side in the present case. Lesions are usually asymptomatic and can be discovered in routine examination. Sometimes, depending on the location and size of the lesion, it may cause swelling, facial asymmetry, and functional impairment. [14] The swelling is usually painless. In our case, the lesion had reached significantly large dimensions and caused facial asymmetry, without any other clinical symptoms. On radiological examination, a peripheral osteoma of the mandible is a classically well-circumscribed, round or oval, mushroom-like radiopaque mass with distinct borders. [15] The lesion may be sessile and attached to the cortical plates with a broad base. Osteomas precede the clinical and radiographic evidence of colonic polyposis or GS; therefore, they may be sensitive markers for the disease. [16] Nearly all untreated patients of intestinal polyps develop into colorectal carcinoma, so mandibular osteomas may be a genetic marker for the development of colorectal carcinoma. [17] Patients with PO and supernumerary or impacted teeth should undergo a work-up for GS. Surgery is indicated only when the lesion is symptomatic or if it becomes large enough to cause facial asymmetry. The surgical approach should be case specific. For the mandible, there are intraoral or extraoral approaches; an intraoral approach is preferable mainly for cosmetic reasons, as in our case. Recurrence of peripheral osteoma after surgical excision is extremely rare. There are no reports of malignant transformation of peripheral osteoma in the literature. [15]

 
   References Top

1.Neville BW, Damm DD, Allen CM, Bouquot JE. Oral and Maxillofacial Pathology. 2 nd ed. Philadelphia: Saunders; 2002. p. 566.  Back to cited text no. 1
    
2.Larrea-Oyarbide N, Valmaseda-Castellon E, Berini-Aytes L, Gay-Escoda C. Osteomas of the craniofacial region. Review of 106 cases. J Oral Pathol Med 2008;37:38-42.  Back to cited text no. 2
    
3.Sayan NB, Ucok C, Karasu HA, Gunhan O. Peripheral osteoma of the oral and maxillofacial region: A study of 35 new cases. J Oral Maxillofac Surg 2002;60:1299-301.  Back to cited text no. 3
    
4.Alicia AM, Daniel JL. Extensive osteomas of the temporal-parietal-occipital skull. Otol Neurotol 2011;32:e3-4.  Back to cited text no. 4
    
5.Pena Gonzalez I, Llorente Pendas S, Rodriguez Recio C, Junquera Gutierrez LM, De Vicente Rodriguez JC. Craniofacial osteomas: Report of 3 cases and review of the literature. Rev Esp de Cir Oral Maxilofac 2006;28:301-6.  Back to cited text no. 5
    
6.Masuki Y. Peripheral osteoma at the mentum of mandible. Rinsho Derma 2002;44:735-7.  Back to cited text no. 6
    
7.Chaurasia A, Balan A. Peripheral osteomas of jaws-a study of six cases. Kerala Dent J 2009;32:23-6.  Back to cited text no. 7
    
8.Bulut E, Acikgoz A, Ozan B, Gunhan O. Large Peripheral Osteoma of the Mandible: A Case Report. Int J Dent 2010;2010:834761.  Back to cited text no. 8
[PUBMED]  [FULLTEXT]  
9.Wesley RK, Cullen CL, Bloom WS. Gardner's syndrome with bilateral osteomas of coronoid process resulting in limited opening. Pediatr Dent 1987;9:53-7.  Back to cited text no. 9
[PUBMED]    
10.Kaplan I, Nicolaou Z, Hatuel D, Calderon S. Solitary central osteoma of the jaws: A diagnostic dilemma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106:e22-9.  Back to cited text no. 10
[PUBMED]  [FULLTEXT]  
11.Ogbureke KU, Nashed MN, Ashraf AF. Huge peripheral osteoma of the mandible: A case report and review of the literature. Pathol Res Pract 2007;203:185-8.  Back to cited text no. 11
    
12.Kashima K, Rahman OI, Sakoda S, Shiba R. Unusual peripheralosteoma of the mandible: Report of two cases. J Oral Maxillofac Surg 2000;58:911-3.  Back to cited text no. 12
[PUBMED]  [FULLTEXT]  
13.Woldenberg Y, Nash M, Bodner L. Peripheral osteoma of the maxillofacial region. Diagnosis and management: A study of 14 cases. Med Oral Pathol Oral Cir Bucal 2005;10 Suppl 2: E139-42.  Back to cited text no. 13
    
14.An SY, An CH, Choi KS. Giant osteoma of the mandible causing breathing problem. Korean J Oral Maxillofac Radiol 2006;36:217-20.  Back to cited text no. 14
    
15.Johann AC, de Freitas JB, Ferreira de Aguiar MC, de Araujo NS, Mesquita RA. Peripheral osteoma of the mandible: Case report and review of the literature. J Cranio-Maxillofac Surg 2005;33:276-81  Back to cited text no. 15
    
16.Madani M, Madani F Gardner's Syndrome Presenting with Dental Complaints. Arch Iran Med 2007;10:535-9.  Back to cited text no. 16
    
17.Lew D, DeWitt A, Hicks RJ, Cavalcanti MG. Osteomas of the condyle associatedwith Gardner's syndrome causing limited mandibular movement. J Oral Maxillofac Surg 1999;57:1004-9.  Back to cited text no. 17
[PUBMED]  [FULLTEXT]  


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]


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