Exostosis of the jaw

Exostosis of the jaw is a benign outgrowth that has the appearance of a bony cartilaginous protrusion similar to an osteophyte. Such overgrowths can be single or numerous, with localization in the area of the jawbone. Their appearance is rarely accompanied by pain syndrome, but as the growths increase, discomfort increases: it becomes more difficult to chew food, speech suffers, there are problems with treatment and prosthetic teeth, etc. Such growths can only be removed surgically. [1], [2]

Epidemiology

Exostosis of the jaw is most often formed at a young age before skeletal growth is complete, including in childhood. The overgrowth may occur on the cheek or lingual side of the jaw.

Exostosis of the jaw may look like a protrusion, ridge, or tubercle. Sometimes its configuration is more flamboyant and unusual. In all cases of such neoplasms, it is necessary to consult not only a dentist, but also other specialists, including oncologists and orthodontists.

In young children, the probability of exostosis formation may be associated with violation of recommendations for the prevention of rickets, with excessive vitamin D intake. After puberty, exostosis of the jaw may regress in some cases.

Causes of the exostosis of the jaw

The exact reasons for the formation of exostoses of the jaw have not been determined. Factors such as these play a role in the appearance of problematic protrusions:

• genetic predisposition;
• recurrent inflammatory processes, purulent inflammation, atrophic diseases, which are accompanied by changes in bone and nearby soft tissue;
• traumatic injuries of the dentoalveolar apparatus, violations of the integrity of the bones of the facial part of the skull, improper fusion of bone elements;
• complex tooth extirpation;
• dental and bite irregularities;
• congenital jaw defects;
• endocrine disruption.

Risk factors

Factors that can increase the risk of osteochondroma:

• ionizing radiation (up to 10% of exostoses are detected in patients who have previously undergone radiation therapy);
• Endocrine disorders, hormone treatments and hormone imbalances;
• alcoholism, smoking (including by a pregnant woman).

In many cases, exostosis of the jaw is an inherited condition. An acquired problem may result from:

• facial and jaw trauma;
• microtraumas that occur on a regular basis;
• infectious inflammatory processes;
• microcirculatory disorders in soft tissue;
• muscular dystrophy;
• severe allergic processes.

Improperly placed dental implants and crowns increase the risk of jaw exostosis.

Pathogenesis

The exact pathogenetic mechanism of exostosis of the jaw is still unknown. In most patients, the neoplasm forms in one or two jaws after tooth extirpation, mechanical damage, or due to hormonal or age-related shift of the alveolar ridge. [3]

In some patients with partial or absolute adentia, symmetrically located exostoses of the jaw in the region of the lower small molars are identified.

The main and most likely pathogenetic components of jaw exostosis formation:

• Non-smoothing of the well margins when performing traumatic tooth extraction with the formation of bony spicules;
• jaw injuries, inadequately joined fragments of damaged jawbone, long-standing jaw fractures for which the patient did not seek medical attention.

Peripheral growths can occur due to osteogenic processes of dysplasia.

Symptoms of the exostosis of the jaw

Exostosis of the jaw is felt by the patient himself as a bulge, an outgrowth that has arisen for no apparent reason. [4] Among the main symptoms:

• the feeling of a foreign body in the mouth;
• discomfort during eating, talking (which is especially true for exostoses of large size);
• an unpleasant sensation when pressing on the growth;
• pallor, redness, thinning of the mucosa in the area of the pathologic focus.

Exostosis of the mandible occurs on the inner side (closer to the tongue).

Exostosis of the maxilla forms predominantly on the outer (cheek) side of the alveolar ridge.

There is also exostosis of the palate - this is called bony palatine torus.

Outgrowths of small size are detected during a dental examination, since the pathology does not have vivid symptomatology.

Complications and consequences

Small neoplasms of the jaw do not pose any serious danger. As for large exostoses, they can exert pressure on the teeth and the dentition as a whole and on individual bone structures as they grow larger. This, in turn, is fraught with displacement of teeth, bite disorders, and distortion of the jaw bones. [5]

Large neoplasms create obstacles to tongue movements, impair diction, and make it difficult to chew food.

Often patients with exostosis of the jaw feel incomplete, which adversely affects their psycho-emotional state.

Malignancy of such growths is not observed, although some experts allow a certain proportion of risk (less than 1%) with regular damage to the neoplasm.

Diagnostics of the exostosis of the jaw

Detection and identification of exostosis of the jaw is usually not difficult. The doctor can make a diagnosis based on the patient's complaints, anamnestic information and the results of dental examination. To clarify the nature and size of the pathology, radiography in two projections is prescribed.

