Subungual Exostosis of the Hand: A Case Report in a 5-Year-Old Boy and Literature Review.

Subungual exostosis is a relatively uncommon benign tumor that occurs at the distal end of the distal phalanx of the toes and rarely the hands. We present in this article a review of the currently published English literature and provide a case report of a 5 year old male with subungual exostosis of the thumb. A 5 year old male presented with a slow growing mass of the distal dorsal aspect of the left thumb. Radiographs showed dorsal calcifications on the thumb. Surgical removal of the mass and histopathological analysis was performed supporting a diagnosis of subungual exostosis. Post-operatively, the patient had complete excision of the mass, normal nail morphology, no reoccurrence, and no post-surgical complications. Subungual exostosis remains a rare entity especially in the upper extremity. Its cause is not fully understood, nor is there an agreed upon method of treatment. However, with careful dissection during surgical removal good outcomes can be obtained. To our knowledge, this is the largest literature review on subungual exostosis and our case report is an uncommon presentation in the youngest reported male patient. It is our hope that this literature review and case report lend to increased awareness of subungual exostosis and how to diagnose and treat this lesion.

Retrocalcaneal Enthesophyte Resection With Functional Lengthening of the Achilles Tendon and Buried Knot Technique: A Case Series.

Retrocalcaneal exostosis can be debilitating and in severe cases, surgical resection is indicated. Complications can arise from surgical resection of the exostosis and reattachment of the Achilles tendon, including irritation of the suture knot, recurrence of the bony prominence, and dehiscence. The use of a buried knot technique with functional lengthening of the Achilles tendon and gastroc-soleal muscle complex can minimize these complications. Complete detachment of the Achilles tendon allows for aggressive and thorough resection of the exostosis and functional lengthening with reattachment. The buried cruciate knot technique allows for firm reattachment with buried knots to prevent soft tissue irritation. A total of fourteen patients (14 limbs) underwent retrocalcaneal enthesophyte resection with functional Achilles tendon lengthening, (8/14) of which had difficultly wearing shoe gear, (10/14) had edema, and (2/14) had erythema preoperatively. Postoperatively, (11/14) of patients returned to full activities and sports, and (11/14) returned to normal shoe gear. Complications included (1/14) of patients with Achilles tendon avulsion and (3/14) of patients with surgical site dehiscence requiring revisional surgery. Overall, this technique helps prevent short-term complications and long-term recurrence due to the functional lengthening mitigating insertional forces on the Achilles tendon.

Development of Bone Exostosis Following the Use of a Free Gingival Graft: A 30-Year Case Report and Literature Review.

Bone exostosis is defined as a benign overgrowth of bone tissue of unclear origin. Rarely, bone exostosis might develop following soft tissue graft procedures like mucogingival surgical interventions (eg, FGG or subepithelial CTG). This aberration has been mainly associated with surgical trauma or fenestration of the periosteum but is still a matter of debate. The present paper (1) presents a clinical case with clinical, radiographic, and histologic findings at 30 years following application of an FGG to increase the gingival width and (2) provides a short literature review on this particular clinical condition. At the clinical examination, the FGG was firm to palpation, and the 3D images showed an area of increased radiopacity. Histologic analysis revealed localized thickening of the bone with an overlaying connective tissue covered by keratinized epithelium. The bony tissue was vital, had a convex shape, and contained many osteocytes and resting lines, demonstrating some moderate signs of bone remodeling. The connective tissue and keratinized epithelium displayed a regular thickness without any signs of inflammation. Taken together, the histologic findings failed to reveal any pathologic signs except for the presence of vital bone formed outside the bony envelope. It can be concluded that: (1) the development of a bone exostosis following a mucogingival procedure is a rare clinical sequela of uncertain etiology, and (2) surgical removal of the exostosis may be indicated accordingly with patient symptoms.

Spontaneous regression of solitary osteochondromas in children: An option to consider in clinical practice.

Osteochondromas are neoplasm that belong to the family of cartilaginous histogenesis tumors and represent 90% of all forms of exostoses. As most osteochondromas are asymptomatic, underdiagnosis is frequent. Symptomatic forms usually manifest before the age of 20 years, and the most common symptoms are pain and the detection of a bony mass. Herein, we report four cases of spontaneous regression of solitary osteochondromas in the light of literature. We consider that orthopedic surgeons should take into account the possibility of spontaneous regression of these tumors, before recommending surgery. Symptoms are usually mild and we recommend following these patients with X-ray and physical examination annually.

Subungual Exostosis on the Right Hallux.

