Bony Exostoses Research Articles

Surgical treatment of torticollis secondary to the presence of a congenital paracondylar process: illustrative case.

A paracondylar process is an abnormal bony exostosis arising from the skull base lateral to the occipital condyle and extending inferiorly toward the transverse process of the atlas. Paracondylar processes are typically identified incidentally and vary in size from a small protuberance to an elongated process. The authors present the first pediatric case of torticollis secondary to a congenital paracondylar process successfully treated with resection of the paracondylar process and sternocleidomastoid release. Cadaveric dissection, three-dimensional models, intraoperative imaging guidance, and multidisciplinary collaboration were paramount to a successful surgical outcome. https://thejns.org/doi/10.3171/CASE2447.

Pre-prosthetic atraumatic laser-assisted mandibular rehabilitation: Er,Cr:YSGG 2780 nm for alveoloplasty and mucocele removal. A case report

Lasers are a popular technology in many areas of dentistry due to their low invasiveness, quick tissue response, and rapid healing time. Mucoceles develop from minor salivary glands, whereas bony exostosis is a prosthodontic challenge that prevents optimal prosthetic management. Scarring, pain, and discomfort are common drawbacks of traditional surgical approaches, which are followed by prolonged postoperative healing. Laser-assisted mandibular rehabilitation is a promising approach with predictable results. The patient complained of severe pain during denture fabrication, as well as a small, painless swelling on the inner aspect of the lower lip. The patient was able to receive the planned complete dentures after undergoing atraumatic laser-assisted removal of mucocele and bone exostosis with an Er,Cr:YSGG (Erbium, chromium-doped, yttrium, scandium, gallium, and garnet) laser treatment at 2780 nm. Both procedures were completed quickly, and there were no postoperative complications to report. Blanching overlying both lesions quickly faded after healing and was replaced by a healthy pink mucosal color; both lesions were monitored until complete healing. The Er,Cr:YSGG effectively ablated and removed both soft and hard tissue lesions with minimal bleeding and pain.

Pre-prosthetic atraumatic laser-assisted mandibular rehabilitation: Er,Cr:YSGG 2780 nm for alveoloplasty and mucocele removal. A case report

Lasers are a popular technology in many areas of dentistry due to their low invasiveness, quick tissue response, and rapid healing time. Mucoceles develop from minor salivary glands, whereas bony exostosis is a prosthodontic challenge that prevents optimal prosthetic management. Scarring, pain, and discomfort are common drawbacks of traditional surgical approaches, which are followed by prolonged postoperative healing. Laser-assisted mandibular rehabilitation is a promising approach with predictable results. The patient complained of severe pain during denture fabrication, as well as a small, painless swelling on the inner aspect of the lower lip. The patient was able to receive the planned complete dentures after undergoing atraumatic laser-assisted removal of mucocele and bone exostosis with an Er,Cr:YSGG (Erbium, chromium-doped, yttrium, scandium, gallium, and garnet) laser treatment at 2780 nm. Both procedures were completed quickly, and there were no postoperative complications to report. Blanching overlying both lesions quickly faded after healing and was replaced by a healthy pink mucosal color; both lesions were monitored until complete healing. The Er,Cr:YSGG effectively ablated and removed both soft and hard tissue lesions with minimal bleeding and pain.

TEMPOROMANDIBULAR DISORDERS CORRELATION TO PARAFUNCTIONAL ACTIVITIES AND ORAL TORI AND BONY EXOSTOSES

Objective: To investigate existence of oral tori and bony exostoses and their correlation/effect to temporomandibular disorders and parafunctional habits. Materials and Methods: A cross sectional descriptive and analytical study was carried out among 100 patients who attended polyclinic KOD, IIUM. Demographic background, status of oral tori, parafunctional activities (PFA) and temporomandibular disorder (TMD) were assessed. A cross analysis was done between gender, age group, oral tori, bony exostoses, temporomandibular disorder and parafunctional activities.Results: In this study, half of the patients had oral tori and bony exostoses; it was significantly seen among the female patients within 21 and 50 year old age group. In a cross analysis between PFA and TMD and oral tori and bony exostoses status, 42% of the sample who did not have both PFA and TMD also did not have both tori and bony exostoses. 4% of the sample had both PFA and TMD but absent of both oral tori and bony exostoses. Although, PFA and TMD were considered as two groups (absent or present), there was a significant association (p<0.05) between PFA and TMD and the existence of oral tori and bony exotoses, not significant (p>0.05) when PFA and TMD as in 4 groups (both absent, only PFA, only TMD and both present). Conclusion: The study showed there is still argument on association between PFA and TMD and the existence of oral tori and bony exostoses. It may be due to both of them are not from the same aetiology and/or small sample size. Further study should be conducted with proper study design with adequate sample size

