OSTEOBLASTOMA VS OSTEOID OSTEOMA: 2 CASE REPORTS

Abstract

<h3>Clinical Presentation</h3> Case 1: A 17-year-old male presented 3 months –after third molar extraction with progressively worsening pain in the lower left extraction site. Clinical examination was unremarkable. Computed tomography (CT) showed a 12 × 10 × 11 mm, well-demarcated, circular, nonexpansile, mixed-density lesion with a sclerotic border and surrounded by a radiolucent rim. Lingual cortical bone defect was noted. Case 2: A 37-year-old male presented with progressively worsening pain in the left posterior mandible and preauricular area. CT showed a 16 × 21 mm well-defined, expansile, mixed-density lesion with a soft tissue capsule, which was surrounded by a sclerotic band. Unusual features included buccal/lingual expansion, new bone apposition, and soft tissue edema in the masseter muscle. Clinically, the site was significant for swelling. <h3>Differential Diagnosis</h3> Given the radiographic findings and the presence of pain, osteoblastoma and osteoid osteoma were considered in the differential diagnoses in both cases. Case 1 included cementoblastoma and foreign body reaction. In case 2, osteosarcoma was considered because of the apparent expansion. Because of the lesion size, osteoid osteoma was considered unlikely. <h3>Diagnosis and Management</h3> Both patients were initially managed pain with nonsteroidal anti-inflammatory drugs (NSAIDs), but the symptoms continued to worsen. Case 1 was treated with enucleation, curettage, and extraction of tooth #18. Case 2 was treated with excisional biopsy and extraction of tooth #17. Histologic reports rendered a final diagnosis of osteoblastoma in both cases. <h3>Discussion</h3> Osteoblastoma is rare, especially in the maxillofacial region. We present 2 unusual and distinct cases of osteoblastoma. In case 1, there was large cortical perforation with no expansion, whereas in case 2, the lesion was expansile with no perforation. To the best of our knowledge, soft tissue edema and new bone apposition, as seen in case 2, have not been reported previously.