Subungual exostosis (SE) is a benign, relatively uncommon bony growth underneath the nails of the distal phalanx of toes or fingers, with a majority on the toes. Clinically, it has two subvariants-protruded and nonprotruded growths from nail plates-which are treated differently. In this article, we report a case of protruded SE in a teenager with illustrative surgical excision. A 15-year-old boy presented with a painful growth on his right great toe of 6 months' duration. Physical examination revealed a 1-cm-diameter, solid, erythematous, rough, irregular growth penetrating through the skin along the dorsolateral nail bed of the right hallux with deformity of the lateral nail plate. Radiographs showed an elevated mass over the distal phalanx of the right lateral hallux. The mass was surgically excised and histopathologic examination confirmed the diagnosis of SE. The patient had no relapse or recurrence at follow-ups of 6 and 18 months. Subungual exostosis is a relatively uncommon bony growth in the toes. Radiography is favored for the diagnosis. Complete surgical excision is the optimal treatment, with rare recurrence. It needs to be differentiated from other bony lesions, including bizarre parosteal osteochondromatous proliferation, myositis ossificans, fibro-osseous pseudotumor, osteochondroma, and enchondroma.

Giant torus mandibularis causing submandibular duct obstruction and sialadenitis.

Torus mandibularis is a benign osseous overgrowth arising from the lingual surface of the mandible. It is a common, incidental finding on imaging due to its relatively high prevalence. In the majority of cases, mandibular tori are asymptomatic. We report a novel presentation of a giant torus mandibularis causing bilateral obstruction of the submandibular ducts and consequent sialadenitis. Our patient presented with progressive pain centered in the floor of his mouth and had bilateral submandibular glandular enlargement on exam. Computed tomography showed a giant right torus mandibularis, which was causing obstruction and dilation of the bilateral submandibular ducts. Although conservative management was attempted, he ultimately underwent surgical resection of his torus with symptomatic improvement. This patient highlights a novel complication of torus mandibularis and illustrates successful treatment. Though not previously described, this complication may be underreported and should be considered in the appropriate clinical setting.

Radiographic Description of a Bone Exostosis Lesion on the Caudal Aspect of the Proximal Tibia in Three Thoroughbred Yearlings (2014-2019).

This manuscript describes exostosis lesions originating from the caudal aspect of the proximal tibia identified in three Thoroughbred yearlings as part of the routine review of presale radiographic images. These lesions are hypothesized to be osteochondromas. The identification of bony exostoses on the proximal tibia has not been reported before in current literature. As they have not been described, the future effect on performance or soundness is unknown. Although these cases were not lame at the time of detection, the future growth of the lesion and its impact on surrounding soft tissues is unknown.

Prospective spine at risk program for prevalence of intracanal spine lesions in pediatric hereditary multiple osteochondromas.

STUDY DESIGN: Retrospective cohort study OBJECTIVES: To determine prevalence of hereditary multiple osteochondromas (HMO) and utility of MRI surveillance in a prospective Spine at Risk (SAR) program. Unidentified intraspinal exostoses in HMO can lead to neurologic injury in children during sedated procedures but no MRI guidelines exist. We sought to determine the prevalence and age of intraspinal exostoses from MRIs, and indications for MRI surveillance. METHODS: Retrospective review was performed of pediatric HMO patients who underwent total spine MRIs at a single institution after a prospective SAR program was instituted. Charts were reviewed for MRI indication and findings, symptoms, surgery, and location of other exostoses. Fisher's exact test was used to compare categorical variables and T test to compare continuous variables. Predictive value of pelvic/rib exostoses was calculated for intraspinal lesions. RESULTS: Forty-three patients with HMO underwent total spine MRIs with average age of 11.5 years. Fifteen (35%) patients had exostoses on vertebral column, eight (19%) had intra-canal spinal exostoses. Higher prevalence of spine lesions occurred in symptomatic patients than asymptomatic (any spinal lesion: 73% prevalence in symptomatic vs 22% in asymptomatic, p < 0.005; intra-canal spinal lesion: 46% vs 9%, p < 0.05). Only two of the 11 'symptomatic presentations' could be attributable to intracanal spinal exostoses. Only one intra-canal exostosis found on asymptomatic surveillance was treated surgically. Presence of pelvic or rib exostoses were not strongly predictive of intra-canal lesions (23% PPV, 85% NPV, 63% sensitivity, 51% specificity). CONCLUSIONS: Even with the presence of intra-canal exostoses, true symptomatic lesions are rare. Rib and pelvic lesions were not predictive of intra-canal lesions in our population. We recommend obtaining MRIs at time of preoperative evaluation in asymptomatic children old enough to not need sedation, or in patients with true neurologic symptoms to prevent unnecessary sedation of younger children for surveillance MRI. LEVEL OF EVIDENCE: III.

