Osteoma: Difference between revisions

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Overview
Historical Perspective
Classification
Pathophysiology
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Differentiating Osteoma from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Staging
History and Symptoms
Physical Examination
Laboratory Findings
X Ray
CT
MRI
Ultrasound
Other Imaging Findings
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VisualWikitext

Latest revision as of 17:22, 3 April 2019

For patient information, click here
For more information about osteoid osteoma that is not associated with sino-orbital osteoma, see osteoid osteoma

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

Synonyms and keywords: Osteoma; Osteomata; Osteoncus; Ivory osteoma; Mature osteoma; Mixed osteoma; Homoplastic osteoma; Heteroplastic osteoma; Osteomas; Ivory exostosis; Sino-orbital osteoma; Sino-nasal osteoma; Paranasal sinus osteoma; Skull vault osteoma; Mandibular osteoma

Overview

Osteoma (also known as Osteomata) is a slow growing benign tumor of bone, occurring most commonly in the craniofacial skeletal structures, primarily in the nasal and paranasal (75-90%) sinuses. Osteoma arises from bone overgrowth, which is normally composed of connective tissue. Osteomas are slow growing tumors composed of compact or mature trabecular bone limited to craniofacial bones. Osteoma may be incidentally identified as a mass in the skull, mandible, or as the underlying cause of sinusitis or mucocele formation within the paranasal sinuses. When they are multiple, Gardner syndrome should be considered. Osteoma represents the most common benign neoplasm of the nose and paranasal sinuses. The causes remain uncertain, but commonly accepted theories propose embryologic, traumatic, or infectious causes. Osteomas are usually asymptomatic. Excision may be performed if osteoma is responsible for symptoms.

Historical Perspective

In 1898, the description of craniofacial osteoma was first reported by Paul Schulze.^[1]
In 1951, Eldon J. Gardner (1909–1989) a geneticist first described the occurrence of multiple osteomas in hereditary familial adenomatous polyposis (FAP).
In 2014, The Lancet published an article named "Did René Descartes have a giant ethmoidal sinus osteoma?" the authenticity has been confirmed by anthropological and historical investigations to be true.^[2]

Classification

Osteoma can be classified based on imaging findings.

Enneking (MSTS) Staging System

The Enneking surgical staging system (also known as the MSTS system) for benign musculoskeletal tumors based on radiographic characteristics of the tumor host margin.^[3]
It is widely accepted and routinely used classification.

Stages	Description

1	Latent: Well demarcated borders
2	Active: Indistinct borders
3	Aggressive: Indistinct borders

Pathophysiology

The exact etiology of osteoma is unknown.^[4]
The possibility of a reactive mechanism, triggered by trauma or infection, has been suggested.^[5]
Osteoma arises from bone overgrowth, which is normally composed of connective tissue.^[6]
Osteomas are slow growing tumors composed of compact or mature trabecular bone limited to craniofacial bones.
Very rarely osteomas of the facial bones may be associated with Gardner's syndrome.
Osteomas have a particular frequency distribution within the paranasal sinuses: frontal sinuses 80%, ethmoid air cells 15%, maxillary sinuses 5% and sphenoid sinus rare.

Genetics

The hallmark of multiple osteomas is a mutation in the APC gene, that results in the Gardner syndrome.^[7]

Causes

The cause of osteoma has not been identified.^[8]

Differentiating ((Page name)) from Other Diseases

Osteoma must be differentiated from other diseases that cause sinus or facial pain, headache, and changes to or loss of sense of smell, such as other osteogenic tumors, fibrous dysplasia, and chronic sinusitis.^[9]^[10]


Differential Diagnosis	Similar Features	Differentiating Features

Fibrous dysplasia	Benign, often an incidental finding, affects the same group of patients, and symptoms include facial pain and headache	In fibrous dysplasia, differentiating features include: More common presentation is on ribs: 28%, no gender predilection, and complete resection is usually not possible
Osteoblastoma	Benign, incidental, and male predilection	In osteoblastoma, differentiating features include: normally affect the axial skeleton, lesions are typically larger than 2 cm, and surgical excision is often the treatment of choice
Adamantinomas	Benign, slow growing, and similar clinical onset	In adamantinomas, differentiating features include: locally aggressive tumor, common in the 3rd to 5th decades of life, and location is usually confined to the jaw
Chronic sinusitis	Affects same group of population (young to middle aged adults) and the clinical presentation is similar	In chronic sinusitis, differentiating features include: fever, previous history of acute sinusitis, lack of facial deformation or imaging findings compatible with osteoma

Epidemiology and Demographics

The prevalence of osteoma is approximately 3000 per 100,000 individuals worldwide.^[11]
The incidence of osteoma remains unknown.
Patients of all age groups may develop osteoma.
The average patient age varies from 25 to 35 years.
The mean age of the patients with osteoma is is 37 years.^[9]
Men are more commonly affected than women, with a 3:1 ratio.^[12]
There is no racial predilection to osteoma.

Risk Factors

There are no established risk factors for osteoma.^[6]

Screening

Screening for multiple osteomas is recommended among patients with family history or/and a confirmed diagnosis of Gardner syndrome. Thyroid exam and annual ultrasound, should be performed starting at age 10 to 12 years.^[13]

Natural History, Complications, and Prognosis

If left untreated, osteoma progression occurs slowly and is then followed by facial distortion.^[14]
Common complications of osteoma include:^[15]
- Proptosis
- Facial deformity
- Airway obstruction
- Sensory loss
- Anosmia
- Visual loss
Prognosis is generally excellent,the lesion does not recur after surgical excision and it is not associated with malignant change.^[15]

Diagnosis

Diagnostic Study of Choice

Biopsy is the diagnostic study of choice for the diagnosis of osteoma.

Gross appearance of osteoma include:
- Osteomas have a spongy to densely appearance, conformed of in a polypoid and lobullated shape.[1]
- The median size tumor size is 3.0 cm (range 0.5-8 cm).
- Osteomas have a smooth surface and composed of dense compact bone (ivory osteoma), trabecular bone (mature osteoma, or both patterns).

