Subungual Osteochondroma of the Great Toe: A Case Report.

Bony outgrowths of the distal phalanx of the great toe have been described in the literature but rarely. These subungual bony outgrowths can be caused by subungual exostosis or subungual osteochondromas. Both of these abnormalities are bony outgrowths with differences in the cartilage cap wherein the exostoses have fibrocartilage, and osteochondromas have hyaline cartilage. The subungual exostosis and osteochondroma that are protruding present symptoms of pain, redness, and deformed nail bed, whereas the nonprotruding osteochondromas have only a lump as the presenting symptom. In both conditions, excision of the lesion and curettage of the base helps prevent a recurrence. Curettage at the end of the excision of the bony outgrowth is required to avoid recurrence. After excision, the specimen should be sent for histopathologic examination to differentiate between the exostosis and osteochondromas, which are underreported in subungual locations, and to rule out malignant transformation. We present a 13-year-old girl with an isolated subungual nonprotruding exostosis of the great toe that was treated by excisional biopsy. The histopathologic examination confirmed it as osteochondroma, which is underreported.

Ankle Muscle Strength and Gait Function After Dorsal Closing Wedge Calcaneal Osteotomy for Haglund Exostosis-Related Heel Pain.

BACKGROUND: Haglund exostosis-related heel pain may be surgically treated with dorsal closing wedge calcaneal osteotomy (DCWCO). Recent reports on this technique show good clinical and self-reported outcomes. However, uncertainty about functional consequences related to ankle muscle strength and gait function due to a shortened Achilles tendon lever arm exists. METHODS: Fifteen patients (15 feet) with Haglund exostosis-related heel pain were surgically treated with DCWCO and evaluated before and 1 year after surgery. Isometric plantar flexion and dorsiflexion strength was quantified for both the involved and the uninvolved limb. Gait analysis was performed at a self-selected walking speed using a 3D motion capture system including force plates. Self-reported outcomes (Foot Function Index and Global Treatment Outcome) were also assessed. RESULTS: Before surgery, as well as after surgery, plantar flexion strength of the involved limb was significantly lower compared to the uninvolved limb while dorsiflexion strength did not differ between limbs at both time points. Step length and time, ankle flexion angles, power generation, and propulsive impulses during gait did not differ between limbs both before and after surgery. Propulsive impulse and step length of the involved limb increased from pre- to postsurgery with an effect size of 1.04 and 0.48, respectively, revealing a general improvement in gait dynamics. Total Foot Function Index improved by 48% after surgery, and 80% of patients rated their surgery as "helped" or "helped a lot" (Global Treatment Outcome). CONCLUSION: In this relatively small cohort, we found that patients treated for Haglund exostosis-related heel pain with DCWCO surgery had minor interlimb differences in gait kinematics and kinetics and generally improved gait dynamics and self-reported function at 1-year follow-up. LEVEL OF EVIDENCE: Level II, observational prospective cohort study.

Surgical and conservative treatment outcomes of medication-related osteonecrosis of the jaw located at tori: a retrospective study.

PURPOSE: Tori and exostoses are considered risk factors for the development of medication-related osteonecrosis of the jaw (MRONJ). The aims of this study were to present the prevalence of MRONJ located at tori in the Copenhagen ONJ Cohort, evaluate the surgical treatment of MRONJ located at tori and explore trauma to tori as an additional risk factor in patients on antiresorptive medication. METHODS: Data from a consecutive series of 506 patients with MRONJ (Copenhagen ONJ Cohort) were reviewed for the presence of tori and MRONJ located at tori. Demographic and medical data were analyzed, and healing outcomes and pain after the prophylactic removal of tori, surgical treatment of MRONJ located at tori, and conservative treatment of MRONJ located at tori were evaluated and compared using Fisher's exact test. RESULTS: MRONJ located at tori was frequent and could be identified in 53% of the patients with tori, which accounts for a prevalence of 5.1% in the entire cohort. Of the 28 surgically treated patients, 27 (96.4%) healed uneventfully with no exposed bone after their first or second revision surgery. Fourteen (41.2%) patients with tori underwent therapeutic removal, eight (23.5%) underwent prophylactic removal, and six (17.6%) underwent both therapeutic and prophylactic removals. Two (33.3%) of the six conservatively treated patients healed spontaneously. Both treatment types resulted in a significant decrease in pain. CONCLUSION: Prophylactic and therapeutic surgical removal of tori are reliable treatments and should be considered if a patient's general health allows surgery. TRIAL REGISTRATION: The study was approved by the Regional Scientific Ethical Committee (H-6-2013-010) on November 20, 2013, and was retrospectively registered.

