ISPUB.COM The Internet Journal of Head and Neck Surgery Volume 3 Number 2 Unusual Solitary Osteoma Coronoid Process And Aesthetic Facial Correction Z Núñez-Gil Citation Z Núñez-Gil.. The Internet Journal of Head and Neck Surgery. 2008 Volume 3 Number 2. Abstract Osteoma is a slow-growing, benign and uncommon neoplasm located primarily in the región of the maxillofacial skeleton. An osteoma on the coronoid process is exceedingly rare. Here, we report a case of osteoma occurring in the pterygomandibular space in a 35-year-old woman. Clinical examination reveal facial asymmetry and difficulty in mouth opening, and the regional lymph nodes were non-palpable. CT images revealed well-circumscribed dense, radiopaque masses located coronoid process.we present a Aesthetic facial correction for this cases. INTRODUCTION CASE REPORT Osteoma is a benign osteogenic tumor arising from the proliferation of cancellous or compact bone[1]. These bony masses may be composed of soft, spongy bone (cancellous osteomata) or of dense, compact bone (hard or ivory osteomata). Characteristically, they are slow growing, circumscribed, and usually. Examination of a 35-year-old white female patient with a 6year history of progressive facial asymmetry and limited mouth opening. A left zygomatic body asymmetry was also noticed. This bone was prominent but no mass or swelling was observed. The mobility of the condyles was normal. There was no clicking or crepitation, and no articular pain. Maximum mouth opening was 33 mm. Osteomas are benign bone neoplasms, classified as either peripheral or central. Osteomas are found mainly in the craniomaxillofacial bones. Most of the osteomas were located in frontal bone (28.57%), mandible (22.85%), and maxilla (14.28%)[2]. Osteoma of the jaws is quite rare. In instances of mandibular involvement, the most common sites are the angle and lower border of the body. Osteoma of the mandibular coronoid process is rare[3]. Since the first case reported by Lewars [5] in 1959, only two other cases have been described. Another two cases have been documented by Plezi [6] and Wesley et al. [7], however, they relied only on the radiographic appearances and histological confirmation was lacking. The present report describes a further case. The lesions generally arise in close proximity to areas of muscle attachment, [3] thus, a peripheral osteoma below the coronoid process, as in this case, is extremely uncommon. [8-14] Occlusal dysfunction and facial asymmetry are the most common findings in condylar osteoma. Multiple osteoma of the jaws are commonly observed in the Gardner síndrome. 1 of 5
Figure 1 Figure 3 Fig 1 and 2. Clinical aspect. Note the facial assimetry. Fig.3 CT Infratemporal fossa. The patient underwent surgical intervention with general aenesthesia and traqueotomy to perform coronoidectomy by submandibular approach. A coronoid osteotomy was performed as well as a smoothing of the zygoma. After raising the hemicoronal scalp flap, the temporalis was reflected from the anterior temporal fossa. Masseter muscles were released from the zygomatic arch, and the zygomatic arch and coronoid process of the mandible were removed or reflected to gain free access to the infratemporal fossa. The coronoid process was resected at the level of the sigmoid notch so as to remove the entire tumor. Figure 4 Figure 2 Fig. 4 Surgical specimen. Computed tomography (CT) demonstrated a mass left coronoid process impinging against the posterior aspect of the zygomatic bone. The left zygomatic body was sectioned and displaced medially to remodeled the zygomatic bone. 2 of 5