Histology of osteoma.Source: Case courtesy of Nephron [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0) or GFDL (http://www.gnu.org/copyleft/fdl.html), from Wikimedia Commons]

Histological appearance includes:
- Presence of dense compact mature bone in paucicellular fibrous stroma.
- Large trabeculae of mature lamellar bone can be also be seen.

History and Symptoms

Small osteomas are asymptomatic and usually incidental findings.
Common symotoms of osteoma include:^[16]^[17]
- Headache
- Nasal congestion
- Facial pain
- Facial tenderness
- Loss of the sense of smell

Physical Examination

X-ray showing osteoma of the frontal sinus.Source: Case courtesy of Dr Ahmed Abdrabou, Radiopaedia.org, rID: 42250

Patients with osteoid osteoma usually appears well.
Common physical examination findings of osteoid osteoma include:^[18]
- Facial tenderness
- Nasal obstruction and discharge
- Tapping over a sinus area produces dull sound
- Physical deformity over mastoid or facial area

Laboratory Findings

There are no diagnostic laboratory findings associated with osteoma.

Electrocardiogram

There are no ECG findings associated with osteoma.

X-ray

Three views of affected bone or joint are recommended.^[19]
Radiological findings for osteoma include:
- Well circumscribed mass
- Varying amounts of central lucency
- Lobulated mass occupying frontal or maxillary sinus

Echocardiography or Ultrasound

CT showing osteoma of the mandible.Source: Case courtesy of Dr Ahmed Abdrabou, Radiopaedia.org, rID: 42250

There are no echocardiography/ultrasound findings associated with osteoma.

CT scan

CT findings of osteoma include:^[20]
- Well-circumscribed mass of variable density
- Ground-glass appearance
- Exophytical mass growing out of a sinus

MRI

MRI findings of osteoma include:^[21]
- Low signal on all sequences.
- Mature osteomas may demonstrate some marrow signal, but are also predominantly low on all sequences

Other Imaging Findings

There are no other imaging findings associated with osteoma.

Other Diagnostic Studies

Nasal Endoscopy

Nasal endoscopy findings include:^[22]

Direct visualization of the nasal passages structures, and sinuses.
Tumor location, size, and adjacent structure evaluation.

Treatment

Medical Therapy

There is no medical treatment for osteoma; the mainstay of therapy is surgery.^[23]

Surgery

Surgery is the mainstay of treatment for osteoma.^[24]^[25]

Indication

For symptomatic lesions, local excision is performed.

Types of Surgery

Medial maxillectomy with a lateral rhinotomy
Craniofacial resection
Endoscopic resection

Recurrence Rare recurrence may occur after several years.

Primary Prevention

There are no established measures for the primary prevention of osteoma.

Secondary Prevention

There are no established measures for the secondary prevention of osteoma.

