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Osteochondroma of the maxilla
VOLUME
15
NUMBER
ORAL ORAL
JULY,
SURGERY
7 1962
MEDICINE and
ORAL
PATHOLOGY
. . . . ..*.t...........................*........
OPERATIVE
ORAL
OSTEOCHONDROMA Report
SURGERY
OF THE
MAXILLA
of a Case
J. M. Gorman, M.D.S., P.D.S.R.C.S., and R. I. H. Whitlock, M.D.S., F.D.S.R.C.S., Belfast, Northern Ireland Boy&
Victoria
A
LTHOUGH
CASE
REPORT
Hospital
osteomas of the maxilla and mandible are not uncommon, chonaromas are relatively rare. Both tumors are derived from osteogenic tissue. In a chondroma, transitions into bone cells may occur and give rise to osteoid tissue or true areas of bone,l the tumor being then termed an osteochondroma. The chondromatous lesions may arise in regions where there are cartilage cell rests. The maxilla and mandible are membrane bones. While part of Meckel’s cartilage is incorporated in the anterior part of the mandible, the chief source of cell rests must be from the secondary or accessory cartilages. These are not part of the primary skeleton but are present in regions where there is a necessity for rapid growth.2 In the mandible, secondary cartilages are present in the condyle, the coronoid process, and the symphysial region. Antoni and associates,3 Levine and associates,4and Shackelford and Brown” have reported osteochonaromas of the coronoid process, and Gingrass” has presented a case of chondrosarcoma of the condyle. In the maxilla, cartilage cell rests remain in the alveolomalar process and in the region of the paraseptal carti1age.l Scott and Symons2 state that a mass of secondary cartilage is present in the malar process region at the 27 mm. stage of development. Hankey, Carter,8 Blum,g Miles,‘O and Link,l’ have reported chondromatous lesions arising from the anterior part of the maxilla. In the case that follows the tumor affected the left side of the maxilla and may have originated in the cell rests in the malar process.
A married woman, 37 years swelling in the left side of the There was no pain or discomfort.
of age, was first seen in May, 1956. She complained of a upper jaw, which she had noticed six months previously. The past medical and family histories were negative. 769
770
(;oK1\l.\S
.\N I) \\‘ll
I’I‘l.0~~li
Volume Ii Number i
Fig.
OSTEOCHONDRO11IA
2.-Ten-degree
Fig.
3.-Specimen
G’owse.-The
occipitomental
with
upper
OF
view
left
showing
third
molar
MAX
771
LLLh
radiopaque
attached
mass
after
in left
first
maxilla.
operation
patient was seen regularly, and the swelling recurred at the previous site later. A second local excision was performed in May, 1957, and the that, compared with the specimen sent previously, this piece conta ined and suggested that the tumor could more appropriately be called an ossii eying chondroma than an ostcoma. A second recurrence was observed a year later (Fig. 5). As the pathologist ‘S rep arts had indicated that the lesion was benign, a third local excision was performed in May, 1 958. As ]previously, the tumor was diagnosed as an osteochondroma. one year less than path lologist reported muc h more cartilage
(X)KII.\S
.\SI)
\~llI’l‘l.o~‘li
773
Fig.
i.-Section
In membrane
showing
cellular
osteochondroma,
March, 1959, there was a definite enlargement covering the tumor became ulcerated (Fig.
maxill:L
was
ttccitlctl
March,
19.59.
(Magnification,
of the maxilla, and later 6). Resection of the left
X100.) the mucous side of the
upon.
h’OZWtlL Oyo,a’tiolL.-IIypotellsive ancsthcsia was used for this procedure. The maxilla was exposed I)y an incision made through the midline of the upper lip, extended laterally Irelow the left nostril, aud then vertically halfway up the left side of the nose. The left side of the maxilla was removed with chisels, the infraorbital margin being left intact. r\n obturator, consisting of an upper denture with a Stcnt’s composition extension, was placed in the cavity. This obturator carried a Thicrsch split-skin graft and was immobilized by an rxtension to a plaster-of-Paris l~cwhap. more
Pathologist’s Eepwt.-The cellular. Part of it was
tissue infected
was the same and necrotic.
as before, Diagnosis:
except that it Osteochondroma
was
probably (Fig. 7).
Co?l,se.-The patient made a good recovery, the skin graft taking well on the area of excision. A pcrmauent obturator was constructed six weeks after the operation. There had been no rwurrcnw when the patient, was last examined, nearly t\vo years l)ostol”!“lt,ivc’ly.
