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Bilateral osteoid osteoma of the mandible: An unusual case report
Abstract
Osteoid osteoma is a slow-growing osteogenic tumor which has seldom been described in the jaws. Usually it is monofocal and unilocular. In extremely rare instances it may be multifocal. This case report highlights the epidemiological, clinical, and radiological features of this rare disease.
We describe a rare case of a patient with bilateral osteoid osteoma of the mandible. Both of them were removed surgically. Histological examination confirmed diagnosis. The follow-up for the last 6 months was normal without recurrence.
Osteoid osteoma is a rare entity. Surgery is the mainstay of treatment. Follow up is discussed in order to detect any recurrence.
... The pain is usually intermittent and responsive to NSAIDs. 8 Osteoid osteoma has two appearances on radiology, the osteoid osteoma proper (nidus) that may appear as radiolucent and mixed radiolucent-radiopaque, or radiopaque lesion depending upon the extent of ossification and reaction in its surrounding extended for a variable distance from the nidus. 9 The patient, in this case, had intermittent pain relieved with NSAIDs and his OPG revealed a crescent-shaped radiolucency with corticated borders in the right retromolar trigone area. ...
Osteoid osteoma is a rare benign bone lesion that is often confused with the osteoblastoma. The osteoid osteoma comprises of 3% of all the primary bone tumours usually found in the long bones and vertebrae with the facial skeleton being the most infrequent site. The lesion usually presents with the swelling and pain that resolves with non-steroidal anti-inflammatory drugs (NSAIDs). Here, we report a case of osteoid osteoma of retromolar trigone, the site which has not been reported in the literature, in a 50-year male patient with a complaint of hard swelling on retromolar trigone associated with the mild intermittent localised pain that aggravated at night and on mastication. Excision of the lesion was carried out with chisel and mallet under local anesthesia with uneventful recovery and no recurrence at the 6 months follow-up. Key Words: Benign, Osteoid osteoma, Retromolar trigone.
... Adouly et al 2015 [30] ...
Introduction:
An osteoid osteoma is a benign bone neoplasm with limited growth potential, characterized by significant nocturnal pain that usually responds to non-steroidal anti-inflammatory drugs (NSAIDs). The tumor may occur in any part of the skeleton, most commonly in the lower extremities and vertebrae.
Presentation of case:
A 46-year-old female was diagnosed with a rare case of an intra-articular variant of osteoid osteoma, involving the articular eminence and glenoid fossa of the temporo-mandibular joint (TMJ).
Discussion:
The tumor presented as a painful progressive swelling in the right pre-auricular area that had lasted for more than 2 years and which had been previously treated as a TMJ disorder. Computed tomography revealed a well-defined heterogeneous nidus involving the articular eminence of the TMJ. Surgical excision was performed and histological examination confirmed the diagnosis. In this article, in addition to describing the case, all cases of osteoid osteoma of the jaws and TMJ reported in the English-language literature are reviewed.
Conclusion:
Osteoid osteoma involving the TMJ is a rare presentation and may exhibit ambiguous symptoms, which could lead to misdiagnosis and delayed treatment.
... Unlike OO in the remaining skeletal areas, no sex predilection was observed in the reported cases of OO in the jaws. Two of 29 cases were multifocal [15,16]. ...
... Other sites include the hands, feet, pelvis, vertebrae, and phalanges. Less than 1% of cases occur in the jaws (Infante-Cossio et al., 2016;Singh and Solomon, 2012;Greene et al., 1968;de Souza Dias and Frost 1974;Zulian et al., 1987;Radcliffe et al., 1998;Tochihara et al., 2001;Liu et al., 2002;Jones et al., 2006;An et al., 2013;Adouly et al., 2015;Da Costa et al., 2015). Osteoma (of the jaw) ...
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.
A case of osteoid osteoma (OO) in the mandible of 26-year-old female is presented. Her main complaint was intermittent pain during a 3 year period. The panoramic radiograph of the mandible showed diffuse sclerosis including an ill-defined circular radiopacity in the molar region. Computed tomography (CT) revealed an osseous lesion of 10 mm diameter that was located in the cortical bone of the mandible. Bone scintigraphy showed a localized region of high uptake of 99mTc HMDP. The lesion was diagnosed as an OO by histopathological examination of the surgical specimen and CT findings. Since radiological appearance has very significant meaning in the differentiation of an OO from other bone forming tumors, CT is the method of choice when the main symptom is pain and the conventional radiography was not informative.