References

↑ Peabody, Terrance (2014). Orthopaedic oncology : primary and metastatic tumors of the skeletal system. Cham: Springer. ISBN 9783319073224.
↑ Charlier P, Froesch P, Benmoussa N, Froment A, Shorto R, Huynh-Charlier I (2014). "Did René Descartes have a giant ethmoidal sinus osteoma?". Lancet. 384 (9951): 1348. doi:10.1016/S0140-6736(14)61816-X. PMID 25307842.
↑ Jawad MU, Scully SP (2010). "In brief: classifications in brief: enneking classification: benign and malignant tumors of the musculoskeletal system". Clin Orthop Relat Res. 468 (7): 2000–2. doi:10.1007/s11999-010-1315-7. PMC 2882012. PMID 20333492.
↑ Athwal P, Stock H (2014). "Osteoid osteoma: a pictorial review". Conn Med. 78 (4): 233–5. PMID 24830123.
↑ Bilkay U, Erdem O, Ozek C, Helvaci E, Kilic K, Ertan Y; et al. (2004). "Benign osteoma with Gardner syndrome: review of the literature and report of a case". J Craniofac Surg. 15 (3): 506–9. PMID 15111819.
↑ ^6.0 ^6.1 Abdel Tawab HM, Kumar V R, Tabook SM (2015). "Osteoma presenting as a painless solitary mastoid swelling". Case Rep Otolaryngol. 2015: 590783. doi:10.1155/2015/590783. PMC 4341844. PMID 25767729. Vancouver style error: name (help)
↑ Bisgaard ML, Bülow S (2006). "Familial adenomatous polyposis (FAP): genotype correlation to FAP phenotype with osteomas and sebaceous cysts". Am J Med Genet A. 140 (3): 200–4. doi:10.1002/ajmg.a.31010. PMID 16411234.
↑ Kaplan I, Calderon S, Buchner A (1994). "Peripheral osteoma of the mandible: a study of 10 new cases and analysis of the literature". J Oral Maxillofac Surg. 52 (5): 467–70. PMID 8169708.
↑ ^9.0 ^9.1 Erdogan N, Demir U, Songu M, Ozenler NK, Uluç E, Dirim B (2009). "A prospective study of paranasal sinus osteomas in 1,889 cases: changing patterns of localization". Laryngoscope. 119 (12): 2355–9. doi:10.1002/lary.20646. PMID 19780030.
↑ Larrea-Oyarbide N, Valmaseda-Castellón E, Berini-Aytés L, Gay-Escoda C (2008). "Osteomas of the craniofacial region. Review of 106 cases". J Oral Pathol Med. 37 (1): 38–42. doi:10.1111/j.1600-0714.2007.00590.x. PMID 18154576.
↑ Earwaker J (1993). "Paranasal sinus osteomas: a review of 46 cases". Skeletal Radiol. 22 (6): 417–23. PMID 8248815.
↑ Boysen M (1978). "Osteomas of the paranasal sinuses". J Otolaryngol. 7 (4): 366–70. PMID 691104.
↑ Septer S, Slowik V, Morgan R, Dai H, Attard T (2013). "Thyroid cancer complicating familial adenomatous polyposis: mutation spectrum of at-risk individuals". Hered Cancer Clin Pract. 11 (1): 13. doi:10.1186/1897-4287-11-13. PMC 3854022. PMID 24093640.
↑ Sayan NB, Uçok C, Karasu HA, Günhan O (2002). "Peripheral osteoma of the oral and maxillofacial region: a study of 35 new cases". J Oral Maxillofac Surg. 60 (11): 1299–301. PMID 12420263.
↑ ^15.0 ^15.1 Wijn MA, Keller JJ, Giardiello FM, Brand HS (2007). "Oral and maxillofacial manifestations of familial adenomatous polyposis". Oral Dis. 13 (4): 360–5. doi:10.1111/j.1601-0825.2006.01293.x. PMID 17577321.
↑ GARDNER EJ, PLENK HP (1952). "Hereditary pattern for multiple osteomas in a family group". Am. J. Hum. Genet. 4 (1): 31–6. PMC 1716387. PMID 14933371.
↑ Smith ME, Calcaterra TC (1989). "Frontal sinus osteoma". Ann Otol Rhinol Laryngol. 98 (11): 896–900. doi:10.1177/000348948909801111. PMID 2817682.
↑ Fu YS, Perzin KH (1974). "Non-epithelial tumors of the nasal cavity, paranasal sinuses, and nasopharynx. A clinicopathologic study. II. Osseous and fibro-osseous lesions, including osteoma, fibrous dysplasia, ossifying fibroma, osteoblastoma, giant cell tumor, and osteosarcoma". Cancer. 33 (5): 1289–305. PMID 4207295.
↑ Schajowicz, Fritz (1994). Tumors and Tumorlike Lesions of Bone : Pathology, Radiology, and Treatment. Berlin, Heidelberg: Springer Berlin Heidelberg. ISBN 9783642499562.
↑ Schajowicz, Fritz (1994). Tumors and Tumorlike Lesions of Bone : Pathology, Radiology, and Treatment. Berlin, Heidelberg: Springer Berlin Heidelberg. ISBN 9783642499562.
↑ Schajowicz, Fritz (1994). Tumors and Tumorlike Lesions of Bone : Pathology, Radiology, and Treatment. Berlin, Heidelberg: Springer Berlin Heidelberg. ISBN 9783642499562.
↑ Li Y, Zhang L, Zhou B, Han D (2009). "[Resection of frontal ethmoid sinus osteomas with nasal endoscopy]". Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi (in Chinese). 23 (14): 628–30. PMID 19894552.
↑ Gorini E, Mullace M, Migliorini L, Mevio E (2014). "Osseous choristoma of the tongue: a review of etiopathogenesis". Case Rep Otolaryngol. 2014: 373104. doi:10.1155/2014/373104. PMC 4279709. PMID 25580337.
↑ Kim WH, Kim DW, Kim CG, Kim MH (2013). "Additional Detection of Multiple Osteomas in a Patient with Gardner's Syndrome by Bone SPECT/CT". Nucl Med Mol Imaging. 47 (4): 297–8. doi:10.1007/s13139-013-0225-5. PMC 4035179. PMID 24900131.
↑ Alexander AA, Patel AA, Odland R (2007). "Paranasal sinus osteomas and Gardner's syndrome". Ann Otol Rhinol Laryngol. 116 (9): 658–62. doi:10.1177/000348940711600906. PMID 17926587.

Template:WikiDoc Sources

[1] Peabody, Terrance (2014). Orthopaedic oncology : primary and metastatic tumors of the skeletal system. Cham: Springer. ISBN 9783319073224.

[pmid25307842-2] Charlier P, Froesch P, Benmoussa N, Froment A, Shorto R, Huynh-Charlier I (2014). "Did René Descartes have a giant ethmoidal sinus osteoma?". Lancet. 384 (9951): 1348. doi:10.1016/S0140-6736(14)61816-X. PMID 25307842.

[pmid20333492-3] Jawad MU, Scully SP (2010). "In brief: classifications in brief: enneking classification: benign and malignant tumors of the musculoskeletal system". Clin Orthop Relat Res. 468 (7): 2000–2. doi:10.1007/s11999-010-1315-7. PMC 2882012. PMID 20333492.

[pmid24830123-4] Athwal P, Stock H (2014). "Osteoid osteoma: a pictorial review". Conn Med. 78 (4): 233–5. PMID 24830123.

[pmid15111819-5] Bilkay U, Erdem O, Ozek C, Helvaci E, Kilic K, Ertan Y; et al. (2004). "Benign osteoma with Gardner syndrome: review of the literature and report of a case". J Craniofac Surg. 15 (3): 506–9. PMID 15111819.

[pmid25767729-6] 6.0 ^6.1 Abdel Tawab HM, Kumar V R, Tabook SM (2015). "Osteoma presenting as a painless solitary mastoid swelling". Case Rep Otolaryngol. 2015: 590783. doi:10.1155/2015/590783. PMC 4341844. PMID 25767729. Vancouver style error: name (help)

[pmid16411234-7] Bisgaard ML, Bülow S (2006). "Familial adenomatous polyposis (FAP): genotype correlation to FAP phenotype with osteomas and sebaceous cysts". Am J Med Genet A. 140 (3): 200–4. doi:10.1002/ajmg.a.31010. PMID 16411234.

[pmid8169708-8] Kaplan I, Calderon S, Buchner A (1994). "Peripheral osteoma of the mandible: a study of 10 new cases and analysis of the literature". J Oral Maxillofac Surg. 52 (5): 467–70. PMID 8169708.

[pmid19780030-9] 9.0 ^9.1 Erdogan N, Demir U, Songu M, Ozenler NK, Uluç E, Dirim B (2009). "A prospective study of paranasal sinus osteomas in 1,889 cases: changing patterns of localization". Laryngoscope. 119 (12): 2355–9. doi:10.1002/lary.20646. PMID 19780030.

[pmid18154576-10] Larrea-Oyarbide N, Valmaseda-Castellón E, Berini-Aytés L, Gay-Escoda C (2008). "Osteomas of the craniofacial region. Review of 106 cases". J Oral Pathol Med. 37 (1): 38–42. doi:10.1111/j.1600-0714.2007.00590.x. PMID 18154576.

