Osteoma periférico de inusual localización mandibular. Presentación de un caso / Peripheral osteoma of unusual mandibular location. Case report / Osteoma periférico de localização mandibular incomum. Apresentação de um caso

RESUMEN Se presentó el caso de una paciente femenina de 40 años de edad que acudió a consulta por presentar aumento de volumen en la región parotídea izquierda. Se realizó ortopantomografía, radiografías simples anteroposterior y lateral de cráneo que revelaron la presencia de una imagen radiolúcida en la región lateral de la rama mandibular izquierda. El diagnóstico clínico fue de osteoma periférico a este nivel, por lo que se realizó remoción quirúrgica total de la lesión. La biopsia confirmó el diagnóstico de osteoma ebúrneo periférico. El osteoma es una neoplasia benigna de tejido óseo, poco frecuente y, rara vez, se localiza de manera aislada en la mandíbula. No se diagnosticaron complicaciones posoperatorias y la paciente mostró satisfacción con la atención estomatológica brindada.

ABSTRACT A 40-year-old female patient came to the consultation due to an increase in volume in the left parotid region. Orthopantomography and simple anteroposterior and lateral skull radiographies were performed, revealing the presence of a radiolucent image in the lateral region of the left mandibular side. The clinical diagnosis at this point was of peripheral osteoma, for which a total surgical removal of the lesion was performed. The biopsy confirmed the diagnosis of peripheral osteoma. An osteoma is a rare benign neoplasm of bone tissue, and is rarely found isolated in the mandible. Postoperative complications were not diagnosed and the patient was satisfied with the dental care provided.

RESUMO Foi apresentado o caso de uma paciente do sexo feminino, 40 anos de idade, que compareceu à consulta por aumento de volume na região da parótida esquerda. Foram realizadas ortopantomografia, radiografias simples ântero-posterior e lateral do crânio, que revelaram a presença de imagem radiotransparente na região lateral do ramo mandibular esquerdo. O diagnóstico clínico foi de osteoma periférico a este nível, para o qual foi realizada a remoção cirúrgica total da lesão. A biópsia confirmou o diagnóstico de osteoma periférico ebúrneo. O osteoma é uma neoplasia benigna do tecido ósseo, pouco frequente e raramente localizada de forma isolada na mandíbula. Complicações pós-operatórias não foram diagnosticadas e o paciente ficou satisfeito com o atendimento odontológico prestado.

Analysis of clinical characteristics of middle ear osteoma at different locations / 中华耳鼻咽喉头颈外科杂志

Objective: To explore the clinical characteristics, intervention and treatment of tympanic osteoma at different locations. Methods: The medical history, audiological and imaging examination, operation and follow-up results of two patients with tympanic osteoma at different sites were reviewed and summarized. Furthermore, the clinical characteristics and interventions of 36 patients reported in literatures with tympanic osteomas were also summarized and analyzed. Results: Osteoma of the two patients collected in this study located at promontory and incus respectively;both of them presented with intact tympanum and conductive deafness, without obvious etiology or predisposing factor. Both of them underwent surgeries and the hearing improved significantly. For patient one, the ossicular chain was intact and restored to activity after removed the osteoma. For patient two, an artificial ossicle was implanted after removed the osteoma and incus. In the 36 patients reported in literatures, the average age was 26.5 years, and 39.47% of them located at promontory; in addition, the main symptoms of them were progressive hearing loss, tinnitus and ear stuffy. Conclusions: Patients with tympanic osteoma are characterized by conduction deafness with intact tympanic membrane, and the most common lesion is promontory. Hearing can be restored by excision of the osteoma and maintenance or reconstruction of the ossicle chain.

