Osteochondromas (OC) in the craniofacial region are very rare. Following on from a literature review published in 2011, further single case reports and case series are reviewed herein. To date, approximately 235 studies on OC of the mandibular condyle have been published in the English language literature. There is debate regarding the surgical techniques for treatment. Whereas the use of condylectomy has shown no recurrences, follow-up of conservative excision of the tumour has shown recurrence in three cases. One of these relates to the case presented here, which was first reported in 2002. The patient has declined any further surgery since that date. The tumour has shown no further growth and there is no functional impairment. This underlines Cottrell’s claim that excision of the entire cartilage cap appears to stop the growth of the tumour and represents the most important focus of surgical treatment.
Osteochondroma (OC) has often been described as the most common benign bone tumour with a cartilage cap, representing 8–15% of all primary bone tumours. The prevalence of OC in the craniofacial region is, however, rare at 0.6%. Most reported cases of OC in the craniofacial region have been published in the form of single case reports. More recently, large case series have also been published.
Details of this patient case were first published in 2002. The patient was a 47-year-old woman with a tumour in the right condyle, which had produced an increasing asymmetry of the face over the course of 8 years. The patient suffered from limited mouth opening, lateral cross-bite, and pain in the right joint. Due to the anterior medial growth of the mushroom-like tumour, the right condyle was not able to swing back into the glenoid fossa ( Figs 1 and 2 ). It was disarticulated. Although an occlusal change was evident intraorally, the patient’s casts did fit very well.
The tumour was excised under general anaesthesia by means of a pre-auricular approach. The tumour was identified as an OC on histopathology. It was possible to restore the occlusion almost immediately after surgery and this was further stabilized with an occlusal splint. Functional mobility was restored to a range of mouth opening of 45 mm without pain within a year, with the assistance of physiotherapy. In the first 3 months after surgery, a weakness of the frontal branch of the facial nerve was observed. Frequent headaches were the only symptoms that persisted over the years.
Panoramic radiography showed an exostosis at the right condyle 12 months after the surgery. It was assumed to be a recurrence due to the conservative surgical treatment and the probability of a remaining primary tumour mass.
The patient was informed of the recurrence but declined a second intervention as there were no functional limitations. The patient has been examined clinically on a regular basis by means of panoramic radiographs, computed tomography (CT), and magnetic resonance imaging (MRI), and to date, no further growth of the tumour has been observed ( Figs 3 and 4 ). The occlusion and mobility of the lower jaw are currently stable.
In the case report published in 2002, the radiologically verified exostosis was assumed to be a recurrence. Due to its stability over the course of 15 years, this assumption has to be corrected. The assumed ‘new’ tumour is much more likely a remaining part of the original one. Imaging directly after surgery was not accomplished, thus this could not be clarified. The stability of the tumour underlines Cottrell’s contribution to the discussion, in which he emphasized the use of a conservative approach to excise the tumour at the base of the lesion, as well as his statement that “there should not be any recurrence as long as the entire cartilage cap is removed”. Assuming that this statement is true, the osseous tumour at the condyle has to be a residue and not a recurrence.
Roychoudhury et al. published a literature review of OC of the mandibular condyle in 2011. They identified 108 published cases of OC in the craniofacial region and reported 10 of their own. Since 2011, further cases have been published, including five single case reports and four case series including a total of 122 patient cases. Some of these cases could have been duplicated in these publications, but 65 cases were not published because they did not involve surgery or the surgery did not follow a specific protocol.
Thus, to date, approximately 235 cases of OC in the maxillofacial region have been reported in the English language literature ( Table 1 ). Roychoudhury et al. pointed out that the increase in reports shows that OC may not be a ‘rare’ entity in the craniofacial region and that awareness of its pathology has grown among surgeons and histopathologists.
|Authors||Number||Age, years (average)||Sex M/F||Side R/L||Position|
|Roychoudhury et al., 2011 (Review)||108||33.9||45/63||18/19||Anterior/anterior-medial n = 43
Superior/superior-medial n = 17
Lateral n = 3
Posterior n = 3
Globular n = 3
Gigantic n = 3
Not specified n = 36
|Meng et al. 2012||34||39.1||11/23||15/19||Superior-medial/anterior-medial n = 19
Lateral n = 3
Anterior/anterior-superior n = 4
Posterior n = 4
Globular n = 4
|Wolford et al. 2014||37 (93) a||26.3||9/28||20/17||Not specified n = 37|
|Chen et al. 2014||38 (47) a||43.7||10/28||22/16||Anterior/anterior-medial n = 25
Medial n = 8
Lateral n = 2
Posterior/posterior-medial n = 3
|Yu et al. 2014||13||26.5||4/9||8/5||Not specified n = 13|
|Friedrich et al. 2012||1||31||Not specified||R||Anterior-lateral|
|Arora et al. 2014||1||38||M||L||Medial|
|Santos et al. 2014||1||46||M||R||Anterior-medial|
|Yang et al. 2015||1||49||M||L||Superior-medial|
|Morey-Mas et al. 2011||1||76||F||R||Globular|
|Total||235 (300) a||41||82/152 (1:1.85)||86/78||Anterior/anterior-medial/anterior-superior/medial/superior/superior-medial n = 119
Lateral/anterior-lateral n = 9
Posterior/posterior-medial n = 10
Globular n = 8
Gigantic n = 3
Not specified n = 86