A 10-year-old boy presented with a swelling on the right side of the jaw. He had undergone excision of the lesion about 10 months ago at a private dental clinic and the swelling began to regrow 4 months after surgery. A panoramic radiograph revealed 4 sclerotic round masses with radiolucent rims surrounded by sclerosis of the right posterior mandible. Computed tomography scan showed 4 round bony masses centered on the buccal cortex and bone marrow space, sclerosis of the adjacent bone and periosteal reaction. He underwent a marginal resection under general anesthesia and the final histopathological report confirmed the diagnosis of osteoid osteoma. Postoperative course was uneventful, and there was no evidence of recurrence at the 5.5-year follow-up. In the review of the literature, 20 osteoid ostemas were found in the jaw and to the best of our knowledge, the present case is the only one showing multifocal nidi.
We present a 13-year-old girl who was referred to our clinic with a 5-month history of right leg pain relieved by salicylates.
Initial CT examination demonstrated a lesion in the posterior tibial cortex in keeping with an osteoid osteoma. This was resected
and the diagnosis confirmed by histology. However, her pain recurred 2weeks after the operation and further imaging identified
a further nidus in the epiphysis. We present the imaging findings in this unique case of multicentric osteoid osteoma with
one nidus located in the epiphysis.
Osteoid osteoma and osteoblastoma are commonly seen benign osteogenic bone neoplasms. Both tumors are typically seen in the second decade of life, with a notable predilection in males. Histologically, these tumors resemble each other, with characteristically increased osteoid tissue formation surrounded by vascular fibrous stroma and perilesional sclerosis. However, osteoblastomas are larger than osteoid osteomas, and they exhibit greater osteoid production and vascularity. Clinically, osteoid osteoma most commonly occurs in the long bones (eg, femur, tibia). The lesions cause night pain that is relieved with nonsteroidal anti-inflammatory drugs (NSAIDs). Osteoblastoma is most frequently located in the axial skeleton, and the pain is usually not worse at night and is less likely to be relieved with NSAIDs. Osteoblastoma can be locally aggressive; osteoid osteoma lacks growth potential. Osteoid osteoma may be managed nonsurgically with NSAIDs. When surgery is required, minimally invasive methods (eg, CT-guided excision, radiofrequency ablation) are preferred. Osteoblastoma has a higher rate of recurrence than does osteoid osteoma, and patients must be treated surgically with intralesional curettage or en bloc resection.
A case is reported of a 16-year-old boy who presented with continuous pain in his right leg. Cortical thickening and diffuse medullary sclerosis was revealed on x-ray of the distal tibia. CT imaging showed a circumscribed annular pattern extending some 2.5 cm-s and indicating the multifocal nature of the lesion. The diagnosis of multifocal osteoid osteoma was confirmed after histological examination of the block of resected bone.
The present article is a report on five cases of a type of benign neoplasm of bone apparently not hitherto classified. All the cases came to my attention during 1933.¹ They had the following features in common: 1. The patients were all adolescents or young adults from 11 to 22 years old. 2. In each case the principal complaint was of local pain, usually increasing and often severe enough to interfere with sleep. It was this symptom that brought the patients to consult a physician. 3. Uniformly, the lesion originated in an area of spongy bone. Although it sometimes involved cortical bone, it never penetrated the periosteum. 4. As observed roentgenographically, the pathologic areas were roundish, clearly circumscribed and confined within the bone. 5. The lesions were small and closely similar in size: Two were about 0.5 cm., two were 1 cm., and one was 2 cm., in diameter.
1. The clinical features in twenty cases of osteoid osteoma have been analysed and compared with other cases reported in the literature.
2. The lesion is regarded as a benign neoplasm and its unusual clinical behaviour is attributed to its vascular nature.
3. The frequency with which an erroneous diagnosis of "neurosis" is made is stressed.
Two adult patients are described with multifocal osteolytic lesions radiologically simulating a vascular tumor. One patient had multiple bones involved. Histologically, the individual lesions had the features of the nidus of osteoid osteoma/osteoblastoma. A review of the English language medical literature yielded only one other reported case with similar features. The process is designated as osteoblastomatosis to indicate its bone-forming character, prominent osteoblast proliferation, and multiplicity. The cases are distinguished from multifocal/multicentric osteoid osteoma and osteoblastoma, and from benign and malignant vascular tumors.
