Osteoma – the benign tumor developing from a bone tissue. Differs in a favorable current: grows very slowly, never it ozlokachestvlyatsya, does not give metastasises and does not sprout in surrounding fabrics. Osteoma develops at patients of children's and young age (from 5 to 20 years) more often. There are several versions ostey, differing on the structure and a location. Usually osteoma are localized on the external surface of bones and settle down on flat bones of a skull, in walls of gaymorovy, trellised, wedge-shaped and frontal bosoms, on tibial, femoral and humeral bones. Bodies of vertebras can be surprised also. Osteoma happen single, an exception – a disease of Gardner of which the multiple tumors and congenital osteoma of bones of a skull caused by violation of development of mesenchymal fabric and which are combined with other defects are characteristic. Treatment of all types ostey only surgical.
Osteoma – the good-quality opukholevidny education which is formed of the high-differentiated bone tissue. Differs in extremely slow growth and very favorable current. Cases of regeneration of an osteoma in a malignant tumor are not revealed. Depending on a version can be followed by pains or proceed asymptomatically. When squeezing the next anatomic educations (nerves, vessels etc.) there is a corresponding symptomatology demanding surgery. In other cases surgical removal of an osteoma is usually made for cosmetic reasons.
Osteoma usually develops at children's and youthful age. More often patients of a male suffer (an exception – osteoma of facial bones which develop at women more often). Gardner's syndrome which is followed by development multiple ostey has hereditary character. In other cases it is supposed that overcooling or repeated injuries can become provocative factors.
Taking into account an origin in traumatology allocate two look ostey:
- Hyper plastic osteoma – develop from a bone tissue. Osteoma and osteoidny osteoma concern to this group.
- Heteroplastic osteoma – develop from connecting fabric. Osteofita enter into this group.
Osteoma on the structure differs in nothing from a normal bone tissue. It is formed on bones of a skull and facial bones, including – in walls of additional bosoms of a nose (frontal, gaymorovy, trellised, wedge-shaped). Osteoma in bones of a skull twice more often is observed at men, in facial bones – is 3 times more often at women. In most cases single osteoma come to light. At Gardner's disease education multiple ostey in long tubular bones is possible. Besides, allocate congenital multiple osteoma of bones of a skull which are usually combined with other malformations. Osteoma in itself are painless and proceed asymptomatically, however when squeezing the next anatomic educations can cause the most various clinical symptomatology – from violation of sight to epileptic seizures.
The Osteoidny osteoma is also the high-differentiated bone tumor, however its structure differs from a normal bone tissue and consists from plentifully vaskulyarizovanny (rich with vessels) the sites of osteogene fabric which are chaotically located bone and zones of an osteoliz (destruction of a bone tissue). Usually osteoidny osteoma does not exceed 1 cm in the diameter. Meets rather often and makes about 12% of total number of benign tumors of bones.
Can settle down on any bones, except a breast and bones of a skull. Typical localization of an osteoidny osteoma – a diaphysis (middle parts) and metafiza (transitional parts between a diaphysis and the articulate end) long tubular bones of the lower extremities. About a half of all osteoidny ostey comes to light on tibial bones and in the field of a proximal metafiz of a femur. Develops at young age, to a thicket it is observed at men. Is followed by the accruing pains which develop even before emergence of radiological changes.
Osteofita can be internal and external. Internal osteofita (enostoza) grow to the marrowy canal, usually happen single (an exception – , the descended disease at which multiple enostoza are observed), proceed asymptomatically and become a casual find on the roentgenogram. External osteofita (ekzostoza) grow on the surface of a bone, can develop owing to various pathological processes or arise for no apparent reason. The last kind of ekzostoz often meets on facial bones, bones of a skull and a basin. Ekzostoza can proceed asymptomatically, be shown in the form of cosmetic defect or squeeze the next bodies. The accompanying deformation of bones and a fracture of a leg of an ekzostoz is in some cases noted.
Heteroplastic osteoma can appear not only on bones, but also in other bodies and fabrics: in places of an attachment of sinews, in a diaphragm, a pleura, brain fabric, heart covers, etc.
The clinic of an osteoma depends on its location. At localization of an osteoma on outer side of bones of a skull it represents painless, motionless, very dense education with a smooth surface. Osteoma located on inside of bones of a skull can cause disorders of memory, a headache, the increased intra cranial pressure and even to become the reason of development of epileptic seizures. And the osteoma which is localized in the field of "the Turkish saddle" can become the reason of development of hormonal violations.
Osteoma, located in additional bosoms of a nose, can cause various eye symptoms: (omission of a century), an anizokoriya (the different size of pupils), a diplopiya (doubling in eyes), (an eyeball vypuchivaniye), decrease in sight etc. Obstruction of airways on the party of defeat is in certain cases also possible. Osteoma of long tubular bones usually proceed asymptomatically and come to light at suspicion of Gardner's disease or become a casual find when carrying out radiological researches.