If the pathology is detected in childhood or adolescence, the child should be tested for endocrine diseases, hormonal failures. It is also necessary to check the blood for the quality of coagulation.

Instrumental diagnosis, in addition to radiography, may include:

• a CT scan;
• MRI.

Differential diagnosis

Differential diagnosis is mainly performed to distinguish exostosis of the jaw from other benign and malignant neoplasms. The main method used in this area is biopsy - removal of a particle of pathological growth for further histological analysis.

Treatment of the exostosis of the jaw

You should not rely on the exostosis of the jaw to disappear on its own. The best solution is to remove the neoplasm to prevent its enlargement and the associated development of complications. [6]

Mandatory removal of the exostosis of the jaw is indicated:

• when the bulge is growing rapidly;
• in the formation of a neoplasm after tooth extirpation;
• in case of pain, persistent discomfort;
• in the appearance of aesthetic defects in the face and jaw area;
• If there are problems with implants, dental treatment and prosthetics;
• if there's a risk of malignant growths.

Meanwhile, the removal procedure may be contraindicated in some patients:

• if there are endocrine or cardiac pathologies in decompensated state;
• if your blood clotting is impaired;
• if any malignant tumors are diagnosed, regardless of the localization;
• if the patient has active tuberculosis;
• if there are signs of severe osteoporosis.

Temporary contraindications may include:

• during pregnancy;
• active acute inflammatory lesions of the gums and teeth;
• acute periods of cardiovascular pathologies and infectious-inflammatory processes.

The actual procedure of surgical removal of exostosis of the jaw is relatively uncomplicated. It is performed under local anesthesia. The gingiva is cut in the area of the pathologic protrusion, peel off the mucosal periosteal flap, remove the growth, grind, and then return the tissue flap to its original place. The wound is sutured. The standard duration of the intervention is about 60-90 minutes. [7]

In addition to conventional surgical excision, it is often practiced to remove exostosis of the jaw by laser, piezo-scalpel. Such operations differ only in the fact that instead of standard instruments in the form of a scalpel and a bur, the neoplasm is excised with the help of a laser beam or a piezo knife. If during the intervention the surgeon discovers a deficit of bone material, the formed cavity is filled with bone-plastic mass, after which the wound is sutured in the usual way.

After removal of gingival exostosis, the patient is allowed to eat soft and warm food only 3 hours after the procedure. Soft grated food should be consumed for a week, then the diet is gradually returned to the preoperative version.

It is important for 7-8 days not to touch the site of the postoperative wound (no toothbrush, no fingers, no tongue), do not smoke or drink alcohol, do not lift weights and do not engage in active sports.

If the doctor prescribes treatment of the postoperative suture, mouth rinses, taking medications, then all recommendations should be followed without fail. This is necessary for the fastest and trouble-free recovery of tissues.

Prevention

It is possible to prevent the development of exostosis of the jaw:

• regular and thorough dental and oral hygiene;
• regular visits to doctors for dental checkups (every 6 months);
• timely treatment of teeth and gums, orthodontic correction of the dentition;
• avoiding maxillofacial trauma.

Doctors recommend paying special attention to self-diagnosis: periodically and carefully examine the oral cavity and teeth, record the appearance of suspicious signs, gently palpate the jaw surfaces and palate area. If the first pathological symptoms are detected, it is important to visit a dentist in a timely manner.

Forecast

In most cases, patients suffering from exostoses of the jaw are voiced a favorable prognosis. Pathological growths usually do not have a tendency to malignancy, but it is still strongly recommended to remove them, because as they grow, they create problems for performing various dental procedures and manipulations, prevent normal chewing of food and speech activity.

If it is possible to establish and eliminate the immediate cause of the growths, as well as timely remove the gingival exostosis, then there are no recurrences: the patient can install dentures, crowns without any obstacles.

Literature

• Kulakov, A. A. Surgical stomatology and maxillofacial surgery / Edited by A. A. Kulakov, T. G. Robustova, A. I. Nerobeev - Moscow : GEOTAR-Media, 2010. - 928 с
• Kabanova, S.L. Fundamentals of maxillofacial surgery. Purulent-inflammatory diseases: textbook; in 2 vol. / S.A. Kabanova. A.K. Pogotsky. A.A. Kabanova, T.N. Chernina, A.N. Minina. Vitebsk, VSMU, 2011, vol. 2. -330с.