GS Monica et al. Buccal Exostosis  

   

4   HECS International Journal of Community Health and Medical Research |Vol. 4|Issue 3| July- Sept 2018

Harsukh Educational Charitable Society International Journal of Community Health and Medical Research

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Case Report BUCCAL EXOSTOSIS - A RARE ENTITY

Monica GS1, Veerpal Brar1, Anand Ajey1, Rakesh Kumar Verma1, Ankit Sidana1, .M.S.M. BIIR2

1Post Graduate Student, 2Professor, Department Of Periodontology And Oral Implantology Maharaja Ganga Singh Dental College And Research Centre, Sriganganagar, Rajasthan

ABSTRACT Buccal exostosis is broad-based, non-malignant surface growth occurring on the outer or facial surface of the maxilla and/or mandible, found usually in the premolar and molar region. It begins to develop in early adulthood and may very slowly enlarge over the years. A 24-year-old female presented with gingival enlargement on the buccal aspect of both the quadrants of the mandibular arch, which was painless, self limiting, increase patient concern about poor esthetics, inability to perform oral hygiene procedures, and compromised periodontal health by causing food lodgment. The bony enlargement was treated with resective osseous surgery. The following paper presents a rare case of the bilateral mandibular buccal exostosis and its successful management.

Keywords: Exostosis, Bony Overgrowth, Resective Osseous Surgery ,Bony Protuberance Corresponding Author: Dr. Monica GS, Post Graduate Student, Department Of Periodontology And Oral Implantology Maharaja Ganga Singh Dental College And Research Centre, Sriganganagar, Rajasthan, India. This article may be cited as: Monica GS, Brar V, Ajey A, Verma RK, Sidana A, .BIIR MSM. Buccal Exostosis - A Rare Entity . HECS Int J Comm Health Med Res 2018; 4(3):4-6

NTRODUCTION An exostosis is a localized, peripheral bony overgrowth of benign nature with unknown etiology.As per some studies says that racial- autosomal dominant factor, dental attrition and even nutritional factor have been suggested as having

an influence1. These benign growths affect both the jaws. Maxilla is shown to exhibit the highest prevalence rate of 5.1:1 in comparison to mandible with a male population afflicted more than females with the ratio of 1.66:1 2 Based upon the anatomic location,the exostosis are named as torus palatines (TP), torus mandibularis (TM) or buccal bone exostosis (BBE). TP is a sessile, nodular bony mass commonly seen on the midline of the hard palate. TM is bony protuberance found on the lingual aspect of the mandible, in the canine and premolar region. Buccal and palatal exostoses are multiple bony nodular masses found less frequently than tori.3,4 An exostosis usually doesn’t require any treatment, but for those possibly affecting the periodontal condition, or when the protruberances cause pain or discomfort to the patient, or when these bony enlargements cause pseudo swelling over the lip, then conservative surgical excision can be performed. The treatment procedure can be carried out with the help of carbide and diamond bur , chisel,rongeurs,Ochsenbein chisels ,back action chisels & inter-proximal files. Currently the piezoelectric surgical instruments has been used successfully in osseous resective surgery.5 The case report presented below illustrates the anterior

bilateral mandibular buccal exostosis and its successful management with the help of resective osseous surgery using carbide bur.

CASE REPORT

A 39-year-old female patient reported to the Department of Periodontology & Oral Implantology, Maharaja Ganga Singh dental college and Research Centre,Sri Ganganagar, Rajasthan, with the chief complaint of bulge in the mandible anterior region for the past one year[figure 1]. Patient noticed the bulge about one year back, which is slowly and steadily increasing in size . History of present illness revealed no pain or discomfort present as well as no trauma to the involved area and also the adjacent teeth were vital. Further, there was no history of sensitivity. Patient was conscious of difficulty in speech,chewing and swallowing.The patient’s medical and dental history further confirmed that the enlargement was familial in nature. There was no history of medication,alcohol and tobacco use.Further,there was no known drug allergy. Physical examination of the oral cavity revealed large, bilateral overgrowths located on the buccal aspect of the mandible anterior region. The lesions were bony-hard on palpation. The overlying mucosa was thin and blanched, and generalized moderate gingivitis with minimal bone loss was present. The exostoses were oblong in shape, measuring

