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REVIEW ARTICLE
Year : 2008  |  Volume : 20  |  Issue : 1  |  Page : 6-8 Table of Contents   

Osteoid osteoma of jaws: An overview


Department of Oral Medicine and Radiology, Government Dental College, Trivandrum, Kerala, India

Correspondence Address:
Akhilanand Chaurasia
Room no.334, Men's P.G.Hostel, Medical college Campus, Trivandrum -695011, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-1363.44353

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   Abstract 

Osteoid osteoma is a rare benign osteoblastic tumor with distinctive histologic characteristics consisting of a central core of vascular osteoid tissue i.e., nidus surrounded by a peripheral zone of sclerotic bone. Most of cases of Osteoid osteoma are reported in long bones of body, however, their occurrence in jaw bones is extremely rare. The purpose of this article is to present an overview regarding its clinical presentation, diagnosis and management.

Keywords: Osteoblastoma, osteoid-osteoma and osteomyelitis


How to cite this article:
Chaurasia A, Balan A. Osteoid osteoma of jaws: An overview. J Indian Acad Oral Med Radiol 2008;20:6-8

How to cite this URL:
Chaurasia A, Balan A. Osteoid osteoma of jaws: An overview. J Indian Acad Oral Med Radiol [serial online] 2008 [cited 2020 Jan 22];20:6-8. Available from: http://www.jiaomr.in/text.asp?2008/20/1/6/44353


   Introduction Top


Osteoid osteoma was first reported by Jaffe in 1935 as a distinct clinical entity. It is a small benign osteoblastic tumor with distinctive histologic characteristics consisting of a central core of vascular osteoid tissue. [1],[2] Lichtenstein defined osteoid osteoma as A small oval or roundish tumor like nidus which is composed of osteoid and trabeculae of newly formed bone deposited within a substratum of highly vascularized connective tissue. He further concluded that osteoid osteoma can develop within spongiosa of bone or in relation to cortex of affected bone. [3] Osteoid osteoma is characterized by varying intermixtures of osteoid, newly formed bone and highly vascular supporting osseous tissue (nidus) surrounded by a distinctive zone of reactive bone formation. The nidus typically measures less than 1.5 cm in diameter. [4] Osteoid osteoma constitute about 12% of benign osseous tumor. It is usually encountered in adolescent and young adults. Most commonly it occurs in the age range of 5 to 25 years with majority of cases in 2 nd decade of life. However, they are very rare above age of 30 years. There is slight male predilection, male to female ratio being 2-3:1. [4],[5],[6] Osteoid osteoma commonly involves the femur (27.33%), tibia (22.1%) followed by spine (10%). Less frequent site for occurance of osteoid osteoma are the mandible, ribs and clavarium. The vertebral column, innominate bone, skull, mandible, maxilla, scapula and clavicle are infrequent site of occurance. [7] The osteoid osteoma have a tendency to involve cortex more frequently than medulla and have limited growth potential. [4],[5] Most of osteoid osteoma are indolent in nature usually having no sign and symptoms which causes unawreness to patient and it takes months or years to seek treatment. The clinical symptoms depends on size, site, age of patient and growth potential of tumor. Most notable early symptom is intermittent vague pain generally increasing in intensity leading to nocturnal paroxysm. This pain responds characteristically to aspirin treatment. [4],[5],[6],[8] The hallmark of osteoid osteoma is dull or aching pain initially mild and intermittent but increasing in intensity and persistence with time. Soft tissue swelling and tenderness is often associated with progression of disease. Clinically, osteoid osteoma causes growth abberations, muscular atrophy and skeletol deformity in immature skeleton.