[pmid8248815-11] Earwaker J (1993). "Paranasal sinus osteomas: a review of 46 cases". Skeletal Radiol. 22 (6): 417–23. PMID 8248815.

[pmid691104-12] Boysen M (1978). "Osteomas of the paranasal sinuses". J Otolaryngol. 7 (4): 366–70. PMID 691104.

[pmid24093640-13] Septer S, Slowik V, Morgan R, Dai H, Attard T (2013). "Thyroid cancer complicating familial adenomatous polyposis: mutation spectrum of at-risk individuals". Hered Cancer Clin Pract. 11 (1): 13. doi:10.1186/1897-4287-11-13. PMC 3854022. PMID 24093640.

[pmid12420263-14] Sayan NB, Uçok C, Karasu HA, Günhan O (2002). "Peripheral osteoma of the oral and maxillofacial region: a study of 35 new cases". J Oral Maxillofac Surg. 60 (11): 1299–301. PMID 12420263.

[pmid17577321-15] 15.0 ^15.1 Wijn MA, Keller JJ, Giardiello FM, Brand HS (2007). "Oral and maxillofacial manifestations of familial adenomatous polyposis". Oral Dis. 13 (4): 360–5. doi:10.1111/j.1601-0825.2006.01293.x. PMID 17577321.

[pmid14933371-16] GARDNER EJ, PLENK HP (1952). "Hereditary pattern for multiple osteomas in a family group". Am. J. Hum. Genet. 4 (1): 31–6. PMC 1716387. PMID 14933371.

[pmid2817682-17] Smith ME, Calcaterra TC (1989). "Frontal sinus osteoma". Ann Otol Rhinol Laryngol. 98 (11): 896–900. doi:10.1177/000348948909801111. PMID 2817682.

[pmid4207295-18] Fu YS, Perzin KH (1974). "Non-epithelial tumors of the nasal cavity, paranasal sinuses, and nasopharynx. A clinicopathologic study. II. Osseous and fibro-osseous lesions, including osteoma, fibrous dysplasia, ossifying fibroma, osteoblastoma, giant cell tumor, and osteosarcoma". Cancer. 33 (5): 1289–305. PMID 4207295.

[19] Schajowicz, Fritz (1994). Tumors and Tumorlike Lesions of Bone : Pathology, Radiology, and Treatment. Berlin, Heidelberg: Springer Berlin Heidelberg. ISBN 9783642499562.

[20] Schajowicz, Fritz (1994). Tumors and Tumorlike Lesions of Bone : Pathology, Radiology, and Treatment. Berlin, Heidelberg: Springer Berlin Heidelberg. ISBN 9783642499562.

[21] Schajowicz, Fritz (1994). Tumors and Tumorlike Lesions of Bone : Pathology, Radiology, and Treatment. Berlin, Heidelberg: Springer Berlin Heidelberg. ISBN 9783642499562.

[pmid19894552-22] Li Y, Zhang L, Zhou B, Han D (2009). "[Resection of frontal ethmoid sinus osteomas with nasal endoscopy]". Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi (in Chinese). 23 (14): 628–30. PMID 19894552.

[pmid25580337-23] Gorini E, Mullace M, Migliorini L, Mevio E (2014). "Osseous choristoma of the tongue: a review of etiopathogenesis". Case Rep Otolaryngol. 2014: 373104. doi:10.1155/2014/373104. PMC 4279709. PMID 25580337.

[pmid24900131-24] Kim WH, Kim DW, Kim CG, Kim MH (2013). "Additional Detection of Multiple Osteomas in a Patient with Gardner's Syndrome by Bone SPECT/CT". Nucl Med Mol Imaging. 47 (4): 297–8. doi:10.1007/s13139-013-0225-5. PMC 4035179. PMID 24900131.

[pmid17926587-25] Alexander AA, Patel AA, Odland R (2007). "Paranasal sinus osteomas and Gardner's syndrome". Ann Otol Rhinol Laryngol. 116 (9): 658–62. doi:10.1177/000348940711600906. PMID 17926587.

