osteoma is a benign osteogenic lesion , which was first described as a specific entity by jaffe in 1935 .
in the course of their slow but steady increase in size , osteomas of the maxillofacial bones remain asymptomatic until they attain sufficient sizes as to cause disfigurement and/or direct interference with the normal function of their anatomic location .
osteomas are bone lesions with different onset and slow growth that may be divided into : ( 1 ) cranial and mandibular exophytic osteomas ( or eburnean exostoses ) ; ( 2 ) paranasal sinuses , facial bones , and orbit osteomas ( orbital cavity osteoma ) ; ( 3 ) exostoses or bone islands ; and ( 4 ) long bone superficial osteomas ( juxtacortical ) .
the etiology seems to be unknown ; however , it may be developmental , infectious , or of traumatic origin .
solitary osteomas of the facial skeleton are quite rare , although multiple osteomas of the jaws have been reported as part of gardner 's syndrome .
little information is available about the gender predilection ; however , some authors suggest that there is a higher incidence of osteomas in male , especially in between second and fourth decade of life .
a 45-year - old male patient was referred to the department of periodontics , krishnadevaraya college of dental sciences and hospital , bangalore , for the evaluation and treatment of a palatal bony swelling [ figures 1 and 2 ] .
patient complained of a slow growing , painless mass in the left palatal maxillary area , which was present since six months .
he also gave a history of foreign body ( fish bone ) lodgement in 25 and 26 region seven months ago ; however , no treatment was taken for the same .
he was systemically healthy with no relevant medical history , and was asymptomatic except for the discomfort in that region and difficulty with mastication .
on oral examination , a firm , lobulated , painless , well - circumscribed , exophytic , mass 1.51 cm in diameter was observed on the maxillary posterior left palatal area in relation to 25 and 26 regions .
periodontal probing revealed a 9 millimeter deep periodontal pocket associated with the mid palatal area of 26 which prompted us to intervene and surgically excise the bony mass .
clinically , the tooth was firm and not associated with any mobility [ figure 3 ] .
bony lesion on palate nine millimeter pocket depth a region of well defined opacity was seen in the palatal regions of 25 and 26 [ figure 4 ] , when seen on a maxillary occlusal radiograph .
the radio - opacity showed a well defined medial convex margin ; laterally , the margins were indistinct with rest of the structures .
region of well defined radio - opacity in the region of 25 and 26 under local anesthesia , buccal and palatal flaps were raised , giving crevicular incisions in 24 , 25 , and 26 regions [ figures 5 and 6 ] .
a second vertical incision was placed on the distal of the first premolar and a full thickness flap was raised to allow for adequate exposure of the surgical site .
the bony mass was excised with the help of a kirkland chisel which has one end that is a back - action chisel and the other end is a straight chisel [ figures 7 and 8 ] .
care was taken to excise the lesion keeping a periphery of healthy tissue around the lesion .
the straight end of the kirkland chisel was used to refine the bone margin of the surgical site and to round off any sharp edges .
thorough scaling and root planing coupled with removal of the granulation tissue followed by irrigation of the surgical site with saline were performed .
margins of the flap were trimmed to achieve good approximation and the flap was sutured with black silk sutures [ figure 9 ] .
the specimen was put in a bottle containing 10% formalin solution and sent for histopathological examination .
the healing was uneventful , and the sutures were removed after 10 days [ figure 10 ] .
the case was followed - up for a period of one year , and there was no sign of recurrence [ figures 11 and 12 ] .
sulcular incision given flap raised using vertical incision excision of bony lesion with kirkland chisel section showed parakeratinized stratified squamous epithelium ; sub epithelially a rim of normal connective tissue was seen around the rete ridges .
deeper connective tissue showed plump mesenchymal cells with prominent nuclei leading to formation of bony trabeculae .
the lesional tissue showed numerous delicately arranged trabeculae with the osteocytes , but was devoid of osteoblastic rimming .
the inter - trabecular tissue showed marrow spaces pre - dominantly made up of adipose tissue , presence of few arterioles and capillaries [ figures 13 and 14 ] .
histopathologically , the lesion was diagnosed as peripheral ( mature ) osteoma , which is also referred to as  ivory osteoma  .