An Atypical Midline Anterior Torus Mandibularis: A Case Report

Benign bony growths called tori can develop in various places throughout the mandible and maxilla, although their exact origin is still unknown. There have been numerous reports of unilateral or bilateral Mandibular Tori (MT); however, no reports of a midline anterior mandibular tori have been made yet. A 27-year-old female patient reported with a complaint of a bony growth on her lower jaw below the tongue. The tori are unusually situated at the midline on the lingual side of the mandibular central incisor. The elements shown to be causal were the gender of the male, the ethnicity of Asians, and developmental in origin. The cornerstone of treatment for Tori is surgical resection. After a year of follow-up, there was no recurrence. The present case highlighted the significance of etiological factors for bony exostosis management and recurrence, which, in conjunction with origin, gender, ethnic and racial factors, may account for the patient’s lack of recurrence.

Relationship between bruxism and mandibular bone modifications based on medical imaging: a scoping review

ObjectivesThis scoping review aimed to assess the current state of knowledge regarding the relationship between bruxism and changes in density or volume of mandibular bone, based on medical imaging.MethodsLiterature review was conducted following the PRISMA-ScR protocol. PubMed, Web of Science and Cochrane library databases were searched for peer-reviewed articles by two blinded reviewers. Studies based on the evaluation of mandibular bone density and/or bone volume with imaging examination in adult patients were examined. The selected articles were summarized in PICOS tables and assessed for methodological quality.ResultsNine articles were included, according to the inclusion criteria. They showed that bruxer patients had more bony exostoses of the mandibular angle, smaller condyles, and morphological changes for cancellous and cortical mandibular bone compared to non-bruxer patients.ConclusionBruxism seems to induce morphological and anatomical changes in the different regions of the mandibular bone (condyles, mandibular angle, mandible body). Given the heterogeneity of the included studies, these results should be interpreted with caution. Further studies are needed to support these results, in particular via the analysis of three-dimensional imaging to overcome the limitations of panoramic radiograph.

An atypical large unilateral torus mandibularis: Case report and review of literature

Benign bony exostosis can be present in the maxilla or mandible. They are non-odontogenic sclerotic lesions which present as bony outgrowths on the jaws. On the lingual aspect of the mandible, these benign bony exostoses resemble peripheral osteomas and when present adjacent to bicuspids they are known as torus mandibularis (TM). Usually these TM are small, bilateral and asymptomatic. This article presents an atypical case of large nodule of unilateral TM associated with discomfort in a 46-year-old male patient with partially edentulous jaws. The bony outgrowth was surgically removed and follow up period of 6 months was uneventful. Review of the literature was undertaken for various etiological factors, clinical features and management of torus mandibularis.

Evaluation of mandibular bone density in bruxers: the value of panoramic radiographs.

This study aimed to establish a difference in mandibular bone density between bruxer and non-bruxer patients, based on panoramic radiographs. Panoramic radiographs of bruxer and non-bruxer patients were analyzed with ImageJ®. Several radiological determinants were studied on the patients' panoramic radiographs: gray values of cancellous bone and cortical bone, and bony exostoses at the mandibular angle. Thirty-seven bruxers and forty-seven non-bruxers were included in the study. A statistically significant difference (p < 0.05) was noted in the cancellous to cortical bone ratios of bruxers and non-bruxers: the density of cancellous bone was greater in bruxers than in non-bruxers. The number of bony exostoses at the mandibular angle was significantly higher in bruxers (p < 0.05). This study obtained radiological determinants of bruxism from panoramic radiographs. Further studies are needed to supplement this preliminary approach, especially via the analysis of three-dimensional imaging to overcome the limitations of panoramic radiography.

Satisfactory Functional Outcome and Significant Correlation with the Length of Haglund's Deformity after Endoscopic Calcaneoplasty: A Minimum 4-Year Follow-Up Study.