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@@ Line 1: / Line 1: @@
 __NOTOC__
 '''For patient information, click [[{{PAGENAME}} (patient information)|here]]'''
 <br>'''For more information about osteoid osteoma that is not associated with sino-orbital osteoma, see [[osteoid osteoma]]'''
 {{Osteoma}}
-{{CMG}}{{AE}}{{MV}}
+{{CMG}}; {{AE}}{{Rohan}}
 {{SK}} Osteoma; Osteomata; Osteoncus; Ivory osteoma; Mature osteoma; Mixed osteoma; Homoplastic osteoma; Heteroplastic osteoma; Osteomas; Ivory exostosis; Sino-orbital osteoma; Sino-nasal osteoma; Paranasal sinus osteoma; Skull vault osteoma; Mandibular osteoma
 ==Overview==
+Osteoma (also known as ''Osteomata'') is a slow growing [[benign]] [[tumor]] of [[bone]], occurring most commonly in the [[craniofacial]] skeletal structures, primarily in the [[nasal]] and [[Paranasal sinus|paranasal]] (75-90%) sinuses. Osteoma arises from [[bone]] overgrowth, which is normally composed of [[connective tissue]]. Osteomas are slow growing [[tumors]] composed of compact or mature [[trabecular bone]] limited to [[craniofacial]] [[bones]]. Osteoma may be incidentally identified as a mass in the [[skull]], [[mandible]], or as the underlying cause of [[sinusitis]] or [[mucocele]] formation within the [[paranasal sinuses]]. When they are multiple, [[Gardner's syndrome|Gardner syndrome]] should be considered. Osteoma represents the most common [[benign]] [[neoplasm]] of the [[nose]] and [[paranasal sinuses]]. The causes remain uncertain, but commonly accepted theories propose [[embryologic]], [[Trauma|traumatic]], or [[Infection|infectious]] causes. Osteomas are usually [[asymptomatic]]. [[Excision]] may be performed if osteoma is responsible for [[symptoms]].
 ==Historical Perspective==
-[Disease name] was first discovered by [name of scientist], a [nationality + occupation], in [year]/during/following [event].
-The association between [important risk factor/cause] and [disease name] was made in/during [year/event].
-In [year], [scientist] was the first to discover the association between [risk factor] and the development of [disease name].
-In [year], [gene] mutations were first implicated in the pathogenesis of [disease name].
-There have been several outbreaks of [disease name], including -----.
-In [year], [diagnostic test/therapy] was developed by [scientist] to treat/diagnose [disease name].
+*In 1898, the description of [[craniofacial]] osteoma was first reported by Paul Schulze.<ref>{{cite book | last = Peabody | first = Terrance | title = Orthopaedic oncology : primary and metastatic tumors of the skeletal system | publisher = Springer | location = Cham | year = 2014 | isbn = 9783319073224 }}</ref>
+*In 1951, Eldon J. Gardner (1909–1989) a [[geneticist]] first described the occurrence of multiple osteomas in [[hereditary]] [[familial adenomatous polyposis]] (FAP).
+*In 2014, The Lancet published an article named "''Did René Descartes have a giant [[Ethmoid sinus|ethmoidal sinus]] osteoma?''" the authenticity has been confirmed by anthropological and historical investigations to be true.<ref name="pmid25307842">{{cite journal |vauthors=Charlier P, Froesch P, Benmoussa N, Froment A, Shorto R, Huynh-Charlier I |title=Did René Descartes have a giant ethmoidal sinus osteoma? |journal=Lancet |volume=384 |issue=9951 |pages=1348 |year=2014 |pmid=25307842 |doi=10.1016/S0140-6736(14)61816-X |url=}}</ref>
 ==Classification==
-There is no established system for the classification of [disease name].
+Osteoma can be classified based on imaging findings.
-OR
-[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].
-OR
-[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3].
-[Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].
-OR
-Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.
-OR
-If the staging system involves specific and characteristic findings and features:
-According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].
-OR
-The staging of [malignancy name] is based on the [staging system].
-OR
+===Enneking (MSTS) Staging System===
+*The Enneking surgical staging system (also known as the MSTS system) for benign [[Musculoskeletal system|musculoskeletal]] [[Tumor|tumors]] based on [[radiographic]] characteristics of the [[tumor]] host margin.<ref name="pmid20333492">{{cite journal| author=Jawad MU, Scully SP| title=In brief: classifications in brief: enneking classification: benign and malignant tumors of the musculoskeletal system. | journal=Clin Orthop Relat Res | year= 2010 | volume= 468 | issue= 7 | pages= 2000-2 | pmid=20333492 | doi=10.1007/s11999-010-1315-7 | pmc=2882012 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20333492  }} </ref>
+*It is widely accepted and routinely used classification.
-There is no established system for the staging of [malignancy name].
+{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
+| valign="top" |
+|-
+! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Stages}}
+! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Description}}
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |1
+| style="padding: 5px 5px; background: #F5F5F5;" | Latent: Well demarcated borders
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |2
+| style="padding: 5px 5px; background: #F5F5F5;" | Active: Indistinct borders
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |3
+| style="padding: 5px 5px; background: #F5F5F5;" | Aggressive: Indistinct borders
+|}
 ==Pathophysiology==
-The exact pathogenesis of [disease name] is not fully understood.
+*The exact etiology of osteoma is unknown.<ref name="pmid24830123">{{cite journal |vauthors=Athwal P, Stock H |title=Osteoid osteoma: a pictorial review |journal=Conn Med |volume=78 |issue=4 |pages=233–5 |year=2014 |pmid=24830123 |doi= |url=}}</ref>
+*The possibility of a reactive mechanism, triggered by trauma or infection, has been suggested.<ref name="pmid15111819">{{cite journal| author=Bilkay U, Erdem O, Ozek C, Helvaci E, Kilic K, Ertan Y et al.| title=Benign osteoma with Gardner syndrome: review of the literature and report of a case. | journal=J Craniofac Surg | year= 2004 | volume= 15 | issue= 3 | pages= 506-9 | pmid=15111819 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15111819  }} </ref>
+*Osteoma arises from bone overgrowth, which is normally composed of [[connective tissue]].<ref name="pmid25767729">{{cite journal |vauthors=Abdel Tawab HM, Kumar V R, Tabook SM |title=Osteoma presenting as a painless solitary mastoid swelling |journal=Case Rep Otolaryngol |volume=2015 |issue= |pages=590783 |year=2015 |pmid=25767729 |pmc=4341844 |doi=10.1155/2015/590783 |url=}}</ref>
+*Osteomas are slow growing [[tumors]] composed of compact or mature [[trabecular bone]] limited to craniofacial bones.
+*Very rarely osteomas of the facial bones may be associated with Gardner's syndrome.
+*Osteomas have a particular frequency distribution within the [[paranasal sinuses]]: frontal sinuses 80%, ethmoid air cells 15%, maxillary sinuses 5% and sphenoid sinus rare.
-OR
+===Genetics===
