Osteoma

Description

Composed of mature compact or cancellous bone

Categories

Epidemiology

Aetiopathogenesis
Arise from:

Bony surface (periosteal, peripheral, exophytic osteoma)

Medullary bone (endosteal, central osteoma)

Within muscle or dermis (extraskeletal osteoma) - osteoma cutis

Common site

Primarily involve craniofacial skeleton

Paranasal sinus

Frontal sinus

Ethmoid

Maxillary sinus

Gnatic

Mandibular body (lingual surface adjacent to premolars and molars

Condyle

Angle of mandible (inferior border)

Coronoid process

Ramus

Clinical features

Solitary, asymptomatic

Very slow growth

Rarely, pain, tooth displacement, tooth impacted, facial deformity

Osteoma 1
 Periosteal osteoma appears polypoid/ sessile mass on bony surface

Endosteal osteoma may not be clinically evident unless large enough to

cause bony expansion

Multifocal osteoma arise in association with Gardner Syndrome

Osteoma involving condyle limits mouth opening/ cause malocclusion with

deviation of dental midline and chin towards unaffected side

Osteoma in paranasal sinus is asymptomatic, or sometimes pain, swelling,

sinusitis, nasal discharge

Rarely, osteoma expands into orbital structure, resulting proptosis, diplopia,

decreased visual acuity

Radiographic features

Circumscribed sclerotic mass

Periosteal osteoma shows uniformly sclerotic pattern/ demonstrate sclerotic

periphery with central trabeculation

Smaller endosteal osteoma difficult to differentiate from condensing osteitis,

focal chronic sclerosing osteomyelitis, idiopathic osteosclerosis

True nature of osteoma can only be confirmed by documentation of growth

Histopathology

Osteoma 2
 Compact osteoma composed of normal-appearing dense bone with minimal
marrow

Cancellous osteoma composed of bony trabeculae and fibrofatty marrow

Investigation and Diagnosis

Treatment

No treatment on small asymptomatic osteoma

Conservative excision for large symptomatic osteoma with 1mm safe margin

Local resection or condylectomy for condylar osteoma

Recurrence is rare

No malignant transformation

Differential diagnosis

Tori

Osteoma usually at skull, jaw bone (angle of mandible)

Tori broad base, osteoma narrow base

Condylar hyperplasia

Osteoma at condyle is lobulated

Hyperplastic condyle retains original shape

Osteoma 3
 Condensing osteitis, focal chronic sclerosing osteomyelitis, idiopathic
osteosclerosis

Smaller endosteal osteoma

Can only be differentiated by documentation of growth

Osteoma 4