Background Haglund's syndrome is a posterosuperior calcaneal prominence with posterior heel pain causing functional disability to the patient. Operative treatment is indicated after failure of conservative measures and includes resection of the bony hump along with retrocalcaneal bursectomy. This study aimed to evaluate the functional outcome and degree of patient satisfaction after endoscopic resection of Haglund's deformity with assessment of correlation with the length of bony exostosis. Methods Seventeen patients (21 feet) with a mean age of 44.7 ± 5.1 years were included in this study. Six females and 11 males underwent endoscopic calcaneoplasty. Clinical outcome evaluation included the assessment of the visual analog scale (VAS) and the American Orthopedic Foot and Ankle Society score (AOFAS). The preoperative and postoperative lengths of bony exostosis were measured radiologically. The paired t test and the Wilcoxon signed-rank test compared the preoperative and final postoperative means. P < 0.05 was considered statistically significant. Results The mean follow-up period was 56.4 ± 5.1 months. Statistically significant improvements in the preoperative mean of AOFAS (from 55.7 ± 9.3 to 94.3 ± 7.1) and VAS (from 8.1 ± 1.4 to 0.7 ± 1.04) at the final follow-up were noted (P < 0.0001). There was a statistically significant correlation between clinical scores (AOFAS and VAS) and the final postoperative length of the bone above parallel pitch lines (PPLs). The patients were satisfied and returned to their previous activities without reporting major morbidities except one patient who had mild pain with exertion. Conclusion Endoscopic calcaneoplasty is a safe, less invasive surgical procedure for the management of Haglund's syndrome after failure of conservative treatment. It provided a satisfactory clinical result without serious complications at a minimum 4-year follow-up.

Haglund’s Syndrome: A Case Report

Haglund’s syndrome is a poorly understood mechanical condition resulting from a conflict between a prominent posterosuperior tuberosity of the calcaneus and the shoe responsible for inflammation of the retrocalcaneal bursa, supracalcaneal bursa, and Achilles’ tendon. Clinical evaluation and lateral radiographs of the ankle are usually sufficient to establish the diagnosis. Haglund’s disease is often treated conservatively, surgical excision of bony exostoses of the calcaneus is necessary only in resistant cases.

Haglund’s Syndrome: A Case Report

Haglund’s syndrome is a poorly understood mechanical condition resulting from a conflict between a prominent posterosuperior tuberosity of the calcaneus and the shoe responsible for inflammation of the retrocalcaneal bursa, supracalcaneal bursa, and Achilles’ tendon. Clinical evaluation and lateral radiographs of the ankle are usually sufficient to establish the diagnosis. Haglund’s disease is often treated conservatively, surgical excision of bony exostoses of the calcaneus is necessary only in resistant cases.

Root coverage of a maxillary lateral incisor with gingival recession, gingival stillman\u2019s cleft, bony exostosis, and denture stomatitis: a case report with 3-year follow-up

BackgroundCoronally advanced flap combined with connective tissue graft is considered as the golden standard of root coverage. Although Miller class I recession is considered to get complete root coverage, there are some uncommon conditions in different cases. This case reported a maxillary lateral incisor with a gingival recession, a stillman’s cleft, a bony exostosis and a denture stomatitis.Case presentationA 27-year-old female with a gingival recession, a stillman’s cleft and a bony exostosis was treated by coronally advanced flap combined with connective tissue graft technique, and the complete coverage was achieved. Later a denture stomatitis occurred when an acrylic removable partial denture was used, however the gingival margin was not affected. The denture stomatitis disappeared when a new denture with casting palatal plane was produced. In this case of 3-year follow-up, the gingival contour remained stable and the outcome was satisfactory.ConclusionCoronally advanced flap combined with connective tissue graft technique is a classic manner to treat gingival recession especially for a long term stability, even when there is a gingival stillman’s cleft, a bony exostosis and a denture stomatitis.

