Osteomas typically occur in the craniofacial structures, with the paranasal sinuses, mandible, or the calvarium (skull vault) being the most commonly affected.

Osteomas are generally asymptomatic except in some cases where they are located near structures that cause signs or symptoms when compressed by the tumor. Osteomas in the paranasal sinuses may cause facial asymmetry, mucocele formation, or sinusitis [2] [3] [10] [11]. Osteomas arising from the orbital bones may lead to visual problems such as diplopia or amaurosis fugax and anatomic abnormalities including ptosis, lid edema, proptosis, or exophthalmos [2] [12]. However, neurologic deficits may arise if the tumor extends intracranially to affect the brain or cranial nerves [13].

Osteomas are usually detected incidentally during imaging studies conducted for other reasons such as trauma [14]. When osteomas produce symptoms, they can cause swelling, pain at the area of the tumor, deformities, or even pathologic fractures.

The typical appearance of osteomas is a round or oval, well-circumscribed, white or tan tumor covered by a thin layer of fibrous periosteum. Osteomas are attached to the underlying bone by either a broad base or a narrow stalk. Osteomas may also be associated with other conditions such as Gardner syndrome, especially when multiple tumors are present.

• Pain

  The classic presentation is that of focal bone pain at the site of the tumor. The pain worsens at night and increases with activity; it is dramatically relieved with small doses of aspirin. [emedicine.com]

  You are likely to have pain and require pain medication on the day of the procedure, but the pain should recede in the following 72 hours, and most patients are free of pain after one week. [columbiaradiology.org]

  Abstract Osteoid osteoma, a rare benign osteoblastic tumor first described by Jaffe in 1935, is characterized as a small but painful lesion that mostly affects younger people. [ncbi.nlm.nih.gov]

  Unlike growing pains, physical activity has no effect on the pain of osteoid osteomas. To find the cause of the pain, your healthcare provider will ask about the nature and severity of the pain. [cedars-sinai.org]

• Asymptomatic

  It is often slow growing and asymptomatic, diagnosed incidentally on radiographs. It can cause deformation of the bone and compression of the adjacent structures such as nerve compression. [ncbi.nlm.nih.gov]

• Swelling

  The swelling resolved over hours to days. A CT scan of the sinuses revealed an osteoma originating from the right ethmoid roof involving the frontal recess and projecting into the orbit. [ncbi.nlm.nih.gov]

  The size of the swelling was 25 × 15 × 10 mm. There was a history of blunt trauma to the left upper lid, and 3 months before she noticed this swelling. There was no history of vision changes, ocular pain, pain with eye movement, or headaches. [touchophthalmology.com]

• Surgical Procedure

  Medical Q&As What is the surgical procedure for the removal of an osteoid osteoma of the hip? Osteoid osteoma is a benign lesion of bone with no malignant potential. This type of tumour accounts for approximately 10% of benign bone tumours. [irishhealth.com]

  A general anesthesia surgical procedure was performed, in a retroauricular approach; mastoid tip was exposed as for simple mastoidectomy. [scitechnol.com]

  Lower eyelid surgery My experience with Dr Harirchian has been fantastic, both in the office and during/after my surgical procedure. She is knowledgeable, caring, warm and confident. I appreciate her personal touch (calling, accessibility). [shfacialplastics.com]

  In the treatment of OO of the CP, we recommend open surgical procedure with tumor ablation by drilling instead of CP resection, presenting a safe, simple and low-cost method that simultaneously completely destroys the lesion and preserves the anatomical [hrcak.srce.hr]

  Surgical treatment For children with pain that cannot be relieved by over-the-counter medications, a procedure may be needed. The gold standard for treating osteoid osteoma is CT-guided radiofrequency ablation (RFA). [chop.edu]

• Fatigue

  We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: January 31, 2019 [patientslikeme.com]

  The most frequent clinical symptoms associated Tumor-induced osteomalacia are muscular cramping, generalized weakness, chronic fatigue, bone pain, severe bone demineralization with increased risk of fractures. [gii.co.jp]

• Abdominal Pain

  Radioisotope scan of the thoracic spine in a 56-year-old woman with giant osteoid osteoma who presented with abdominal pain shows increased uptake in the T11 vertebral body. [emedicine.com]

• Macula

  It typically appears as an orange-yellow to yellow-white lesion in juxtapapillary region which can extend over to involve macula. Lesion solely located in macular region is less common. [ncbi.nlm.nih.gov]

  It is commonly juxtapapillary or peripapillary, but may extend to the macula. It is rare that it would be found only in the macula. It is yellow-white to orange-red in color with clumping of brown, orange, or gray pigment. [eyewiki.aao.org]

  Symptoms In general, it grows very slowly and far from the macula (the central part of the retina) which is why symptoms only occur at the later stages. [barraquer.com]

