882
OSTEOMA OF THE MAXILLARY
J Oral Maxillofac 49:892-993.
SINUS
Surg
1990
Osteoma of the Maxillary Sinus LCDR ANTHONY
P. VARBONCOEUR, DDS,* CAPT HARVARD J. VANBELOIS, AND CAPT LATHE L. BOWEN, DDS*
The osteoma is a benign proliferative bony lesion that may form peripherally in a periosteal location or in a central (endosteal) position. Osteoma of the maxillary sinus is an uncommon lesion1-4 and is most likely to occur in the frontal and ethmoid sinuses. Osteoma of the maxillary antrum was first described by Rawlins in 1938,5 and Fetisop suggested that an osteoma might be the result of persistent embryonic periosteum initiating the formation of new bone. Another theory holds that the maxillary antral osteoma represents reactive bone in an antral polyp. Osteomas of the maxillary sinus may be composed of either compact or cancellous bone. Most reported lesions have demonstrated attachment to the sinus wall by a pedicle. Radiographically, the lesion appears as a well-circumscribed radiopacity. Clinically, the osteoma is usually asymptomatic, but it can produce swelling and cause asymmetry which may decrease air flow when protruding into the sinus. The lesion is generally slow growing. Histologically, osteomas usually shows trabeculae of lamellar bone with a fibrofatty marrow. They have not been reported to recur after removal.
DDS,t
FIGURE 1. Panoramic radiograph taken in 1986 showing lesion associated with tooth no. 16.
A review of systems and physical examination revealed a well-developed black man in no acute distress. Laboratory values, consisting of complete blood cell count, urinalysis, prothrombin time, and partial thromboplastin time, were within normal limits. The patient was asymptomatic and had no facial swelling, sinus congestion, nasal discharge, or history of epistaxis, paresthesia, headache, or odontalgia. Due to the peculiar radiographic presentation and possible association with the impacted tooth, it was decided to surgically remove the lesion. A Caldwell-Luc procedure was performed to explore the left maxillary antrum. Through this approach, a 3 x 4 cm hard, pedunculated lesion was observed on the floor
Report of a Case A 33-year-old black man was referred for evaluation and treatment of a radiopaque lesion in the left maxillary sinus. The lesion was originally discovered on routine panoramic examination for evaluation of a symptomatic impacted third molar. The lesion had not been present on a panoramic radiograph taken 7 years earlier. The lesion was a well-defined dense mass in the midportion of the left maxillary sinus, which appeared to be separated from the impacted maxillary third molar (Figs 1 and 2).
* Head, Oral and Maxillofacial Surgery Department, Naval Dental Clinic, Long Beach, CA. t Head. Oral and Maxillofacial Suraerv Denartment. US Naval Hospital, Roosevelt Roads, Puerto Rico. _ $ Director, Resource Allocation Division, Naval Medical Command, Washington, DC. Address correspondence and reprint requests to LCDR Varboncoeur: 1739 E Broadway, No. 19, Long Beach, CA 90802. 0 1990 American
Association
geons 0278-2391/90/4808-0020$3.00/O
of Oral
and Maxillofacial
Sur-
FIGURE 2. volvement.
Waters’ view showing right maxillary sinus in-
VARBONCOEUR,
VANBELOIS,
883
AND BOWEN
of the maxillary antrum (Fig 3). The lesion had the consistency and appearance of bone. The lesion with its bony stalk was sectioned and removed. It was not associated with the impacted tooth, but a soft tissue mass was associated with the base of the stalk. The impacted tooth was removed by a gingival flap approach. An oral-antral communication was noted, and primary closure was obtained. Microscopic examination of the decalcified specimen revealed curved fragments of lamellar bone with associated fibrofatty marrow that contained a very vascular infiltrate of chronic inflammatory cells, predominantly lymphocytes and plasma cells (Fig 4). On the periphery, multinucleated giant cells were found. The diagnosis was compatible with osteoma. The patient was asymptomatic, and the surgical sites were well healed 3 months postoperatively.
Discussion Trauma or infection has often been suggested as an etiologic factor in the formation of an osteoma.
FIGURE 4. Photomicrograph original magnification, X20.)
of osteoma. (Hematoxylin-eosin,
Neither trauma nor infection was a factor in this case. The lesion was shown to be present for no more than 7 years and thus was not developmental in origin. Various theories as to the etiology of osteomas have been proposed, but no definite cause is known. The discovery of an osteoma of the facial skeleton should raise the possibility of Gardner’s syndrome. However, no corroborating syndromal lesions were found in this patient. References
FIGURE 3.
Intraoperative
view of maxillary sinus lesion.
1. Shafer WG, Hine MK, Levy BM: A Textbook of Oral Pathology (ed 3). Philadelphia, PA, Saunders, 1983 2. Seward MH: An osteoma of the maxilla. Br Dent J 118:27, 1965 3. Leopard PJ: Osteoma of the maxillary antrum. Br J Oral Surg 10:73, 1972 4. Walter JB, Israel MS: General Pathology. London, England, Churchill Livingston, 1979 5. Rawlins AG: Osteoma of the maxillary sinus. Ann Otol Rhino1 Laryngol47:73.5, 1938 6. Fetisoff AG: Pathogenesis of osteomas of the nasal accessory sinuses. Ann Otol Rhino1 Laryngol 38404, 1938 7. Gardner EJ, Richards RD: Multiple cutaneous and subcutaneous lesions occurring simultaneously with hereditary polyposis and osteomatosis. Am J Hum Genet 5: 139. 1953
OSTEOMA OF THE MAXILLARY
J Oral Maxillofac 49:892-993.
