Osteoma: causes, types, symptoms, diagnosis and treatment in Moscow

Traumatologist-orthopedist

Shelepov

Alexander Sergeevich

12 years of experience

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Many people mistake a small bulge that appears on the bone as the result of an injury. Education in the early stages does not create any special problems or cause discomfort, so a visit to the doctor is postponed. As a result, patients consult a doctor after the onset of painful sensations, when the osteoma becomes visually noticeable, begins to cause severe discomfort and leads to deterioration of health.

Osteoma is a benign tumor-like neoplasm developing from bone tissue, which is not predisposed to transition to a malignant state. It develops slowly. Osteoma is dangerous because it develops imperceptibly, without pronounced symptoms, so most people turn to doctors when the pathology is severely advanced and long-term treatment is necessary. Osteoma grows slowly, which allows patients to be successfully treated if treated in a timely manner.

Types of osteomas

Diagnosis of osteoma involves differentiation from similar neoplasms and determination of its type in order to select subsequent treatment.
Tumors are divided by number, type of tissue they are made of, method of germination and complexity of structure. Each of them can be located in different parts of the musculoskeletal system and provoke different symptoms. Based on the number of tumors, they are divided into single (solitary) and multiple, and based on their composition into solid, spongy and medullary. The first consist entirely of bone tissue without bone marrow, the second of spongy substance, and the third of bone marrow cavities. Tumors originate from different tissues (bone or connective) and because of this they have different names:

hyperplastic – consist exclusively of bone (osteomas and osteoid osteomas),
heteroplastic - osteophytes, composed of different tissues.

Osteomas are composed of normal bone tissue, are localized on the bones of the skull, and often put pressure on neighboring organs, such as the eyes. Osteoid osteomas consist of osteogenic tissue penetrated by blood vessels, bone membranes, areas of destroyed bone tissue, and are localized anywhere, in 50% of cases - on the tibia. At the initial stage of development of the disease, there are no symptoms, and then a flat, thin infiltrate appears (if we talk about epiphyseal osteoma, it accumulates in the joint). If in children this type of tumor occurs in the bone growth zone, then one limb will increase in length.

Osteophytes are also divided into 2 types - ectostoses, which grow from above (the skull, face, pelvic bones are the favorite places for their localization), and enostoses, internal, growing into the medullary canal. Exostoses have the shape of a hemisphere, cauliflower, thorn, or mushroom. One of the features of osteophytes (heteroplastic osteomas) is that they appear on the diaphragm, lining of the heart, brain tissue, etc.

Diagnostic tests

If a tumor is detected in the mouth, you should not hope for it to disappear on its own. Diagnosis begins with a visit to the dentist's office. After examining the oral cavity, a detailed examination is recommended.

An x-ray of the jaw is prescribed. On a radiograph, the osteoma appears as a limited ball or oval. If the tumor is located above the tooth (at the level of the root), it may be mistaken for an odontoma. A compact peripheral tumor is easier to diagnose. It affects the spongy bone layer and is characterized by heterogeneous color and structure.
CT scans provide a broad view. Detects minor changes in bone tissue, detects neoplasms, their size and location.
If there is a lack of information after an x-ray, scintigraphy may be necessary.
To differentiate osteoma cells, a biopsy of the affected tissue is performed.
In case of inflammation of the submandibular lymph node, a cytological examination of the contents of the cavity is recommended.
If a tumor is detected on the upper jaw, the patient seeks advice from an ophthalmologist and otolaryngologist.

The actions of doctors are aimed at distinguishing a benign process from a malignant one. Pathologies are treated in completely different ways.

The disease is similar in symptoms to diseases of the jaw:

With hyperostosis, inflammation of the periosteum and accumulation of a large number of bone elements in healthy tissue are noted.
Odontoma is characterized by the growth of dental tissue and the appearance of purulent fistulas.
Osteoid osteoma begins to hurt from the moment of formation. Night pain is typical. The neoplasm is not large. Does not violate the integrity of the bone.
Osteoid osteoma has a different cellular composition, but is also not cancer.
Fibrous osteodysplasia is similar in appearance to spongy osteoma. It is a bone growth defect, but not a neoplasm.
Chondroma includes mature cartilage cells. Rarely found in the jaw. Can degenerate into a malignant tumor.
With intraosseous sclerosis, blood flow is disrupted. The tumor has no contours, so it affects the blood vessels.
Salivary stone provokes a painful process of blockage of the salivary glands.
Exastosis is similar in appearance to osteoma. Causes bone deformation after tooth extraction. The lesions are single and symmetrical.