  If in the center of the macula, the blood and neovascularization can cause distortion or loss of vision. Diagnosis A choroidal osteoma is characterized by bone in the choroidal vascular layer of the eye. [eyecancer.com]

• Visual Acuity Decreased

  A 25-year-old female presented to our hospital with chief complaint of sudden unilateral visual acuity decrease for one week, with metamorphopsia in the left eye. Her best corrected visual acuity was 0.12 in the left eye. [ncbi.nlm.nih.gov]

• Prolapse

  During removal of anterior lesions the temporo-mandibular joint can be violated resulting in temporo-mandibular joint prolapse and sub-cutaneous emphysema secondary to air entry into the joint through a bony defect. [ispub.com]

• Visual Impairment

  Rarely, intracranial and orbital extension is present, leading to rhinoliquorrhea, pneumocephalus, or neurologic and visual impairment, which might be potentially life-threatening. [ncbi.nlm.nih.gov]

• Hip Pain

  Radionuclide bone scan of the hip in an 8-year-old child who presented with left hip pain and restriction of movement shows avid uptake in the left femoral neck, which is consistent with osteoid osteoma. [emedicine.com]

  […] benign tumors 3% of benign tumors Size < 2 cm (typically >2 cm (average, 3.5 - 4.0 cm) Site > 50 % in long bone diaphysis > 35% in posterior elements of the spine Location Proximal femur > tibia diaphysis > spine vetebral column > proximal humerus > hip [orthobullets.com]

  Rare Never-symptoms Symptoms that never occur with osteoid osteoma: Hip pain Bilateral leg swelling Weakness in both arms Weakness of both legs Osteoid Osteoma Symptoms The main symptom of osteoid osteoma is the associated bone pain. [buoyhealth.com]

• Bone Disorder

  The book details the pathologic and radiologic characteristics of all bone and joint diseases, including arthritis, metastatic bone disease, osteoporosis, trauma, osteomyelitis, developmental bone disorders, and tumor-like lesions. [books.google.com]

• Spine Pain

  Symptoms Nocturnal pain, relieved by NSAIDS Dull ache, not relieved by NSAIDS. >50% of spine tumors have neurologic symptoms. Management of Spine Lesions Nonsurgical management is indicated as first-line treatment. [orthobullets.com]

• Suggestibility

  To the best of our knowledge this is the first case report in which there is a definitive history of trauma preceding the development of osteoma suggesting its possible role as an inciting factor. [ncbi.nlm.nih.gov]

  The peculiarity of this observation lies in the rarity of this localization and the deceptive clinical picture suggesting a shoulder pathology in first intention. [panafrican-med-journal.com]

  The possibility of a reactive mechanism, triggered by trauma or infection, has also been suggested. Very rarely osteomas of the facial bones may be associated with Gardner's syndrome. [atlasgeneticsoncology.org]

  On ultrasonography, the lesion demonstrated a hyperechoic signal with posterior shadowing suggestive of calcification. [retinatoday.com]

  Note the absence of periosteal reaction that suggests intramedullary or cancellous osteoid osteoma. Radiograph of the hip in an 8-year-old child who presented with left hip pain and restriction of movement. [emedicine.com]

• Irritability

  But they can cause problems such as stomach irritation, ulcers, bleeding, high blood pressure, rash, and ankle swelling. They can sometimes also cause kidney or heart problems. [cedars-sinai.org]

  The latter can be due to the irritation of the greater auricular or small occipital nerves [10]. Figure 4. Osteoma on elevation of the periosteum. Figure 5. Chisel being used to separate the osteoma from its base. Figure 6. [file.scirp.org]

• Neuralgia

  Upper airway obstruction, painful throat, unilateral tinnitus, trismus, dysarthria, glossopharyngeal neuralgia, and cranial nerve palsies are other reported symptoms. [ncbi.nlm.nih.gov]

The most useful diagnostic tests for osteomas are imaging studies, with the plain radiograph being the most cost-effective. Ivory osteomas have a characteristic radiodense appearance in radiographs, whereas mature osteomas demonstrate a radiodense margin with a central hypodense marrow. Pathologic fractures caused by osteomas are readily detected through radiographs as well. The suspicion of malignancy in some lesions that are not clearly benign on X-ray examination may require advanced imaging techniques such as CT scans, magnetic resonance imaging (MRI), or scintigraphy.

Osteoid osteomas have a slightly different appearance from osteomas, having an intracortical nidus with varying degrees of calcification accompanied by bone marrow edema, cortical thickening, or sclerosis. However, these findings may be seen in other conditions such as arthritis, infections, or other tumors.

Osteomas generally do not require excision since they are benign and have very low potential for malignant transformation. However, tumors that cause significant complications due to mass effect, such as cosmetic or neurologic abnormalities, may require treatment. Excision of the tumor can be achieved through radiofrequency ablation or surgery. However, surgical removal is preferred over radiofrequency ablation if the tumor lies near the skin, nerves, or blood vessels since the heat produced by radio waves may damage these structures.