Aspectos clínicos e tomográficos de exostose mandibular extensa e o seu manejo para melhora na qualidade de vida: relato de um caso incomum na literatura / Clinical and tomographic aspects of extensive mandibular exostoses and their management to improve quality of life: report of an unusual case in the literature / Aspectos clínicos y tomográficos de excisis mandibular extensa y su manejo para mejora en la calidad de vida: relato de un caso inusual en la literatura

O tórus mandibular é considerado uma protuberância óssea (exostose) de etiologia desconhecida classificada como não-patológica, comumente vista em região lingual dos incisivos até pré-molares inferiores. Sua característica histopatológica é semelhante ao osso normal descrevendo-se osso cortical lamelar com a presença de canais de Havers, osteócitos normais e áreas dispersas de tecido conjuntivo. Normalmente se apresentam bilateralmente e indolores. Sem causar prejuízo na vida da pessoa que apresenta esta condição, devido estes aspectos, na maioria dos casos, não há intervenção cirúrgica, sendo o caso apenas acompanhado clinicamente. Neste caso apresentado, o objetivo é expor uma condição extrema desta exostose mandibular, tendo como finalidade a melhora na qualidade de vida do paciente(AU)

The mandibular torus is considered a bone protuberance (exostosis) of unknown etiology classified as non-pathological, commonly seen in the lingual region from the mandibular incisors to premolars. Its histopathological characteristic is similar to normal bone constituting lamellar cortical bone with the presence of Haversian channels, normal osteocytes and scattered areas of tissue containing connective tissue. They usually present bilaterally and painless. Without causing damage to the life of the person who shows this condition, due to these aspects, in most cases, there is no surgical intervention, being the case only followed clinically. In this case, the aim is to expose an extreme condition of this mandibular exostosis, with the purpose of improving the quality of life of the patient(AU)

El tórus mandibular se considera una protuberancia ósea (exostosis) de etiología desconocida clasificada como no patológica, comúnmente vista en región lingual de los incisivos hasta pre-molares inferiores. Su característica histopatológica es similar al hueso normal constituyéndose por hueso cortical lamelar con la presencia de canales de Havers, osteocitos normales y áreas dispersas de tejido que contiene tejido conectivo. Normalmente se presentan bilateralmente e indolores. Sin causar daño en la vida de la persona que presenta esta condición, debido a estos aspectos, en la mayoría de los casos, no hay intervención quirúrgica, siendo el caso sólo acompañado clínicamente. En este caso presentado, el objetivo es exponer una condición extrema de esta excisose mandibular, teniendo como finalidad la mejora en la calidad de vida del paciente(AU)

Torus palatinus / Torus Palatinus

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Osteocondroma del radio. Presentación de un caso / Osteochondroma of the radio. Presentation of a case

Se presenta un paciente portador de un osteocondroma localizado en la metafisis del radio izquierdo, diagnosticado por estudios radiográficos y anatomopatológicos, en el Hospital Universitario Celia Sánchez Manduley de Manzanillo, provincia Granma. Se realiza intervención quirúrgica con exéresis del tumor. La evolución clínica del paciente fue satisfactoria. El objetivo del presente trabajo fue realizar una revisión de la entidad y señalar la importancia de su conocimiento para establecer el diagnóstico correcto y la toma de decisiones terapéuticas adecuadas y oportunas(AU)

