osteoma is a slow growing benign lesion which is characterized by proliferation of cancellous or compact bone .
multiple osteomas are mainly associated with gardner 's syndrome while solitary osteomas can be further classified as peripheral , central or extra skeletal depending on the origin .
clinically , osteomas are mostly asymptomatic , bony hard tumors which may result in progressive facial asymmetry or malocclusion .
i hereby present a case of maxillary compact peripheral osteoma leading to gross facial asymmetry .
examination revealed a bony hard lesion on the right side of the face in the right maxillary region about 6.3  6.3 cm [ figure 1 ] .
intra - oral examination revealed a circumscribed lesion extending from the right maxillary incisors to the right maxillary second molar region .
there was normal overlying mucosa and right permanent canine was missing [ figure 2 ] .
all the involved teeth were sent to endodontist for pulp vitality and were found vital .
cone - beam computed tomography ( ct ) showed the lesion involving part of the right maxillary alveolar process , anterior wall of maxillary sinus , infraorbital rim and the right piriform rim measuring 63  63  65 mm .
the right canine is seen in the center of the lesion with a well - defined hypodense tract seen extending 25 mm inferiorly from canine to alveolar process [ figures 3 and 4 ] .
osteoma of unusual size involving right maxilla cone - beam computed tomography showing size and extent of lesion cone - beam computed tomography showing impacted canine a differential diagnosis of an ossifying fibroma or osteoma was made and a biopsy confirmed the diagnosis .
the histopathology report was that of a cortico cancellous osteoma . as the patient had no obstruction to his breathing , it was decided to surgically remove the protruding part of the lesion , that is in the region of maxilla , alveolar process , piriform rim , infraorbital rim , canine and tract extending from canine to alveolar process was removed .
intraoperatively , the facially protruding part of the lesion was removed and the involved teeth were spared .
postoperative healing was uneventful with no sensory deficit and the involved teeth were not devitalized .
macroscopically , the lesion consisted of a homogenous bony appearance measuring 5  5.5  4.5 cm .
microscopically it consisted of dense compact bone with no evidence of inflammation or malignancy and also no features of fibro - osseous proliferation .
some lesions likely to present as true neoplasm of bone , other lesion may be alteration of bone as a response to trauma or infection , although their etiology is unclear .
patients presenting with peripheral osteomas and supernumerary or impacted teeth should be investigated for gardner 's syndrome .
the triad of polyposis coli , skeletal abnormalities , such as peripheral and endosteal osteomas , and multiple impacted or supernumerary teeth is consistent with this syndrome . for osteomas imaging by conventional radiograph
can be achieved for diagnostic purpose but ct scan and 3d reconstruction makes it possible to achieve a better resolution and precise localization .
surgery is indicated only when the lesion is symptomatic , actively growing , or for cosmetic reasons .
 osteoma is a benign osteogenic lesion with a very slow growth , characterized by proliferation of either compact or cancellous bone . 
 most cases of peripheral osteomas are asymptomatic and produce swelling and asymmetry . 
 its pathogenesis is unclear but commonly accepted theories propose embryologic , traumatic , or infectious causes . 
 the osteoma may appear in the form of a limited peripheral lesion involving the alveoli or cheek or as a tumoral growth developing inward toward the sinus . 
 recurrences of osteomas have not been reported in the literature . 
 we report a rare case of maxillary peripheral osteoma with impacted right canine in a 32-year - old female patient . 
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