|Year : 2015 | Volume
| Issue : 3 | Page : 441-444
"Out of the ordinary": A case report of osteoma of mandibular condyle
Vaishali Mysore Rajshekar1, Neelakantam Rajarathnam Basetty2, Roopashri Govindaraju1, Maria Priscilla David1
1 Department of Oral Medicine and Radiology, MR Ambedkar Dental College and Hospital, Bengaluru, Karnataka, India
2 Dr. Syamala Reddy Dental College, Hospital and Research Centre, Bengaluru, Karnataka, India
|Date of Web Publication||25-Nov-2015|
Vaishali Mysore Rajshekar
MR Ambedkar Dental College and Hospital, Bengaluru - 560 005, Karnataka
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Osteomas are relatively rare in the jaws. The causes of these lesions are unknown, although trauma, infection, and developmental abnormalities have been suggested as contributing factors. To the best of our knowledge, only 13 cases of osteomas of the condyle have been reported in literature. Here we report a rare case of osteoma of the right condyle in a 35-year-old male. The patient presented with inability to open the mouth since 15 years, with a history of trauma to the chin. He had facial asymmetry, deviation of the mandible to the unaffected side, and reduced mouth opening. Considering the patient's history and clinical features, a provisional diagnosis of bony ankylosis was considered. This case highlights the importance of performing a detailed examination in patients presenting with limited mouth opening caused by uncommon conditions such as osteomas of the condyle.
Keywords: Limited mouth opening, mandibular condyle, osteomas
|How to cite this article:|
Rajshekar VM, Basetty NR, Govindaraju R, David MP. "Out of the ordinary": A case report of osteoma of mandibular condyle. J Indian Acad Oral Med Radiol 2015;27:441-4
|How to cite this URL:|
Rajshekar VM, Basetty NR, Govindaraju R, David MP. "Out of the ordinary": A case report of osteoma of mandibular condyle. J Indian Acad Oral Med Radiol [serial online] 2015 [cited 2022 Jul 7];27:441-4. Available from: https://www.jiaomr.in/text.asp?2015/27/3/441/170490
| Introduction|| |
Osteomas are benign tumors composed of mature compact or cancellous bone. They are essentially restricted to the craniofacial skeleton and rarely diagnosed in other bones. There is some question as to whether osteomas represent true neoplasms and some likely represent the end stage of an injury or inflammatory process or a hamartomatous process such as fibrous dysplasia.  Osteoma is usually a slow-growing, asymptomatic solitary lesion, which mainly affects young adults. , The cause of osteoma is obscure, but it may arise from cartilage or embryonal periosteum. Osteomas occur most frequently in paranasal sinuses. They can be divided into three types: Those composed of compact bone, those composed of cancellous bone, and those composed of a combination of both.  Osteomas of the jaws may arise as a polypoid or sessile mass (periosteal osteoma), or may be located in the medullary bone (endosteal osteoma).  In recent studies on peripheral osteomas of the maxillofacial region, males were twice as commonly affected as females, with ages ranging from 14 to 58 years. On the other hand, osteoma of the condyle is uncommon, with only 13 cases reported to date. , In view of the paucity of documented reports of this entity, an osteoma involving the right condyle is described here.
| Case Report|| |
A 35-year-old male patient [Figure 1] reported to the Department of Oral Medicine and Radiology with a chief complaint of inability to open the mouth since 15 years. The patient gave a history of trauma to the chin 20 years ago after which the mouth opening gradually reduced. Past medical and dental history was not significant. On general physical examination, patient was found to be moderately built and nourished. The vital signs were within the normal limits. On extraoral examination, there was mild facial asymmetry, presence of healed scar on the chin, with fullness and deviation of mandible to the left side. Inter-incisal mouth opening measuring 0.5 cm was seen [Figure 2]. Bilateral submandibular lymph nodes were palpable, single, firm in consistency, freely movable, and non-tender. On palpation, inspectory findings were confirmed and there was absence of condylar movements on the right side and slight movements on the left side and presence of deepened antegonial notch on the right side. No abnormalities were found on intraoral examination. Considering the patient's history and clinical features, a provisional diagnosis of bony ankylosis of right temporomandibular joint was considered. Malunion due to condylar fracture was considered in the differential diagnosis.