We present a patient with an osteochondroma located in the metaphysis of the left radius, diagnosed by radiographic and anatomopathological studies, at the Celia Sánchez Manduley University Hospital of Manzanillo, Granma province. Surgical intervention isperformed with excision of the tumor. The clinical evolution of the patient was satisfactory. The objective of the present work was to conduct a review of the entity and indicate the importance of their knowledge to establish the correct diagnosis and the appropriate and timel y therapeutic decisions(EU)

Síndrome de Haglund. A propósito de 2 casos / Haglund's syndrome. Two case reports

El síndrome de Haglund es una causa de atrapamiento tendino-bursal posterior del talón, producida por una exostosis posterosuperior del calcáneo, denominada deformidad de Haglund, asociada a tendinitis aquílea y bursitis retrocalcánea. Su patogenia es desconocida. Se presentan 2 casos, diagnosticados clínicamente, confirmados radiológicamente, y tratados conservadoramente uno y con cirugía el otro. El diagnóstico se realiza por la clínica y por las imágenes radiológicas con el método de medición de las líneas de inclinación paralelas, en una radiografía lateral del tobillo. El tratamiento inicial suele ser conservador e incluye antiinflamatorios o analgésicos, fisioterapia y zapatos con talón abierto y sin tacón alto. Si el tratamiento conservador no alivia el dolor, puede ser necesaria la cirugía (AU)

Haglund's syndrome produces posterior impingement of the heel, which is caused by a posterosuperior calcaneal exostosis, known as Haglund's deformity, associated with Achilles tendinitis and retrocalcaneal bursitis. Its pathogenesis is unknown. We report two cases that were diagnosed clinically and confirmed radiographically. One patient was treated conservatively and the other underwent surgery. The diagnosis is based on clinical signs and radiological images, using the measurement of the parallel pitch lines, in a lateral radiograph of the ankle. Initial treatment is usually conservative and includes anti-inflammatory or analgesic agents, physiotherapy and low-heeled, open-heeled shoes. If conservative treatment does not relieve the pain, surgery may be necessary (AU)

Utilização de exostose óssea associada com biomaterial em cirurgia de levantamento do soalho do seio maxilar / Use of bone exostosis associated with biomaterial in maxillary sinus floor elevation

Exostoses ósseas são crescimentos ósseos benignos do esqueleto craniofacial, que ocorrem ao longo da região vestibular, lingual (tórus mandibular) ou palatina (tórus palatino) dos maxilares. A presença dessas estruturas pode interferir na fonação, mastigação e adaptação de próteses parciais removíveis ou totais, devendo sua remoção ser sempre considerada. Além disso, a remoção e aproveitamento de tais estruturas deve ser considerada, também, nos casos de atrofia do rebordo alveolar, quando o objetivo é a reabilitação por meio de implantes dentários. Sendo assim, o objetivo do presente trabalho é relatar o caso clínico de uma paciente que apresentava um tórus palatino e necessitava de cirurgia para levantamento do soalho do seio maxilar, para posterior colocação de implante; o tórus foi removido e aproveitado em associação com biomaterial heterógeno...

Bone exostosis refers to benign bone growth in the craniofacial skeleton. They occur along the labial, lingual (mandibular torus) or palatal (palatal torus) regions of the jaws. The presence of these structures can affect phonation, chewing and adaptation to partial or completely removable dental prostheses. The removal of these structures should always be considered. In addition, the removal and use of these structures should also be considered in cases of atrophy of the alveolar ridge, when seeking to promote rehabilitation through the use of dental implants. Therefore, the aim of the present study was to report a clinical case in which a patient exhibited a palatal torus and required surgery for maxillary sinus floor lifting and subsequent implant placement. The palatal torus was removed and used in association with heterogeneous biomaterial...