   Diagnosis Top


Radiographic examination - The roentgenological appearance of osteoid osteoma is, as a rule, characteristic. There is a centrally located oval or round radiolucent area measuring less than 1 cm in diameter surrounded by a uniform zone of sclerosis. The size of this sclerotic zone is usually out of all proportion to the focal area of diminished density. Osteoid osteoma originating from cortex of bone have no characteristic sclerotic margin. In cortical lesions, cortex becomes thickened in vicinity of lesion because the periosteum is stimulated to lay down subperiosteal bone. This is the reason for swelling present in relation to lesion. Occasionally, there may be calcification or ossification of a portion or all of radiolucent nidus. However, appearance of osteoid osteoma on radiograph may be modified according to specific skeletal location and precise site of involvement in bone. In long bones, osteoid osteoma is typically located in diaphyseal cortex, the nidus is a radiolucent lesion with peripheral bone sclerosis and cortical thickening from endosteal and subperiosteal new bone formation. The degree and extent of sclerotic reaction surrounding the nidus is also variable. [9]

Computed tomography - It is the imaging modality of choice for diagnosis of osteoid osteoma. It demonstrates a small osteolytic lesion less than 1.5 cm in diameter with a dense sclerotic ring having central calcification in 20 to 30% cases. It is also observed that osteoid osteoma may be completly calcified. [10]

MRI - It is not diagnostic in osteoid osteoma cases because appearance of osteoid osteoma depends on amount of calcification of nidus, size of fibrovascular zone, reactive sclerosis and amount of oedema in bone. [11] However, on bone scintigraphy osteoid osteoma appears as increased area of radio-tracer uptake on blood flow, blood pool and delayed phases in the nidus and less intense uptake in sclerotic bone. This pattern has been designated as double density sign and it is diagnostic for osteoid osteoma. [12],[13]


   Histology Top


The histological hallmark of osteoid osteoma is the nidus which is characterized by varying intermixtures of osteoid, newly formed bone and highly vascular supporting fibrous tissue. Osteoid may appear in broad sheet in some areas or it may present bony trabeculae in process of calcification or ossification. The trabeculae are thin and show prominent osteoblastic rimming. The nidus is surrounded by thickened cortical bone. [4],[5]


   Treatment Top


Large osteoid osteomas are generally managed by surgical resection. However, for small lesions routine clinical and radigraphic follow up is indicated. [9]


   Discussion Top


Osteoid osteoma is a benign lesion consisting of small round nidus. It accounts for 3% of all primary bone tumors and about 10% of all benign tumors. About 80% of osteoid osteoma occurs in long bone while less than 1% occurs in jaws. Osteoid osteoma is most frequently reported in 2 nd and 3 rd decade of life more commonly in males than females at a ratio of 2:1. [14],[15],[16],[17] Differential diagnosis of osteoid osteoma includes osteomyelitis and osteoblastoma. Osteomyelitis may form a localized abcess termed Brodie's abcess which radiographically simulate appearance of osteoid osteoma. However histologically Brodie's abcess shows inflamation and not a bony nidus. [5] Osteoblastoma is characterized by inconsistent pain, rapid increase in size and lesion usually measures greater than 2 cm. [4]

But, histologically it is very difficult to distinguish osteoid osteoma from osteoblastoma because of histological similarities. In such cases diagnosis is based on size of nidus and presence of reactive bone formation. However, in practice, lesions smaller than 1.5 cm is considered as osteoid osteoma and the lesions greater than 1.5 cm as osteoblastoma. [4],[5],[6] Osteoid osteoma and benign osteoblastoma are closely related entities and are sometimes reported under common heading. [18],[19],[20],[21],[22] In general, osteoblastoma is less common than osteoid osteoma. [16],[17] But, in jaws osteoid osteoma are less frequent than osteoblastoma. [18],[23],[24],[25] Although there are no specific histologic criteria to distinguish osteoid osteoma from osteoblastoma. [14],[15] These two are widely accepted as different diseases because of their differences in size, site, clinical presentation and radiological appearance. [14],[15],[16],[17] It has been reported that osteoid osteoma does not recur after complete removal of nidus [14],[16],[17] while recurrence of osteoblastoma after complete resection has been reported in several cases. [24],[25],[26] A few cases of malignant transformation of osteoblastoma have been reported [27],[28],[29] but none of osteoid osteoma. [14] Radiographically, the typical nidus of osteoid osteoma is a round or ovoid radiolucency less than 1 cm in diameter, having a small radiopacity in the centre located at intracortex or subperiosteal site that is surrounded by reactive sclerosis of the bone and sometimes with thick homogenous periosteal reaction. These radiological features have been suggested to be diagnostic of an osteoid osteoma. [16],[17] In contrast, osteoblastoma is a radiolucent or mixed radiopaque lesion larger than 2 cm in diameter in the medullary bone and causing expansion of the affected bone. Surrounding reactive sclerosis is usually absent except for a thin border of sclerotic bone. [24],[26] The radiographic features of osteoblastoma are variable and nonspecific. [14],[17],[24] Many investigators agree that the differentiation between osteoid osteoma and osteoblastoma should be based on size, site and radiological appearance. [14],[15],[18],[30] However, a radiolucent nidus of osteoid osteoma is not always easily recognized on a radiograph because of superimposition of other bony structures because it is often obscured by extremly dense sclerosis around it. [31] Computed tomography (CT) has been suggested to be one of most useful modalities to diagnose the bone tumors in the complex anatomical site of jaws. [32] A small lesion like osteoid osteoma covered with thick bone is best visualized by CT. [33] Bone scan is considered useful in some cases with osteoid osteoma because the rich bone producing osteoid osteoma is associated with a hot radionclide bone scan. [19]