HEREDITARY MULTIPLE EXOSTOSES PRESENTING WITH CHEST PAIN IN ADOLESCENT MALE

TOPIC: Pediatrics TYPE: Fellow Case Reports INTRODUCTION: Hereditary multiple exostoses (HME) is a syndrome characterized by presence of two or more osteochondromas (exostoses) in the appendicular or axial skeleton. Here, we present a case of an adolescent patient presenting with chest pain as the only symptom of an intrathoracic exostosis leading to the diagnosis of HME. CASE PRESENTATION: A previously healthy 15-year-old male presented to the pediatric pulmonary clinic for months-long history of recurrent left-sided chest pain, without any associated symptoms. Chest x-ray showed an ill-defined nodular opacity in the left upper lobe, with central calcification identified. Additional work-up with spirometry, complete blood count, fungal antibody panel, and Histoplasma urine antigen testing was normal. Family history was positive for pulmonary embolism and "blood clotting issues" with no specific syndromes identified. A chest computed tomography angiography (CTA) with contrast was ordered for further evaluation.Chest CTA revealed a large bony exostosis arising from the anterior aspect of the left third rib, with two areas of surrounding nodular soft tissue measuring 3 cm x 1.3 cm x 2.6 cm. There was extension into the lung abutting the pleura and lateral aspect of the mediastinum. Additional bony protuberances were noted along the left fifth rib, right second rib, and bilateral scapulae. A diagnosis of HME was made because of the presence of multiple exostoses. Due to continued chest pain he was referred to cardiothoracic surgery. The decision was made to monitor symptoms and obtain repeat imaging in six months to monitor growth or worsening lung impingement. DISCUSSION: HME is characterized by the presence of two or more exostoses in the appendicular or axial skeleton. The most common location of exostoses is in the appendicular skeleton. Though rare, involvement of the ribs can occur [1]. Previous case reports have identified presence of multiple costal exostoses in patients with known HME [1,2]. The patient presented here represents a case with chest pain as the only presenting complaint prior to diagnosis of HME being made. The presence of a costal exostosis should be considered in adolescents presenting with chest pain if other more common causes are ruled out. The presence of multiple exostoses supports the diagnosis of HME. Cases of HME with costal exostoses can be associated with intrathoracic complications, including hemothorax, pneumothorax, and pericardial effusion [3]. Supportive care and observation is the usual plan of care. However, if complications develop, surgical resection may be necessary and cardiothoracic surgery consultation is recommended. CONCLUSIONS: Chest pain may be the only presenting symptom in pediatric patients with HME. REFERENCE #1: Mazza D, Fabbri M, Calderaro C, Iorio C, Labianca L, Poggi C, Turturro F, Montanaro A, Ferretti A. Chest pain caused by multiple exostoses of the ribs: A case report and a review of literature. World J Orthop. 2017 May 18;8(5):436-440 REFERENCE #2: Khosla A, Parry RL. Costal osteochondroma causing pneumothorax in an adolescent: a case report and review of the literature. J Pediatr Surg. 2010 Nov;45(11):2250-3. REFERENCE #3: Yan G, Littlewood A, Latimer MD. Unusual cause of pleuritic chest pain in a child. BMJ Case Rep. 2016 Nov 28;2016:bcr2016217307. DISCLOSURES: No relevant relationships by Brooke Gustafson, source=Web Response No relevant relationships by Lisa Ulrich, source=Web Response

PREVALENCE OF TORUS PALATINUS IN ADULT HUMAN CRANIA OF EAST INDIAN ORIGIN

Torus Palatinus or Palatine torus is a benign bony exostosis that exists on the hard palate along the mid-palatal or interpalatine suture. Although smaller tori are clinically asymptomatic, bigger ones may require surgical intervention.This study is an attempt to analyze the incidence of palatine tori in East Indian population and to assess any signicant sexual variation between male and female crania. In the present study, 96 skulls (60 male and 36 female) from different medical colleges of West Bengal were examined at Department of Anatomy, N.R.S. Medical College, Kolkata, West Bengal between 2017-2019 to observe the presence of torus on the hard palate. While 8.33% of the total sample showed the presence of palatine torus; no statistically signicant sex difference was noted in its prevalence in male and female skulls. Male skulls were documented with a 10% prevalence rate while female skulls were found to have a 5.55% prevalence of Torus Palatinus. This data is not only useful in comparing skulls of various races but also bears importance in dentistry and facio-maxillary operative interventions.

Unconventional dentures – A literature review

Routine complications faced by the dentist include atrophic ridge, microstomia, flabby tissue, xerostomia, bony exostosis, labially inclined premaxilla, esthetic demand, bruxism, systemic disorders, patient’s demand for duplicating dentures, etc. Management of these difficulties can be done by proper incorporating of suitable materials and advanced techniques. This article describes the unconventional approaches to various modalities so as to provide ultimate satisfaction for the patient. Keywords: Unconventional dentures, Liquid supported dentures, Xerostomia.

Radiographic Description of a Bone Exostosis Lesion on the Caudal Aspect of the Proximal Tibia in Three Thoroughbred Yearlings (2014–2019)

This manuscript describes exostosis lesions originating from the caudal aspect of the proximal tibia identified in three Thoroughbred yearlings as part of the routine review of presale radiographic images. These lesions are hypothesized to be osteochondromas. The identification of bony exostoses on the proximal tibia has not been reported before in current literature. As they have not been described, the future effect on performance or soundness is unknown. Although these cases were not lame at the time of detection, the future growth of the lesion and its impact on surrounding soft tissues is unknown.

