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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 7  |  Issue : 2  |  Page : 67-69

Cancellous osteoma of temporomandibular joint


Department of Oral and Maxillofacial Surgery, Chhattisgarh Dental College and Research Institute, Rajnandgaon, Chhattisgarh, India

Date of Submission17-Feb-2020
Date of Decision04-Mar-2020
Date of Acceptance27-Apr-2020
Date of Web Publication20-Jun-2020

Correspondence Address:
Sagar Bhure
Department of Oral and Maxillofacial Surgery, Chhattisgarh Dental College and Research Institute, Rajnandgaon, Chhattisgarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdrr.jdrr_14_20

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  Abstract 


Osteoma is a rare growth of bone, benign in nature, usually occurring in the craniofacial region. It usually results from the long-term deposition of compact and cancellous bone. The etiology of the tumor is not clear but can be linked with infections, inflammatory processes trauma, or/and abnormalities in growth. It manifests with symptoms of painful/painless swelling, dull pain in the preauricular region, clicking/popping and difficulty in mastication, trismus, gradual midline shift developing malocclusion, mandibular deviation of the contralateral side, and facial asymmetry. The diagnosis is mostly made by clinical and radiological imaging and is affirmed by histopathological examination. These condylar tumors have been usually treated by either resection through local excision or condylectomy with or without reconstruction. Therefore, we describe a rare case report of osteoma arising from the mandibular condylar neck of a 26-year-old female patient giving a chief complaint of difficulty in opening the mouth in the last 15 days along with pain. Radiographic images and computed tomography were suggestive of osteochondroma involving right condyle which, on excision and histopathological examination, was found to be cancellous osteoma.

Keywords: Benign tumor, osteoma, temporomandibular joint


How to cite this article:
Singh R, Bhure S, Krishna B P, Mazhar H, Thomas A, Soni SK. Cancellous osteoma of temporomandibular joint. J Dent Res Rev 2020;7:67-9

How to cite this URL:
Singh R, Bhure S, Krishna B P, Mazhar H, Thomas A, Soni SK. Cancellous osteoma of temporomandibular joint. J Dent Res Rev [serial online] 2020 [cited 2020 Aug 3];7:67-9. Available from: http://www.jdrr.org/text.asp?2020/7/2/67/287330




  Introduction Top


Osteoma is a rare growth of bone, benign in nature mostly occurring due to the frequent deposition of compact and cancellous bone. The etiology of the tumor is not clear but may be linked with growth abnormalities, trauma, and infections or inflammation. In the craniofacial skeleton, the tumor is rare. However, when they occur in the jaw region, they are mostly occurred in the mandible rather than the maxilla. In mandible, the body, angle, and condyle regions are often affected.[1],[2],[3]

It is a benign skeletal neoplasm usually seen in young adults below the age of 30. Pain along with vasomotor disturbances is the main feature of osteoma. The prevalence of tumor in jaws is <1%, making it an exceptional existence exceeding rare in the jaw bones.[4]

We present a rare case of osteoma arising from the mandibular condylar neck of a 26-year-old female patient who gave a chief complaint of difficulty in opening the mouth for the past 15 days along with pain on opening. Radiographic images and computed tomography were suggestive of osteochondroma involving the right condyle which, on excision and histopathological examination, was found to be cancellous osteoma.


  Case Report Top


A 26-year-old female reported to the outpatient department with inability to open mouth along with pain while mastication for the 15 days. Pain was dull and intermittent which aggravated on mastication and was relived with analgesic medications. No positive history of any trauma, infection of ear, and pain in other joints of long bone was suspected. There was no significant history of any systemic disease or disorder. Difficulty in mouth opening led her to consult a doctor. Extraoral examination revealed well-defined progressive preauricular swelling on the right side [Figure 1]. Unilateral clicking sound was heard on the right side with slight deviation toward the same side. A bony hard swelling, which was nontender and adhered to the underlying bone, was found on palpation. There was normal overlying skin which was movable. Local temperature was not raised. The regional lymph nodes were established as nonpalpable. The interincisal distance/mouth opening was seen to be approximately 25 mm. No abnormalities were found on intraoral examination.
Figure 1: Preauricular swelling on the right side

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The patient was subjected to radiological examination for further evaluation of underlying cause. The panoramic radiograph showed small, ovoid-to-round, well-demarcated radiopacity, roughly measuring about 1 cm × 1.3 cm approximately. Noncontrast computed tomography revealed a sessile bony outgrowth measuring roughly about 10 mm × 10 mm at the right condyle [Figure 2] and also involving the condylar head, which was suggestive of osteochondroma of the right condyle. Routine hematological and biochemical investigations were under normal limits.
Figure 2: Computed tomography three-dimensional