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approximately 3 cm ×4 cm on the right side and 3 cm × 4 cm on the left side.There was mild inflammation in the right side of the mandible area & probing depths were upto to 4mm. Treatment consisted of oral hygiene instructions and motivation, mechanical debridement and periodontal resective osseous surgery with the help of diamond bur with the following steps [figure 2,3,4]. To handle the multitude of clinical situations,the following sequential steps are followed in resective osseous surgery, Vertical grooving,Radicular blending,Flattening interproximal bone,Gradualizing marginal bone. Not all steps are necessary in every case,but the sequencing of the steps in the order given is necessary to expendite the reshaping procedure,as well as to minimize the removal of bone. Chlorhexidine gluconate mouth rinse 0.12% twice daily was prescribed as a bacteriostatic dose. Uneventful healing led to a satisfied patient with improvements in chewing, speech and swallowing.

Figure 1 : Pre- Operative Picture

Figure 2: Bony Mass Seen After Flap Reflection

Figure 3: Performing Resective Osseous Surgery By Diamond Bur

Figure 4: sutures placed

DISCUSSION

Buccal exostosis is found only on the facial surface of the alveolar bone, usually maxillary alveolous.Buccal surface involvement, however typically in the mandible has been an unusual occurrence. Basha and Dutt et al reported a rare case of buccal exostosis at the angle of the mandible. In this present case, the exostosis is present in mandibular anteriors bilaterally which is rare entity6. The gingiva showed no abnormality in clinical features other than an apparent increase in the size in that area and Chandna S et al reported the similar findings7. It was difficult to find out the etiology of exostosis based on patient’s dental and medical history. The provisional diagnosis of a buccal exostosis in this case was done based on clinical and radiographic findings as was carried out by same was reported by Poswal R et al8. Exostosis should be differentiated from compact osteoma,cancellous osteoma ,osteocondroma, organized sub periosteal hematoma, mature ossifying fibroma (expanding cortical lamina ),periosteal osteosarcoma or condrosarcoma. Osteomas are benign,developmental neoplasms, which induce proliferation of dense,compact or coarse,cancellous bone usually in an endosteal or periosteal location.Neither the torus nor the bony exostosis require treatment unless it becomes large enough to interfere with function,denture placement,causes recurring traumatic surface ulceration ( usually from sharp food)9. The bony mass may be removed by using bone cutting bur or chiseled off through the base of the lesion.In this present study the bony mass was excised with the help of diamond bur along with saline irrigation as performed by Medsinge S V et al10.

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CONCLUSION

The case report presented above illustrates a unique and rare presentation of exostosis on the buccal aspect of the mandible anterior region, bilaterally. A proper diagnosis was made and the bony mass was successfully removed and without any untoward complications was accomplished. REFERENCE 1)Stafne EC,Gibilisco JA.Oral roentgenographic diagnosis.4th ed.philadelphia:WBSaunders company:1975.p.89-91 2)Jainkittivong A,Langlais R.Buccal and palatal exostoses:prevalence and concurrence with tori.Oral Surg Oral Med Oral Pathol Oral Radio Endod2000;90:48-53 3) Neville BW, Damm DD, Allen CM, Bouquot JE, (Editors). Oral and Maxillofacial Pathology, Philadelphia: WB Saunders Co.; 1995. p. 17-20. 4) Antoniades DZ, Belazi M, Papanayiotou P. Concurrence of torus palatinus with palatal and buccal exostoses: Case report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;85(5):552-7. 5)Carnevale G,Kaldahl WB:Osseous Resective Surgery,J Periodontal 22:59-87,2000. 6)Basha S,Dutt SC.Buccal-sided mandibular angle exostosis :a rare case repot.Contemp Clin Dent 2011;2:237-239 7) Chandna, et al.: Bilateral maxillary buccal exostosis. Jisp.2015;19( 3):352-355. 8)Rani A,Poswal R.Rare case of buccal exostosis in edentulous mandibular body region .j orofac Res 2015;5(2):65-67 9) Shafer WG, Hine MK, Levy BM. Textbook of Oral Pathology. 4th ed. Philadelphia: WB Saunders; 1983. p. 2�85. 10) Medsinge SV, Kohad R, Budhiraja H, Singh A, Gurha S, Sharma A. Buccal exostosis: A rare entity. J Int Oral Health 2015;7(5):62-64

Source of support: Nil Conflict of interest: None declared

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