The differential diagnosis ostey in facial bones and bones of a skull is carried out with a solid odontomy, ossifitsirovanny fibrous dysplasia and jet growths of a bone tissue which can arise after severe injuries and infectious defeats. Osteoma of long tubular bones it is necessary to differentiate from an osteokhondroma and an organized periostalny callosity.
The diagnosis of an osteoma is exposed on the basis of additional researches. At the initial stage the X-ray analysis is carried out. However such research is not always effective because of the small sizes ostey and features of their arrangement (for example, on the internal surface of bones of a skull). Therefore by the main method of diagnostics it becomes frequent more informative computer tomography.
Depending on localization ostey either neurosurgeons, or maxillofacial surgeons, or traumatologists are engaged in treatment. At cosmetic defect or emergence of symptoms of squeezing of the next anatomic educations operation is shown. At an asymptomatic current of an osteoma perhaps dynamic observation.
Most often the osteoidny osteoma develops in areas of a diaphysis of long tubular bones. First place on prevalence is won by a tibial bone, then also flat bones follow femoral, low-tibial, humeral, beam. About 10% of total number of cases make osteoidny osteoma of vertebras.
Limited pain in the field of defeat which in character reminds in the beginning muscular pains becomes the first symptom of an osteoidny osteoma. In the subsequent pains become spontaneous, gain the progressing character. The pain syndrome at such an osteomove decreases or disappears after reception of analgetics and also after the patient "disperses", but again appears at rest. If the osteoma is localized on bones of the lower extremities, the patient can spare a leg. In certain cases lameness develops.
In an onset of the illness no external changes come to light. Then over area of defeat flat and thin painful infiltrate is formed. At emergence of an osteoma in the field of an epifiz (an articulate part of a bone) in a joint the liquid congestion can be defined. At an arrangement near growth zone the osteoidny osteoma stimulates growth of a bone therefore at children asymmetry of a skeleton can develop. At localization of an osteoma in vertebras scoliosis can be formed. Both at adults, and at children at such location emergence of symptoms of squeezing of peripheral nerves is also possible.
The diagnosis of an osteoidny osteoma is exposed on the basis of a characteristic radiological picture. Usually because of the arrangement such tumors are better visible in x-ray pictures in comparison with usual osteomine. However in some cases difficulties because of the small size of an osteoidny osteoma or its localization are also possible (for example, in a vertebra). In such situations for specification of the diagnosis the computer tomography is used.
During the radiological research under a kortikalny plate the small roundish site of an enlightenment surrounded with an osteosclerosis zone which width increases in process of progressing of a disease comes to light. At the initial stage accurately visible border between a rim and the central area of an osteoma is defined. In the subsequent this border is erased as the tumor is exposed to calcification.
At a histologic research of an osteoidny osteoma osteogene fabric with a large number of vessels is found. The central part of an osteoma represents sites of education and destruction of a bone with fancifully intertwining balochka and tyazha. In mature tumors the sklerozirovaniye centers, and in "old" - sites of the real fibrous bone come to light.
The differential diagnosis of an osteoidny osteoma is carried out with limited skleroziruyushchy osteomyelitis, the cutting osteochondrosis, osteoperiostity, a chronic Brodie's abscess, is more rare – Ewing's tumor and osteogene sarcoma.
Traumatologists and orthopedists usually are engaged in treatment of an osteoidny osteoma. Treatment only surgical. During operation the resection of an affected area, whenever possible – together with the osteosclerosis zone surrounding it is carried out. A recurrence is observed very seldom.
Such growths can arise for various reasons and on a number of characteristics (in particular, to an origin) differ from classical ostey. However, because of similar structure – the high-differentiated bone tissue – some authors carry osteofita in group ostey.
Ekzostoza – osteofita on the external surface of a bone are of practical interest. They can have the form of a hemisphere, a mushroom, a thorn or even a cauliflower. Hereditary predisposition is noted. Educations arise during puberty more often. The most widespread ekzostoza – the top third of bones of a shin, the lower third of a femur, the top third of a humeral bone and the lower third of bones of a forearm. Less often ekzostoza are localized on flat bones of a trunk, vertebras, bones of a brush and an instep. Can be single or multiple (at an ekzostozny hondrodisplaziya).
The diagnosis is exposed on the basis of data of a X-ray analysis and/or computer tomography. When studying x-ray pictures it is necessary to consider that the actual size of an ekzostoz does not correspond to data of the roentgenogram as the top, cartilaginous layer in pictures is not displayed. At the same time thickness of such layer (especially at children) can reach several centimeters.