Excessive bone formation (oral exostosis) on Mandibule PDF Print E-mail
Dentistry - Surgery
Written by Michel Jazzar   
Jun 07, 2008 at 06:00 PM
Excessive bone formation (oral exostosis).
1st step: May 18, 2008 History:
When questioned, the patient appeared to be in a general good state of health, with no significant past medical history. The patientís dental history included regular dental examinations and routine dental treatment and many extractions. At the time of the dental appointment, the patient was not taking medications of any kind.
The patient`s vital signs were all found to be within normal limits. Examination of the head and neck region revealed no enlarged or palpable lymph nodes. Examination of the soft tissues of the oral cavity revealed no unusual findings. Large, bilateral bony masses were noted on the buccal of the lower maxilla in the premolar and molar areas (see photos).
Exostosis on the left and on the right sides.
Exostosis on the left side.
Exostosis on the right side.
Radiograph examination of the involved areas revealed well-defined ovoid radiopacities superimposed over the roots of the premolar and molars. The adjacent teeth were tested for vitality; all tested vital.
Clinical diagnosis:
Based on the clinical and radiographic information available, which one of the following is the most likely diagnosis?
Panoramic Xray before the surgery.
* buccal exostoses
* florid cemento-osseous dysplasia
* fibrous dysplasia
* ossifying fibroma
Buccal exostoses
Exostoses are protuberances of bone that arise from the cortical plates in the maxilla and mandible. The cause of exostoses is unknown.
Clinical features:
"Exostoses occur most often in adults. There is no sex predilection and approximately one in 1,000 adults are affected. Buccal exostoses occur as bilateral, smooth bony masses along the buccal aspect of the maxillary and/or mandibular alveolar ridge, usually in the premolar-molar area." When palpated, the exostoses feel rock-hard.
Symptoms are not associated with buccal exostoses. The mucosa overlying the buccal exostoses typically appears intact and is normal in color. Ulcerations may occur if the mucosa is traumatized. The adjacent teeth are vital, and there is no history of pain or sensitivity.
Buccal exostoses are typically discovered during the oral examination. Radiographically, the exostosis appears as an ovoid radiopacity superimposed over the roots of the premolars and molars.
Buccal exostoses are benign lesions of little clinical significance. The diagnosis of a buccal exostosis is made based on the clinical and radiographic findings. If the diagnosis is in question, a biopsy should be performed to rule out other bony lesions.
Typically, no treatment for buccal exostoses is indicated. Buccal exostoses may complicate the construction of dental appliances.
Therefore, surgical reduction of the lesion to the level of surrounding bone may be indicated if a partial or complete denture is needed.

2nd step: May 24, 2008
Surgical reduction on left buccal side on mandibule:
A Technique for Surgical Mandibular Exostosis Removal
The presence of an exostosis may pose a problem in successful construction of dentures. If large enough, an exostosis may create speech issues because of limited tongue space. After a discussion, the patient requested that the exostosis be removed to help decrease future food abrasion of the thin overlying tissue.
Anesthetic 2% was administered to block the inferior alveolar nerve, and it was then applied locally at the papilla to control bleeding at the surgical site.
The incision was made with a scalpel blade.
Reflection of the soft tissue was accomplished with a periosteal elevator. Care was given to avoid tearing the thin tissue. Tissue was reflected as a full-thickness flap, with the entire inferior left exostosis exposed.
A surgical length CA in a low-speed handpiece with serum was used to score a line on the superior aspect of the exostosis (Figure 4). The score line should be placed close to the normal contour of the alveolar ridge.
A monoplane chisel was placed in the score line, allowing the exostosis to be cleaved from the alveolar ridge.
The exostosis is removed in one piece. [See photos]
The tip of the periosteal elevator was kept in contact with the bone, and a gentle tap was applied to the chisel with a surgical mallet.
The flap was repositioned [see photo], and a vertical mattress suture was placed at each papilla with 4-0 silk sutures. The silk sutures will be removed after 14 days.

The exostosis is removed in one piece.
Other view of the exostosis
End of surgical operation.

3rd step: June 7, 2008
Surgical reduction on right buccal side on mandibule:
Surgery done on right side.
ImageExostosis Right side view1
ImageExostosis Right side view2

Final step: [starting 20 June 2008]
Final look before taking impression for a stellite lower partial.

[photos will be displayed on time]
Before and After removing the exostosis on both sides.

Last Updated ( Jan 17, 2012 at 10:52 AM )