+*The hallmark of multiple osteomas is a mutation in the [[APC]] gene, that results in the Gardner syndrome.<ref name="pmid16411234">{{cite journal| author=Bisgaard ML, Bülow S| title=Familial adenomatous polyposis (FAP): genotype correlation to FAP phenotype with osteomas and sebaceous cysts. | journal=Am J Med Genet A | year= 2006 | volume= 140 | issue= 3 | pages= 200-4 | pmid=16411234 | doi=10.1002/ajmg.a.31010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16411234  }} </ref>
-It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
-OR
-[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
-OR
-Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
-OR
-[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
-OR
-The progression to [disease name] usually involves the [molecular pathway].
-OR
-The pathophysiology of [disease/malignancy] depends on the histological subtype.
 ==Causes==
-Disease name] may be caused by [cause1], [cause2], or [cause3].
+*The cause of osteoma has not been identified.<ref name="pmid8169708">{{cite journal| author=Kaplan I, Calderon S, Buchner A| title=Peripheral osteoma of the mandible: a study of 10 new cases and analysis of the literature. | journal=J Oral Maxillofac Surg | year= 1994 | volume= 52 | issue= 5 | pages= 467-70 | pmid=8169708 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8169708  }} </ref>
-OR
-Common causes of [disease] include [cause1], [cause2], and [cause3].
-OR
-The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].
-OR
-The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click [[Pericarditis causes#Overview|here]].
 ==Differentiating ((Page name)) from Other Diseases==
-[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
+Osteoma must be differentiated from other diseases that cause sinus or facial pain, [[headache]], and changes to or loss of sense of smell, such as other osteogenic [[tumors]], [[fibrous dysplasia]], and [[chronic sinusitis]].<ref name="pmid19780030">{{cite journal |vauthors=Erdogan N, Demir U, Songu M, Ozenler NK, Uluç E, Dirim B |title=A prospective study of paranasal sinus osteomas in 1,889 cases: changing patterns of localization |journal=Laryngoscope |volume=119 |issue=12 |pages=2355–9 |year=2009 |pmid=19780030 |doi=10.1002/lary.20646 |url=}}</ref><ref name="pmid18154576">{{cite journal| author=Larrea-Oyarbide N, Valmaseda-Castellón E, Berini-Aytés L, Gay-Escoda C| title=Osteomas of the craniofacial region. Review of 106 cases. | journal=J Oral Pathol Med | year= 2008 | volume= 37 | issue= 1 | pages= 38-42 | pmid=18154576 | doi=10.1111/j.1600-0714.2007.00590.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18154576  }} </ref>
-OR
+{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center"
+| valign="top" |
-[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
+|+
+! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differential Diagnosis}}
+! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Similar Features}}
+! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Differentiating Features}}
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | [[Fibrous dysplasia]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*Benign, often an incidental finding, affects the same group of patients, and symptoms include facial pain and headache
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*In fibrous dysplasia, differentiating features include:  More common presentation is on ribs: 28%,  no gender predilection, and complete resection is usually not possible
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | [[Osteoblastoma]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*Benign, incidental, and male predilection
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*In osteoblastoma, differentiating features include:  normally affect the axial skeleton, lesions are typically larger than 2 cm, and surgical excision is often the treatment of choice
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | [[Adamantinoma|Adamantinomas]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*Benign, slow growing, and similar clinical onset
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*In adamantinomas, differentiating features include: locally aggressive tumor, common in the 3rd to 5th decades of life, and location is usually confined to the jaw
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | [[Chronic sinusitis]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*Affects same group of population (young to middle aged adults) and the clinical presentation is similar
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*In chronic sinusitis, differentiating features include:  fever, previous history of acute sinusitis, lack of facial deformation or imaging findings compatible with osteoma
+|}
 ==Epidemiology and Demographics==
-The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.
+*The prevalence of osteoma is approximately 3000 per 100,000 individuals worldwide.<ref name="pmid8248815">{{cite journal| author=Earwaker J| title=Paranasal sinus osteomas: a review of 46 cases. | journal=Skeletal Radiol | year= 1993 | volume= 22 | issue= 6 | pages= 417-23 | pmid=8248815 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8248815  }} </ref>
+*The incidence of osteoma remains unknown.
-OR
+*Patients of all age groups may develop osteoma.
+*The average patient age varies from 25 to 35 years.
-In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.
+*The mean age of the patients with osteoma is is 37 years.<ref name="pmid19780030">{{cite journal |vauthors=Erdogan N, Demir U, Songu M, Ozenler NK, Uluç E, Dirim B |title=A prospective study of paranasal sinus osteomas in 1,889 cases: changing patterns of localization |journal=Laryngoscope |volume=119 |issue=12 |pages=2355–9 |year=2009 |pmid=19780030 |doi=10.1002/lary.20646 |url=}}</ref>
+*Men are more commonly affected than women, with a 3:1 ratio.<ref name="pmid691104">{{cite journal| author=Boysen M| title=Osteomas of the paranasal sinuses. | journal=J Otolaryngol | year= 1978 | volume= 7 | issue= 4 | pages= 366-70 | pmid=691104 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=691104  }} </ref>
-OR
+*There is no racial predilection to osteoma.
-In [year], the incidence of [disease name] is approximately [number range] per 100,000 individuals with a case-fatality rate of [number range]%.
-Patients of all age groups may develop [disease name].
-OR
-The incidence of [disease name] increases with age; the median age at diagnosis is [#] years.
-OR
-[Disease name] commonly affects individuals younger than/older than [number of years] years of age.
-OR
-[Chronic disease name] is usually first diagnosed among [age group].
-OR
-[Acute disease name] commonly affects [age group].
-There is no racial predilection to [disease name].
-OR
-[Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].
-[Disease name] affects men and women equally.
-OR
-[Gender 1] are more commonly affected by [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.
-The majority of [disease name] cases are reported in [geographical region].
-OR