I)ISCl’SSI(~S
,I
L
The pathologist’s first report indicated that the tumor was an osteoma, but it, was noted that some of the boric was of the chondroid type. In the later specimens much more cartilage was present and the t,umor was considered to be an osteochondroma. It is interesting to compare this case with that reported by Link,ll in which the original diagnosis was osteoma and there had been a history of three previous operations before a chondrosarcoma of low malignancy was removed from the canine region of the maxilla. While chondroma and osteochondroma are regarded as benign neoplasms, Rlum” points out that recurrences are frequent and that the intervals between
I. 2. Scott, 3. 1. 5. 6. 7. x. 0. 10. 11. 12.
.J. H., and Sgmons, X. 1%. H. : Introdudion to I)vntxl .\n:;torny, ~4. 1. Edinlnqh. 1952, E. R- S. Lioingstxmc, l,tcl., pp. 111, 115. Autoni, A. A., Brown, A., and .lohn~on, J. H. : Ostc~o~llon(lrl,t,I:r of the (‘oronoid I’rnwss. Report of a Case, .J. Oral Surgery 16: 514, 1958. Ixvinc, V. H., Chessen, J., and McCarthy, W. D.: OstPo~llontlronla of thcl ('oronoicl Process; Report of a Cast, I). Abs. 3: 145, 1958. Sl~ackclford, R. T., anil Rronn, 1%‘. II. : R.estrictc:d .law Motion I)uc t,o Ostco~~lioll~l~~Iln:t of the Coronoid Process, .J. Hone R- *Joint Surg. 31-A: 107, 1919. Gingrass, R. P.: Chondrosarcorna of the Mandibular *Joint, .I. Oral Rurg. 12: 61, 19%. IIankey, G. T.: Chondrossrcoma of Maxilla and Septum, Proc. Itoy. Hoc. hid. 50: 679. 1957. Carter, .J.: Destruction of the Prc-maxilla 1)~ Chondroma. I’roc. ROE. Ser. M(YI. 48: 9X:{. 1955. .I:Iw, OKSI. SI-a(;.. Ck4r. MWL S- Ot:hr, t’.\ur. T{lum, Thcodor : Cartilage Tumors of thr 7’ 1‘3“O 1951.
15
NUMBER
ORAL ORAL
JULY,
SURGERY
7 1962
MEDICINE and
ORAL
PATHOLOGY
. . . . ..*.t...........................*........
OPERATIVE
ORAL
OSTEOCHONDROMA Report
SURGERY
OF THE
MAXILLA
of a Case
J. M. Gorman, M.D.S., P.D.S.R.C.S., and R. I. H. Whitlock, M.D.S., F.D.S.R.C.S., Belfast, Northern Ireland Boy&
Victoria
A
LTHOUGH
CASE
REPORT
Hospital
osteomas of the maxilla and mandible are not uncommon, chonaromas are relatively rare. Both tumors are derived from osteogenic tissue. In a chondroma, transitions into bone cells may occur and give rise to osteoid tissue or true areas of bone,l the tumor being then termed an osteochondroma. The chondromatous lesions may arise in regions where there are cartilage cell rests. The maxilla and mandible are membrane bones. While part of Meckel’s cartilage is incorporated in the anterior part of the mandible, the chief source of cell rests must be from the secondary or accessory cartilages. These are not part of the primary skeleton but are present in regions where there is a necessity for rapid growth.2 In the mandible, secondary cartilages are present in the condyle, the coronoid process, and the symphysial region. Antoni and associates,3 Levine and associates,4and Shackelford and Brown” have reported osteochonaromas of the coronoid process, and Gingrass” has presented a case of chondrosarcoma of the condyle. In the maxilla, cartilage cell rests remain in the alveolomalar process and in the region of the paraseptal carti1age.l Scott and Symons2 state that a mass of secondary cartilage is present in the malar process region at the 27 mm. stage of development. Hankey, Carter,8 Blum,g Miles,‘O and Link,l’ have reported chondromatous lesions arising from the anterior part of the maxilla. In the case that follows the tumor affected the left side of the maxilla and may have originated in the cell rests in the malar process.
A married woman, 37 years swelling in the left side of the There was no pain or discomfort.
of age, was first seen in May, 1956. She complained of a upper jaw, which she had noticed six months previously. The past medical and family histories were negative. 769
770
(;oK1\l.\S
.\N I) \\‘ll
I’I‘l.0~~li
Volume Ii Number i
Fig.