Aspectos descriptivos imagenológicos del osteoma de los maxilares: Revisión de la literatura / Descriptive imagenological aspects of osteoma in the jaws: review of the literature

El osteoma es una lesión osteogénica benigna, derivado de hueso compacto o esponjoso. Se caracteriza por ser de crecimiento lento y aparece con más frecuencia entre los 20 y los 50 años de vida, con una prevalencia mayor en hombres con respecto a las mujeres. Clínicamente asintomáticos, los podemos encontrar en la región craneofacial, particularmente en los senos paranasales y la mandíbula, y pueden presentarse de tres formas: central, periférica y extraósea, siendo más comunes los solitarios, a diferencia de los múltiples que están relacionados con el síndrome de Gardner. El tratamiento de los osteomas es quirúrgico cuando causan complicaciones. Los estudios por imágenes, como la radiografía panorámica y la TCHC, son las modalidades de mayor uso para determinar la ubicación, la extensión y las relaciones anatómicas de la lesión. Las características imagenológicas pueden presentarse como una excrecencia ósea de hueso compacto, esponjoso o mixto. El conocimiento de esta lesión nos permitirá tener mejores propuestas diagnósticas. (AU)

Osteomas are benign osteogenic lesions derived from compact or spongy bone. They are characterized by their slow growth and appear more frequently between 20 and 50 years of age, with a higher prevalence in men than in women. These lesions are clinically asymptomatic and can be found in the craniofacial region, particularly in the paranasal sinuses and the mandible, and may have a central, peripheral or extraosseous presentation. Multiple osteomas are related to Gardner's Syndrome. Treatment of osteoma is surgical when complications develop. Imaging studies such as panoramic radiography and cone beam computed tomography are the modalities most widely used to determine the location, extent, and anatomical relationships of the lesion. Imaging features may present as a bony excretion of compact, spongy, or mixed bone. Adequate knowledge of these lesions allows adequate diagnosis and better treatment planning. (AU)

Tumores fibroóseos de cavidades paranasales: experiencia en el Hospital Clínico de la Universidad de Chile y revisión de la literatura / Fibro-osseous tumors of paranasal cavities: experience in the Hospital Clínico de la Universidad de Chile and review of the literature

Los tumores de cavidades paranasales presentan una baja frecuencia. Dentro de éstos, entre los benignos destacan las lesiones fibroóseas que se caracterizan por el reemplazo de hueso normal por estroma celular fibroso. Dentro de estas lesiones se describen osteoma, displasia fibrosa y fibroma osificante. Se revisan 3 casos de pacientes del Hospital Clínico de la Universidad de Chile y se presenta una revisión bibliográfica en cuanto a las lesiones fibroóseas, su clínica, diagnóstico, imagenología y tratamiento.

The tumors of paranasal cavities present a low frequency. Among the benign tumors are fibro-osseous lesions characterized by the replacement of normal bone by fibrous cell stroma. Osteoma, fibrous dysplasia, and ossifying fibroma are described within these lesions. Three cases of patients from the Hospital Clínico de la Universidad de Chile are reviewed and a bibliographic review is presented regarding the fibro-osseous lesions, their clinical features, diagnosis, imaging and treatment.

Gardner syndrome imaging features in plain radiographs and computed tomography: a case report / Síndrome de Gardner: Características imaginológicas por meio da radiografia convencional e tomografia computedorizada

Gardner syndrome (GS) is a genetic disease with high penetration characterized by a signal triad of colonic polyposis, multiple osteomas and mesenchymal tumors in the soft tissues and skin. The colonic polyposis is associated to the development of malignant disease. Patients may also present maxillomandibular alterations such as impacted teeth, supernumerary teeth, congenital missing teeth and odontomas. Bone lesions and maxillomandibular alterations usually precedes the gastrointestinal alterations; hence dentists should be aware of GS syndrome main radiographic signals, in order to detect the disease and proper referred the patient to medical treatment and surveillance. Thus, in this report, it is described a case of GS in a male patient, as well as discussed GS features.(AU)

A síndrome de Gardner (GS) é uma doença genética caracterizada pela seguinte tríade: polipose colônica, múltiplos osteomas e tumores mesenquimais em tecidos moles e pele. A polipose colônica está associada ao desenvolvimento de tumores malignos. Os pacientes também podem apresentar alterações maxilomandibulares, como dentes impactados, dentes supranumerários, agenesia congênita e odontomas. Lesões ósseas e alterações maxilomandibulares geralmente precedem as alterações gastrointestinais; portanto, os dentistas devem estar cientes dos principais sinais imaginológicos da GS, a fim de detectar a doença e encaminhar adequadamente o paciente para tratamento. Neste relato de caso é descrito um caso de GS em um paciente do gênero masculino, além de discutir as características da GS.(AU)

