osteoma is a benign osteogenic tumor arising from the proliferation of the cancellous or compact  ivory osteoma  bone
. it can be central osteoma arising from the endosteum , peripheral osteoma ( po ) arising from the periosteum or extra - skeletal soft tissue osteoma that usually develops within the muscle .
these occur frequently in the sinuses , most common in the frontal sinus , followed by the ethmoidal and maxillary sinus .
most cases of po appear to have a very slow growth rate , are asymptomatic and produce swelling and asymmetry .
its pathogenesis is unclear ; some believe it to be a true neoplasm while others classify it as a developmental anomaly .
association between maxillofacial osteomas , cutaneous sebaceous cysts , multiple supernumerary teeth and colorectal polyposis has also been reported ( gardner 's syndrome ) .
a 50-year - old female patient reported with a chief complaint of swelling in the anterior region of the upper jaw , present since 10 years .
history revealed that the swelling initially started as a peanut size and had gradually increased to the present size .
the patient gave a past history of trauma to the upper jaw 15 years back during a road accident .
she was given some drugs ( patient was unaware of this ) and , within 1 week , she was asymptomatic .
after 4 years , she observed an asymptomatic peanut - sized swelling in the same region of the jaw , which has been slowly increasing in size .
extraoral examination revealed a diffuse swelling measuring about 1 cm  1 cm in the midline below the nose , with slight obliteration of the left nasolabial fold [ figure 1 ] .
facial view showing the extraoral diffuse swelling intraoral examination revealed a well - circumscribed swelling of about 2 cm  2 cm on the alveolar process obliterating the labial vestibule in the 11 - 22 region .
on palpation , the swelling was non - tender , bony hard ( non - compressible ) , non - fluctuant and non - pulsatile .
the pulp vitality test confirmed all the anterior teeth ( 13 , 12 , 11 , 21 , 22 , 23 ) to be vital .
the intra - oral periapical radiograph revealed a well - demarcated radio - opaque mass superimposing the roots of 21 and 22 , clearly demarcated from the surrounding normal bone .
based on the clinical and radiological findings , a provisional differential diagnosis of peripheral ossifying fibroma , osteoma and maxillary torus was made .
intraoral photograph revealing the extension and appearance of the swelling the lesion was excised under local anesthesia .
the gross specimen was bony hard , round in shape and measured about 2 cm  2 cm .
the superficial surface appeared pale and smooth whereas the cut surface was rough [ figure 3 ] .
the tissue was fixed in 10% neutral buffered formalin , decalcified in 5% formic acid and was routinely processed .
gross surgical specimen showing the superficial and cut surfaces the decalcified section was stained with hematoxylin and eosin , which revealed surface epithelium overlying the stromal tissue , consisting of lamellar bone and adipose tissue in the lamina propria and submucosa .
the lamina propria consisted of multiple trabeculae of mature lamellar bone with a variable amount of fibro - fatty marrow tissue [ figures 4 and 5 ] .
large and small trabeculae of lamellar bone were seen extending into the submucosa , suggestive of cancellous bone . based on these histopathologic features , a diagnosis of peripheral cancellous osteoma was made .
photomicrograph showing stratified squamous epithelium overlying the stroma consisting of trabeculae of mature lamellar bone ( hematoxylin and eosin , original magnification 4 ) photomicrograph showing trabeculae of mature lamellar bone with a variable amount of fibro - fatty marrow tissue ( hematoxylin and eosin , original magnification 40 )
osteoma is a rare benign tumor characterized by excessive and persistent proliferation of the bone .
it may arise from proliferation of the medullary bone ( endosteal ) or on the bone surface as a polypoid or sessile growth ( periosteal ) . depending on the location
the size of the tumor may cause facial deformity . in the maxillofacial region , these tumors are mainly located on the skull .
po occurs most frequently in the sinuses , of which the frontal sinus is the most common site , followed by ethmoidal and maxillary sinuses .
po has also been described in the external auditory canal and , rarely , in the temporal bone and pteygoid plate .
the most common affected sites are angle and lower border of the body of the mandible , the sites most susceptible to trauma .
there is a 3:1 female predilection , but different authors have reported both female and male predilection in case series of osteomas of the maxillofacial region .
to best of our knowledge , and apart from osteomas located in the maxillary sinuses , there are only 10 cases of maxillary osteomas previously described in the english language literature [ table 1],[11114 ] of which complete clinical data of five cases is not available .
their age ranged from 16 to 76 years , with a mean age of 45.5 years .
the mean age range of the patients with osteoma in the maxillofacial region has been reported to be 29.4 and 40.5 years .
various hypotheses have been put forward , which include congenital and hereditary disorder , a developmental origin , neoplastic or a reactive mechanism to trauma or infection .
location of po of the jaws is usually in close proximity to the area of muscle attachment , suggesting that muscle traction may also play an important role in its development . the combination of trauma and muscle traction has also been suggested in the pathogenesis of po .
differential diagnosis includes exostosis , but these tend to stop growing after puberty ; periosteal osteoblastoma , osteoid osteoma and paraosteal osteosarcoma usually present as a rapidly growing painful swelling .
summary of clinical data of maxillary osteomas previously published in the english language literature , including the present case surgical removal of po is not generally necessary unless and until there are symptoms like facial asymmetry or other secondary problems .
the present case of po was seen in a 50-year - old female patient with swelling in the anterior region of the upper jaw that was present since 10 years following a history of trauma .
the swelling was solitary , sessile , slow growing , non - tender , non - compressible , non - fluctuant and non - pulsatile .
the lesion was surgically excised , histopathological examination revealed the presence of a surface - stratified squamous non - keratinized epithelium overlying the stromal tissue , consisting of lamellar bone and adipose tissue . the stromal tissue consisted of multiple trabeculae of
medullary spaces consist of fibro - fatty marrow tissue with endothelial - lined blood vessels .
the patient has been asymptomatic , with no evidence of recurrence since 2 years after surgery .
the possibility of po should be kept in mind as a differential diagnosis for any peripheral , solitary , bony hard , slowly growing painless swelling encountered in the oral and maxillofacial region .
to best of our knowledge this is the eleventh case of maxillary osteoma reported in the english language literature . although the exact etiology and pathogenesis of this type of lesion is unclear , additional molecular and genetic research is required to improve the understanding .
 osteoma is a benign osteogenic lesion with a very slow growth , characterized by proliferation of either cancellous or compact bone . 
 depending on its location , osteoma may be classified as central , peripheral or extraskeletal type . 
 although peripheral osteomas of the upper jaw are rare , diagnosticians can however encounter them in their clinical practice , which are probably misdiagnosed . 
 these should be considered in the differential diagnosis of any slow - growing , non - tender , bony hard , non - compressible , non - fluctuant and non - pulsatile swelling present on the oral and maxillofacial region . 
 we report a rare case of maxillary peripheral osteoma in a 50-year - old female patient . 
 to best of our knowledge this is the eleventh case of maxillary osteoma reported in the english language literature . 
Introduction
Case Report
Discussion
Conclusion