Solitary peripheral osteoma of the body of the mandible

Medhini Madi; Subhas G Babu; Renita Castelino; Supriya Bhat; Ananya Madiyal

doi:10.4103/srmjrds.srmjrds_34_17

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CASE REPORT

Year : 2017 | Volume : 8 | Issue : 3 | Page : 136-139

Solitary peripheral osteoma of the body of the mandible

Medhini Madi, Subhas G Babu, Renita Castelino, Supriya Bhat, Ananya Madiyal
Department of Oral Medicine and Radiology, A. B. Shetty Memorial Institute of Dental Sciences, NITTE University, Mangalore, Karnataka, India

Date of Web Publication

18-Sep-2017

Correspondence Address:
Medhini Madi
Department of Oral Medicine and Radiology, A. B. Shetty Memorial Institute of Dental Sciences, NITTE University, Deralakatte, Mangalore - 575 018, Karnataka
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/srmjrds.srmjrds_34_17

Abstract

Osteomas are benign osteogenic tumors that are often slow growing and frequently arising in the craniofacial bones and rarely originating from the mandible. Central, peripheral, and extraskeletal are the three varieties of osteomas of which the central and the peripheral types are commonly seen in the facial bones. Peripheral osteomas most commonly were seen in the frontal, ethmoidal, and maxillary sinus and very rarely seen in the jaws. Typically asymptomatic in nature, osteoma presents itself as a welldefined radiopaque mass. Herein, we report a rare case of peripheral osteoma of the body of the mandible of a 45-year-old female patient.

Keywords: Benign, mandible, osteoma, tumor

How to cite this article:
Madi M, Babu SG, Castelino R, Bhat S, Madiyal A. Solitary peripheral osteoma of the body of the mandible. SRM J Res Dent Sci 2017;8:136-9

How to cite this URL:
Madi M, Babu SG, Castelino R, Bhat S, Madiyal A. Solitary peripheral osteoma of the body of the mandible. SRM J Res Dent Sci [serial online] 2017 [cited 2023 May 28];8:136-9. Available from: https://www.srmjrds.in/text.asp?2017/8/3/136/215018

Introduction

Peripheral osteomas of the facial bones that are solitary in nature are benign osteogenic tumors characterized by proliferation of compact or cancellous bone. They are bosselated, round to oval, sessile, and originate from the craniomaxillofacial region such as temporal bones, sinuses, maxilla, or mandible. Although they can occur at any age, they are generally seen between 2^nd and 5^th decades of life. There are three subtypes of osteomas: peripheral (also known as parosteal or periosteal or exophytic), central (also called endosteal), and extraskeletal (also known as osseous choristoma osteoma).^[1],[2]

The central osteoma arises from the endosteum, the peripheral osteoma from the periosteum, and the extraskeletal soft tissue osteoma usually develop within the muscle. Osteomas are essentially restricted to the craniofacial skeleton and rarely, if ever, are diagnosed in other bones.^[3] A peripheral osteoma arises most frequently in the paranasal sinuses. Other locations include the orbital wall, temporal bone, pterygoid processes, external ear canal, and mandible. In the mandible, dense peripheral osteoma is most commonly found and the cancellous osteoma is relatively rare. A solitary peripheral osteoma of the jaw bones is quite rare. When it involves the jaw bones, the involvement of mandible is seen more often than the maxilla. Males and females are equally affected without predisposition for any age. Peripheral osteomas are slow growing and clinically asymptomatic. Nonetheless, when they reach a large size, they can produce swelling and asymmetry.^[4]

Here, we report a case of a solitary peripheral osteoma arising at the left body of the mandible with its clinicopathological and radiological findings along with differential diagnosis and treatment plan.