Um raro diagnóstico de osteoma periférico em palato duro: relato de caso / A rare diagnosis of peripheral osteoma in the hard palate: case report

Objetivo: relatar uma biópsia excisional de um osteoma periférico no palato duro direito de uma paciente jovem, do sexo feminino e não sindrômica. Relato de caso: paciente do sexo feminino, 32 anos de idade, melanoderma e normossitêmico, buscou atendimento no ambulatório de diagnóstico estomatológico da Faculdade de Odontologia da Universidade Federal de Uberlândia com queixa quanto ao surgimento de lesão na região de palato. Após avaliação clínica e imaginológica, foi decidido realizar biópsia excisional sob anestesia local da lesão. Foram levantadas três hipóteses de diagnóstico: osteoma periférico, exostose ou osteossarcoma. O material coletado foi enviado para análise histopatológica, que confirmou a hipótese de osteoma periférico. Considerações finais: os osteomas periféricos na região de palato duro são raríssimos. Essa lesão geralmente é assintomática ­ exceto quando há impacto traumático durante a mastigação ­, de crescimento lento, podendo se desenvolver em osso cortical ou medular. O tratamento de escolha é a remoção cirúrgica e o índice de recorrência é raro. O caso enfatiza a condição rara, pois foram encontrados apenas seis casos semelhantes relacionados na literatura. (AU)

Objective: To report an excisional biopsy of a peripheral osteoma in the right hard palate in a non-syndromic young female patient. Case Report: A 32-year-old female patient, black, and normosystemic sought assistance in the stomatological diagnosis outpatient clinic of the School of Dentistry of the Federal University of Uberlândia, Brazil, complaining about the appearance of a lesion in the palate region. After clinical and imaging assessment, it was decided to perform an excisional biopsy under local anesthesia of the lesion. Three diagnostic hypotheses were raised - peripheral osteoma, exostosis, or osteosarcoma. The material collected was sent for histopathological analysis, which confirmed the hypothesis of peripheral osteoma. Final considerations: Peripheral osteomas in the hard palate region are very rare. This lesion is usually asymptomatic, except when there is a slow-growing chewing impact during mastication, which may develop in cortical or spinal bone. Surgical removal is the treatment of choice and the rate of recurrence is rare. The case emphasizes the rare condition, considering only six similar cases were found in the literature. (AU)

Popliteal Vein Aneurysm Associated with Varicose Veins, Hydrocele, and Multiple Congenital Osteomas: A Case Report and Review of the Literature

Popliteal vein aneurysms (PVAs) represent a rare form of venous aneurysms and necessitate prompt management because of their well-established risk of pulmonary embolism (PE). Herein, we report a rare case of PVA without PE, successfully treated with open surgical repair. A 27-year-old man presented to our vascular clinic with chronic pain and swelling in his left lower limb. He had a long history of facial surgeries for the removal of congenital multiple osteomas. Physical examination revealed varicosities with an abnormal distribution. Duplex ultrasound showed a left PVA measuring 2.3 cm in diameter and 4 cm in length. Open surgical excision of the PVA with lateral venorrhaphy was performed through a medial approach. Prophylactic anticoagulation was performed postoperatively. In this case, the PVA was detected, with a high degree of suspicion by the clinician, before it caused fatal PE. The patient was successfully treated with aneurysm excision and lateral venorrhaphy.

Two cases of osseous choristoma on tongue base / 대한두경부종양학회지

Osseous choristoma is a rare, benign proliferative osseous lesion, which is defined as the growth of normal tissue in an abnormal location. The etiopathogenesis for its formation is unknown, but various hypotheses have been proposed. Treatment of choice is en-bloc resection, and no recurrence has been reported. Here, we report the two cases of osseous choristoma, presented with a mass on the base of the tongue with/without globus symptom and were treated with surgical excision.