Statin Use and Knee Osteoarthritis Outcome Measures according to the Presence of Heberden Nodes: Results from the Osteoarthritis Initiative.

Background The exact contribution of statins to knee osteoarthritis (OA) radiographic outcomes and the characteristics of patients with OA as potential responders to statins remain unclear. Purpose To evaluate the effect of statin use on the incidence of radiographic knee OA (development of Kellgren-Lawrence grade ≥2) and progression of joint space narrowing (JSN) according to the nodal OA status defined according to the presence of Heberden nodes (HNs). Materials and Methods Institutional review boards approved this HIPAA-compliant protocol, and all participants gave informed consent. The Osteoarthritis Initiative (OAI) cohort, which began in 2004 and is ongoing (https://clinicaltrials.gov identifier, NCT00080171), was used to conduct a longitudinal 1:1 propensity score-matched retrospective analysis of prospectively collected data. Participants were classified as having HN-positive or HN-negative findings according to the presence of HNs at baseline physical examination. In each cohort, per-protocol and new-user design were used to match statin initiators (participants who reported ≤1 year of statin use before enrollment) and nonusers (participants who reported no statin use before enrollment) for variables that potentially contributed to confounding by indication bias. Participants were followed up annually over 8 years. Any associations between statin use and longitudinal knee OA radiographic incidence, JSN progression, or nonacceptable symptomatic state incidence was assessed by using hazard ratios (HRs) of Cox regression. Results In the longitudinal analysis, there were 832 knees of 602 participants (pair-matched knees of statin initiators and nonusers) in the HN-positive cohort (mean age, 64.7 years ± 8.0 [standard deviation]; 377 patients were female [62.6%]) and 386 knees of 285 participants in the HN-negative cohort (mean age, 58.9 years ± 8.2; 144 patients were female [50.5%]). In the HN-positive cohort, statin users had 46% lower risk of JSN progression in comparison with matched nonusers (HR, 0.54; 95% confidence interval [CI]: 0.36, 0.93; P = .02). In contrast, in the HN-negative cohort, statin use had no association with radiographic JSN progression (HR, 1.37; [95% CI: 0.74, 2.53]; P = .32). Conclusion Statin use was associated with reduced risk of radiographic knee osteoarthritis joint space narrowing progression in patients with nodal osteoarthritis. © RSNA, 2019 Online supplemental material is available for this article.

Exostose palatina bilateral em bebê / Exostosis palatina bilateral en bebé / Bilateral palatal exostosis in an infant

RESUMO Introdução: As exostoses são definidas como protuberâncias ósseas localizadas, de caráter benigno, sendo uma rara patologia em bebês. Objetivo: Relatar um caso de exostose palatina bilateral em um bebê melanoderma do sexo feminino de 1 ano e 4 meses de idade. Relato de caso: A criança compareceu a Clínica Escola de Odontopediatria, acompanhada de sua mãe, para avaliação odontológica. Durante a anamnese, o responsável queixou-se de atraso na irrupção dos dentes decíduos e presença de protuberância na arcada superior, sem sintomatologia dolorosa. Foi relatado que três membros da família também apresentavam essa mesma alteração na maxila ou mandíbula, possivelmente sugerindo um componente genético. Ao exame clínico intrabucal, verificou-se um aumento de volume ósseo bilateral plano localizado na maxila, na região lingual das tuberosidades palatinas, recoberto por mucosa bucal normal. A superfície era rígida à palpação e com bordas claramente definidas. O componente genético foi associado ao aspecto clínico da lesão, bem como o sexo e a etnia. O diagnóstico estabelecido foi exostose palatina bilateral. A biópsia e o tratamento ativo para remoção da patologia não se justificaram devido à pouca idade da criança, ausência de sintomatologia dolorosa e de interferências na alimentação, deglutição ou outra função bucal. A paciente foi acompanhada periodicamente e apresentou sequência de irrupção dos dentes decíduos normal. Conclusão: Embora a exostose palatina apresente baixa prevalência em crianças, é importante que o cirurgião-dentista tenha conhecimento para realizar seu correto diagnóstico e plano de tratamento(AU)

