Head & Neck Osteomas are extremely rare osteogenic benign tumors, with unclear pathogenesis and heterogeneous clinical behavior. There are no studies in literature showing the characteristics of dimensional growth of such lesions. We report a case of a peripheral solitary osteoma of the sigmoid notch of the mandibular ramus, describing its radiographic growth in fourteen years. Measurements from OPTs (2003–6x7mm, 2008–8x12mm, 2014–17 × 24mm, 2016–19 × 25mm and 2017–21 × 28mm) and 3d cone-beam computed tomography scan (2016–19 × 15 × 21mm, 2017–21,4 × 19,2 × 22,7) were obtained. The growth of the lesion measured on OPTs was in mean 1.1 × 1.5 mm per year. This is the first case report in literature quantitatively assessing the growth of a solitary osteoma of the mandible through radiographic imaging, which seems to be more than 1 mm per dimension per year.
Head & Neck Osteomas are extremely rare osteogenic benign tumors.
Differential diagnosis: osteosarcoma, Paget’s disease, odontoma, ossifying fibroma.
Patients with osteomas may be affected by Gardner’s syndrome.
Diagnosis is performed on orthopantomographic radiograph (OPT)/CT.
The case is based on a quantitatively analysis, thank to 14-years radiographic evaluations, of the growth of Osteomas tumor.
Osteomas are defined as osteogenic, slow-growing, benign tumors, caused by cortical and/or spongious bone proliferation. Clinical variants include “peripheral” from periosteum, “central” from the endosteum and “extra-skeletal” from soft tissues osteomas [ ].
When located in the Head & Neck, “central” osteomas are localized more frequently in the splanchnocranium (especially mandible) . Solitary osteomas are usually classified into two histological subcategories [ ]:
“Compact/ivory osteomas” composed of mature lamellar bone, without any fibrous component.
“Trabecular osteomas”, composed of cancellous trabecular bone, showing bone marrow and cortical bone at margin.
Differential diagnosis must be done with inflammatory and neoplastic diseases, such as osteosarcoma, Paget’s disease, odontoma, ossifying fibroma [ ]. Patients with osteomas may be affected by Gardner’s syndrome, a familial adenomatous polyposis, autosomal dominant, characterized by polyps located in digestive tract combined to multiple osteomas, soft tissue neoplasm, cutaneous sebaceous cysts and multiple supernumerary teeth [ ].
Solitary osteomas of the Head & Neck anatomical district are rare lesions [ ], with unclear pathogenesis and heterogeneous clinical behavior. Diagnosis is performed examining an orthopantomographic radiograph (OPT)/CT scan in case of symptoms outburst referred by the affected patient or, frequently, incidentally. Solitary osteomas have peculiar radiological aspect: an oval or spherical radiopaque mass, with well-defined margins, that, in case it is a peripheral variant, is linked to the cortical part of the bone (mushroom-like mass) [ ]. As far as we know, dimensional variations of such lesions have never been essayed nor reported in literature. Through a case of peripheral solitary osteoma of the sigmoid notch of the mandibular ramus, we quantitatively assessed, with a fourteen-years radiographic analysis, the growth of this benign tumor.
In December 2017, a 53-year-old white man was referred to the Maxillofacial and ENT Surgery Department of the Istituto Nazionale Tumori – IRCCS “Fondazione G. Pascale” of Naples, for evaluation of a radiopaque lesion of the right mandibular ramus. Collecting anamnesis, the patient reported that the lesion was found incidentally on an OPT during dental routine evaluation in 2003, but he refused to undergo surgery being asymptomatic and underwent regular follow-up. He thus performed periodic control OPTs, in 2003, 2008, 2014, 2016 and 2017. In order to program dental implant treatment, his dentist requested one 3d cone-beam computed tomography (CBCT) scan in 2016. At the time of the inspection, the patient still referred to be completely asymptomatic. Physical intraoral examination confirmed the presence of a small lesion, well-defined with hard consistency, on the medial aspect in right mandibular ramus. As preoperative exams, a novel CBCT were performed. A preoperative colonoscopy, to exclude Garner’s syndrome, was requested to the patient. The 3d CBCT scan showed a bone-like mass, located in medial portion of the right ramus in the notch, with dimensions of 21,4 × 19,2 × 22,7mm. Due to such dimension and localization of the mass, the patient was thus advised to undergo surgery for transoral excision. Written informed consent with exhaustive oral explanations was administered to the patient prior to perform the surgical procedure.
Excision of the lesion was performed under general anesthesia after nasal intubation ( Fig. 1 A). The mass was approached intraorally. After soft tissue dissection, the mass was found adherent to mandibular notch and was removed using a small chisel. A first wound closure was granted. Ten days after surgery, patient showed no longer any sign of swelling. Histological examination of the specimen confirmed the diagnosis of osteoma- “ivory” variant.