Osteoid Osteoma of the Maxilla: Literature Review and Case Report

Roscher DF¹*, Belossi ME¹, Paparella ML² and Stolbizer F¹

¹Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Buenos Aires, Argentina

²Department of Oral Pathology, School of Dentistry, University of Buenos Aires, Argentina

*Corresponding author: Daniel Roscher, School of Dentistry, University of Buenos Aires, Marcelo T. Alvear, CABA, Buenos Aires, Argentina

Received: January 09, 2018; Accepted: February 13, 2018; Published: March 01, 2018

Abstract

Osteoid osteoma (OO) is a benign osteogenic tumor, usually less than 2cm in size. It is associated with nocturnal pain, and in most cases, is alleviated with non-steroidal anti-inflammatory drugs (NSAIDs). It usually presents in the first three decades of life, and is predominant in men. Osteoid osteoma usually affects long bones, and rarely occurs in the jaws. When it does, it is mostly localized in the mandible. Differential diagnosis of OO includes fibroosseous lesions, tumors of osseous origin, and odontogenic tumors. Because of overlapping and superimposition of anatomical structures on conventional radiographs, it is difficult to visualize the architecture of this type of lesion using radiography. Cone beam computerized tomography allows observing the different planes of the lesion, without superimposed structures, and should therefore be the method of choice to analyze jaw lesions suspicious for OO. We herein present a case of OO in the maxilla, which brings the total number of reported cases to six.

Keywords: Osteoid osteoma; Jaws; Pain

Introduction

Osteoid osteoma (OO) is a benign osteogenic tumor, which is usually less than 2cm in size. It is associated with nocturnal pain, and in most cases, is alleviated with non-steroidal anti-inflammatory drugs (NSAIDs). It usually presents in the first three decades of life, and is predominant in men [1,2]. Osteoid osteoma accounts for 12% of benign skeletal bone tumors [3], and usually affects lower limb long bones, like the femur (40%), tibia and fibula. Location in the humerus and vertebrae is also frequent [3,4]. Less than 1% of OOs affect the jaws. In these cases, the lingual aspect and lower border of the mandible are usually affected [5]. Osteoid osteoma can present a diagnostic challenge since it has the same clinical, radiographic, and histologic features as other lesions, such as osteoblastoma, cementoblastoma, osteosarcoma, and fibro-osseous lesions [6,7].

Imaging studies are critical to the diagnosis of this pathology. Radiographically, the tumor presents a rounded or oval radiolucent area, the “nidus”, surrounded by a radiopaque rim corresponding to a peripheral sclerotic reaction zone. The “nidus” may also be surrounded by a radiolucent halo [3,8,9].

The first description of osteoid osteoma was made by Berg strand in 1930. The author reported two cases: one in the metatarsal and the other case in the phalanx of a finger. Clinically, both were thought to be osteogenic sarcoma; the metatarsal was resected and the finger was amputated. The detailed clinical features and photomicrograph left no doubt about the identity of the lesions, which were interpreted as rare benign osteoblastic lesions, and were attributed to embryonic rests [10].

Although osteoid osteoma had been reported as “chronic bone abscess”, “non suppurative sklerosing osteomyelitis”, and “osteomyelitis with annular sequestrum”, Jaffe is due the credit for establishing it as a distinct entity in 1935. In his original report, Jaffe studied five cases of OO and evaluated all their clinical and histopathological features. The author identified certain features that were common to all the cases of OO he included in his study: 1) all patients were adolescents or young adults; 2) the presenting complaint was pain, which increased during the night; 3) radiographically, all lesions were rounded and well delimited; 4) the lesions were small and similar in size; 5) surgical excision was performed in all cases on the assumption that the lesion was inflammatory – osteomyelitis or abscesses – although there was no evidence of infection in any of the cases; 6) excision of the lesion resulted in disappearance of all symptoms without recurrence of the local condition [11].

In 1945, Jaffe reported 62 proven and treated cases, and confirmed most of the features of the tumor he had reported in his first publication on 5 cases in 1935. In 1966, Eideken identified three types of osteoid osteoma, the cortical, medullary, and subperiosteal type, depending on the radiographic location of the nidus, and found the cortical type to be the most common [13].

