Journal of Stomatology, Oral and Maxillofacial Surgery
Case ReportCentral compact osteoma of the mandible: case report featuring unusual radiographic and computed tomographic presentations and brief literature review
Introduction
Craniofacial osteoma is an uncommon benign osseous tumor with an insidious growth rate, with a male predilection, and the mean age at diagnosis is 50 years [1]. Histopathologically, osteomas are characterized by 3 subtypes, as compact or ivory (composed of normal dense bone and scattered bone marrow spaces), cancellous (predominated by trabeculated bone and abundant fibroadipose marrow) and a mixed pattern (showing both histological features) [2].
Most osteomas are painless and arise in peripheral, central, and extraskeletal sites. The craniofacial skeleton is the primary location for osteomas, most frequently arising in the paranasal sinus and frontal bone, with fewer cases found in the jaws, predominately the posterior body of the mandible and less often in the maxilla and condyle [3]. Symptomatic patients often present with sinusitis, facial tenderness and asymmetry, headache and paresthesia [4]. Nonsyndromic peripheral and central osteomas typically appear as 1–2 firm structures, while cutaneous counterparts may exceed 100 in total [5]. Osteomas have been associated with Gardner syndrome, Haberland syndrome, Opitz G/BBB syndrome and acromegaly [6], [7].
A limited number of central osteomas (within medullary bone) of the jaws has been reported, principally in the molar-premolar region, and appearing as a well-defined radiographic opacity and as a hyperdensity on computed tomography scans. The aim of this article is to describe the unusual clinical, radiographic and cone beam computed tomography (CBCT) findings of a central compact osteoma of the posterior mandible.
Section snippets
Case report
In 2019, a 25-year-old female sought evaluation at the University of Maryland School of Dentistry for a persistent mildly tender, expansile mass of the right posterior mandible of 1 year’s onset. In 2015, the lesion had been discovered as an incidental ovoid radiolucency on a panoramic radiograph (Fig. 1a). The attending clinician elected to maintain clinical observation due to the lack of symptomatology. In 2018, an intraoral radiograph revealed a 5 × 4 mm interradicular mixed osteosclerotic
Discussion
At least 72 central osteomas of the jaws have been reported (57 mandibular, 16 maxillary). Typically, central compact osteomas of the craniofacial region display a well-circumscribed sclerotic mass on radiographic projections and a predominately hyperdense lesion on CT imaging [8]. Craniofacial cancellous osteomas are far less common than compact osteomas. Due to their reduced calcification and fibroadipose cellular population, they appear as a mixed composition on conventional radiography and
Conclusions
Our well-documented case has expanded the phenotypic expression of central gnathic osteomas. We propose hyperdense lesions with hypodense borders, as seen on CT images, be included in the differential diagnosis of central osteomas. Suspected cases, particularly with an atypical clinical and radiographic/CT presentation, should undergo surgical removal and histopathologic diagnosis to rule out malignancy. As central osteomas may grow to large proportions, timely recognition and surgical removal
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Declarations of interest
None.
Acknowledgments
The authors wish to thank Dr. Behzad Mostoufi for his photographic records of the surgical field, Dr. Michelle Andersen for acquisition of the follow-up panoramic radiograph, and Dr. Simone de Queiroz Chaves Lourenço for his amended CT description of a mandibular central osteoma that appeared in: Skrivan JM, do Carmo Rodrigues V, de Brito Resende RF, et al. Solitary endosteal osteoma of the mandible-a case report. Oral Surg Oral Med Oral Pathol Endod 2020;129(1):e94. Previously, it was
References (19)
- et al.
Mandibular osteoma in the encephalocraniocutaneous lipomatosis
J Craniomaxillofac Surg
(2005) - et al.
Review of 43 osteomas of the craniomaxillofacial region
J Oral Maxillofacial Surg
(2012) - et al.
A huge osteoma of the mandible detected with head and neck computed tomography
Psychol Behav Sci Int J
(2015) - et al.
Solitary endosteal osteoma of the mandible-a case report
Oral Surg Oral Med Oral Pathol Endod
(2020) - et al.
Osteomas of the craniofacial region. Review of 106 cases
J Oral Pathol Med
(2008) - et al.
Benign maxillofacial bone and cartilage tumours
- et al.
Central compact osteoma of mandibular condyle
BMJ Case Rep
(2020) - et al.
Growth characteristics and clinical manifestations of the paranasal sinus osteomas
Otolaryngol Head Neck Surg
(2011) Multiple miliary oseoma cutis of the cheeks-incidental dental radiographic finding with long term follow-up
N Y State Dent J
(2017)
Cited by (3)
Diagnosis and Management of Craniofacial Osteomas
2023, Journal of Craniofacial SurgerySolitary central osteoma of the mandible with unusual clinicoradiological presentations: A case report and literature review
2023, Oral Science InternationalCraniofacial osteomas: From diagnosis to therapy
2021, Journal of Clinical Medicine