MON-363 Massive Bony Exostoses and Diffuse Osteosclerosis Secondary to Hepatitis C: Case Report

Introduction:Acquired osteosclerosis due to hepatitis C is a rare complication. While there are previously published case reports of this condition, to our knowledge this is the first case reported with diffusely increased osteosclerosis and prominent bony exostoses.Clinical Case:A 52-year old woman was evaluated in the Metabolic Bone Clinic for non-radiating left hip pain and visibly prominent hard, non-tender masses at the lateral aspect of her bilateral hips and proximal humerus. She denied history of fragility fractures, radiation exposure, risk factors for sexually transmitted diseases or substance abuse. Laboratory evaluation showed vitamin D deficiency with a value of 18 ng/mL (reference range: 25-100 ng/mL), elevated alkaline phosphate of 426 IU/L (reference range: 30-116 IU/L) and markedly increased serum C-telopeptide with a value of 1901 pg/mL (reference range: <1008 pg/mL). Plain radiographs showed multiple exostoses at the pelvis, hip, and shoulders. MRI showed extensive thoracic spine endplate sclerosis and increased sclerosis throughout the pelvis and proximal femurs. Massive calcifications adjacent to the greater trochanters were also identified. A total body bone scan revealed intensely increased uptake in multiple bones consistent with a “super scan.” Bone biopsy showed sclerotic bone with extensive remodeling. Computed tomography of the chest, abdomen, and pelvis was negative for malignancy. Given the symmetric nature of these lesions and diffusely increased uptake, the diagnosis of metabolic bone disease was considered. Further testing revealed hepatitis C Ab positivity confirmed with HCV Quant PCR 1553475 IU/mL (reference range: undetected). Pathologic findings were attributed to hepatitis C and treatment for hepatitis c was initiated with subsequent improvement in alkaline phosphate to 273 IU/L.Clinical Lessons:Osteosclerosis represents a little-known complication of hepatitis C. It is postulated that hepatitis C itself or other unknown agents may stimulate hepatic growth factors that increase osteoblast action. The radiographic and bone scan findings are classic for acquired osteosclerosis seen as increased cortical thickening with an intensely increased uptake in multiple bones. It frequently affects the lower extremity and this condition may take years to develop. Bone formation markers such as alkaline phosphate are typically elevated and bone biopsies show increased rates of remodeling as seen in our patient. While bisphosphonates may improve the serum markers for bone formation, they have not been shown to reverse or halt the progression of skeletal changes. Thus far, there has been a single case report showing improvement in sclerosis following treatment for hepatitis C with ribavirin and interferon. Natural history, progression and treatment of this condition have not been well established.

A Multi-Ethnic Study to Determine the Prevalence of Bony Exostoses Among Residents in Abuja, North Central Nigeria

A Multi-Ethnic Study to Determine the Prevalence of Bony Exostoses Among Residents in Abuja, North Central Nigeria

Prevalence and risk factors for corkscrew claw syndrome in dairy cattle

The objective of this study was to determine the prevalence and associated risk factors for an emerging hoof lesion in growing heifers and adult dairy cattle with no prior reports in the peer-reviewed literature. Corkscrew claw syndrome (CCS) is not the corkscrew claw that we used to see affecting the rear lateral claws of multiparous cows who were victims of poor housing and hoof care. Nor is it the mild corkscrew of the front medial claw that we commonly recognize. Rather, corkscrew claw syndrome is the combination of corkscrew deformities of the medial claws of both the rear and front feet in combination, and it occurs in heifers predominantly, rather than older cows. The condition can be so severe by the time that the heifer calves, the rear medial claw is the dominant weight bearing claw. The anatomical changes that result in this condition appear to be permanent and unrepairable. The pedal bones are irreversibly changed, developing bony exostoses and becoming narrower and rotated within the claw capsule. For that reason, affected herds will see this syndrome affecting all age groups, starting in growing age heifers and following through all the way to the oldest cows in the herd.

A Young Boy with Multiple Bony Overgrowths

Hereditary multiple exostoses is a rare autosomal dominant pediatric disorder with an incidence of about 1:50000 characterized by multiple cartilage-capped bony protuberances, called osteochondromas or exostoses, projecting from the metaphyses of long bones. It is caused by loss of function mutations in exostosin-1 and exostosin-2 genes that encode glycosyltransferase enzymes involved in the synthesis of heparan sulfate which has fundamental role in extracellular matrix formation during bone development. It commonly presents with compressive symptoms due to bony overgrowth involving all bones except calvarium and rarely transformed into malignancy. No definite treatment is available, but careful screening of these exostoses with timely referral to respective surgeon prevents long term complications and improves quality of life.&#x0D; J Enam Med Col 2019; 9(1): 60-63