Hemotórax traumático causado por exostosis costal solitaria / Traumatic Hemothorax Caused by Solitary Costal Exostosis

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Utilização de placa de silicone após tratamento cirúrgico de torus palatino: relato de caso / Use of Silicon Plaque After Surgery Treatment of Torus Palatino: Case Report

O torus palatino é uma alteração de desenvolvimento, resultante de um crescimento ósseo (exostose) e está localizado na linha média do palato duro. A patogênese ainda não está definida, podendo estar associado à origem genética, a fatores ambientais e/ou as características raciais, apresentando maior prevalência no sexo feminino. Clinicamente, o toro palatino é assintomático e de pequenas dimensões, mas pode aumentar lentamente de tamanho ao longo da vida, causando queixas ao paciente. A remoção cirúrgica está indicada quando há intervenção nas funções de fonação, mastigação, deglutição, trauma recorrente e para correção de deformidades ósseas que impeçam a adaptação de próteses. Este trabalho visa relatar o uso de uma placa de silicone confeccionada a partir da cirurgia de modelo pré-operatória para tratamento cirúrgico de um torus palatino com finalidade protética... (AU)

The palatal torus is a development change, a result of bone growth (exostosis) and is located in the midline of the hard palate. The pathogenesis is not yet defined, may be associated with genetic, environmental factors and / or racial characteristics, with higher prevalence in females. Clinically, palatal torus is small and asymptomatic, but can slowly increase in size throughout life causing patient complaints. Surgical removal is indicated when there is intervention in the function of speech, chewing, swallowing, and repeated trauma to correct bone deformities that prevent denture fitting. This article describes the use of a silicon plate made from the surgery preoperative model for surgical treatment of torus palatal prosthetic purposes... (AU)

Exposición espontánea de un torus palatino de la línea media / Spontaneous exposition of a midline palatal torus

Introducción. El torus , o rodete, palatino es una alteración ósea benigna que puede generar molestias en la fonación y en la deglución. Cuando su crecimiento o exposición persistente producen síntomas molestos, debe ser resecado quirúrgicamente. Presentación del caso. Se trata de una paciente de 82 años de edad, que consultó por una lesión ulcerativa de un año de evolución, que producía dolor, halitosis y molestia a la deglución. En el examen físico de la cavidad oral, se observó una prominencia de consistencia dura en la línea media, con perforación y ulceración de la mucosa palatina en su porción lateral posterior izquierda. Se consideraron los diagnósticos de torus palatino, osteoma, granuloma piógeno y neoplasia de tejidos blandos. Se decidió resecarla quirúrgicamente y hacer el estudio histopatológico. La evolución clínica fue satisfactoria, con resolución completa un mes después de la cirugía. En el estudio de histopatología se observó hiperostosis ósea con inflamación crónica de los tejidos blandos e hiperplasia simple de la mucosa, que corresponden a un torus palatino. Discusión. Se reporta un inusual caso de exposición espontánea de un torus palatino que ocupaba casi toda la bóveda palatina, se describe su resección quirúrgica y se informan los hallazgos de histopatología. En la revisión bibliográfica realizada, no se encontró un reporte previo de exposición espontánea de torus palatino.

Introduction: Palatal torus, or torus palatinus, is a benign bone alteration that may cause some discomfort during phonation or swallowing. When its growth or persistent exposition produces unpleasant symptoms, it must be surgically removed. Case presentation: We treated an 82-year-old female patient who consulted for a painful ulcerous lesion she had had for a year and which produced halitosis and discomfort when swallowing. During the oral cavity physical exam we observed a hard protuberance on the midline. It showed a perforation and ulceration of the lateral posterior palatal mucosa on the left side. We considered the following diagnosis: palatal torus, osteoma, pyogenic granuloma, or a soft-tissue neoplasia. We decided to surgically remove it and to perform a histopathological examination. Clinical evolution was satisfactory with complete resolution one month after surgery. The histopathological examination showed hyperostosis along with chronic inflammation of the soft tissues and a simple hyperplasia of the mucosa, which in turn indicated a palatal torus. Discussion: We report an unusual case of spontaneous exposition of a palatal torus which took up almost all of the hard palate area. Its resection is described and we inform the histopathological findings. In the literature review, we did not find a previous report of a spontaneous exposition of a palatal torus.