RESUMEN Introducción: Las exostosis son definidas como bultos óseos, de carácter benigno, y contituyen una infrecuente afección en bebés. Objetivo: Describir un caso de exostosis palatina bilateral en un bebé melanoderma del sexo femenino de 1 año y 4 meses de edad. Presentación del caso: La niña acudió a la Clínica Escuela de Odontopediatría, con su madre, para evaluación odontológica. Durante la anamnesis, la madre refiere retraso en la erupcíon de los dientes deciduos, además de la presencia de bultos en la arcada superior, sin dolores sintomáticos. Fue informado que tres familiares también presentaban la misma alteración en la maxila o mandíbula, posiblemente sugiriendo componente genético. El examen clínico intrabucal, verificó un aumento de volumen óseo bilateral plano ubicado en la maxila, en la región lingual de las tuberosidades palatinas, recubierto por una mucosa bucal normal. La superficie era rígida a la palpación y con bordes bien definidos. El componente genético fue asociado al aspecto clínico de la lesión, al igual que el sexo y la etnia. El diagnóstico establecido fue exostosis palatina bilateral. La biopsia y el tratamiento activo para la remoción de la afección no se pudieron justificar por la poca edad de la niña, ausencia de dolores sintomáticos, además de interferencias en la alimentación, deglución u otra función bucal. La paciente fue controlada periódicamente y presentó secuencia de irrupción de dientes deciduos normal. Conclusiones: Aunque la exostosis palatina sea infrecuente en niños, es importante que el cirujano dentista tenga conocimiento para realizar el correcto diagnóstico y el plan de tratamiento(AU)

ABSTRACT Introduction: Exostoses are localized bony lumps of a benign nature. They are an infrequent condition in infants. Objective: Present a case of bilateral palatal exostosis in a dark-skinned female infant aged one year and four months. Case presentation: The girl was brought by her mother to the Children's Dental Clinic for oral examination. During anamnesis, the mother referred to delay in the eruption of deciduous teeth and the presence of lumps on the upper arch without any painful symptom. She also reported that three relatives had the same alteration in their maxilla or mandible. Oral examination revealed a bilateral flat bony lump in the maxilla, in the lingual region of the palatal tuberosities, covered by normal oral mucosa. The surface was stiff to palpation with well defined borders. The genetic factor was associated to the clinical aspect of the lesion, as well as the sex and ethnicity of the patient. The diagnosis was bilateral palatal exostosis. Biopsy and active treatment for removal of the lesion were not justified due to the patient's age, absence of painful symptoms, and potential interference with feeding, swallowing and other oral functions. The patient was periodically followed-up and was observed to present a normal process of deciduous tooth eruption. Conclusions: Even though palatal exostosis is infrequent in children, it is important for dental surgeons to be knowledgeable about the topic so as to reach an appropriate diagnosis and treatment plan(AU)

Subungual exostosis in an 8-year-old child: clinical and dermoscopic description.

We report the case of an 8-year-old child with subungual exostosis, whose diagnosis was suspected on the basis of dermoscopic findings and subsequently confirmed by X-ray and histopathology.

Subungual exostosis in an 8-year-old child: clinical and dermoscopic description

Abstract We report the case of an 8-year-old child with subungual exostosis, whose diagnosis was suspected on the basis of dermoscopic findings and subsequently confirmed by X-ray and histopathology.

Bennett lesions in overhead athletes and associated shoulder abnormalities on MRI.

OBJECTIVE: To determine if a Bennett lesion and its size are associated with additional MRI shoulder abnormalities in an overhead athlete. MATERIALS AND METHODS: An IRB-approved retrospective review of our database from 1 January 2012 to 1 April 2018 identified 35 overhead athletes with a Bennett lesion on MRI. A control group consisting of 35 overhead athletes without a Bennett lesion were matched for age, level of play (professional vs non-professional), and type of study (arthrogram vs non-arthrogram). Each study was assessed independently by two MSK fellowship trained radiologists. The sizes of the Bennett lesions were measured. Each MRI was assessed for the presence of a labral tear, posterior glenoid cartilage abnormality, humeral head notching or cysts, and fraying or tear of the supraspinatus or infraspinatus tendons. Statistical analyses were performed using Student's t test, Fisher's exact test, and Chi-squared test. RESULTS: There was an increased incidence of posterior glenoid cartilage abnormalities in athletes with Bennett lesions vs those without (23% vs 3%, p value = 0.01). There was no difference in any other MRI abnormalities, including labral tears and findings of internal impingement between these two groups (p value range = 0.09-0.46). There was no association between the size of a Bennett lesion and the presence of glenoid cartilage lesions, labral tears, internal impingement, age, professional status, or need for surgery (p value range = 0.08-0.96). CONCLUSION: Symptomatic overhead athletes with Bennett lesions have an increased frequency of posterior glenoid cartilage abnormalities, but not labral tears or findings of internal impingement compared to those without Bennett lesions.