Osteoid osteomas generally cause night pain and can be treated by salicylates. Asymptomatic lesions do not require aggressive treatment and may be observed using regular X-ray examinations every 6 months. Recent evidence suggests that the use of NSAIDs may cause spontaneous resolution in certain groups of patients within 2-3 years [15].

Osteomas are benign tumors with no malignant transformation potential. Excision is not necessary except in some cases when they cause significant cosmetic damage, mass effect (i.e. impingement of a blood vessel or nerve), or complications such as mucocele formation. Recurrence of osteomas rarely occurs, even in tumors that are not completely excised.

The pathologic mechanism behind osteomas is poorly understood. Some theories regarding their etiology include a pathologic reaction against trauma or infection, a relationship to osteoblastoma, or a developmental anomaly. Other theories suggest that osteomas may also be a type of inflammatory reaction. Osteomas in the facial bones may be associated with Gardner syndrome.

Osteomas commonly occur between the fourth and fifth decades of life [3] [4] but may affect all age groups with a slight male predilection. Osteomas of the paranasal sinuses are diagnosed incidentally and may appear in approximately 3% of computed tomography (CT) scans of the sinuses [5]. Osteoid osteomas, on the other hand, are more prevalent in younger males between the ages of 10 to 35 and represent approximately 10% of all benign bone lesions [2].

Choroidal osteomas and osteoma cutis, in contrast, are more common in females. Multiple military osteoma cutis, characterized by numerous small osteomas affecting the face, is typically seen in middle-aged Caucasian women [6], whereas choroidal osteomas are associated with young white women [7]. However, osteoma cutis may affect patients of all ages.

Osteomas may have variable composition and are classified according to the type of bone present in the tumor. Ivory osteomas, also known as eburnated osteomas, are the most common type [8] and are composed mainly of dense, compact bone without trabecular bone, Haversian canals, or fibrous components. Mature osteomas, on the other hand, are composed of dense and trabecular bone much like normal bone. They are also called osteoma spongiosum or trabecular osteomas due to the presence of spongy bone and marrow tissue in some cases. Mixed osteomas, as their name implies, comprise features of both ivory and mature osteomas.

The histological patterns of osteomas also vary according to where they are located. The fibrovascular component of osteomas arising from bone sutures is significantly reduced compared to osteomas arising from different areas [9].

There are no preventive measures against osteomas. However, they are slow-growing, benign tumors that do not have the potential to metastasize or become malignant. Most osteomas can be left untreated and do not cause symptoms or complications.

Osteomas are bone-forming (osteogenic) tumors whose growth is almost limited to membranous bones, especially the skull and craniofacial structures. However, they can also arise from other areas of the body such as the skin or soft tissues. Based on their origin, osteomas are classified as homoplastic if they arise from bone and heteroplastic if they arise from soft tissues.

Osteomas commonly grow from the paranasal sinuses and are usually diagnosed incidentally during routine imaging procedures. Another form of osteoma known as choroidal osteoma may occur in the choroid layer of the eyeball. Children and adolescents are more prone to develop osteoid osteomas, which are tumors arising from bones of the skull. These types of osteomas usually cause night pain that can be relieved with salicylates.

An example of heteroplastic osteoma is osteoma cutis, which is the presence of bone tissue in the skin that is not due to mechanisms that cause cutaneous ossification such as trauma, neoplasms, or inflammation [1].

Osteomas are benign and do not have the potential to become malignant. They can be left untreated unless they cause significant symptoms or disability, such as obstruction of the paranasal sinuses or compression of the structures of the central nervous system.

Osteomas are benign tumors arising from membranous or flat bones such as the skull and the bones inside the nasal cavity. They can also grow from soft tissues such as the skin and a layer of the eyeball known as the choroid (choroidal osteoma). Osteomas are slow-growing, non-malignant tumors that generally do not cause symptoms and are usually detected only during X-rays or scans performed for different reasons.

Osteomas generally affect people in theirs 30's or 40's, especially males. However, another form of osteoma called osteoid osteoma commonly affects younger males. Osteomas arising from the skin (osteoma cutis) can affect individual of all ages. A form of osteoma producing numerous small osteomas on the skin of the face (multiple miliary osteoma cutis) affects middle-aged Caucasian women.

Osteomas can be left untreated unless they cause significant deformities or complications such as compression of an adjacent anatomical structure, for which they can be removed by surgery or a special procedure called radiofrequency ablation. Osteomas are not cancerous and will not spread to other parts of the body. Surgical removal of the tumor is often enough to relieve the pain caused by the tumor. However, analgesics or NSAIDs can be taken by patients who do not prefer to undergo surgery.

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