Clinical Analysis of External Auditory Canal Osteoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: External auditory canal osteoma is an uncommon benign lesion and represents as unilateral solitary pedunculated mass. The aim of this study is to evaluate the clinical symptoms of osteoma and its treatment outcomes over a 10-year period in a tertiary hospital. SUBJECTS AND METHOD: Eight patients underwent operation to remove an external auditory canal osteoma at Chungbuk National University Hospital from 2008 to 2017. The medical records were retrospectively reviewed with regard to clinical characteristics, size and location of osteoma, method of surgery and treatment outcomes. RESULTS: The average age of patients was 41.8 years with the male predominance of 6:2. All of the lesions in the osteoma were unilateral and solitary (average size 5.0 mm). All of the eight cases were pedunculated: in four cases, the stalks of the osteoma were found on the tympanomastoid suture line and in three cases, it was found on the tympanosquamous suture line. Four patients were asymptomatic, where the lesions were found incidentally during unrelated evaluations. No patients were found with conductive hearing loss in the pure tone audiometry. Transcanal and endaural approach were used in five and three cases, respectively. Most of the cases were removed by curettage only, except for the two who needed additional drilling. The average surgery time was 15.6 minutes. There was no postoperative complication or recurrence. CONCLUSION: The external auditory canal osteoma was mostly unilateral and solitary. The removal of osteoma in the early stage was relatively easy with no recurrence or complication.

Peripheral osteoma on the medial eyebrow successfully extracted while preserving supratrochlear nerve

Osteomas are benign, slow-growing osteogenic lesions frequently found in the craniomaxillofacial region. They can be classified as peripheral, central, or extraskeletal. Reactive mechanisms to trauma or infection, as well as muscle traction, are thought to play a major role in the development of peripheral osteomas. In the present report, a 41-year-old woman presented with a slow-growing, painless mass on her left eyebrow. She had suffered trauma 15 years prior. In the computed tomography scan, a 2.5 × 2 × 0.7-cm radio-opaque tumor was detected just medial to the left supraorbital foramen, and a peripheral osteoma was clinically diagnosed. An elective operation under general anesthesia was planned. Following a suprabrow incision, subcutaneous and intramuscular dissection was performed. In the surgical plane deep to the corrugator muscles and superficial to periosteum, a branch of the supratrochlear nerve was encountered and preserved using a vessel loop. The osteoma beneath the periosteum was extracted in multiple fragments using a chisel and mallet to minimize trauma to the nerve. Contour and facial symmetry were corrected. To use a suprabrow incision, the surgeon must understand neighboring anatomical structures, including the course of the supratrochlear and supraorbital neurovascular bundles. When these structures are located adjacent to tumor lesions, careful surgical maneuvers should be performed to preserve them.

Peripheral Osteoma of Mandibular Angulus: Analysis of the Literature and Report of a New Case / Osteoma periférico del ángulo mandibular: Análisis de la literatura e informe de un nuevo caso

Abstract Osteoma is a benign osteogenic neoplasm originating from the continuous proliferation of compact and/or cancellous mature bone. The tumor can be classified as peripheral, central or extra-skeletal regarding location and it commonly seen in the cranio-facial region especially at the skull and paranasal sinuses. The exact etiology of the tumor is still controversial; however, it is considered that infection, trauma, muscle activity contributes the occurrence of the tumor. Due to the slow growing nature of osteoma, it is coincidentally detected on radiographs or when the tumor reaches a large size enough to trigger symptoms and cause facial disfigurement. Although mainly detected in the craniofacial bones, osteomas are rarely located in the jaw bones. The purpose of this review, is to present the diagnosis and treatment plan of a peripheral osteoma in the mandibular angulus region of an 8-year-old boy together with a review of published cases of peripheral osteomas of mandibular angulus.

