Giant osteoid osteoma of mandible in a 24-year-old female: a case report

Abstract

Background: Osteoid osteoma is a benign osteoblastic neoplasm characterized by the production of osteoid and immature bone within a highly vascularized, osteogenic connective tissue stroma. This lesion predominantly occurs in individuals during their second and third decades of life, with a male-to-female predilection ratio of 2:1 to 3:1. This report presents an uncommon case of a giant osteoid osteoma involving the mandibular ramus managed via complete intraoral surgical excision.

Case presentation: A 24-year-old female of Persian ethnicity presented with a 12-month history of a slowly progressive mass involving the right mandibular ascending ramus and coronoid process. The patient reported a 7-month history of intermittent pain and swelling in the right preauricular region, facial area, and submandibular region. The associated pain exhibited marked alleviation following nonsteroidal anti-inflammatory drug administration. Clinical evaluation, radiographic findings, and physical examination strongly suggested a benign lesion; therefore, surgical intervention was performed via an intraoral approach for complete excisional removal. Intraoperatively, an irregular, solid soft tissue mass measuring 3 × 2 × 0.8 cm was successfully resected in its entirety. Histopathological analysis demonstrated thick trabeculae embedded within a vascular connective tissue stroma, accompanied by scattered chronic inflammatory infiltrates and prominent blood vessels surrounding the nidus. The lesion exhibited multiple nidi with heterogeneous architecture, including a sclerotic network of bone trabeculae. These findings confirmed the diagnosis of osteoid osteoma.

Conclusion: In this case, a rare giant osteoid osteoma was effectively excised using an intraoral approach, resulting in significant improvement in both facial swelling and mouth opening, with no major postoperative complications.

Keywords: Bone; Case Report; Mandible; Neoplasms; Osteoma.

Fig. 1

The initial panoramic radiography (A). The maximum mouth opening of the patient at the first appointment (B)

Fig. 2

The MRI T1 (A) and T2 (B) axial of the lesion (axial, coronal sections)

Fig. 3

Spiral CT scan of the lesion: axial (A), coronal (B), and sagittal (C) sections

Fig. 4

Intraoperative view of the lesion

Fig. 5

The gross view of lesion after excision

Fig. 6

Photomicrograph showing compact lamellar bone with incomplete Haversian canals and small bone marrow spaces (A), along with well-defined capsule-like borders and sclerotic borders (B) (hematoxylin and eosin (H&E) stain, ×100)

Fig. 7

The maximum mouth opening in the follow-up session (A), The panoramic radiography at 12 month post-operation (B)