Torus mandibulares y palatinos en pacientes atendidos en la Policlínica Pedro Díaz Coello / Torus Palatinus and Torus Mandibularis in Patients A ttended at Pedro Diaz Coello P olyclinic

Introducción : los torus son exóstosis óseas benignas que ocurren en el paladar duro y en la parte lingual de la mandíbula. Muchas veces los pacientes que presentan estas exóstosis lo desconocen.Objetivo : determinar la presencia de los torus mandibulares y palatinos en la población atendida en la Policlínic a Pedro Díaz Coello.Método : se realizó un estudio de serie de casos en el periodo comprendido entre septiembre de ,2010, y marzo de ,2011, El universo fue de ,132, pacientes y la muestra aleatoria quedó constituida por ,48, de ellos . Los datos fueron recogidos de las historias clínicas , con los requerimientos éticos establecidos. Resultados : predominó la edad de 35 - 59 años con el 54,17 por ciento. El sexo femenino comprendió el 75 por ciento de los casos . Los torus en el paladar representaron el 50 por ciento y el 87,5 por ciento presentaron torus lobulados . La necesidad de tratamiento fue del 60,42 por ciento . Conclusiones : se observó un predominio de los torus palatinos aunque se necesitan estudios más amplios para determinar la presencia real de esta afección y su epidemiología en la población en general(AU)

I ntroduction : torus is benign bone exostosis that occurs in the hard palate and in t he lingual part of the jaw, which is unknown for many patients that suffer from it.Objective: to determine the present torus palatinus and torus mandibularis in patients attended at Dental Department of Pedro Diaz Coello poly clinic.Methods : a s eries of case s study from September ,2010, to March ,2011, was carried out. The universe comprise d ,132, patients and the s ample ,48, of them . The data were collected in clinical records which were made at the time of patients' arrival to the poly clinic. The results were analyzed and presented in tables. Results : the predominant age group was from ,35, to ,59, years old, representing ,54.17 percent,Females had the highest incidence representing ,75 percent, Torus in the palate had an incidence of ,50 percent, whereas ,87 percent, of patients had lobular torus. The need of treatment reached ,60.42 percent, of patients. Conclusions: t here was a predominance of torus in the palate although larger studiesare needed to determine the actual presence of this disease and its epidemiology in the general population(AU)

Exostosis tibial: osteocondroma / Tibial exostoses: osteochondroma

El osteocondroma o exostosis cartilaginosa es el tumor óseo más frecuente, representando el 10-15% de la totalidad. Alrededor del 3% de la población lo padece. Es un tumor propio de individuos jóvenes con ligero predominio en varones. Puede ser solitario o múltiple, formando parte del síndrome de exostosis múltiple hereditaria. Suele ser un hallazgo accidental, normalmente asintomático, cuya localización más frecuente es la rodilla, aunque puede aparecer en otras localizaciones. El diagnóstico se realiza por imagen radiográfica, que suele ser patognomónica, y el tratamiento definitivo consiste en la extirpación quirúrgica (AU)

Osteochondroma, also known as osteocartilaginous exostoses, is the most common bonetumor, representing 10-15% of them. According to research, around 3% of the population suffers from this disease. This tumor is common among young people and it has a small predominance in males. Its radiologic features are often pathognomonic. Osteochondromas can be either solitary or multiple. They are connected with hereditary multiple exostoses. And usually reveal themselves as incidental, mostly located in knees. Surgical excision is the definitive treatment for this pathology (AU)

Tumoración verrugosa y dolorosa subungueal / Subungueal verrucous and painful tumor

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Quiste de inclusión epidérmica secundario a cirugía interdigital / No disponible