( b ) adipose cells ( a ) parakeratinized stratified squamous epithelium ( b ) connective tissue
a region of well defined opacity was seen in the palatal regions of 25 and 26 [ figure 4 ] , when seen on a maxillary occlusal radiograph .
the radio - opacity showed a well defined medial convex margin ; laterally , the margins were indistinct with rest of the structures .
under local anesthesia , buccal and palatal flaps were raised , giving crevicular incisions in 24 , 25 , and 26 regions [ figures 5 and 6 ] .
a second vertical incision was placed on the distal of the first premolar and a full thickness flap was raised to allow for adequate exposure of the surgical site .
the bony mass was excised with the help of a kirkland chisel which has one end that is a back - action chisel and the other end is a straight chisel [ figures 7 and 8 ] .
care was taken to excise the lesion keeping a periphery of healthy tissue around the lesion .
the straight end of the kirkland chisel was used to refine the bone margin of the surgical site and to round off any sharp edges .
thorough scaling and root planing coupled with removal of the granulation tissue followed by irrigation of the surgical site with saline were performed .
margins of the flap were trimmed to achieve good approximation and the flap was sutured with black silk sutures [ figure 9 ] .
the specimen was put in a bottle containing 10% formalin solution and sent for histopathological examination .
the healing was uneventful , and the sutures were removed after 10 days [ figure 10 ] .
the case was followed - up for a period of one year , and there was no sign of recurrence [ figures 11 and 12 ] .
section showed parakeratinized stratified squamous epithelium ; sub epithelially a rim of normal connective tissue was seen around the rete ridges .
deeper connective tissue showed plump mesenchymal cells with prominent nuclei leading to formation of bony trabeculae .
the lesional tissue showed numerous delicately arranged trabeculae with the osteocytes , but was devoid of osteoblastic rimming .
the inter - trabecular tissue showed marrow spaces pre - dominantly made up of adipose tissue , presence of few arterioles and capillaries [ figures 13 and 14 ] .
histopathologically , the lesion was diagnosed as peripheral ( mature ) osteoma , which is also referred to as  ivory osteoma  .
( a ) trabeculae with osteocytes ( b ) adipose cells ( a ) parakeratinized stratified squamous epithelium ( b ) connective tissue
in gnathic bones , osteoma can appear in bone 's surface , as mushroom - like masses pedunculated or sessile ( periosteum osteoma ) , or located in medullary space ( endosteum osteoma ) .
these lesions are usually asymptomatic , but may proliferate in medullary bone ( endosteal ) or on the bone surface as a polypoid or sessile mass ( periosteal ) .
reactive bone growth from infection , trauma , or vascular malformation may produce lesions simulating an osteoma .
these lesions may arise at any age but with a distinct predilection for elderly adults and they are twice more common in male than in female . as a pathologic entity , osteoma is difficult to differentiate radiographically from other lesions with pronounced ossifications .
exostosis , which is the term generally applied for well demarcated and extremely opaque bony lesion , osteosclerosis and similar alterations of the bone are always discussed alongside osteomas .
the other differential diagnosis include enostosis , cementoma , complex odontome , fibrous dysplasia , osteochondroma , paget 's disease , peripheral ossifying fibroma , a reactive focal lesion ; periosteal osteoblastoma , osteoid osteoma , and paraosteal osteosarcoma that present as painful masses of rapid growth.[79 ] though the exact etiology is not known , it may be suggested , in this case that trauma from foreign body lodgment as afore mentioned might have been the trigger for this proliferative response .
osteomas are slow growing benign osteogenic lesions arising from the proliferation of either cancellous or compact bone . they are usually asymptomatic and have a low recurrence rate . simple excision of the lesion in its entirety is the treatment of choice in symptomatic lesions .
the association of osteoma with gardner 's syndrome must always be kept in mind before deciding the treatment plan .
 osteomas are benign slow growing , osteogenic lesions which may arise from proliferation of either cancellous or compact bone . 
 they are usually sessile tumours composed of dense sclerotic , well formed bone projecting out from the cortical surface , most often of the skull and facial bones . 
 this paper reports a case of a peripheral osteoma in the hard palate of a 45-year - old man , which was treated by periodontal flap surgery with surgical excision of the bony lesion . 
 peripheral osteomas of jaw bone are uncommon and usually associated with gardner 's syndrome . 
 histological examination confirmed the clinical impression of a peripheral osteoma . 
 patient was reviewed after one year and was asymptomatic with no recurrence of the lesion . 
INTRODUCTION
CASE REPORT
Radiographic examination
Surgical procedure
Histopathology
DISCUSSION
CONCLUSION