From the Guidelines
Patients with multiple hereditary exostoses (MHE) should undergo lifelong monitoring and treatment, with whole-body magnetic resonance imaging (WB-MRI) being the preferred imaging modality for screening and surveillance due to its ability to precisely depict soft-tissue pathology and differentiate malignant transformation 1.
Key Considerations
- MHE is an autosomal dominant hereditary disease characterized by the growth of multiple benign and symptomatic osteochondromas, requiring lifelong monitoring and treatment of tumors.
- Young subjects with MHE have an increased risk of developing chondrosarcoma as an adult, with a transformation rate of 2-4% of affected patients.
- WB-MRI is the most valuable imaging modality in symptomatic MHE, allowing for precise depiction of soft-tissue pathology and differentiation of malignant transformation.
Screening and Surveillance
- A screening protocol for patients with MHE, including lifelong biennial surveillance with WB-MRI, has been proposed by Sonne-Holm et al. in 2014.
- Centralization of examinations in high-volume tumor departments is recommended to coordinate screening and treatment interventions in these patients.
Management
- Asymptomatic exostoses may not require treatment, while painful or problematic growths may necessitate surgical removal.
- Symptomatic management, such as the use of anti-inflammatory medications like ibuprofen (400-800mg every 6-8 hours), can help alleviate pain temporarily.
- Patients with MHE should be evaluated by a healthcare provider if they experience pain, functional interference, or rapid growth, as these symptoms may indicate a different condition requiring alternative treatment.
From the Research
Definition and Characteristics of Extoses
- Extoses are broad-based, non-malignant surface growth occurring on the outer or facial surface of the maxilla and/or mandible, found usually in the premolar and molar region 2
- They tend to appear in early adolescence and may very slowly increase in size with time 2
- Extoses are painless, self-limiting and may increase patient concern about poor esthetics, inability to perform oral hygiene procedures, and compromised periodontal health by causing food lodgment 2
Etiology of Extoses
- The etiology of extoses is still not established, but it has been suggested that the bony overgrowth can be because of abnormally increased masticatory forces to the teeth 2
Management of Extoses
- Surgical exploration is a management option for extoses, as presented in a case of bilateral buccal-sided maxillary exostoses 2
- There is no direct evidence in the provided studies regarding the use of ibuprofen or other analgesics for the management of extoses 3, 4, 5
- However, ibuprofen has been shown to be effective in managing various types of pain, including acute and chronic pain conditions 3, 4
Related Conditions
- Intermittent exotropia is a condition that can be managed conservatively with part-time alternate occlusion and overminus spectacles with prism to defer or avoid surgery 6
- This condition is not directly related to extoses, but highlights the importance of conservative management options for various conditions 6