Dental Asia March/April 2022

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CLINICAL FEATURE Osteoma of the maxilla A rare and benign bony lesion in the oral maxillofacial region, osteomas may lead to facial deformity and other debilitating issues which cause pain and discomfort to individuals. By Dr Lordjie Marr O. Morilla Fig 1a In 1935, Jaffe described osteoma as a specific entity. Since then, there are hundreds of published cases of osteoma. Jaffe has the following criteria for osteoma: (1) the lesion is a benign neoplasm; (2) forms a large amount of osteoid which become calcified; (3) has little or no evidence that the lesion was an inflammatory process; (4) has characteristic radiographic changes; and (5) presence of pain 5 . Osteoma is a benign, osteogenic lesion. It can grow to a large mass that can cause facial deformity or dysfunction. Some authors consider it as a true neoplasm, while others noted it as a developmental anomaly 1,3,8 . Osteomas that occur in the oral maxillofacial region, when associated with sebaceous cysts, multiple supernumerary teeth, and colorectal polyposis, can be a sign of Gardner’s syndrome. The purpose of this report is to present a case of an osteoma that occurred in the maxilla, which includes clinical, radiographical descriptions, and treatment. CASE REPORT A 43-year-old female patient consulted for the assessment and management of swelling on her maxillary right posterior residual ridge area. The patient had been aware of the slow but steady enlargement of the mass for 10 months to its current size. The lesion was associated with pain, but there was no problem with the mouth opening. She had no previous facial trauma nor significant medical, familial, or social history related to the lesion. The patient had already experienced tooth extraction but no adverse reaction to local anaesthesia nor complications post-extraction. Extraoral examination revealed neither facial asymmetry nor perioral lesions. Lymph node examination was insignificant (Figs. 1a-b). Intraoral examination revealed swelling on her maxillary right posterior residual ridge area that extended from her right upper premolar area up to the right upper molar area (Fig. 2). Mucosa overlying the swelling has the same colour as the surrounding. Torus palatinus and mandibularis were also observed on the patient. On palpation, swelling is bony-hard, Fig 1b Fig 2 Figs. 1a-b: Extraoral photographs show no facial deformity nor perioral lesion: (a) Facial profile (b) Top view profile Fig. 2: Intraoral view of the maxillary arch showing the lesion on the right posterior area of the patient (yellow arrow) and the torus palatinus (blue arrow) 36 DENTAL ASIA MARCH / APRIL <strong>2022</strong>
CLINICAL FEATURE Fig 3b Fig 3a Fig 3c Fig 3d Figs. 3a-d: (a) Panoramic radiograph (b) Periapical radiograph (c,d) CBCT radiographs show a radiopacity on the right maxillary area. Small pedunculated protuberance can be seen on the palatal side of the right maxillary alveolar ridge (orange circles) non-compressible, non-fluctuant and non-pulsatile but presents dull pain. Intraoral and panoramic radiographs together with conebeam computed tomography (CBCT) revealed a diffused radiopacity on the area of the patient’s maxillary right posterior residual ridge area (Figs. 3a-d). Provisional diagnosis of osteoma, osteoblastoma, and exostosis was made. After case presentation and discussion, it was decided that an incisional biopsy be done first. Under local anaesthesia, a flap was made crestal to the lesion enough to have good access. Upon flap opening, several bony protrusions from the periosteum were seen (Figs. 4a-b). These protrusions from the buccal and lingual sides of the lesion, which are bony hard and round, were removed using a chisel and rotary instrument. The superficial surfaces of the specimens appeared pale and smooth, whereas the cut surface was rough. These specimens were fixed in 10% formaldehyde, decalcified, and were routinely processed. The final histopathological diagnosis revealed the lesion to be an osteoma. Because the lesion was making the patient uncomfortable while eating, the patient was prepared for definitive surgical treatment, excisional removal of the lesions, bone recontouring, and curettage. DISCUSSION Osteomas are benign, osteogenic lesions characterised by excessive and persistent but slow proliferation of bone 1,3,9,10 . These lesions may arise from the proliferation of cancellous, compact, or a combination of both types of bone 1,2,5 . Three different types are present depending on the location. It can be central, peripheral, and extraskeletal osteoma 1,2,3,5,12,22 . Central osteomas arise from the endosteum, peripheral osteomas DENTAL ASIA MARCH / APRIL <strong>2022</strong> 37
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Dental Asia March/April 2022

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