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Exostosis

Bony Exostosis


Presentation

  • A 18-year-old man presented with a lump, ulceration, and pain on his right big toe. This complaint was present for the past 2 years. Initially, lump and pain were present, and since the past 6 months ulceration and superadded infection occurred.[ncbi.nlm.nih.gov]
  • Also, a therapeutic algorithm that describes surgical approaches to the different presentations of this disorder is presented.[ncbi.nlm.nih.gov]
  • CASE PRESENTATION: Twenty nine year old female of white British ethnic origin, presenting to a primary care clinic with a three year history of intermittent left distal medial thigh pain.[ncbi.nlm.nih.gov]
  • The case we present is the only one due to an exostosis, as well as the only one that required bilateral surgical repair. The patient presented when his pain became significant enough to interfere with his ability to continue competitive cycling.[ncbi.nlm.nih.gov]
  • OBJECTIVES: Present a case of SCC with subungual location in a toe, and carry out a review of the literature in relation to the most important aspects of subungual SCC in toes.[ncbi.nlm.nih.gov]
Camping
  • Author information 1 1st Marine Logistics Group, Camp Pendleton, California 92055, USA. thomasjgar@yahoo.com Abstract Subungual exostosis (SE) is a relatively uncommon benign tumor of the bone occurring in the distal phalanx of a digit.[ncbi.nlm.nih.gov]
Intermittent Claudication
  • Here, we report the case of a 35-year-old male patient complaining of intermittent claudication over the previous 4 months, without history of trauma or hereditary multiple exostoses. Clinical examination found no popliteal or distal pulses.[ncbi.nlm.nih.gov]
Dyspnea
  • We report the case of a 10-year-old boy, admitted for dyspnea and chest pain related to a hemothorax due to a right eighth rib exostosis. He was successfully treated by costal resection and chest tube drainage.[ncbi.nlm.nih.gov]
Severe Osteoporosis
  • The patient had history of severe osteoporosis with multiple fractures and was on teriparatide for 16 months. On examination, the right thumb was swollen and tender with no superficial erythema or signs of an infection.[ncbi.nlm.nih.gov]
Papule
  • An 18-year-old male presented with a protruding papule on the right great toenail. Diagnosis of subungual exostosis had been established and complete excision was performed.[ncbi.nlm.nih.gov]
Diplopia
  • We report a case of lateral rectus restriction secondary to a traumatic exostosis in the lateral orbital wall with resolution of diplopia after surgical removal of the lesion.[ncbi.nlm.nih.gov]
Neuralgia
  • Abstract We report a case of a 35-year-old woman affected by costal exostosis, originating from the posterior arc of the left fifth rib, who complained of a persistent intractable neuralgia in the left T5 dermatome.[ncbi.nlm.nih.gov]

Workup

  • Radiography of the digit is a noninvasive test that should be part of the initial workup whenever subungual exostosis is in the differential diagnosis.[ncbi.nlm.nih.gov]
Human Papillomavirus
  • In 50% of cases, aetiology is unknown or indeterminate; in 22.3% of cases, aetiology is metastatic; and in 19.5% of cases, it is associated with human papillomavirus (HPV).[ncbi.nlm.nih.gov]

Treatment

  • […] features of the lesion, surgical treatment methods, and duration of follow-up.[ncbi.nlm.nih.gov]
  • We also review the clinical presentation, pathogenesis, histologic and radiographic findings, diagnosis, and treatment of SE.[ncbi.nlm.nih.gov]
  • The curative treatment for a subungual exostosis is complete excision, and the cartilaginous cap must be totally resected to prevent a possible recurrence.[ncbi.nlm.nih.gov]
  • Successful treatment of patients with vascular complications secondary to osteochondromas has generally required early surgical intervention.[ncbi.nlm.nih.gov]

Prognosis

  • Cartilaginous Exostosis Prognosis This disease does not carry a deadly prognosis. However, the onset of cartilaginous exostosis can lead to serious health complications for the patient.[knowcancer.com]
  • The prognosis is good and depends on the degree of soft-tissue damage. 2018 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA)[merckvetmanual.com]
  • The prognosis is very good if surgically excised, and as with all growths or masses, a biopsy should be obtained to rule out a more serious condition.[lifootcare.com]
  • What patient characteristics are associated with better prognosis? What disease characteristics are associated with better prognosis? Methods : We searched the literature using three major databases with no publication date restrictions.[doi.org]
  • Prognosis The prognosis depends on the development of complications. Spontaneous resolution of osteochondromas during childhood and puberty is rare but has been described.[patient.info]

Etiology

  • Hereditary/surgery Gait Disorders, Neurologic/etiology Humans Magnetic Resonance Angiography Male Peroneal Neuropathies/diagnosis Peroneal Neuropathies/etiology* Popliteal Artery*/diagnostic imaging Popliteal Artery*/surgery Tomography, X-Ray Computed[ncbi.nlm.nih.gov]
  • Etiology is multifactorial and not well established. Tori and exostoses have been associated with parafunctional occlusal habits, temporomandibular joint (TMJ) disorders, migraine and consumption of fish.[ncbi.nlm.nih.gov]
  • The authors conclude that exostosis of the rib is a rare cause of hemothorax in children and should be considered among possible etiologies in diagnosis.[ncbi.nlm.nih.gov]
  • […] instrumentation Arthroplasty, Replacement, Hip/methods* Exostoses, Multiple Hereditary/complications Exostoses, Multiple Hereditary/diagnostic imaging Exostoses, Multiple Hereditary/surgery* Hip Joint/diagnostic imaging Humans Middle Aged Osteoarthritis, Hip/etiology[ncbi.nlm.nih.gov]
  • Case 1: Unknown etiology Case 2: Post traumatic Case 3: Congenital Click on each image for a larger picture Case 1. 14 year old boy with radial prominence and ulnar deviation of the middle finger proximal interphalangeal joint.[eatonhand.com]

Epidemiology

  • Clinical and retrospective epidemiological surveys have revealed a strong positive correlation between EAE development and habitual exposure to cold water.[ncbi.nlm.nih.gov]
  • Epidemiology Affects 2 per 100,000 population. [ 2 ] More frequently found in Caucasians than in other races. Risk factors Inheritance is autosomal dominant, with near-complete penetrance.[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiology is not clearly understood, but the lesion has base of trabecular bone with a proliferating fibrocartilaginous cap. Teriparatide can stimulate the trabecular bone formation.[ncbi.nlm.nih.gov]
  • Etiology and pathophysiology The pathogenesis of subungual exostosis is unknown, but current theories include trauma, infection, tumor, hereditary abnormality, or activation of a cartilaginous cyst.[clinicaladvisor.com]

Prevention

  • The curative treatment for a subungual exostosis is complete excision, and the cartilaginous cap must be totally resected to prevent a possible recurrence.[ncbi.nlm.nih.gov]
  • Space occupying lesions in the tendon bed, although uncommon, may prevent smooth tendon gliding. These include lipoma, anomalous muscle insertions, tumours of the tendon sheath and haemangiomas.[ncbi.nlm.nih.gov]
  • Many suggestions have been made regarding prevention, diagnosis, and treatment of these false aneurysms, although there are no official guidelines.[ncbi.nlm.nih.gov]
  • Surgical resection should be considered as a preventive measure when exostoses form sharp tips close to neurovascular structures regardless of total osteochondroma size.[ncbi.nlm.nih.gov]
  • Clinical and radiological features allow early diagnosis and treatment thus preventing the lesion to progress to the stage of onycholysis. LEVEL OF EVIDENCE: Therapeutic, Level IV.[ncbi.nlm.nih.gov]

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