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ISSN 1681-715X |
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CASE REPORT |
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Volume 22 |
January March 2006 |
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Published by : PROFESSIONAL MEDICAL PUBLICATIONS |
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CASE REPORT |
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Volume 22 |
January March 2006 |
Number 1 |
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Osteoma of Mastoid Bone: A Case Report
Shahzad Salim1, Javed Iqbal2 & Muhammad Amjad3
Abstract:
Osteoma of the mastoid process of temporal bone is rare; only a few cases have been reported. The first case was reported from Italy in 1967. We describe an unusual case of large osteoid osteoma of the mastoid bone and its management.
Key Words: Osteoma, Benign, Nidus.
Pak J Med Sci January-March 2006 Vol. 22 No. 1 80-81
1. Dr. Shahzad Salim
Senior House Officer in Surgery,
South Tyneside District Hospital,
South Shields, Tyne & Wear NE34 OPL UK.2. Dr. Javed Iqbal MCPS
Registrar, ENT Unit-1,
Services Hospital, Lahore.Pakistan.3. Prof. Muhammad Amjad FCPS
ENT Unit-1,
Services Hospital, Lahore.Pakistan.Correspondence:
Dr. Shahzad Salim
248-Staff Residence,
South Tyneside District Hospital,
South Shields, Tyne & Wear NE34 OPL UK.
E-Mail: shahzadslim@bst.rcsed.ac.ukReceived for Publication: June 2, 2005
Accepted: August 9, 2005
Case report
A thirty-year female who is a house wife presented in the out patient department of Services hospital Lahore with swelling in the left mastoid region for the last five years. It was gradually increasing in size. Initially it was painless but now for the last few weeks the patient was feeling dull localized pain. There was no history of ear discharge, deafness, headache, facial weakness, and vomiting, focal neurological deficits and other otological sign and symptoms.
On her first visit an X-ray skull was performed which showed a large left radio-opaque mass in the mastoid area of the left temporal bone. The mass was smooth surfaced and similar in density to normal bone.
Surgical exploration was carried out under general anaesthesia. A long curved incision was made in the mastoid region over the Osteoma. Skin, subcutaneous tissue and periosteum were incised. Subperiosteal flaps were elevated exposing a 1.5 into 2.5 inches mass attached to the mastoid process by a narrow stalk. It was excised using a chesal leaving the inner table of skull intact. Histopathological examination showed the specimen is containing woven bone, osteoclasts and fibrovascular stroma. The postoperative course was uneventful.
Discussion
Osteoid osteoma accounts for 2.6 per cent of primary bone tumors. It usually affects children or young adults. Male: female ratio, 2.5:1. The highest incidence occur in the long bones like proximal shaft of femur 19% followed by Proximal tibia 10%, head and neck osteomas comprises less than one percent.
It is characterized by pain worse at night, greatly relieved by aspirin. In most instances a definitive diagnosis of osteoid osteoma is possible from routine radiographs in conjunction with tomography. The characteristic radiological features are:
1. A central spherical to oval bony density usually less than 1cm in diameter which is the nidus.
2. A thin (1 to 3 mm) collar of lucency surounding the nidus.
3. Variable degree of increased homogenous host bone and /or periosteal density, which surround the nidus.
Usually nidus is not seen on plain radiographs because of the dense sclerosis in the surrounding host bone that masks it.
Management is by simple excision. The first and most important step in the pathological diagnosis of an Osteoid Osteoma is to find the nidus. If nidus is not readily appreciated upon gross examination of the removed bone or its fragments, the specimen should be taken to the radiology department and penetrated adequately, since diagnosis and proper treatment are absolutely dependent upon its demonstration. The nidus on the specimen radiograph will appear as either a spherical or elliptical, or lucent or dense mass. Its radiographic density will depend upon the ratio of osteoid to woven bone present in the nidus.
A nidus always contains either osteoid or woven bone in variable proportions. A 1 to 3 mm zone of loose fibrovascular tissue most often surrounds the nidus.
SELECTED READINGS
1. Dufour A. Zibordi F. [Osteoid osteomas of the cranial bones. Report of a case with mastoid site, the only case in the literature]. Annali di Laringologia, Otologia, Rinologia, Faringologia 1967; 66(4): 526-34.
2. Pardal RJL, Ursua SI, Benito AF. Osteoid osteoma of the temporal bone (mastoid). Report of one case. Acta Otorrinolaringologica Espanola 1995; 46(3): 215-7.
3. Wilder WM, Dowling EA, Brogdon BG. Osteoid osteoma of the mastoid tip. Skeletal Radiology 1995; 24(7): 551-2.
4. Gungor A, Cincik H, Poyregaglu E, Saglam O, Candan H. Mastoid osteomas: report of two cases: Oto Neurotol 2004; 25(2): 95-97.
5. Guerin N, Chauveau E, Julien, Dumont JM, Merignergues G. Osteoma of mastoid: A reportof two cases.Rev Laryngol, Oto Rhinol 1996; 117(2): 127-32.
6. Burton DM, Gonzalez C. Mastoid osteomas:case reports: Ear nose and throat J 1991; 70(3): 161-2.
7. Schulze W, Richter J, Kuhnen C, Henschel MG, Muhr G. Osteoid osteoma that occurred in a former fracture site. Clinical Orthopaedics & Related Research 2001; (387): 200-6.
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