Causes

The cause of osteoma is said to be heredity, but its appearance and progression can also be facilitated by certain diseases, including gout, syphilis and rheumatism (the trigger is often trauma, especially repeated trauma). The pathology of calcium metabolism sometimes causes the development of inert tumors, the pathological development of embryonic cells can lead to the development of growths, and when localized in the nasal sinuses - a purulent complication or inflammation, puncture of the maxillary sinus. Ectostoses can form during puberty.

Factors

There is a consensus among experts on the question “what are the reasons for the formation of such a tumor?” does not exist. It is argued that there is a connection between osteoma of the jaw and a number of factors. These include:

Trauma to the maxillofacial bones, chronic or one-time (bruise, damage to the integrity of the oral mucosa, untreated teeth (which caused them to quickly collapse), tartar (hard dental deposits), dentures and dental implant crowns that change the bite (poorly fitted) ), poor surface treatment of dental fillings that do not allow the jaws to fully close).
Inflammation in the area of the nose and jaw (actinomycosis, sinusitis, periodontitis, osteomyelitis, periostitis, sinusitis and other pathologies), chronic or acute.
Aggressive environmental effects (smoking, chemical, ionizing and radioactive exposure).
Foreign particles in the sinuses above the upper jaw (often fragments of teeth or particles of materials used to fill teeth).

Experts do not classify osteoma itself as an odontogenic disease. But there are factors that provoke the appearance of a tumor.

Symptoms

The signs of osteomas depend on the location, are not similar to each other, and are sometimes difficult to differentiate due to symptoms similar to other common diseases. It is easier to make a diagnosis in the presence of convex external tumors that are visible to the naked eye.

If the tumor is located on the bones of the head, depending on the location, symptoms are observed:

on the posterior wall of the frontal sinus - intracranial pressure, headaches (do not go away), size from 2 to 30 mm;
on the lower wall of the frontal sinus - moving the eye forward;
on the frontal bone (internal plates) - memory problems, headaches, seizures with convulsions, intracranial pressure;
in the nasal cavity - difficulty breathing through the nose, decreased sense of smell, problems with the eyes (drooping eyelid, double vision, decreased vision);
on the occipital bone - pain in the head, sometimes epileptic seizures;
on the parietal and temporal bone - noticeable, but does not cause painful symptoms;
on the lower jaw (lateral branch or posterior side) - when compressing the soft tissues of the muscles, they can lead to asymmetry and dysfunction, the edges of the tumor are smooth, and the shape is oval or round.

In addition to the bones of the skull, the tumor also affects the bones of other parts of the musculoskeletal system, respectively, symptoms of osteoma and pain appear at its location:

thigh bones - muscle pain, worse at night, swelling in the legs, altered gait;
knee joint - makes movement difficult;
vertebral arch or its process – the formation of scoliosis, symptoms of spinal compression, pain.

Pain due to osteophytes is eliminated completely or partially with the help of analgesics, however, if there are regular repeated attacks of pain, difficulty moving, or the appearance of visible lumps, you should immediately consult a doctor to avoid complications.

Treatment tactics

Treatment of the disease is based on surgery. Traditional and conservative methods are not relevant in the fight against benign neoplasms. Only removal of the tumor body can eliminate the problem.

The operation is performed if the following symptoms are present:

Regular pain of increasing nature.
The tumor visually deforms the face.
The patient cannot open his mouth and chew food.
The tumor on the palate does not allow the installation of a prosthesis, braces or crowns.

When the final diagnosis is determined, the tumor is removed followed by jaw plastic surgery.

The procedure is performed under general anesthesia.
Access to the tumor is gained through the oral cavity.
The mucous and soft tissues are incised.
A hole is drilled in the osteoma.
The dental surgeon uses a chisel to remove the tumor.
If necessary, plastic surgery is performed.
The void at the site of the tumor is filled with the patient's bone tissue.
The jaw is polished.
The wound is sutured.