Regarding radiographic findings, orthopantomogram (OPG) revealed presence of well-defined radiopacity measuring about 3 × 2.5 cm in dimension in the right temporomandibular joint (TMJ) with loss of condylar morphology [Figure 3]a. Lateral TMJ view also revealed the same features [Figure 3]b. The coronal, sagittal, and axial sections in computed tomography (CT) revealed hyperdense bony mass in right condyle [Figure 3]c and d. 3D CT showed a large hyperdense bony mass which was fused with the temporal bone and loss of condylar morphology on the right side was found [Figure 3]e. Condylectomy was done and the excised specimen was subjected to histopathological evaluation. H&E stained sections showed trabeculae of bone with osteocytes embedded in the bone. Resting and reversal lines were seen. Marrow spaces were seen in between the trabeculae with few extravasated RBCs [Figure 4]a and b. Overall histological features suggested osteoma and final diagnosis of osteoma of the right condyle was considered. Six months follow-up of the patient showed no recurrence [Figure 5]a and b.
|Figure 3: (a) OPG showing presence of well-defined radiopacity measuring about 3 × 2.5 cm in dimension in the right TMJ with loss of condylar morphology. (b) TMJ view showing the same features of right condyle as in OPG. (c) The coronal sections of CT showing hyperdense bony mass in the right condyle. (d) The axial sections (CT) showing hyperdense bony mass in the right condyle. (e) 3D reconstruction showing a large hyperdense bony mass which is fused with temporal bone and loss of usual condylar morphology in the right side|
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|Figure 4: (a) H and E stained section showing trabeculae of bone with osteocytes embedded in the bone. Resting and reversal lines are also seen. (b) H and E stained section showing trabeculae of bone with osteocytes embedded in the bone. Resting and reversal lines are also seen|
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|Figure 5: (a) Postoperative follow-up OPG showing no recurrence after condylectomy. (b) TMJ view showing no recurrence after condylectomy|
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| Discussion|| |
Limited mouth opening is commonly encountered by dental practitioners. It has several causes, of which osteoma of condyle should be considered as a likely etiology as illustrated by the current case. Osteoma of the condyle may cause a slow, progressive shift in the patient's occlusion with deviation of the mandible toward the unaffected side resulting in facial asymmetry and TMJ dysfunction. The most common clinical manifestations are malocclusion and facial asymmetry.  In the current case, the presenting complaint was a progressive, painless restriction of mouth opening.
In 1927, Ivy reported the first case of osteoma involving the condylar process.  Since then, only 13 cases of osteoma arising in the condylar process have been reported.  In the study by Sayan et al., of the 35 new cases of peripheral osteomas, 8 occurred in the mandible and 5 in the maxilla. Most of them appeared as unilateral, pedunculated, mushroom-like masses.  According to a meta-analysis, 63 cases were reported from 1927 to 2003, of which 30.5% arose from the posterior body, 28.5% from the condyle, 14.2% from the angle region, 11.1% from ascending ramus, 7.9% from the coronoid process, 6.3% from the anterior body, and 1.5% from the sigmoid notch.  There are no reports of osteomas undergoing malignant transformation. There was only one case of recurrence after 9 years of surgical excision, which was reported by Bosshardt et al. 
Osteomas can be classified into two types. The first type of osteomas are those that proliferate and cause replacement of the condyle by the osteoma, and the second type of osteomas are those that form a pedunculated or osseous mass on the condyle or the neck of mandible.  However, a combination of the above types has been reported by Siar et al.  Tarsitano and Marchetti reported an unusual case of giant osteoma of the mandible depressing the lateral pharyngeal wall, which interfered with normal respiration during the night causing sleep apnea. 
The pathogenesis of the osteoma is unknown. Some consider the osteoma a true neoplasm and others classify it as a developmental anomaly. The possibility of a reactive mechanism, triggered by trauma or infection, has also been suggested. Minor trauma may cause subperiosteal edema or bleeding, and the muscle traction could locally elevate the periosteum. This can initiate an osteogenic reaction that could be preserved by the continuous muscle traction. 
Radiologically, osteomas have well-defined borders. They are composed of compact bone which is uniformly radiopaque; those containing cancellous bone show evidence of internal trabecular structure. Large lesions can displace adjacent muscles and cause dysfunction. Osteomas involving the condylar head can be difficult to differentiate from osteochondromas, osteophytes, or condylar hyperplasia, and those involving the coronoid process may be similar to osteochondromas. Smaller endosteal osteomas are difficult to diagnose, if not impossible to differentiate from condensing osteitis or from idiopathic osteosclerosis.  Patients with osteomas should be evaluated for Gardner's syndrome. Osteoma resulting in facial asymmetry and malocclusion may require condylectomy, whereas for small, asymptomatic lesions, periodic observation is necessary. In the present case, condylectomy was done for normal functioning of the mandibular jaw and no recurrence was reported after 6 months follow-up.
| Conclusion|| |
Osteoma of the condyle is a rare, benign, bony growth that may cause painless restriction in mouth opening. It should be considered as one of the possible etiologies in patients with limited mouth opening. Early diagnosis and surgical excision of this osteogenic lesion helps in alleviating subsequent facial asymmetry. Even though recurrence is rare, it is appropriate to provide both periodic clinical examination and radiographic follow-up after the surgical excision of such lesions.
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.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]