Resumen El osteoma es una neoplasia osteogénica benigna que se origina de la proliferación continua de hueso maduro compacto y/o esponjoso. El tumor se puede clasificar como periférico, central o extraesquelético con respecto a la ubicación y se ve comúnmente en la región craneofacial, especialmente en el cráneo y los senos paranasales. La etiología exacta del tumor sigue siendo controvertida; sin embargo, se considera que la infección, el trauma y la actividad muscular contribuyen a la aparición del tumor. Debido a la naturaleza de crecimiento lento del osteoma, se detecta casualmente en las radiografías o cuando el tumor alcanza un tamaño grande lo suficiente como para desencadenar síntomas y causar desfiguración facial. Aunque se detecta principalmente en los huesos craneofaciales, los osteomas rara vez se localizan en los huesos de la mandíbula. El objetivo de esta revisión es presentar el diagnóstico y el plan de tratamiento de un osteoma periférico en la región angular mandibular de un niño de 8 años junto con una revisión de casos publicados de osteomas periféricos de angulación mandibular.

Giant fronto-ethmoidal osteoma - selection of an optimal surgical procedure / Osteoma fronto-etmoidal gigante - escolha do procedimento cirúrgico ideal

Abstract Introduction Osteomas of the paranasal sinuses are benign bone tumours that produce clinical signs depending on their size and location. In most reported cases large tumours are excised by an external approach or in conjunction with an endoscopic technique. Endoscopic treatment of such tumours is a huge challenge for the operator. Objective Determine the optimal surgical approach by analysing giant osteomas of the frontal and ethmoidal sinuses in the literature. Methods Group of 37 osteomas obtained from the literature review. A group of osteomas removed only by endoscopy was compared with a group in which an external approach (lateral rhynotomy or craniotomy) or combined external and endoscopic approach was applied. Results The authors, based on the statistical analysis of the literature data, have found that the average size of osteomas excised endoscopically and those removed by external approaches does not differ statistically, when the osteomas are located in the ethmoidal cells (p = 0.2691) and the frontal sinuses (p = 0.5891). Conclusion The choice of surgical method appears to be independent of the osteoma size and the decision is likely to be taken based on the experience of the surgeon, available equipment and knowledge of different surgical techniques.

Resumo Introdução Osteomas dos seios paranasais são tumores ósseos benignos cujas manifestações clínicas ocorrem em função de seu tamanho e localização. Na maioria dos casos relatados os tumores grandes são excisados por uma abordagem externa ou associada a uma técnica endoscópica. O tratamento endoscópico destes tumores ainda é um grande desafio para o cirurgião. Objetivo Determinar a abordagem cirúrgica ideal ao analisar osteomas gigantes dos seios frontal e etmoidal na literatura. Método Um total de 38 osteomas foram avaliados a partir da revisão da literatura. Um grupo de osteomas removidos apenas por cirurgia endoscópica foi comparado com um grupo para o qual foi utilizado uma abordagem externa (rinotomia lateral ou craniotomia) ou uma abordagem combinada, externa e endoscópica. Resultados Os autores, com base na análise estatística dos dados da literatura, observaram que o tamanho médio dos osteomas excisados endoscopicamente e daqueles que foram removidos através de uma abordagem externa não diferiram estatisticamente, tanto para osteomas localizados no seio etmoidal (p = 0.2691) quanto para os localizados no seio frontal (p = 0.5891). Conclusão A escolha do método cirúrgico parece ser independente do tamanho do osteoma e a decisão provavelmente será tomada com base na experiência prévia do cirurgião, nos equipamentos disponíveis e conhecimento de diferentes técnicas cirúrgicas.

Choroidal Osteoma Accompanied by Proliferative Diabetic Retinopathy

No abstract available.

