Dx: Mandible-Maxilla Osteoma

KEY FACTS

Terminology Definition: Benign bone-forming neoplasm producing either compact or cancellous bone Imaging Peripheral: Well-defined, bone density, radiopacity arising from cortical plates Pedunculated or sessile with broad base Central: Arising from endosteal surfaces of bone No radiolucent halo; may cause expansion and displace teeth Mandible > maxilla: Posterior (especially ramus and condyle) > anterior CBCT and bone CT best show extent, size, location, and expansion if present Top Differential Diagnoses
Idiopathic osteosclerosis Sclerosing osteitis Buccal and lingual exostoses Mandibular tori

Pathology Associated with Gardner syndrome (familial adenomatous polyposis): Autosomal dominant Multiple osteomas precede presentation of intestinal polyps, which have 100% potential for malignant change Clinical Issues Hard bony swelling or expansion of jaws Can be painful especially if infected Range: 13-69 years; mean = 40 years Gardner patients usually 20-40 years old Surgical excision for cosmetics & to restore function Diagnostic Checklist Consider Gardner syndrome if multiple lesions
TERMINOLOGY

Definitions Benign bone-forming neoplasm producing either compact or cancellous bone

IMAGING

General Features Best diagnostic clue Peripheral: Well-defined bone density, radiopacity arising from cortical plates Central: Defined radiopacity, without a radiolucent halo, arising from endosteal surfaces of bone Extraskeletal osteomas found in soft tissue (e.g., muscle) Location Majority occur in craniofacial bones Paranasal sinuses most frequent: Frontal (89%) > ethmoid (20%) > maxillary > sphenoid Mandible > maxilla Posterior (especially ramus and condyle) > anterior Solitary lesions rare: Multiple lesions associated with Gardner syndrome (GS)

Size: Can be very small (mms) to very large (cms) Morphology Peripheral: Round, well-defined, exophytic bony masses; solitary lesions most often peripheral May be pedunculated or sessile with broad base Central: Well-defined dense bone islands arising from endosteal surface of bone May cause expansion Imaging Recommendations Best imaging tool: CBCT or bone CT Radiographic Findings Intraoral and extraoral plain views Central lesions: No radiolucent halo to radiopacity May displace teeth CBCT and bone CT Shows extent, size, & location of peripheral lesions Will show expansion if present with central lesions
DIFFERENTIAL DIAGNOSIS

Idiopathic Osteosclerosis

Histologically same as central osteoma: Does not tend to increase in size, expand or displace teeth Monitor over time for change
Sclerosing Osteitis Associated with nonvital tooth; does not expand

Radiopacity separated from tooth by widened periodontal ligament space

Buccal and Lingual Exostoses

Occur on alveolar bone: Peripheral osteomas in this area may be indistinguishable May look similar to central osteomas on intraoral views
Mandibular Tori

Lingual aspect of mandible adjacent to premolar teeth

PATHOLOGY

General Features Associated abnormalities Gardner syndrome (familial adenomatous polyposis): Autosomal dominant genetic disease Multiple osteomas precede presentation of intestinal polyps, which have 100% potential for malignant change Supernumerary teeth, hypercementosis, odontomas; in alveolar bone density and loss of periodontal ligament spaces; epidermoid cysts Staging, Grading, & Classification Compact (ivory) osteoma Mature dense bone with scant marrow Cancellous osteoma Lamellar trabeculae with abundant marrow Mixed: Bone and fibrous tissue Microscopic Features Peripheral and central osteomas are histologically identical Normal bone with no inflammation

CLINICAL ISSUES

Presentation Most common signs/symptoms: Hard bony swelling or expansion of jaws: Overlying mucosa is normal Other signs/symptoms: Can be painful especially if infected Demographics Age Range: 13-69 years; mean: 40 years Gardner patients usually 20-40 years old Gender Compact: Males > females Cancellous: Females > males Natural History & Prognosis Lesions are slow-growing with no potential for malignant transformation Some believe osteomas are hamartomas because of limited growth potential Treatment Surgical excision for cosmetics and to restore function Central lesions may "shell out" of surrounding bone Screening for GS if not previously diagnosed
DIAGNOSTIC CHECKLIST

Consider Gardner syndrome if multiple lesions present