OSTEOCHONDRO11IA
2.-Ten-degree
Fig.
3.-Specimen
G’owse.-The
occipitomental
with
upper
OF
view
left
showing
third
molar
MAX
771
LLLh
radiopaque
attached
mass
after
in left
first
maxilla.
operation
patient was seen regularly, and the swelling recurred at the previous site later. A second local excision was performed in May, 1957, and the that, compared with the specimen sent previously, this piece conta ined and suggested that the tumor could more appropriately be called an ossii eying chondroma than an ostcoma. A second recurrence was observed a year later (Fig. 5). As the pathologist ‘S rep arts had indicated that the lesion was benign, a third local excision was performed in May, 1 958. As ]previously, the tumor was diagnosed as an osteochondroma. one year less than path lologist reported muc h more cartilage
(X)KII.\S
.\SI)
\~llI’l‘l.o~‘li
773
Fig.
i.-Section
In membrane
showing
cellular
osteochondroma,
March, 1959, there was a definite enlargement covering the tumor became ulcerated (Fig.
maxill:L
was
ttccitlctl
March,
19.59.
(Magnification,
of the maxilla, and later 6). Resection of the left
X100.) the mucous side of the
upon.
h’OZWtlL Oyo,a’tiolL.-IIypotellsive ancsthcsia was used for this procedure. The maxilla was exposed I)y an incision made through the midline of the upper lip, extended laterally Irelow the left nostril, aud then vertically halfway up the left side of the nose. The left side of the maxilla was removed with chisels, the infraorbital margin being left intact. r\n obturator, consisting of an upper denture with a Stcnt’s composition extension, was placed in the cavity. This obturator carried a Thicrsch split-skin graft and was immobilized by an rxtension to a plaster-of-Paris l~cwhap. more
Pathologist’s Eepwt.-The cellular. Part of it was
tissue infected
was the same and necrotic.
as before, Diagnosis:
except that it Osteochondroma
was
probably (Fig. 7).
Co?l,se.-The patient made a good recovery, the skin graft taking well on the area of excision. A pcrmauent obturator was constructed six weeks after the operation. There had been no rwurrcnw when the patient, was last examined, nearly t\vo years l)ostol”!“lt,ivc’ly.
I)ISCl’SSI(~S
,I
L
The pathologist’s first report indicated that the tumor was an osteoma, but it, was noted that some of the boric was of the chondroid type. In the later specimens much more cartilage was present and the t,umor was considered to be an osteochondroma. It is interesting to compare this case with that reported by Link,ll in which the original diagnosis was osteoma and there had been a history of three previous operations before a chondrosarcoma of low malignancy was removed from the canine region of the maxilla. While chondroma and osteochondroma are regarded as benign neoplasms, Rlum” points out that recurrences are frequent and that the intervals between
I. 2. Scott, 3. 1. 5. 6. 7. x. 0. 10. 11. 12.
.J. H., and Sgmons, X. 1%. H. : Introdudion to I)vntxl .\n:;torny, ~4. 1. Edinlnqh. 1952, E. R- S. Lioingstxmc, l,tcl., pp. 111, 115. Autoni, A. A., Brown, A., and .lohn~on, J. H. : Ostc~o~llon(lrl,t,I:r of the (‘oronoid I’rnwss. Report of a Case, .J. Oral Surgery 16: 514, 1958. Ixvinc, V. H., Chessen, J., and McCarthy, W. D.: OstPo~llontlronla of thcl ('oronoicl Process; Report of a Cast, I). Abs. 3: 145, 1958. Sl~ackclford, R. T., anil Rronn, 1%‘. II. : R.estrictc:d .law Motion I)uc t,o Ostco~~lioll~l~~Iln:t of the Coronoid Process, .J. Hone R- *Joint Surg. 31-A: 107, 1919. Gingrass, R. P.: Chondrosarcorna of the Mandibular *Joint, .I. Oral Rurg. 12: 61, 19%. IIankey, G. T.: Chondrossrcoma of Maxilla and Septum, Proc. Itoy. Hoc. hid. 50: 679. 1957. Carter, .J.: Destruction of the Prc-maxilla 1)~ Chondroma. I’roc. ROE. Ser. M(YI. 48: 9X:{. 1955. .I:Iw, OKSI. SI-a(;.. Ck4r. MWL S- Ot:hr, t’.\ur. T{lum, Thcodor : Cartilage Tumors of thr 7’ 1‘3“O 1951.