   Conclusion Top


Osteoid osteoma is a rare tumor of jaw. This article has presented a thorough review of this rare entity with its clinical presentations, diagnosis and management. Whenever bony growths are encountered in jaws of adolescence and young adults, osteoid osteoma should always be considered in differential diagnosis.

 
   References Top

1.Jaffe HL. Osteoid osteoma: A benign osteoblastic tumor composed of osteoid and a typical bone. Arch Surg 1935;31:709-28.  Back to cited text no. 1    
2.Jaffe HL. Osteoid osteoma of bone. Radiology 1945;45:319-34.   Back to cited text no. 2    
3. Lichtenstein L. Bone tumors. St Louis: C.V. Moby Co; 1952. p. 71-81.   Back to cited text no. 3    
4. Huvos GA. Bone tumors, diagnosis, treatment and prognosis 2. Philadelphia: WB Saunders Company; Osteoidosteoma: 1991. p. 49-66.   Back to cited text no. 4    
5. Unni KK, Inwards CY. Tumors of osteoarticular system. In: Christofer DM Fletcher, editor. Diagnostic histopathology of Tumors 2. Vol.2. London: Churchill Livingstone; 2002. p. 1563-4.   Back to cited text no. 5    
6. Dahlin DC, Unni KK. Bone tumors General aspects and data on 8542 cases 4. In: Charles CT, editor. Illinois: Spring Field; 1987. p. 88-101.   Back to cited text no. 6    
7. Resnick D, Niwayamma G. Tumors and tumor like lesions of bone: Imaging and pathology of specific lesions. In: diagnosis of bone and joint disorders. Vol 36. Philadelphia: WB Saunders; 1988. p. 20-35.   Back to cited text no. 7    
8. Greenspan A. Benign bone forming lesions: osteoma, osteoid osteoma posteoblastoma clinical, imaging, pathologic and different considerations. Skeletal Radiol 1993;22:485-500.   Back to cited text no. 8    
9. Foss EL, Dockerty MB, Good CA. Allen Good. Osteoid osteoma of mandible: Report of a case. Cancer 1955;8:592-4.   Back to cited text no. 9    
10. Bahloul K, Xhumari A, Feydy A, Kalamarides M, Redondo A, Rey A. Thoraco spine osteoid osteoma. Eur J Radiol 2003;46:74-7.   Back to cited text no. 10    
11. Hermann G, Abdelwaheb F, Casden A, Mosesson R, Klein MJ. Osteoid osteoma of a cervical vertibral body. Br J Radiol 1999;72:1120-3.   Back to cited text no. 11    
12. Helms CA, Hattner RS, Vogler JB 3rd. Osteoid osteoma: Radionuclide diagnosis. Radiology 1984;151:779-84.   Back to cited text no. 12    
13. Smith FW, Gilday DL. Scintigraphic appearances of osteoid osteoma. Radiology 1980;137:191-5.   Back to cited text no. 13    
14. Mirra JM, Gold RH, Picci P. Osteoid osteoma. In: Mirra JM, editor. Bone tumors. Philadelphia: Lea Febiger; 1989. p. 226-48.   Back to cited text no. 14    
15. Schajowicz F. Bone-forming tumours 1.1.2 Osteoid osteoma and osteoblastoma. In: Schajowicz F, editor. Histological typing of bone tumours. 2 nd ed. Berlin: Springer-Verlag; 1993. p. 7-9.   Back to cited text no. 15    
16. Resnick DL, Kyriakos M, Greenway G, editors. Tumors and tumor like lesions of bone: Imaging and pathology of specific lesions. In: Resnick DL, editor. Diagnosis of bone and joint disorders. 3rd ed. Philadelphia: Saunders; 1995. p. 3629-47.   Back to cited text no. 16    