-[Disease name] is a common/rare disease that tends to affect [patient population 1] and [patient population 2].
 ==Risk Factors==
-There are no established risk factors for [disease name].
+There are no established risk factors for osteoma.<ref name="pmid25767729">{{cite journal |vauthors=Abdel Tawab HM, Kumar V R, Tabook SM |title=Osteoma presenting as a painless solitary mastoid swelling |journal=Case Rep Otolaryngol |volume=2015 |issue= |pages=590783 |year=2015 |pmid=25767729 |pmc=4341844 |doi=10.1155/2015/590783 |url=}}</ref>
-OR
-The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].
-OR
-Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
-OR
-Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.
 ==Screening==
-There is insufficient evidence to recommend routine screening for [disease/malignancy].
+Screening for multiple osteomas is recommended among patients with [[family history]] or/and a confirmed diagnosis of [[Gardner's syndrome|Gardner syndrome]]. [[Thyroid]] exam and annual [[ultrasound]], should be performed starting at age 10 to 12 years.<ref name="pmid24093640">{{cite journal |vauthors=Septer S, Slowik V, Morgan R, Dai H, Attard T |title=Thyroid cancer complicating familial adenomatous polyposis: mutation spectrum of at-risk individuals |journal=Hered Cancer Clin Pract |volume=11 |issue=1 |pages=13 |year=2013 |pmid=24093640 |pmc=3854022 |doi=10.1186/1897-4287-11-13 |url=}}</ref>
-OR
-According to the [guideline name], screening for [disease name] is not recommended.
-OR
-According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].
 ==Natural History, Complications, and Prognosis==
-If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
+*If left untreated, osteoma progression occurs slowly and is then followed by facial distortion.<ref name="pmid12420263">{{cite journal| author=Sayan NB, Uçok C, Karasu HA, Günhan O| title=Peripheral osteoma of the oral and maxillofacial region: a study of 35 new cases. | journal=J Oral Maxillofac Surg | year= 2002 | volume= 60 | issue= 11 | pages= 1299-301 | pmid=12420263 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12420263  }} </ref>
+*Common complications of osteoma include:<ref name="pmid17577321">{{cite journal| author=Wijn MA, Keller JJ, Giardiello FM, Brand HS| title=Oral and maxillofacial manifestations of familial adenomatous polyposis. | journal=Oral Dis | year= 2007 | volume= 13 | issue= 4 | pages= 360-5 | pmid=17577321 | doi=10.1111/j.1601-0825.2006.01293.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17577321  }} </ref>
-OR
+**[[Proptosis]]
+**Facial deformity
-Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
+**[[Airway obstruction]]
+**[[Sensory loss]]
-OR
+**[[Anosmia]]
+**[[Visual loss]]
-Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
+*Prognosis is generally excellent,the lesion does not recur after surgical [[excision]] and it is not associated with [[Malignant|malignant change]].<ref name="pmid17577321">{{cite journal| author=Wijn MA, Keller JJ, Giardiello FM, Brand HS| title=Oral and maxillofacial manifestations of familial adenomatous polyposis. | journal=Oral Dis | year= 2007 | volume= 13 | issue= 4 | pages= 360-5 | pmid=17577321 | doi=10.1111/j.1601-0825.2006.01293.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17577321  }} </ref>
 ==Diagnosis==
 ===Diagnostic Study of Choice===
-The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
+Biopsy is the diagnostic study of choice for the diagnosis of osteoma.
+*Gross appearance of osteoma include:
-OR
+**Osteomas have a spongy to densely appearance, conformed of in a polypoid and lobullated shape.[1]
+**The median size tumor size is 3.0 cm (range 0.5-8 cm).
-The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
+**Osteomas have a smooth surface and composed of dense [[compact bone]] (ivory osteoma), [[trabecular bone]] (mature osteoma, or both patterns).
+{| align="right"
-OR
+|
+[[File:Histology osteoma.jpg|200px|thumb|Histology of osteoma.[https://commons.wikimedia.org/wiki/File:Osteoma_--_high_mag.jpg Source: Case courtesy of Nephron [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)], from Wikimedia Commons]]]
-The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
+|}
+*Histological appearance includes:
-OR
+**Presence of dense compact mature bone in paucicellular fibrous stroma.
+**Large trabeculae of mature lamellar bone can be also be seen.
-There are no established criteria for the diagnosis of [disease name].
 ===History and Symptoms===
-The majority of patients with [disease name] are asymptomatic.
+*Small osteomas are asymptomatic and usually incidental findings.
+*Common symotoms of osteoma include:<ref name="pmid14933371">{{cite journal |vauthors=GARDNER EJ, PLENK HP |title=Hereditary pattern for multiple osteomas in a family group |journal=Am. J. Hum. Genet. |volume=4 |issue=1 |pages=31–6 |year=1952 |pmid=14933371 |pmc=1716387 |doi= |url=}}</ref><ref name="pmid2817682">{{cite journal| author=Smith ME, Calcaterra TC| title=Frontal sinus osteoma. | journal=Ann Otol Rhinol Laryngol | year= 1989 | volume= 98 | issue= 11 | pages= 896-900 | pmid=2817682 | doi=10.1177/000348948909801111 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2817682  }} </ref>
-OR
+**[[Headache]]
+**[[Nasal congestion]]
-The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
+**Facial [[pain]]
+**Facial [[tenderness]]
+**[[Anosmia|Loss of the sense of smell]]
 ===Physical Examination===
-Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
+{| align="right"
+|
-OR
+[[File:Xray osteoma.gif|200px|thumb|X-ray showing osteoma of the frontal sinus.[https://radiopaedia.org/cases/ivory-osteoma?lang=us Source: Case courtesy of Dr Ahmed Abdrabou, Radiopaedia.org, rID: 42250]]]
+|}
-Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
+*Patients with osteoid osteoma usually appears well.
+*Common physical examination findings of osteoid osteoma include:<ref name="pmid4207295">{{cite journal| author=Fu YS, Perzin KH| title=Non-epithelial tumors of the nasal cavity, paranasal sinuses, and nasopharynx. A clinicopathologic study. II. Osseous and fibro-osseous lesions, including osteoma, fibrous dysplasia, ossifying fibroma, osteoblastoma, giant cell tumor, and osteosarcoma. | journal=Cancer | year= 1974 | volume= 33 | issue= 5 | pages= 1289-305 | pmid=4207295 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4207295  }} </ref>
-OR
+**Facial [[tenderness]]
+**Nasal obstruction and [[discharge]]
-The presence of [finding(s)] on physical examination is diagnostic of [disease name].
+**Tapping over a [[sinus]] area produces dull sound
+**Physical deformity over [[mastoid]] or facial area
-OR
-The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
 ===Laboratory Findings===
-An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
+There are no diagnostic laboratory findings associated with osteoma.
-OR
-Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
-OR
-[Test] is usually normal among patients with [disease name].
-OR
-Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
-OR
-There are no diagnostic laboratory findings associated with [disease name].