Osteoid osteoma of the maxillofacial region is very rare. It was first described by Rushton et al. in 1951; the authors reported a 27-year-old male patient presenting a 6mm lesion on the mandibular alveolar ridge associated with the lower first molar [14]. Since that first report, only 29 cases of OO in the jaws (Table 1) have been reported, 83% of which were located in the mandible and 17% in the maxilla. Unlike OO in the remaining skeletal areas, no sex predilection was observed in the reported cases of OO in the jaws. Two of 29 cases were multifocal [15,16].

Table 1: Review of the literature of case reports of osteoid osteoma in the maxillofacial region.




  
    Case 
    Author/Year 
    Age 
    Sex 
    Location 
    Size 
    Symptoms 
  
  
    1
    Rushton (1951) [14]
    27
    M
    Mandible
    6mm
    Pain
  
  
    2
    Foss (1955) [29]
    26
    F
    Mandible
    5mm
    Pain
  
  
    3
    Nelson (1955)[18]
    17
    M
    Mandible
    25mm
    Pain
  
  
    4
    Stoopack (1958) [19]
    25
    M
    Mandible
    -
    No
  
  
    5
    Lind (1964)
    48
    M
    Mandibular condyle
    3mm
    Pain
  
  
    6
    Hillman (1965) [20]
    4
    F
    Maxilla
    -
    No
  
  
    7
    Borello (1967) [30]
    21
    M
    Maxilla
    30x20 mm
    No
  
  
    8 
    Greene (1968) [31]
    45
    F
    Maxilla
    10mm
    Pain
  
  
    9
    Brynolf (1969) [32]
    77
    M
    Maxilla
    4mm
    No
  
  
    10
    Gupta (1985) [33]
    18
    F
    Mandible
    30mm
    Pain
  
  
    11
    Zulian (1987) [34]
    17
    F
    Mandible
    10mm
    Pain
  
  
    12
    Tochihara (2001) [35]
    21
    F
    Mandibular condyle
    8mm
    Pain
  
  
    13
    Liu (2002) [36]
    18
    M
    Mandible
    12mm
    Pain
  
  
    14
    Ida (2002) [37]
    26
    F
    Mandible
    5x10 mm
    Pain
  
  
    15
    Badauy (2007) [38]
    26
    M
    Mandible
    8mm
    Pain
  
  
    16
    do Egito Vasconcelos (2007) [39]
    23
    F
    Mandibular condyle
    8x11 mm
    Pain
  
  
    17
    Rahsepar (2009) [40]
    21
    M
    Mandible
    6x8 mm
    Pain
  
  
    18
    Manjunatha (2009) [41]
    18
    F
    Mandible
    10mm
    Pain
  
  
    19
    Walia (2010) [42]
    18
    M
    Mandible
    10x20 mm
    Pain
  
  
    20
    Karandikar (2011) [21]
    14
    M
    Mandible
    35mm
    No
  
  
    21
    Singh (2012) [8]
    20
    M
    Mandible
    35mm
    Pain
  
  
    22
    Mohammed (2013) [7]
    20
    -
    Mandible
    30mm
    Pain
  
  
    23
    An (2013) [15]
    10
    M
    Mandible
    7x20 mm
    No
  
  
    24
    Adouly (2015) [16]
    11
    F
    Bilateral mandible
    6mm - 25mm
    Pain
  
  
    25
    Khaitan (2016) [5]
    40
    M
    Maxilla // Upper jaw
    10x20 mm
    Pain
  
  
    26
    Maccotta (2016) [9]
    20
    M
    Mandible
    10mm
    Pain
  
  
    27
    Martin (2016) [6]
    14
    M
    Mandible
    17mm
    No
  
  
    28
    Raja Devathambi (2016) [43]
    13
    F
    Mandible
    10mm
    Pain
  
  
    29
    Infante-Cossio (2017) [44]
    44
    F
    Mandible
    10mm
    Pain
  
  
    30
    Our case (2017)
    21
    M
    Maxilla
    4mm
    Pain



Table 1: Review of the literature of case reports of osteoid osteoma in the maxillofacial region.

When OO is located in the jaws, it is necessary to establish differential diagnosis from fibro-osseous lesions, bone tumors, and odontogenic tumors. The main differential diagnosis is from osteoblastoma. Although they are very similar lesions, osteoblastoma is usually larger9. Treatment of choice for OO in the jaws is enucleation, since it eliminates the pain. Recurrence is infrequent, and is usually due to incomplete excision of the tumor [1,9].

Osteoid Osteoma of the Maxilla: Literature Review and Case Report

Abstract

Introduction

Case Presentation

Discussion

References