Case Report

A 45-year-old female patient reported to the Department of Oral Medicine and Radiology with a chief complaint of swelling in the left lower jaw for 10 years. The patient noticed a small growth 10 years back in the left lower jaw which grew in size gradually and reached the present size. It has remained the same size since approximately 4–5 years. No associated pain or discharge for 10 years. She had undergone extractions 13 years back in the left lower jaw and postextraction period was uneventful. She was conscious, cooperative, well oriented to time, place, and person, moderately built, and nourished with proportionate development of the body. No signs of pallor, icterus, clubbing, cyanosis, and edema were seen. Vital signs were within normal limits.

On extraoral examination, a swelling measuring approximately 1.5 cm × 1.5 cm in dimension was seen in the left lower body of the mandible, extending anteriorly from 3 cm away from the midline, posteriorly 4 cm away from the angle of the mandible, superiorly 2 cm away from the left angle of the mouth, inferiorly lower border of the mandible. On palpation, inspectory findings regarding site, shape, and size were confirmed. The swelling was bony hard in consistency, fixed to the underlying bone, non-tender on palpation. No surface change in color, no ulceration on the overlying skin and no bleeding or discharge [Figure 1].

Figure 1: (a-c) Clinical photograph showing the extraoral swelling on the left body of the mandible

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On intraoral examination, the swelling could not be noticed on inspection. On palpation, swelling could be palpated on the buccal side of the region with respect to 36, 37. It was bony hard in consistency and nontender with no surface change in color, no discharge, and no ulceration. On hard tissue examination, there was restored teeth with respect to 17, 26; missing teeth with respect to 27, 37, 38, 46; and decay with respect to 16 [Figure 2].

Figure 2: Clinical photograph showing the mandibular left quadrant intraorally

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Mandibular occlusal radiograph showed a well-defined homogeneously radiopaque pedunculated mass roughly measuring 2 cm × 2 cm in size with lobulated surface attached to the buccal cortical plates in the region of the left posterior body of the mandible. The lateral oblique view of the body of the left mandible also showed a radiopaque mass that is lobulated [Figure 3].

Figure 3: (a) Mandibular lateral occlusal radiograph showing well – defined radiopaque mass. (b) Left lateral oblique view of the mandible showing well – defined radiopaque pedunculated mass

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Panoramic radiography revealed normal condylar and coronoid process, restored teeth with respect to 17, 26; missing teeth with respect to 27, 37, 38, 46; and decay with respect to 16. A radiopaque mass is seen in the region of left body of the mandible measuring approximately 2 cm × 2 cm in dimension and appearing lobulated and well defined at the region below the apex of 36 [Figure 4].

Figure 4: Panoramic radiograph showing the radiopaque mass

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On the basis of clinical and radiographic examination, osteoma of the mandible was considered as provisional diagnosis. Excision was performed under general anesthesia with extraoral approach and the mass was excised with chisel and mallet. The patient was discharged without complications.

The excised mass was sent for histopathological examination. The gross specimen which was a whitish solid mass was roughly 1.5 cm × 1.5 cm in dimension. The submitted tissue specimen was fixed in 10% formaldehyde. It was then decalcified in 8% formic acid solution. Histopathological examination of the hematoxylin and eosin-stained slides revealed areas of mature compact bone formation with haversian canals, lacunae with osteocytes, resting lines, and lamellae. These features were compatible with the clinical diagnosis of osteoma [Figure 5].

Figure 5: (a) Photograph of the gross specimen of osteoma (b-d) Photomicrograph suggestive of osteoma

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Discussion

Peripheral osteomas are unusual entities that are commonly asymptomatic in nature if symptomatic, symptoms vary depending on the site and size of the mass. They are pedunculated mushroom-like mass originating from the periosteum.^[5] The etiology is still unknown. Several explanations have been given regarding the possible etiology. Some researchers believe that it may be a true neoplasm or it may be developmental anomaly.^[6] It may be a reactive lesion secondary to trauma, infection, or muscle traction according to Kaplan et al.^[7] Since most of the peripheral osteomas are in close contact with muscles such as masseter, medial pterygoid, and temporalis, few investigators have proposed an etiology secondary to muscle traction.^[6] Peripheral osteomas can originate from body or the angle of the mandible, condyle, coronoid process because these regions are more susceptible to trauma.^[5]

