TEMPOROMANDIBULAR CONDYLAR OSTEOCHONDROMAS: CHARACTERISTICS AND COMPLICATIONS

Background Benign, solitary osteochondromas arise in response to an event (e.g., trauma, x-radiation), rather than as true neoplasms. Typically, osteochondromas represent 10% to 15% of all bone tumors and approximately 35% of benign bone tumors. They usually develop during a known age range and at largely predictable anatomic sites, whether the osteochondroma is benign or malignant. The most important piece of clinical information is the patient's age, although exceptions exist. Most osteochondromas occur on the metaphysis of appendicular long bones. Clinical and Radiographic findings Three cases are of temporomandibular condylar osteochondromas are presented. All patients were adult males with ages 29, 55, and 56 years. Each tumor arose from the condylar articular surface and developed into abnormal morphologies that followed the outline of adjacent structures. Definitive Interpretation The radiographic findings of an exostotic bony tumor with smooth but irregular outlines, sclerosed cortices, and moderately dense trabeculation confined within the joint capsule were consistent with the radiographic appearance of osteochondroma. Discussion Radiographically, 2-D imaging is adequate to establish an initial radiographic diagnosis. However, more advanced modalities (computed tomography/magnetic resonance imaging [CT/MRI) are indicated to better evaluate the orientation of the tumor and assist in the surgical management. The 3-D imaging of the 3 cases presented here emphasize this point. Positron emission tomography/fluorodeoxyglucose (PET/FDG) imaging has also been recommended for specific cases. MRI may overestimate tumor aggressiveness secondary to the influence of bone marrow and soft tissue edema. The recognition of an osteochondroma is significant because it is benign, but it can lead to disfigurement and loss or altered mandibular function, if not treated. Benign, solitary osteochondromas arise in response to an event (e.g., trauma, x-radiation), rather than as true neoplasms. Typically, osteochondromas represent 10% to 15% of all bone tumors and approximately 35% of benign bone tumors. They usually develop during a known age range and at largely predictable anatomic sites, whether the osteochondroma is benign or malignant. The most important piece of clinical information is the patient's age, although exceptions exist. Most osteochondromas occur on the metaphysis of appendicular long bones. Three cases are of temporomandibular condylar osteochondromas are presented. All patients were adult males with ages 29, 55, and 56 years. Each tumor arose from the condylar articular surface and developed into abnormal morphologies that followed the outline of adjacent structures. The radiographic findings of an exostotic bony tumor with smooth but irregular outlines, sclerosed cortices, and moderately dense trabeculation confined within the joint capsule were consistent with the radiographic appearance of osteochondroma. Radiographically, 2-D imaging is adequate to establish an initial radiographic diagnosis. However, more advanced modalities (computed tomography/magnetic resonance imaging [CT/MRI) are indicated to better evaluate the orientation of the tumor and assist in the surgical management. The 3-D imaging of the 3 cases presented here emphasize this point. Positron emission tomography/fluorodeoxyglucose (PET/FDG) imaging has also been recommended for specific cases. MRI may overestimate tumor aggressiveness secondary to the influence of bone marrow and soft tissue edema. The recognition of an osteochondroma is significant because it is benign, but it can lead to disfigurement and loss or altered mandibular function, if not treated.