Figure 5 Figure 6 Fig.5: Piece of zygomatic body osteotomizaded. Fig.6: Hemicoronal approach. Stabilitation with 2.0 mm plate. Figure 7 Fig 7 and 8: Inmediatly postsurgical facial aspect. 8 days postsurgical. The zygomatic arch was then repositioned and stabilized with plate and screws 2.0 mm. after surgery, the patient presented an interincisal opening of 40 mm. 3 of 5
Figure 8 diagnosis includes osteochondroma. The treatment of osteoma is surgical excision. Recurrence after surgical procedure is rare and there are no reports of malignant transformation. References 1. Regezi JA, Sciubba J.(eds ) Oral Pathology (ed 2). Philadelphia: PA, Saunders;1993. p. 407. 2. Nejat Bora Sayan, Cahit [Uuml ][ccedil]ok, Hakan Alpay Karasu, DISCUSSION Osteomas are benign, slow-growing tumors that should be monitored and removed surgically when causing symptoms. Osteomas of the jawbones are uncommon. They may arise from the surface of bone as a polypoidal or sessile mass (periosteal osteoma) or may be located within the medullary bone (endosteal osteoma). Different approaches maybe attempted depending on the size and location of the osteoma Although trauma, inflammatory or infectious processes are the causes commonly cited in literature[5,6 and 10], no etiological factor can be associated with this case. The radiographical findings are usually described as an oval or round mass bound to a large base. A large solitary osteoma may resemble a parosteal osteogenic sarcoma, which in many cases may appear as a well-defined circumscribed mass, lobulated and radiopaque [7]. In this case, differential 4 of 5 eripheral osteoma of the oral and maxillofacial region: A study of 35 new cases. Journal of Oral and Maxillofacial Surgery, Volume 60, Issue 11, November 2002, Pages 1299-1301 3. Chen YK, Lin LM, Lin CC.: Osteoma of the mandibular coronoid process. Report of a case. Int J Oral Maxillofac Surg. 1998 Jun;27(3):222-3. 4. I Kaplan, S Calderon and A Buchner, Peripheral osteoma of the mandible: A study of 10 new cases and analysis of the literature. J Oral Maxillofac Surg 52 (1994), p. 467. 5. Lewars, Osteoma of the mandible, Br J Plast Surg 12 (1959), pp. 277 279. 6. RA Plezia, Osteoma of the coronoid process, Oral Surg 57 (1983), p. 111. 7. R Wesley, CL Cullen and WS Bloom, Gardner's syndrome with bilateral osteomas of coronoid process resulting in limited opening, Pediatr Dent 9 (1987), pp. 53 57 8. L. Bodner, A. Gatot, N. Sion-Vardy and D.M. Fliss, Peripheral osteoma of the mandibular ascending ramus. J. Oral Maxillofac. Surg. 56 (1998), pp. 1446 1449. 9. K. Bessho, K. Murakami, T. Iizuka and T. Ono, Osteoma in mandibular condyle. Int. J Oral Maxillofac. Surg. 16 (1987), pp. 372 375. 10. K. Kashima, O.I. Rahman, S. Sakoda and R. Shiba, Unusual peripheral osteoma of the mandible: report of 2 cases. J. Oral Maxillofac. Surg. 58 (2000), pp. 911 913 11. D.F. Nelson, B.D. Gross and F.E. Miller, Osteoma of the mandibular condyle: report of case. J. Oral Surg. 30 (1972), pp. 761 763. 12. N.B. Sayan, C. Ucok, H.A. Karasu and O. Gunhan, Peripheral Osteoma of the oral and maxillofacial region: a study of 35 new cases. J. Oral Maxillofac. Surg. 60(2002), pp. 1299 1301. 13. KK Kurita, T Kawai, N Ikeda and Y Kameyama, Cancellous osteoma of the mandibular coronoid process: report of a case, J Oral Maxillofac Surg 50 (1991), pp. 753 756PHD 14. RA Meyer, Osteochondroma of coronoid process of the mandible: report of a case, J Oral Surg 30 (1972), pp. 297 300. 15. RA Ord, JS Rennie, DG MacDonald and KF Moos, Cancellous osteoma of the coronoid process: report of a case, Br J Oral Surg 21 (1983), pp. 49 55 16. L.C. Schneider, H.B. Dolinsky and J.E. Grodjesk, Solitary peripheral osteoma of the jaws: report of case and review of literature. J. Oral Surg. 38 (1980), pp. 452 455.
Author Information Z. Núñez-Gil, DDS, MA Professor and Chief of Oral and Maxillofacial Surgery, St. Vincent Regional and University Hospital Dominican Republic 5 of 5