Although the existence of facial osteoma leads to a suspicion about a possible Gardner's syndrome, in our case, Gardner's syndrome was not considered because such patients usually present with accompanying diarrhea, pain abdomen, rectal bleeding, colorectal polyposis, multiple osetomas, tumors of both skin and soft tissues, and multiple impacted supernumerary teeth.^[1]

Radiographically peripheral osteomas are well-demarcated, round, or oval mushroom-like radiopaque masses. Sessile lesions are attached to the cortex with a broad base, while pedunculated lesions have a thin contact area with compact bone.^[8] In our case, well-defined, lobulated, solitary radiopaque mass at the left body of the mandible was detected with radiographs.

Exostoses, osteoblastoma, osteoid osteoma, or complex odontoma should be considered in the differential diagnosis. Exostoses are an extension of bone and usually stop growing after puberty. Hence, the possibility of the growth being exostoses is ruled out. Osteoblastoma and osteoid osteoma are painful lesions that have a tendency to grow very fast. Osteoblastoma are osteoblastic tumor and characterized with radiopaque and radiolucent patterns, depending on the degree of calcification. Osteoblastoma arises from the medullary bone, whereas osteoid osteoma arises from the cortical bone. Pain due to osteoblastoma reduces with aspirin while that of osteoid osteoma does not show a reduction in pain with aspirin. Since our case never showed symptoms of pain at any stage of the lesions' existence, both osteoid osteoma and osteoblastoma were ruled out. Complex odontoma is a well-defined radiopacity, which is denser than the adjacent bone tissue. In addition, narrow radiolucent rim can be seen around the mass.^[9] In the present case, there was a well-defined lobulated radiopaque mass without a radiolucent rim.

Asymptomatic, small osteomas can be just followed up with physical and radiological examinations. However, surgical removal is indicated only for large, deforming and progressing osteomas to cause facial asymmetry or functional malfunction. Recurrence after resection is very rare, and malignant transformation has not been reported in the literature.

Conclusion

Osteomas are slow-growing benign tumors with rare recurrence rate, and malignant transformation is very unusual. Surgery is indicated only when the lesion is symptomatic or if it becomes large enough to cause facial asymmetry.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Iwai T, Izumi T, Baba J, Maegawa J, Mitsudo K, Tohnai I. Peripheral osteoma of the mandibular notch: Report of a case. Iran J Radiol 2013;10:74-6. [PUBMED]
2.	Alves N, Oliveria RJ, Deana NF, Freitas NM. Peripheral osteoma in the ramus of mandible: Report of case. Int J Odontostomatol 2011;5:215-9.
3.	Neville BW, Damm DD, Allen CM, Bouquot JE. Oral and Maxillofacial Pathology. 2^nd ed. Philadelphia: Saunders; 2002. p. 566.
4.	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. [Full text]
5.	Kshirsagar K, Bhate K, Pawar V, SanthoshKumar SN, Kheur S, Dusane S. Solitary peripheral osteoma of the angle of the mandible. Case Rep Dent 2015;2015:430619. [PUBMED]
6.	Shakya H. Peripheral osteoma of the mandible. J Clin Imaging Sci 2011;1:56. [PUBMED] [Full text]
7.	Kaplan I, Calderon S, Buchner A. Peripheral osteoma of the mandible: A study of 10 new cases and analysis of the literature. J Oral Maxillofac Surg 1994;52:467-70.
8.	Bulut E, Acikgoz A, Ozan B, Gunhan O. Large peripheral osteoma of the mandible: A case report. Int J Dent 2010;2010:834761.
9.	White SC, Pharoah MJ. Benign tumors of the jaws. In: Oral Radiology: Principles and Interpretation. Ch. 21. St. Louis, Mo, USA: Mosby; 2004. p. 410-57.