SINUS
Surg
1990
Osteoma of the Maxillary Sinus LCDR ANTHONY
P. VARBONCOEUR, DDS,* CAPT HARVARD J. VANBELOIS, AND CAPT LATHE L. BOWEN, DDS*
The osteoma is a benign proliferative bony lesion that may form peripherally in a periosteal location or in a central (endosteal) position. Osteoma of the maxillary sinus is an uncommon lesion1-4 and is most likely to occur in the frontal and ethmoid sinuses. Osteoma of the maxillary antrum was first described by Rawlins in 1938,5 and Fetisop suggested that an osteoma might be the result of persistent embryonic periosteum initiating the formation of new bone. Another theory holds that the maxillary antral osteoma represents reactive bone in an antral polyp. Osteomas of the maxillary sinus may be composed of either compact or cancellous bone. Most reported lesions have demonstrated attachment to the sinus wall by a pedicle. Radiographically, the lesion appears as a well-circumscribed radiopacity. Clinically, the osteoma is usually asymptomatic, but it can produce swelling and cause asymmetry which may decrease air flow when protruding into the sinus. The lesion is generally slow growing. Histologically, osteomas usually shows trabeculae of lamellar bone with a fibrofatty marrow. They have not been reported to recur after removal.
DDS,t
FIGURE 1. Panoramic radiograph taken in 1986 showing lesion associated with tooth no. 16.
A review of systems and physical examination revealed a well-developed black man in no acute distress. Laboratory values, consisting of complete blood cell count, urinalysis, prothrombin time, and partial thromboplastin time, were within normal limits. The patient was asymptomatic and had no facial swelling, sinus congestion, nasal discharge, or history of epistaxis, paresthesia, headache, or odontalgia. Due to the peculiar radiographic presentation and possible association with the impacted tooth, it was decided to surgically remove the lesion. A Caldwell-Luc procedure was performed to explore the left maxillary antrum. Through this approach, a 3 x 4 cm hard, pedunculated lesion was observed on the floor
Report of a Case A 33-year-old black man was referred for evaluation and treatment of a radiopaque lesion in the left maxillary sinus. The lesion was originally discovered on routine panoramic examination for evaluation of a symptomatic impacted third molar. The lesion had not been present on a panoramic radiograph taken 7 years earlier. The lesion was a well-defined dense mass in the midportion of the left maxillary sinus, which appeared to be separated from the impacted maxillary third molar (Figs 1 and 2).
* Head, Oral and Maxillofacial Surgery Department, Naval Dental Clinic, Long Beach, CA. t Head. Oral and Maxillofacial Suraerv Denartment. US Naval Hospital, Roosevelt Roads, Puerto Rico. _ $ Director, Resource Allocation Division, Naval Medical Command, Washington, DC. Address correspondence and reprint requests to LCDR Varboncoeur: 1739 E Broadway, No. 19, Long Beach, CA 90802. 0 1990 American
Association
geons 0278-2391/90/4808-0020$3.00/O
of Oral
and Maxillofacial
Sur-
FIGURE 2. volvement.
Waters’ view showing right maxillary sinus in-
VARBONCOEUR,
VANBELOIS,
883
AND BOWEN
of the maxillary antrum (Fig 3). The lesion had the consistency and appearance of bone. The lesion with its bony stalk was sectioned and removed. It was not associated with the impacted tooth, but a soft tissue mass was associated with the base of the stalk. The impacted tooth was removed by a gingival flap approach. An oral-antral communication was noted, and primary closure was obtained. Microscopic examination of the decalcified specimen revealed curved fragments of lamellar bone with associated fibrofatty marrow that contained a very vascular infiltrate of chronic inflammatory cells, predominantly lymphocytes and plasma cells (Fig 4). On the periphery, multinucleated giant cells were found. The diagnosis was compatible with osteoma. The patient was asymptomatic, and the surgical sites were well healed 3 months postoperatively.
Discussion Trauma or infection has often been suggested as an etiologic factor in the formation of an osteoma.
FIGURE 4. Photomicrograph original magnification, X20.)
of osteoma. (Hematoxylin-eosin,
Neither trauma nor infection was a factor in this case. The lesion was shown to be present for no more than 7 years and thus was not developmental in origin. Various theories as to the etiology of osteomas have been proposed, but no definite cause is known. The discovery of an osteoma of the facial skeleton should raise the possibility of Gardner’s syndrome. However, no corroborating syndromal lesions were found in this patient. References
FIGURE 3.
Intraoperative
view of maxillary sinus lesion.
1. Shafer WG, Hine MK, Levy BM: A Textbook of Oral Pathology (ed 3). Philadelphia, PA, Saunders, 1983 2. Seward MH: An osteoma of the maxilla. Br Dent J 118:27, 1965 3. Leopard PJ: Osteoma of the maxillary antrum. Br J Oral Surg 10:73, 1972 4. Walter JB, Israel MS: General Pathology. London, England, Churchill Livingston, 1979 5. Rawlins AG: Osteoma of the maxillary sinus. Ann Otol Rhino1 Laryngol47:73.5, 1938 6. Fetisoff AG: Pathogenesis of osteomas of the nasal accessory sinuses. Ann Otol Rhino1 Laryngol 38404, 1938 7. Gardner EJ, Richards RD: Multiple cutaneous and subcutaneous lesions occurring simultaneously with hereditary polyposis and osteomatosis. Am J Hum Genet 5: 139. 1953
