|Year : 2015 | Volume
| Issue : 4 | Page : 598-602
Solitary peripheral osteoma of the mandible: Report of 2 cases
Sanat Kumar Bhuyan1, Ruchi Bhuyan2, Smita R Priyadarshini1, Bikash Biswadarshee Nayak1
1 Department of Oral Medicine and Radiology, Institute of Dental Sciences and Hospital, Siksha 'O' Anusandhan University, Bhubaneswar, Odisha, India
2 Department of Oral Pathology and Microbiology, Institute of Dental Sciences and Hospital, Siksha 'O' Anusandhan University, Bhubaneswar, Odisha, India
|Date of Submission||20-Jun-2015|
|Date of Acceptance||01-Jun-2016|
|Date of Web Publication||19-Aug-2016|
Dr. Smita R Priyadarshini
Plot No. 476, Near Radha Rani Towers, Nayapalli, Bhubaneswar - 751 012, Odisha
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Osteomas are benign slow-growing lesions. A very few cases of the peripheral type arising from periosteum have been reported. In the facial region, periosteal osteomas mostly occur in the paranasal sinuses; thus, solitary osteomas of the jaws bones are rare. The etiology is unknown although it could be attributed to as a developmental anomaly, due to trauma or infection. Herein, we have reported two cases of large solitary peripheral osteoma discussing the clinical, radiological, and histological features of the lesion located in the buccal and lingual surface in the left posterior part of mandible causing facial asymmetry and the other being asymptomatic.
Keywords: Benign bony neoplasm, mandible, peripheral osteoma
|How to cite this article:|
Bhuyan SK, Bhuyan R, Priyadarshini SR, Nayak BB. Solitary peripheral osteoma of the mandible: Report of 2 cases. J Indian Acad Oral Med Radiol 2015;27:598-602
|How to cite this URL:|
Bhuyan SK, Bhuyan R, Priyadarshini SR, Nayak BB. Solitary peripheral osteoma of the mandible: Report of 2 cases. J Indian Acad Oral Med Radiol [serial online] 2015 [cited 2021 Jul 26];27:598-602. Available from: https://www.jiaomr.in/text.asp?2015/27/4/598/188771
| Introduction|| |
Osteomas are osteogenic lesions developing from compact or cancellous bone. It is benign and slow growing.  They most frequently occur in the paranasal sinuses and rarely occur in the jaws. In the jaws, maxilla is the common site of occurrence; however, here we report two cases of peripheral osteoma of the mandible. They are usually classified as central from endosteum (endosteal), peripheral from periosteum (parosteal, periosteal, or exophytic), and extraskeletal (osseous choristoma).  Osteomas are mostly asymptomatic. Sometimes they may cause facial asymmetry due to swelling. They appear as a polypoid or sessile mass (periosteal osteoma) which may be located in the medullary bone (endosteal osteoma). They are bony hard, nonfluctuant, noncompressible, nonpulsatile swellings. 
| Case Reports|| |
A 60-year-old male patient reported to the dental outpatient department of oral medicine and radiology with the chief complaint of swelling in the left lower third of the face. The history revealed that the patient noticed a slow-growing swelling on the left lower side of the face for 5 years with no history of trauma, toothache, pain, or discharge from the swelling. The past medical, surgical, dental, personal, and family history were noncontributory.
On extraoral examination, a single unilateral diffuse swelling was present in the left lower one-third of the face measuring approximately 1 cm × 1 cm in size, spherical in shape, and smooth surface without any change in overlying skin [Figure 1]. The swelling extended 1 cm below the corner of the lip till 4 cm below the midline of the lower eyelid anteriorly and 1 mm above the inferior border of the mandible posteriorly. There were no secondary changes, discharge, pigmentation, vascular change, or other changes associated with it. On extraoral examination, the inspection findings of site, size, shape, and borders were confirmed. It was a nontender, hard, and afebrile swelling with smooth diffuse edges which did not yield to pressure and the overlying skin was pinchable. Swelling was attached to the bone with a pedunculated base, nonfluctuant, noncompressible, and nonreducible.
On intraoral examination, a single diffuse swelling was present in the left buccal sulcus measuring approximately 1 cm × 1 cm in diameter. The shape of the swelling was roughly oval with no change in mucosal color extending anteriorly in the buccogingival sulcus from 35 to 36 posteriorly causing obliteration of the vestibule. On palpation, the swelling was nontender, bony hard in consistency and nonfluctuant [Figure 2]. Considering all the features, a provisional diagnosis of benign bony neoplasm was made and differential diagnoses of central hemangioma, bony exostosis, osteoid osteoma, osteoblastoma, and osteoma were considered.
