33 years old female PT come with slow growing swelling in the angle of the mandible.
Radiograph show radio-opaque with radio-lucent border diagnosis:
- Osteoma.
- Osteosarcoma.
- Cementoblatoma.
Osteomas are uncontrolled bone growths in the soft tissues, the muscles in general, that often appear as a result of trauma, sometimes after spinal cord injury or stroke. Osteomas appear at the joints and hinder patient mobility.
What is an osteoma?
In one third of cases, the osteoma is located at the hip. But an osteoma can also occur in the knee, shoulder or elbow.
In the case of osteoma, it's a bit like muscle cells suddenly deciding to make bone and cartilage where it should not be.
This abnormal ossification grows rapidly in just a few weeks to become denser after six to nine months. More than half of the paraplegics who develop osteomas have at least two.
At present, we do not know what causes the appearance of an osteoma. Several hypotheses are emitted: the lack of proteins, the immobilization, the circulatory disorders and the serious disorders of oxygenation in particular.
These growths have a development process similar to that of tumors but they are not cancerous. However, osteomas cause functional discomfort (the patient can no longer bend the elbow, for example). In addition, they pose a risk of phlebitis if they compress a nerve or a blood vessel and may cause pulmonary embolism.
Removal of osteomas:
Preventive or pharmacological treatments do not yet prevent the appearance or recurrence of osteoma. Only the surgical treatment, associated with a rigorous postoperative management, allows a real treatment.
The goal of the procedure is to remove the osteoma so that the patient can flex and extend his limbs properly. The main difficulty of the operation comes when the osteoma develops all around the blood vessels. The surgeon must then quickly locate the nested artery in the ossification so as not to damage it.
The benefits of removing the osteoma on mobility are immediate. The goal is not necessarily to remove the osteoma in its entirety, only the part that hinders the patient. Because the intervention involves risks among which vascular lesions, infections ...
With rehabilitation, patients can then return to near normal mobility. Since they are benign, the pieces of osteoma are not analyzed in anatomopathology as are the cancerous tumors. On the other hand, they are used for basic research.
After an operation, the osteoma recurrence rate exists, but remains low, less than 5%.
Osteoma: regain joint mobility
The operation is important because by restoring mobility to the joint, the patient can have access to rehabilitation previously impossible. However, in the event of marrow injury, stroke or head trauma, the sooner the rehabilitation begins, the greater the chance for the patient to regain autonomy.
Recent studies have made it possible to hope that, in the future, it will be possible to avoid the formation of osteomas by means of medicinal treatments.
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