Multiple miliary osteoma cutis

Osteoma Cutis of the Face in CBCT Images

Osteoma cutis (OC) is a rare benign disorder where osseous nodules form in the reticular layer of normal skin. These nodules are formed by the deposition of lamellar bone and are characterized by osteocytes in the core and osteoclasts around the periphery. Interpretation of osteoma cutis cases has always been challenging especially using conventional two-dimensional (2D) radiographs, owing to difficulty in localization. Cone beam CT (CBCT), with its three-dimensional (3D) capabilities, offers a great tool to help detect and diagnose these calcific entities. We report a case of miliary type OC incidentally detected in the maxillofacial region using CBCT imaging.

Gold-wire artifacts on diagnostic radiographs: A case report

This report described a case in which diagnostic radiographs showed irregular dense radiopaque strings and curved lines in the head and neck area. These artifacts could lead to misinterpretation since they may obscure anatomical structures and/or mask critical structures/pathologies. A more detailed history of the patient indicated that these strings originated from a facelift procedure in which a gold-wire technique was used. Considering that such intervention may cause a radiodiagnostic burden, it should be included in the anamnesis prior to radiography.

Miliary osteoma cutis of the face

BACKGROUND

Miliary osteoma cutis (OC) of the face is a rare benign extra skeletal bone formation. For our knowledge, only 23 cases have been reported in the English literature. These lesions may be primary or secondary. They cause diagnostic, therapeutic and cosmetic concern especially in women who are usually concerned. Our purpose is to present a case which is completely documented with the clinical, histological and radiological findings. We also report a possible pathogenic theory according to our histologic findings.

MAIN OBSERVATION

We report a case of a multiple miliary OC of the face in a 45-year-old woman which suffered from gravidarum acne. These lesions were treated by focal surgical treatment.

CONCLUSIONS

Based on our histological findings, an osteoblastic metaplasia seems to be a possible pathogenic theory. This metaplasia seems to be secondary to a chronic inflammation. Concerning therapeutic procedures, they are non consensual and debated and are based on surgical or medical treatment. More reports are needed in order to assess the therapeutic management of this disease and its inducing factors.

Facial miliary osteoma in HIV patient

Facial miliary osteoma is characterized by the presence of multiple normochromic papules, affecting mainly middle-aged women, with a previous history of acne. A 39-year-old HIV positive female patient presented hardened papules which had appeared 3 years before, located on the malar region, glabella and mentum. Optical microscopy showed spherical bone formations in the dermis. Computerized tomography of the face revealed small calcifications on the surface consistent with bone formation. Multiple facial osteomas are rare as well as its association with HIV virus infection.

Multiple miliary osteoma cutis is a distinct disease entity: four case reports and review of the literature

BACKGROUND

Multiple miliary osteoma cutis (MMOC) is a rare nodular skin disease characterized by tiny bone nodules which usually form on the facial skin, typically in middle age. The aetiology of this phenomenon is poorly understood.

OBJECTIVES

To search for possible bone formation progenitors and to look for a possible association with mutations in the GNAS gene (encoding the G-protein α-stimulatory subunit) and related hormonal parameters in patients with MMOC. We also reviewed the literature and discuss the aetiology and pathogenesis of adult-onset primary osteomas.

METHODS

We report four cases of MMOC. Histological samples were analysed for bone morphogenetic protein (BMP)-2, BMP-4 and oestrogen receptor-α known to be involved in bone formation. Endocrinological laboratory investigations and hand X-rays were performed to exclude a systemic disease. The GNAS gene was sequenced from DNA extracted from peripheral blood in all four patients and from a skin sample in one patient to exclude somatic mutations.

RESULTS

Histological analyses revealed intramembranous cutaneous bone formation resembling the findings seen in GNAS gene-based osteoma cutis disorders. However, we did not find any germline or somatic GNAS gene mutations in our patients and all laboratory investigations gave normal results. BMP-2 and -4 were expressed normally in MMOC samples, but oestrogen receptor-α was not expressed. Altogether 47 MMOC cases, 41 female and six male, have been published between 1928 and 2009. Of these cases, 55% had a history of pre-existing acne and only 15% had extrafacial osteomas.

CONCLUSIONS

MMOC is a rare but distinct disease entity of unknown aetiology. Histologically, the tiny nodular osteomas show intramembranous superficial ossification but the aetiology appears to be different from GNAS-related disorders. The osteomas seem to increase slowly in number after appearing in middle age.

Treatment of multiple miliary osteoma cutis of the face with local application of tretinoin (all- trans retinoic acid): a case report and review of the literature

BACKGROUND

Multiple miliary osteoma cutis of the face represents primary extra-skeletal bone formation that arises within the skin of the face.

METHODS

A 60-year-old woman with multiple miliary osteoma cutis of the face was treated by application of 0.05% tretinoin (all-trans-retinoic acid) cream nightly.