With osteoma of the hard palate, removal of the lesion is carried out if the patient has difficulty swallowing or speaking:

General anesthesia is administered.
The affected tissue is removed with a chisel.
The bone is polished with cutters.
Stitches are placed on the wound.

Complications may include vomiting, because during surgery there is pressure on the root of the tongue. There is a risk of blood entering the trachea.

The surgery is performed by a team of medical personnel. These are 1 or 2 (depending on the degree of neglect) dental surgeon, anesthesiologist and nurses. If necessary, a resuscitator is present during the procedure.

The patient must be tested for the anesthesia and painkillers used to exclude the development of allergies and anaphylactic shock.

Diagnostics

Diagnosis of the tumor is carried out to determine its type and location in order to select tactics for treating osteoma. As part of its implementation, X-ray and CT are used. The most informative is a 3D reconstruction; it shows all the details and outlines, as well as the extent of damage to surrounding tissues. In the process, it is important to differentiate osteoma from chronic Brody’s abscess, organized periosteal callus, osteochondrosis dissecans, osteogenic sarcoma, osteoperiostitis and other diseases.

Before prescribing an x-ray or tomography, the doctor conducts an examination and identifies:

presence of pain when pressing;
location;
growth rate;
functionality of the tissue that has been affected.

Using X-rays, a specialist detects the number of tumors, their structure, location, and the degree of bone destruction. It should be noted that on an x-ray the exostosis looks smaller than in reality, since its upper cartilaginous layer is not visible. In children it reaches a thickness of several centimeters. The benign nature of the tumor is indicated by correct geometry and structure, a clear contour, a small degree of calcification and growth at a low rate.

Treatment

Removal of osteoma is indicated if it compresses neighboring organs, is visible visually, that is, acts as a cosmetic defect (especially on the face and head), changes the shape of bones, reduces mobility, leads to scoliosis, and causes pain. Most often, tumors are removed from the sinuses, ear canal, jaws, knee and hip joints.

If the tumor does not manifest itself in any way and does not cause discomfort, the doctor observes it and evaluates its growth rate. A small osteoma that has stopped growing does not need to be removed or treated.

The operation to remove the tumor is performed by maxillofacial surgeons or neurosurgeons. During the operation, the doctor cuts the tissue, removes the growth and part of the bone/tissue around it to avoid relapse.

The doctor will suggest removing the osteoma in the following ways:

complete excision – used for tumors in the sphenoid sinus;
curettage - an incision in the skin, removal of a tumor, cleansing the lesion by curettage;
endoscopic removal - suitable for small tumors with a difficult approach, used using computed tomography to monitor the progress of the operation and a radiofrequency probe, takes about 2 hours.

Tumor recurrence occurs in 10% of cases due to incomplete removal. To exclude this possibility, you need to choose a good clinic and specialist.

Why should jaw osteophytes be removed?

A bone growth on the gum is not dangerous until it begins to grow. Increasing in volume, the osteophyte puts pressure on the dentition and bone structures. This leads to tooth displacement, malocclusion, and jaw deformation. Large growths impede the movements of the tongue, complicate diction, and interfere with normal chewing of food. Large growths prevent prosthetics and implantation. Osteophyte of the jaw will not disappear on its own. The only effective method of treatment is surgical removal of the pathological formation.

Is osteoma dangerous?

Speaking about the dangers of osteoma, one should note first of all the compression of neighboring organs and symptoms that cause inconvenience to the patient. If the tumor does not manifest itself and does not grow, it can be left in place. A neoplasm of this kind never develops into malignant – there is no need to be afraid of cancer. Tumors on the head should be treated with particular care - they not only cause unpleasant symptoms, but can also lead to a brain abscess. As a rule, they are removed surgically.

Etiology and pathogenesis

The causes and origin of osteoma are not fully known. Some researchers consider it a neoplasm that develops at a certain time. Others tend to classify the lesion as an anomaly of the craniofacial bones.

Doctors also named the following as possible etiological factors:

trauma, since most formations are located in the lower part, which is more susceptible to traumatic lesions;
combination of injury and muscle strain;
infectious or inflammatory processes of the oral cavity or jaw bone tissue

Study of the etiology of benign jaw lesions

Solitary form of peripheral osteoma on the lower jaw