BrazJOtorhinolaryngol.2015;81(1):107---108
Brazilian
Journal
of
OTORHINOLARYNGOLOGY
www.bjorl.org
CASE
REPORT
Giant
osteoma
of
the
mandible
夽
Osteoma
gigante
na
mandíbula
Paula
Demétrio
de
Souza,
Fernando
Danelon
Leonhardt
∗,
Nicolas
Galat
Ahumada,
Márcio
Abrahão,
Onivaldo
Cervantes
DepartmentofOtorhynolaryngologyandHeadandNeckSurgery,UniversidadeFederaldeSãoPaulo---EscolaPaulistade Medicina(UNIFESP-EPM),SãoPaulo,SP,Brazil
Received5December2012;accepted10February2013
Availableonline12June2014
Introduction
Craniofacial osteomas arerare conditions, and few cases have been described in the literature.1,2 They are benign
tumorsofbonecharacterizedbycorticalormedullarybone
proliferation, affecting mainly young adults.2,3 Peripheral
osteomashave been described inthefrontal andethmoid
bonesandthemaxillarysinus,buttheyareunusualinthe
mandible.3,4In themandible,themost frequent locations
aretheangleandthecondyle,followedbythemandibular
bodyandtheascendingramus.4
Thisisacasereportofanexuberantosteomaofthe
inter-nalaspectoftheleftangleofthemandibleinasurgically
treatedasymptomaticpatient.
Case
report
A41-year-oldfemaleresidentofSãoPaulo,Brazil,presented
totheoutpatientclinicwiththecomplaintofahard,slowly
growing,painlessswellingintheleftsubmandibularregion
forapproximatelyoneyear.Shehadexperiencednoweight
loss, dysphagia,and dyspnea, hadno smokingor drinking
history.
夽 Pleasecitethisarticleas:deSouzaPD,LeonhardtFD,Ahumada NG,AbrahãoM,CervantesO.Giantosteomaofthemandible.Braz JOtorhinolaryngol.2015;81:107---8.
∗Correspondingauthor.
E-mail:fernandodanelon@uol.com.br(F.D.Leonhardt).
Onphysicalexamination,shewasingoodhealthandwas
eutrophic(BMI:24.6). Oroscopy,otoscopy,and rhinoscopy
revealednoabnormalities.Two nodulescouldbepalpated
intheneck;theywerehardandfixedtodeeptissueplanes.
A3-cmnodulewasfound atlevel II;another2-cmnodule
was found on the left angle of the mandible. Computed
tomographyindicated that thelatter bonylesion was
sin-gle,lobulated,andpedunculatedontheleftinnerfaceof
themandibularangle(Fig.1AandB).
Totalresectionviacross-sectionalcervicotomyipsilateral
tothelesionwasperformedthroughosteotomyofthelesion
pedicle(Fig. 1C).The finalhistopathological study of the
specimenrevealedanosteoma.Thepatienthadagood
post-operativecourseandhasbeenfollowedupasanoutpatient
forfour months.She is asymptomatic andhasno signsof
recurrence(Fig.1D).
Discussion
Most osteomas consist of small lesions; however, larger
lesionscanoccur,asinthispatient’scase.Eventhoughthey
canaffectindividualsatanyagebetween16and74years,1
thesetumorsaremoreoftenfoundinpatientsaged20---50
years.5 Anumberofstudies reportnodifferencebetween
genders,2whereasothersindicateafemalepredominance.4
Thecurrentcaseisinlinewiththeliteratureregardingage
andgender.
Asinourcase,patientswithosteomaareusually
asymp-tomaticand the lesion grows slowly. When the mandible
http://dx.doi.org/10.1016/j.bjorl.2014.05.025
108 deSouzaPDetal.
A
C
D
B
Figure1 (A)Contrastedcomputedtomographyoftheface,showinganosteomaofthemandible.Axialviewexhibitinglargemass
withabonycomponentoccupyingtheparapharyngealspace.(B)Computedtomography,axialviewexhibitingpedicle(redarrow)
ontheinternalaspectoftheleftangleofthemandible.(C)Surgicalspecimen,osteomaremovedthroughresectionofitspedicle
totheleftangleofthemandible.(D)Follow-upcomputedtomographydemonstratingnolesions(theredarrowshowsthepointat
whichtheosteomawaspedunculated).
isaffected,theymayshowchangesinbiteanddentition.2
Osteomascanbesessileorpedunculated,2,6andarefound
inthemandibleangle,condyle,ormolarbodyregions.2In
thepresentpatient,thelesionwaspedunculatedtotheleft
mandibleangleandhadacranialgrowth.
Diagnosticwork-up can be complementedwith a plain
radiograph, a panoramic radiograph, or computed
tomo-graphy; tomography is considered best for delimiting
size,location,andanatomicalrelationshipswithadjacent
structures.1
Final
comments
Surgicalmanagementshouldbeindicatedbothforcosmetic
complaints and for diagnostic confirmation, especially in
bulky lesions.Differential diagnoses include inflammatory
orneoplasticdiseases,suchasossifyingfibroma,exostosis,
chronic osteomyelitis, chondroma, osteosarcoma, Paget’s
disease, fibrous dysplasia, and osteoblastoma.1,6 On the
basis of the clinical presentation and imaging studies,
resection of the lesion via cervicotomy was chosen;
mandibularreconstructionwasnotneeded.
Conflicts
of
interest
Theauthorsdeclarenoconflictsofinterest.
References
1.GuimarãesKB,CavalcanteJR,Ferraro-BezerraM,SilvaDN, Vas-concellosRJ,VasconcelosBC.Peripheralosteomabilateralofthe mandiblewithoutassociationwithGardnersyndrome.J Cranio-facialSurg.2012;23:e83---6.
2.Almeida EA, Oliveira Filho MA. Giant mandibular condyle osteoma: case report. J Craniofacial Surg. 2011;22: 1147---9.
3.GondoRM,CostaMD,BatistaJD,MeloPE,SilvaCM.Peripheral osteomainthemandibularbody:casereport.RevCirTraumatol Buco-Maxilo-Fac.2007;8:23---8.
4.ShakyaH.Peripheralosteomaofthemandibule.JClinImaging Sci.2011;1:56.
5.Longo F, Califano L, De Maria G. Solitary osteoma of the mandibular ramus: report of a case. J Oral Maxillofac Surg. 2001;59:698---700.