Se presenta el caso de una paciente de 46 años deedad, que acude a consulta por presentar tumefaccióndolorosa en la zona interna del quinto dedo,cuarto espacio interdigital. La paciente refiere que hasido intervenida hace 3 meses de exostosis interdigital.La exploración revela crecimiento quístico, que requierede intervención quirúrgica para su extirpación.Se sospecha que pueda ser un quiste secundarioa la inclusión de material óseo que no fue correctamenteeliminado de la zona. El estudio anatomo-patológicorevela que es un quiste de inclusión epidérmico,resultado de la invasión de material epidérmicodentro de la dermis(AU)

The case of a 46 year-old patient is presented. Shepresents an interdigital swelling, in the medial sideof fifth toe. The exploration reveals cystic growththat requires a surgical intervention for itsextirpation. It is suspected that it can be a secondarycyst to the inclusion of bony material that was notcorrectly eliminated of the area. The anatomicpathologicalstudy reveals that it is an inclusionepidermic cyst, results of the invasion of epidermiccells inside the dermis(AU)

Tratamiento quirúrgico de las exóstosis de conducto auditivo externo / Surgical treatment of exostosis in the external auditory canal

Las exóstosis de conducto auditivo externo (CAE) son formaciones óseas benignas muy frecuentes entre los practicantes de deportes acuáticos. Generalmente cursa de forma asintomática. Cuando la estenosis del conducto se hace más severa comienzan los síntomas que generalmente son taponamiento del conducto por acumulación de cera, otitis externa e hipoacusia de transmisión. En la mayoría de los casos estos síntomas se resuelven con aspirado y limpieza del oído así como gotas óticas con antibiótico para las infecciones. Sólo en los casos más severos donde los síntomas no pueden resolverse de manera conservadora o en los que la estenosis del CAE es casi completa se recurre al tratamiento quirúrgico. En el presente trabajo revisamos los 45 pacientes, 52 oídos, que se han intervenido en nuestro Servicio en los últimos 13 años. Describimos la técnica y los resultados obtenidos

Exostoses of the external auditory canal are benign bony tumours very common in individuals who frequently participate in aquatic activities. Although most of the cases are asymptomatic, patients with more severe exostoses have recurrent episodes of external otitis and related conductive hearing loss. In the great majority of these cases, a medical treatment (aspiration and antibiotic drops) resolves the symptoms. Patients with more severe canal stenosis, resistant to medical treatment, are candidates for surgical removal of the exostoses. This report reviews our surgical experience with 45 patients, 52 ears, who have undergone surgical removal of exostoses in our Institution during the last 13 years. We describe the technique that we use a well as the results that we achieve

Cirugía en la exostosis periungueal. A propósito de un caso clínico / Surgery in periungual. A report on a clinical case

Las exostosis suelen aparecer en cualquier hueso de origen cartilaginoso. Por lo general las exostosis digitales se manifiestan en forma de lesiones subungueales, pero no exclusivamente así. El término de sobra conocido como exostosis subungueal puede modificarse en virtud de la naturaleza de la lesión. En algunos casos, la tumoración no es subungueal; no se encuentra bajo la uña ni crea alteración de la misma. Las lesiones pueden apareceren la región periungueal sin gran alteración de la uña en sí. Es precisamente a este grupo, en el que se basa este artículo. Aunque en un principio el temapodría parecer demasiado abordado, creo que al visualizar el alcance que puede llegar a tener esta lesión (en particular este caso clínico) puede llamarla atención

Exostosis usually appear in any bone of cartilage origin. The digital exostosis generally become apparent in the form of subungual lesions, but not exclusively so. The well known term exostosis subungual can be modified in virtue of the nature of the lesion. In some cases the tumoration is not subungual; it is not found under the nail nor does it cause it any alteration. The lesions can appear inthe periungual region without any great change in the nail. It is precisely this group on which this articleis based. Although at first glance the subject might seem over treated, I believe that by visualizing the extension that this lesion can reach (this clinical case in particular) it is worth the attention