Osteomas are benign growths of bone that often appear on the skull and facial bones. Most osteomas are discovered incidentally during medical imaging for unrelated issues, meaning they are present but not causing any symptoms. Understanding the nature of this bony growth, its typical progression, and when intervention is necessary is helpful for anyone newly diagnosed with an osteoma.
What Exactly Is an Osteoma
An osteoma is a non-cancerous growth composed of mature bone tissue that typically forms on the surface of an existing bone. These growths are classified as benign tumors, meaning they do not spread to other parts of the body or pose a risk of becoming malignant. The exact cause of osteomas remains unknown, though theories suggest they may develop in response to trauma, infection, or genetic factors.
Osteomas are most frequently found in the bones of the skull and face, including the paranasal sinuses and the jawbone. They are generally slow-growing, varying in size from a few millimeters to several centimeters. Healthcare providers categorize them into two main types based on structure: compact osteomas (dense and solid) and cancellous (spongy) osteomas (more porous).
The Natural Progression of Osteomas
The central question is whether an osteoma will resolve spontaneously, and generally, the answer is no. Since an osteoma is composed of mature bone tissue, it is a solid, stable structure that does not typically regress or disappear once formed. These growths are usually static or exhibit very slow growth over many years, which is why many individuals remain unaware of their presence.
The standard protocol for an osteoma that is not causing symptoms is conservative management, known as “watchful waiting.” This approach involves regular monitoring with imaging studies, such as CT scans, to track the lesion’s size and assess changes over time. This monitoring confirms the slow or static nature of the growth and ensures it is not impinging on nearby sensitive structures.
A distinction must be made regarding a related but different lesion called an osteoid osteoma, which occurs in the long bones of the body and can cause pain. Unlike the osteoma of the skull and facial bones, an osteoid osteoma has been occasionally documented to spontaneously regress over time, sometimes aided by anti-inflammatory medication. However, this spontaneous resolution is not the expected course for the classic osteoma.
When and Why Treatment Is Necessary
Since osteomas rarely disappear on their own, intervention is only considered when the growth begins to cause problems. The decision to treat is based on the development of symptoms or significant cosmetic concerns. The location of the osteoma dictates the type of symptoms that may arise.
For example, an osteoma growing in a paranasal sinus can obstruct drainage pathways, leading to chronic sinus infections, pressure, and headaches. If the growth is near the eye socket, it can cause the eye to protrude (proptosis) or lead to vision disturbances by compressing the optic nerve. Osteomas on the outer surface of the skull, particularly the forehead, often prompt treatment due to the noticeable cosmetic impact of the hard, visible lump.
The primary treatment for a symptomatic osteoma is surgical excision, which involves physically removing the bony growth. The choice of surgical technique depends heavily on the osteoma’s location and size.
Small to medium-sized osteomas in the sinuses can often be removed using minimally invasive endoscopic techniques, where instruments are passed through the nasal passages. This approach offers benefits like no external incisions, reduced recovery time, and minimal disfigurement. For larger or more complex osteomas, or those situated in difficult-to-reach areas, a traditional open surgical approach may be necessary to ensure complete removal. Recovery following surgical removal is typically straightforward, with minimal downtime for most patients, often returning to normal activities within a week. The goal of surgery is complete removal to provide a permanent solution and restore function or aesthetic contour.