RESULTS

After 3 months of therapy there were fewer papules and a decrease in size of remaining lesions. In a literature search, it was found that local application of tretinoin was successful and achieved a decrease in the number of papules over the face in all patients with multiple miliary osteoma cutis of the face; however, the length of time to achieve response varied from a few weeks to 6 months.

CONCLUSION

It is suggested that local application of tretinoin cream should be considered in the therapy of multiple miliary osteoma cutis of the face, particularly when the lesions are small and superficial.

Soft tissue augmentation of the cheeks detected on intra- and extraoral radiographs: a case report

Augmentation material used in plastic surgery such as facelift procedures can be radiopaque and thus become visible on extra- and intraoral radiographs. These objects may obscure anatomical structures and mask critical findings, therefore leading to potential misinterpretation of otherwise successful images. The present report describes a case in which the radiographic intra- and extraoral data are partly masked by a superimposed radiopaque mesh, which was suspected to originate from a facelift procedure. A gold thread lift was confirmed by the plastic surgeon.

Miliary osteoma cutis of the face: treatment with the needle microincision-extirpation method

Multiple miliary osteoma cutis of the face represents primary extra-skeletal bone formation that arises within the skin of the face. Multiple miliary osteoma cutis of the face is a rare complication of chronic inflammatory acne vulgaris and has invasive and non-invasive treatment alternatives different from acne vulgaris. Invasive techniques should be simple, easy, and inexpensive, with minimal risk of scarring and pigmentation. We used a needle microincision-extirpation technique in a patient with multiple miliary osteoma cutis unresponsive to non-invasive treatment modalities. Skin overlying the papules was incised with a needle and then the calcificated papules were extirpated by using a small curettage device. Lesions were left to secondary healing. Results were quite good and cosmetically acceptable.

Isolated Primary Osteoma Cutis of the Head:

Osteoma cutis is a rare disease in which there is formation of bony tissue in the skin that causes deformities. The etiology remains unknown and its treatment is controversial. A rare case of primary osteoma cutis in the face and scalp, which was not associated with any syndrome, is described. The patient was treated with surgery and topical retinoic acid. The retinoic acid treatment resulted in an improvement of the frontal area, and stabilized the disease over a two-year follow-up period. Surgical resection was a simple treatment with a quick recovery, minimal scarring and no local recurrence. The patient was followed for two years and presented a satisfactory result. The treatment of osteoma cutis is quite variable, and surgery is the most frequently reported treatment. However, a combination of clinical and surgical treatments seems to be an efficient way to manage these patients.

Bilateral calcifications secondary to synthetic soft tissue augmentation of the cheeks: report of a case

Although esthetic soft tissue augmentation of the cheeks has been in practice for over a century, calcifications associated with the soft tissue substitutes were rarely reported. A case demonstrating bilateral concentric opacities in the soft tissues of the cheek secondary to cheek augmentation is presented. The opacities were detected accidentally during routine intraoral radiographic examination. This condition initially posed a challenge in radiographic diagnosis in the absence of adequate history and clinical information. In this report we have briefly reviewed different types of implant materials used for soft tissue augmentation. We believe that inflammation of the tissues adjacent to the implant material is possibly responsible for the development of calcifications associated with esthetic soft tissue augmentations.

Treatment of primary miliary osteoma cutis with incision, curettage, and primary closure

BACKGROUND

Primary miliary osteoma cutis is characterized by de novo bone formation in skin without a known associated or pre-existing cutaneous disorder. These lesions often develop on the face and cause cosmetic concern.

OBJECTIVE

Multiple treatments have been attempted, including topical and systemic agents and surgical techniques. The ideal treatment modality should be simple and effective with minimal side effects.

METHODS

The technique of scalpel incision over visible lesions, curette extraction of bony fragments, and primary suture repair was used to remove multiple lesions of primary miliary osteoma cutis on the cheeks of an affected patient.

RESULTS

This surgical technique resulted in a significant reduction of visible and palpable lesions and a smoother surface contour with minimal scarring.

CONCLUSION

This surgical technique offers a simple but effective method for removal of multiple bony fragments in primary miliary osteoma cutis with minimal side effects.

Idiopathic multiple miliary osteomas of the face

A case of multiple miliary osteomas of the face arising in a 45-year-old Caucasian female with no history of skin disease is reported. Spontaneous development of numerous asymptomatic, skin-coloured facial papules had occurred over a 3 year period. Originally described in association with long-standing acne vulgaris, multiple miliary osteomas of the face has recently been reported in patients without prior skin disease. The pathogenesis, classification and treatment of this rare condition are discussed.

Congenital platelike osteoma cutis: case report and review of the literature

An 18-year-old girl had a progressive enlarging plate of subcutaneous bone in the scalp since birth. Histologic examination of the lesion showed typical osteoma cutis. There was no history of any skin disease prior to development of the osteoma. Frequently congenital and usually located on the scalp, platelike osteoma is a rare variant of osteoma cutis.