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Excisional biopsy of the lesion was planned because of small dimensions of the lesion, through a modified preauricular incision, and the specimen was sent for histopathological examination. The patient was posted for surgical excision of the lesion under general anesthesia after getting a written informed consent from the patient. The modified preauricular incision (Al-Kayat and Bramley incision) [Figure 3] anticipated good surgical access to the lesion. The lesion on the right mandibular condyle was identified, osteotomized from adjacent structure, and delivered in toto. Postoperative mouth opening achieved was 43 mm approximately [Figure 4]. Clinically, excised specimen measured roughly 1 cm × 1 cm approximately in its greatest dimensions [Figure 5]. The antibiotics and analgesics were given by traditional protocol. The excised specimen was sent for histopathological examination. Decalcified specimen lesion tissue composed of trabeculae of cancellous bone with the layer of cortical bone surrounding it; in between trabeculae of cancellous bone, red marrow and fibrofatty marrow were also seen which was suggestive of cancellous osteoma.
Figure 3: Al-Kayat Bramley incision

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Figure 4: Postoperative mouth opening

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Figure 5: Specimen

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  Discussion Top


Osteoid osteoma was first described as a specific entity by Jaffe in 1935. Osteoid osteoma cases occur <1% in the jaws whereas about 80% occur in the long bones.[5] Osteoma is a rare, benign osteogenic tumor, resulting in rapid expansion of the cortical or spongy bone. It arises from the periosteum (also called as peripheral osteoma), endosteum (also called as central osteoma), and even extraskeletal soft tissue. Although the exact cause is yet not known, osteomas are formed when there is uninhibited growth in a bone.[6],[7] Most of the jaw osteomas are seen in young adult but can arise at any age. The osteoma lesions in general are solitary and asymptomatic without sex predilection.[8] Kaplan et al., in their case series, showed a male-to-female ratio of 2:1.[9] Osteomas are most commonly asymptomatic, based on their location and size. The lesions are usually nonnoticeable because of it small, slow-growing, painless nature and are only noticed during routine clinical examinations. The lesion gradually becomes larger and painful and progressively worsening in nature that can result in facial asymmetry, limitation of mouth opening, and mandibular deviation on the contralateral side.[10],[11] Usually, osteomas occur alone or in isolation. However, a syndrome is associated with the appearance of multiple osteomas called as Gardner syndrome. This syndrome is an autosomal dominant disorder, characterized by multiple osteomas (often in the facial bones and long bones), connective tissue tumors, epidermoid cysts on the skin, supernumerary teeth, colorectal polyps with a great propensity of malignant transformation and malignant thyroid neoplasm.[12]

The differential diagnosis of these lesions can be summed up as exostoses (maxillary or mandibular) osteoid osteoma, chondroma, osteoblastoma, odontoma, and cemento-ossifying fibroma.[13]

Conclusive diagnosis can only be ruled out by histopathological examination after radiographic examination which showed an oval or round well-circumscribed radiopaque mass.[13]

Complete surgical excision of the base of tumor along with the compact bone is the treatment option for osteomas. There is rare recurrence of tumor, but regular follow-ups are suggested along with radiographic examination after surgical excision.[1]

Declaration of patient consent

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

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Mancini JC, Woltmann M, Felix VB, Freitas RR. Peripheral osteoma of the mandibular condyle. J Oral Maxillofac Surg 2005;34:92-3.  Back to cited text no. 1
    
2.
Ogbureke KU, Nashed MN, Ayoub 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. 2
    
3.
Brucoli M, Giarda M, Benech A. Gardner syndrome: Presurgical planning and surgical management of craniomaxillofacial osteomas. J Craniofac Surg 2011;22:946-8.  Back to cited text no. 3
    
4.
Ida M, Kurabayashi T, Takahashi Y, Takagi M, Sasaki T. Osteoid osteoma in the mandible. Dentomaxillofac Radiol 2002;31:385-7.  Back to cited text no. 4
    
5.
Singh A, Solomon MC. Osteoid osteoma of the mandible: A case report with review of the literature. J Dent Sci 2017;12:185-9.  Back to cited text no. 5
    
6.
Yang C, Qiu WL. Osteoid osteoma of the eminence of temporomandibular joint. Br J Oral Maxillofac Surg 2001;39:404-6.  Back to cited text no. 6
    
7.
Kademani D, Bevin C. A mass in the temporomandibular joint. J Am Dent Assoc 2008;139:301-3.  Back to cited text no. 7
    
8.
Neville W, Damm D, Allen C, Bouquot JE. Oral & Maxillofacial Pathology. 3rd ed. Rajnandgaon, chhatisgarh: Elsevier; 2011. p. 650-1.  Back to cited text no. 8
    
9.
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. 9
    
10.
Almeida LE, Filho MA. Giant mandibular condyle osteoma. J Craniofac Surg 2011;22:1147-9.  Back to cited text no. 10
    
11.
Thoma KH. Tumors of the mandibular joint. J Oral Surg Anesth Hosp Dent Serv 1964;22:157-63.  Back to cited text no. 11
    
12.
de Souza NT, Cavalcante RC, de Albuquerque Cavalcante MA, Hespanhol W, de Oliveira MR Jr., de Carvalho Ferreira D, et al. An unusual osteoma in the mandibular condyle and the successful replacement of the temporomandibular joint with a custom-made prosthesis: A case report. BMC Res Notes 2017;10:727.  Back to cited text no. 12
    
13.
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.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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