A Case of Choroidal Osteoma with Subretinal Hemorrhage Improved by Intravitreal Bevacizumab and Aflibercept Injections

PURPOSE: To report a case of choroidal osteoma (CO) complicated by extensive subretinal hemorrhage treated with intravitreal bevacizumab and aflibercept injections. CASE SUMMARY: A 42-year-old female patient presented with decreased visual acuity and a temporal visual field defect in the left eye. The patient had a history of retinal hemorrhage in the left eye 3 years prior, which improved without any treatment. The patient's visual acuity had decreased to 0.6 at the initial visit. On fundus examination, orange-colored elevated lesions involving the superior peripapillary area with massive subretinal hemorrhage extending to the macular area were revealed. Optical coherence tomography, fluorescein angiography, and B-scan ultrasonography results indicated CO complicated by choroidal neovascularization (CNV). With multiple intravitreal injections of bevacizumab and aflibercept (bevacizumab ×1, aflibercept ×2), the patient's visual acuity improved and the CNV lesion was kept stable without recurrence as of the 1-year follow-up visit. CONCLUSIONS: Intravitreal bevacizumab and aflibercept injections can be helpful in the treatment of CO complicated by CNV, by improving visual acuity and the retinal anatomy.

Ankylosing Neurogenic Myositis Ossificans of the Hip: A Case Series and Review of Literature / 대한고관절학회지

PURPOSE: Neurogenic myositis ossificans (NMO) in patients with traumatic spinal cord or brain injuries can cause severe joint ankylosis or compromise neurovascularture. The purpose of this study was to evaluate the clinical and radiological outcomes of and review considerations relevant to surgical resection of NMO of the hip joint. MATERIALS AND METHODS: Six patients (9 hips) underwent periarticular NMO resection between 2015 and 2017. The medical records of these patients were retrospectively reviewed. Preoperative computed tomography including angiography was performed to determine osteoma location and size. Improvement in hip motion allowing sitting was considered the sole indicator of a successful surgery. The anterior approach was used in all patients. The ranges of motion (ROM) before and after surgery were compared. RESULTS: The mean time from accident to surgery was 3.6 years. Average ROM improved from 24.3°(flexion and extension) to 98.5°(flexion and extension) after surgery, and improvement was maintained at the last follow-up. No commom complications (e.g., deep infection, severe hematoma, deep vein thrombosis) occurred in any patient. Improvement in ROM in one hip in which surgical resection was performed 10 years after the accident was not satisfactory owing to the pathologic changes in the joint. CONCLUSION: Surgical excision of periarticular NMO of the hip joint can yield satisfactory results, provided that appropriate preoperative evaluation is performed. Early surgical intervention yields satisfactory results and may prevent the development of intra-articular pathology.

Giant complex odontoma in the posterior mandible: A case report and literature review

Odontomas are considered a type of odontogenic hamartoma, and are generally reported not to exceed 3 cm in diameter. Some authors have referred to odontomas with a diameter exceeding 3 cm as giant odontomas. As hamartomas, giant odontomas generally show no signs or symptoms, but if they perforate the mucosa to become exposed in the oral cavity, oral and maxillofacial infections can result. Surgical removal and a histopathological examination may also be required to differentiate them from osteomas, cemento-osseous dysplasia, or mixed odontogenic tumors. This report presents the case of a 28-year-old woman with a giant odontoma in the right mandibular third molar area. Based on a review of the literature published since 2010, only 11 cases of “giant” or “large” odontomas have been reported, most of which were of the complex odontoma type. It was confirmed that they tend to occur in the right posterior mandible.

Ostéomes maxillo-mandibulaires : épidémiologie, diagnostic, classification et thérapeutique au centre hospitalier et universitaire de Yaoundé (Cameroun)

Cette étude rétrospective a porté sur les ostéomes, sur une durée de quatre ans au CHU de Yaoundé. En tenant compte des données cliniques et des comptes rendus opératoires, les patients dont les dossiers jugés satisfaisants pour remplir les critères d'inclusions ont été retenus.Il est apparu que les ostéomes sont peu fréquents dans notre contexte puisqu'ils ne représentent que 12,6 % des tumeurs osseuses. Ils se développent lentement et sans douleurs aux maxillaires comme à la mandibule. Cependant ils se localisent préférentiellement aux maxillaires. Ces ostéomes sont plus fréquents chez la femme et touchent surtout les adultes jeunes. Les diagnostics cliniques, radiologiques et histologiques sont assez aisés, permettant de classer les ostéomes en exostose et en énostose (endostose) selon qu'ils ont une évolution extra ou endosseuse. Le traitement est uniquement chirurgical et ne donne pas lieu aux récidives