Osteoma of Temporal Bone: A Case of Post Aural Swelling

Osteoma of impermanent Bone A Case of Post Aural Swelling mental home- Osteomas atomic number 18 benign tumours of the lamellar haves. In routine ENT practice they ar unremarkably seen as dense radio opaque shadows arising from within the paranasal sinuses. Osteoma of the temporary deck up occurs infrequently, and when they occur, ar seen most common in the outside(a) stiletto heel television channel. Osteoma originating from the middle ear is very rargon. That from the mastoid atomic number 18 r atomic number 18r. We document much(prenominal) a rare put ination of osteoma arising from the mastoid.Case report-Presenting case of a previously healthy 32-year-old woman, referred to the ENT clinic for assessment of a left over(p) retroauricular mass that had been belatedly increasing in size for past 1 year. This patient was asymptomatic, further reported ugly appearance of this mass. On interrogation, she was found to take up a 3 cm X 3cm globular hard bony bulge a bove and behind the left mastoid process fixed to the vestigial stand up. It was non tender.Detailed ENT examination including facial nerve function was figure. There were no bony exostoses in the foreign ear television channel.CT scan of the stonelike blase hit the bookss demonstrated a lift tumour arising from the left mastoid cortex with no other associated abnormality of the petrous laic bone, suggesting a typical mastoid osteoma (Fig. 2). operative resection was performed under local anaesthesia via a retroauricular incision. Following skin dissection and icon of the bone tumour, the tumour was exclusively resected by a mastoid drill with cutting burr(fig 3a,b,c). Finally the edges of the bone were polished with a round burr and the incision closed in layers. She had an uneventful postoperative period(fig 4). Histopathology confirmed an osteoid osteoma(fig 5).Discussion-Osteoma is a slow outgrowth tumor formed by mature bone tissue. Osteoid osteoma is a primary c oil bone tumor accounting for 10% of all primary bone tumors.1It mostly occurs in long bones. In the skull it mainly affects thefrontoethmoid region. Very uncommonly it affects the temporal bone.They are rare in the sphenoid sinus and highly rare on temporal and occipital squama.2In the temporal region, osteomas are essentially reported in the external auditive canal, or more(prenominal) rarely in the middle ear,along the auditory canal or the styloid process, in the temporomandibular joint, in the apex of the petrous temporal bone or in the internal auditory canal 3 and only exceptionally in the mastoid 4. It has higher incidence in female patients,predominantly in the second and 3rd decade of life and is rare in puberty. 6As illustrated by the case reported here, osteomas arising from outer cortex of the mastoid are associated with minimal or no symptoms. They are essentially responsible for unsightly deformity of the retroauricular region, or even detachment of the external ear in the case of a very large, anterior tumour. Mastoid osteomas can excite local tenderness and interfere with wearing glasses.Even though it is normally asymptomatic it may produce agony by invasion of contact structures or widening of periosteium.If located in the external auditory canal it may lead to occlusion progressing to chronic otitis externa (30% of cases) and conductive hearing loss7,8.In the evince case patient did non have any complaints and swelling was remove for enhancive reasons.While the exact etiology of osteomas is not well understood, they are thought to arise from preosseus connective tissue. There is some evidence that osteomas are of congenital nature 9. The most widely accepted theories for the etiopathogenesis of osteomas include embryogenesis and metaplasia adjacent recurrent local irritation and trauma.Three types of mastoid osteomas have been described, establish on structural characteristics.10,11,12 Compact The most frequent one. Comprising dens e, compact and lamellar bone, with a few(prenominal) vessels and Haversian canals system. Those with dense sclerotic bone are called ivory osteoma. Compact osteomas have a wider base and are very slow growing cartilaginous Comprising bone and cartilaginous elements Spongy Rare type. Comprised by spongy bone and fibrous cell tissue,with tendency to expand to the diploe and involving the internal and external lamina of the touched bone, have bone marrow and also known as cancellate or osteoid osteomas. They are more likely to be pedunculated and grow relatively faster. Mixed Mixture of spongy and compact types.It is important to differentiate osteomas from exostoses. They should be considered separate clinical entities. Osteomas are bony growths that are single,unilateral and pedunculated and arise from the tympanosquamous or tympanomastoid suture lines laterally, whereas exostoses are multiple, usually bilateral and broad based and are found medial to the sutures of the temporal b one 13. Osteomas are true bone tumors and exostoses are thought to be a reactive condition unoriginal to multiple cold-water immersions or recurrent otitis externa. Disagreement still exists whether external auditory canal exostoses and osteoma should be considered as separate histopathological entities. JE Fenton et al in their study have concluded that they cannot be differentiated on routine histopathological examination 14. Osteoma occurrence may be syndromic or non syndromic. They may occur as a feature of Gardeners syndrome, which is characterized by multiple enteral polyps, epidermoid inclusion cysts, fibromas of the skin and mesentery and osteomas. Osteomas in Gardeners syndrome have a predilection for membranous bones and as such the mandible and upper jawbone are more commonly involved 15.Non-contrast computed tomography of the petrous temporal bones is the examination of choice for diagnosis and staging. It reveals a rounded bone lesion of the outer cortex of the masto id, with regular margins, with a pedunculated or sessile implantation base. Superficial mastoid osteoma presents no signs of intrapetrosal extension and the mastoid air cells watch perfectly aerated. In rare cases, the osteoma can extend medially into the petrous temporal bone adjacent to the facial nerve, lateral semicircular canal or ossicles. In these cases, imaging can define the anatomical dealings with these structures before considering surgical resection 3,4,16-18. Imaging is also useful to define the derived function diagnosis between osteoma and other mastoid bone tumours, especially osteosarcoma, bone metastases, multiple myeloma, giant cell tumour, lesions encountered in Pagets disease or fibrous dysplasia 3,4. Signs suggestive of a malignant lesion are rapid growth, pain and a poorly delimited, heterogeneous, osteolytic appearance on CT.Treatment is indicated for osteomas that are symptomatic or cosmetically unacceptable. Excision or drilling of superficial lesions of the mastoid and squama is a simple procedure. At surgery, since the lesions are always limited to the external cortex a cleavage plane is always encountered when tumor meets normal bone19. In mastoid osteomas extending into the fallopian canal and bony labyrinth, complete excision is not indicated since there may be damage to these structures .Follow up is requireed in cases where partial excision isdone or where expectant treatment is adopted. Surgical resection usually raises few technical problems retroauricular incision adapted to the size of the lesion, exposure of the osteoma, then resection with a bone chisel or curette or by reaming, depending on the size of the osteoma and its sessile or pedunculated implantation. A retroauricular subcutaneous depression may be observed after the operation 20.Conclusions-Osteomas are tumors predominantly arising from the long bones and rarely from the flat bones of the skull. When present they should be treated as per the symptoms of th e patient. Osteomas present within the ear need to be dealt carefully, for fear of damage to vital structures.Osteomas present on the mastoid or squamous portion of the temporal bone need to be dealt for cosmetic purposes or if they are causing symptoms.References-1. Kransdorf MJ, Stull MA, Gilkey FW, et al. Osteoid osteoma. Radiographics 1991 11671 -962. Sente M, Topolac R, Peic-Gavran K, Aleksov G. 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