 ===Electrocardiogram===
-There are no ECG findings associated with [disease name].
+There are no ECG findings associated with osteoma.
-OR
-An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 ===X-ray===
-There are no x-ray findings associated with [disease name].
+*Three views of affected bone or joint are recommended.<ref>{{cite book | last = Schajowicz | first = Fritz | title = Tumors and Tumorlike Lesions of Bone : Pathology, Radiology, and Treatment | publisher = Springer Berlin Heidelberg | location = Berlin, Heidelberg | year = 1994 | isbn = 9783642499562 }}</ref>
+*Radiological findings for osteoma include:
-OR
+**Well circumscribed mass
+**Varying amounts of central lucency
-An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
+**Lobulated mass occupying [[frontal]] or [[maxillary sinus]]
-OR
-There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
 ===Echocardiography or Ultrasound===
-There are no echocardiography/ultrasound  findings associated with [disease name].
+{| align="right"
+|
-OR
+[[File:CT osteoma.gif|200px|thumb|CT showing osteoma of the mandible.[https://radiopaedia.org/cases/ivory-osteoma?lang=us Source: Case courtesy of Dr Ahmed Abdrabou, Radiopaedia.org, rID: 42250]]]
+|}
-Echocardiography/ultrasound  may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
+There are no echocardiography/ultrasound  findings associated with osteoma.
-OR
-There are no echocardiography/ultrasound  findings associated with [disease name]. However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
 ===CT scan===
-There are no CT scan findings associated with [disease name].
+*CT findings of osteoma include:<ref>{{cite book | last = Schajowicz | first = Fritz | title = Tumors and Tumorlike Lesions of Bone : Pathology, Radiology, and Treatment | publisher = Springer Berlin Heidelberg | location = Berlin, Heidelberg | year = 1994 | isbn = 9783642499562 }}</ref>
+**Well-circumscribed mass of variable density
-OR
+**Ground-glass appearance
+**Exophytical mass growing out of a [[sinus]]
-[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
-OR
-There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
 ===MRI===
-There are no MRI findings associated with [disease name].
+*MRI findings of osteoma include:<ref>{{cite book | last = Schajowicz | first = Fritz | title = Tumors and Tumorlike Lesions of Bone : Pathology, Radiology, and Treatment | publisher = Springer Berlin Heidelberg | location = Berlin, Heidelberg | year = 1994 | isbn = 9783642499562 }}</ref>
+**Low signal on all sequences.
-OR
+**Mature osteomas may demonstrate some marrow signal, but are also predominantly low on all sequences
-[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
-OR
-There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
 ===Other Imaging Findings===
-There are no other imaging findings associated with [disease name].
+There are no other imaging findings associated with osteoma.
-OR
-[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 ===Other Diagnostic Studies===
-There are no other diagnostic studies associated with [disease name].
-OR
-[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
-OR
+===Nasal Endoscopy===
+Nasal endoscopy findings include:<ref name="pmid19894552">{{cite journal |vauthors=Li Y, Zhang L, Zhou B, Han D |title=[Resection of frontal ethmoid sinus osteomas with nasal endoscopy] |language=Chinese |journal=Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi |volume=23 |issue=14 |pages=628–30 |year=2009 |pmid=19894552 |doi= |url=}}</ref>
-Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].
+*Direct visualization of the nasal passages structures, and [[sinuses]].
+*Tumor location, size, and adjacent structure evaluation.
 ==Treatment==
 ===Medical Therapy===
-There is no treatment for [disease name]; the mainstay of therapy is supportive care.
+There is no medical treatment for osteoma; the mainstay of therapy is surgery.<ref name="pmid25580337">{{cite journal| author=Gorini E, Mullace M, Migliorini L, Mevio E| title=Osseous choristoma of the tongue: a review of etiopathogenesis. | journal=Case Rep Otolaryngol | year= 2014 | volume= 2014 | issue=  | pages= 373104 | pmid=25580337 | doi=10.1155/2014/373104 | pmc=4279709 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25580337  }} </ref>
-OR
-Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
-OR
-The majority of cases of [disease name] are self-limited and require only supportive care.
-OR
-[Disease name] is a medical emergency and requires prompt treatment.
-OR
-The mainstay of treatment for [disease name] is [therapy].
-OR
-The optimal therapy for [malignancy name] depends on the stage at diagnosis.
-OR
-[Therapy] is recommended among all patients who develop [disease name].
-OR
-Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
-OR
-Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
-OR
-Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
-OR
-Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
 ===Surgery===
-Surgical intervention is not recommended for the management of [disease name].
+Surgery is the mainstay of treatment for osteoma.<ref name="pmid24900131">{{cite journal| author=Kim WH, Kim DW, Kim CG, Kim MH| title=Additional Detection of Multiple Osteomas in a Patient with Gardner's Syndrome by Bone SPECT/CT. | journal=Nucl Med Mol Imaging | year= 2013 | volume= 47 | issue= 4 | pages= 297-8 | pmid=24900131 | doi=10.1007/s13139-013-0225-5 | pmc=4035179 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24900131  }} </ref><ref name="pmid17926587">{{cite journal| author=Alexander AA, Patel AA, Odland R| title=Paranasal sinus osteomas and Gardner's syndrome. | journal=Ann Otol Rhinol Laryngol | year= 2007 | volume= 116 | issue= 9 | pages= 658-62 | pmid=17926587 | doi=10.1177/000348940711600906 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17926587  }} </ref>
-OR
+'''Indication'''
+*For symptomatic lesions, local [[excision]] is performed.
-Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]
+'''Types of Surgery'''
+*Medial maxillectomy with a lateral rhinotomy
+*[[Craniofacial]] resection
+*[[Endoscopy|Endoscopic]] resection
-OR
+'''Recurrence'''
+Rare recurrence may occur after several years.
-The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].
-OR
-The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
-OR
-Surgery is the mainstay of treatment for [disease or malignancy].
 ===Primary Prevention===
-There are no established measures for the primary prevention of [disease name].
+There are no established measures for the primary prevention of osteoma.
-OR
-There are no available vaccines against [disease name].
-OR
-Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
-OR
-[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].
 ===Secondary Prevention===
-There are no established measures for the secondary prevention of [disease name].
+There are no established measures for the secondary prevention of osteoma.
-OR
-Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].
 ==References==