|Figure 2: Case 1- Intraoral picture of the lesion with normal overlying mucosa|
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Intraoral periapical radiograph revealed a single well-defined radiopacity in the periapical region of 36 which appeared more opaque resembling the opacity of enamel of corresponding teeth. Multiple irregular radiopacities were seen with varying intensity in the periapical region of 46 and 47. Lateral occlusal view of the left side revealed a well-defined outgrowth of a pedunculated radiopaque area, round in shape, measuring approximately 1 cm × 1 cm in the buccal aspect of the mandible [Figure 3]. The panoramic radiograph (OPG) revealed multiple irregular radiopacities with varying intensity in periapical region of 36, 37, 46, and 47. Periapical radiopacity in relation to 36 appeared more opaque resembling radiopacity of enamel of corresponding teeth [Figure 4]. A lateral oblique radiograph was advised which revealed a well-defined radiopacity in the periapical region in relation to 36 which was more radiopaque than the irregular radiolucency present in the periapical region of 37. Computed tomography of the lesion was performed along with three-dimensional reconstruction. It revealed a well-defined radiodense outgrowth from the left hemi-mandible measuring 1.5 × 1 cm. Thus, on the basis of radiographic findings, a final diagnosis of osteoma was made [Figure 5] and [Figure 6].
|Figure 5: Case 1- Axial computed tomography scan view of the lesion showing hyperdense mass protruding to the buccal side|
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|Figure 6: Case 1- Three-dimensional reconstruction image of the lesion showing the pedunculated lesion|
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Surgical excision of the lesion was planned under local anesthesia. Intraoral full-thickness buccal mucoperiosteal flap was reflected from 35 to 37 [Figure 7]. During excision, the lesion appeared hard and homogenous. The residual bed was debrided, smoothened, and the flaps were sutured. After surgical excision, the specimen was sent for histopathological examination [Figure 8] which revealed normal appearing dense compact bone with features suggestive of osteoma with missing Haversian systems. The patient was scheduled for regular follow-ups [Figure 9].
|Figure 7: Case 1- Intraoral image showing full-thickness buccal mucoperiosteal flap reflected from 35 to 37|
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|Figure 9: Case 1- Photomicrograph showing dense compact bone with no Haversian system|
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A 59-year-old male patient reported to the outpatient department for the evaluation of a slow-growing swelling in the left lower back tooth region for 4 years. He reported with no pain and no difficulty in chewing food. There was no history of any trauma and had no contributory family history. On examination, the patient had no facial asymmetry and a well-defined, oval, sessile immobile mass was present in the lingual plate of the left posterior mandible with lingual expansion which was bony hard on palpation. The overlying oral mucosa was normal. There was no pain, tenderness, or paresthesia. The second molar was missing and there was generalized attrition in the posteriors [Figure 10]. A provisional diagnosis of benign bony neoplasm was made, and differential diagnoses of bony exostosis, osteoid osteoma, and osteoma were considered.
|Figure 10: Case 2- Intraoral picture revealing swelling in the lingual aspect 36|
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Intraoral periapical radiograph revealed a diffuse radiopacity superimposing 35 and 36 which appeared more opaque resembling the opacity of enamel of corresponding teeth. Occlusal radiograph revealed a well-defined outgrowth in the lingual aspect with respect to 35, 36, and 37, oval in shape, measuring approximately 2 cm × 1 cm in size resembling that of the cancellous bone [Figure 11]. Surgical excision of the lesion was planned under local anesthesia, and the specimen was sent for histopathological evaluation which revealed normal appearing dense compact bone.
|Figure 11: Case 2- Occlusal radiograph showing expansion of the lingual plate|
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| Discussion|| |
Peripheral osteomas are most uncommon lesions which occur mostly among young adults and do not have any gender predilection. Maxilla is more frequently affected than mandible. The angle and the condyle are involved followed by body of the mandible and ascending ramus with lingual aspect of the molar and premolar region being the most frequent site in mandible. , Osteomas are usually present unilaterally and appear as pedunculated masses which are associated with facial asymmetry and occlusal dysfunction.
The pathogenesis of peripheral osteomas is still controversial.  According to developmental and embryological theory, osteomas would originate from sutures between bones of different embryological derivation, but this is rather unlikely as they develop in adults and not during childhood or adolescence. The inflammatory theory suggests that chronic infections of paranasal sinuses could stimulate proliferation of periosteum related osteogenic cells although it is rarely impossible to determine whether it is the infection or osteoma that preceded. Moreover, this does not explain pathogenesis of osteomas in other locations.  In the cases reported here, osteoblastoma and osteoid osteomas were considered in the differential diagnosis, but they are frequently painful and grow rapidly than peripheral osteomas. 
Recurrence of peripheral osteoma after surgical excision is extremely rare and the goal of follow-up is to look out for new osteomas or other signs indicative of Gardner syndrome, which was not ruled out in our case, as the OPG revealed many mixed radiopaque and radiolucent areas which were present on both sides of the mandible. , Osteomas may have varied presentations and early detection and ruling out of Gardner syndrome which presents with multiple osteomas in jaw bones is extremely important because of its tendency to develop into colorectal adenocarcinoma; moreover, the maxillofacial features could appear even before the patient could develop intestinal polyposis. This feature of osteoma becomes imperative for oral physicians to be familiar with the significance of Gardner syndrome as a precancerous condition. ,,
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