17. Ayala AG. Ro JY, Raymond AK, editors. Bone tumors. In: Damjanov I, Linder J, editors. Anderson's pathology. 10th ed. St. Louis: Mosby; 1996. p. 2531-96.   Back to cited text no. 17    
18. Farman AG, Nortje CJ, Grotepass F. Periosteal benign osteoblastoma of the mandible : Report of a case and review of the literature pertaining to benign osteoblastic neoplasm of the jaws. Br J Oral Surg 1976;14:12-22.   Back to cited text no. 18    
19. Greer RO, Berman DN. Osteoblastoma of the jaws: Current concepts and differential diagnosis. J Oral Surg 1978;36:304-7.   Back to cited text no. 19    
20. Miller AS, Rambo HM, Bowser MW, Gross M. Benign osteoblastoma of the jaws: Report of three cases. J Oral Surg 1980;38:694-7.   Back to cited text no. 20    
21. Shatz A, Calderon S. Mintz S. Benign osteoblastoma of the mandible. Oral Surg Oral Med Oral Pathol 1986;61:189-91.   Back to cited text no. 21    
22. Eisenbud L, Kahn LB, Friedman E. Benign osteoblastoma of the mandible: Fifteen year follow-up showing spontaneous regression after biopsy. J Oral Maxillofac Surg 1987;45:53-7.   Back to cited text no. 22    
23. Yang C, Qiu WL. Osteoid osteoma of the eminence of the mandible. Br J Oral Maxillofac Surg 2001;39:404-6.   Back to cited text no. 23    
24. Smith RA, Hansen LS, Resnick D, Chan W. Comparison of the osteoblastoma in gnathic and extragnathic site. Oral Surg Oral Med Oral Pathol 1982;54:285-98.   Back to cited text no. 24    
25. Weinberg S, Katsikeris N, Pharoah M. Osteoblastoma of the mandibular condyle: Review of the literature and report of a case. J Oral Maxillofac Surg 1987;45:350-5.   Back to cited text no. 25    
26. Tonai M, Campbell CJ, Ahn GH, Schiller AL, Mankin HJ. Osteoblastoma: Classification and report of 16 patients. Clin Orthop Relat Res 1982;167:222-35.   Back to cited text no. 26    
27. Mayer L. Malignant degeneration of so-called osteoblastoma. Bull Hosp Joint Dis 1967;28:4-13.   Back to cited text no. 27    
28. Seki T, Fukuda H, Ishii Y, Hanaoka H, Yatabe S. Malignant transformation of benign osteoblastoma: A case report. J Bone Joint Surg Am 1975;57:154-9.   Back to cited text no. 28    
29. Case records of the Massachusetts General Hospital. Case 40-1980. N Eng J Med 1980;303:866-73.   Back to cited text no. 29    
30. Waldron CA. Fibro-osseous lesions of the jaws. J Oral Maxillofac Surg 1985;43:249-62.   Back to cited text no. 30    
31. Sim FH, Dahlin DC, Beabout JW. Osteoid osteoma: Diagnostic problems. J Bone Joint Surg Am 1975;57:154-9.   Back to cited text no. 31    
32. Cerase A, Priolo F. Skeletal benign bone-forming lesions. Eur J Radiol 1998;27:91-7.   Back to cited text no. 32    
33.Kayser F, Resnick D, Haghighi P, Pereira Edo R, Greenway G, Schweitzer M, et al. Greenway osteoid osteomas in tubular bones: Analysis by CT and MR imaging. AJR Am J Roentgenol 1998;170:609-14.   Back to cited text no. 33  [PUBMED]  [FULLTEXT]




 

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  In this article
    Abstract
    Introduction
    Diagnosis
    Histology
    Treatment
    Discussion
    Conclusion
    References

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