From the Guidelines
The initial approach to managing osteochondroma should be observation and monitoring with annual physical examinations starting in childhood, and considering a baseline skeletal survey at early adolescence (around 12 years) using WBMRI or plain radiographs if available 1.
Key Considerations
- Regular follow-up is crucial to monitor for any changes in size or appearance of the osteochondroma, with a focus on identifying potential malignant transformation, which is suggested by rapid growth, increasing pain, or a bulky cartilage cap thicker than 2.0 to 3.0 cm on MRI or CT scan 1.
- The tendency of osteochondromas to enlarge until skeletal maturity and the risks of bony deformities and cord compression (especially in vertebral lesions) justify close monitoring 1.
- For patients with hereditary multiple osteochondromas (HMO), annual MRI screening may be valuable between 20 and 40 years of age, but in childhood, routine surveillance is not currently recommended due to lack of data 1.
- Regular regional MRI (every 2–3 years) of osteochondromas in the pelvis or scapula is recommended due to the higher risk of transformation in these locations, particularly in males or EXT1 PV carriers 1.
Management Approach
- Orthopedic providers should be involved in the monitoring of osteochondromas, and care should preferably be taken in an academic center with expertise in rare syndromes or syndromes of bone lesions, especially for conditions like Potocki–Shaffer syndrome (PSS) and trichorhinophalangeal syndrome II (TRPS II) 1.
- Surgical intervention is generally reserved for symptomatic cases, such as those causing persistent pain, impingement on surrounding structures, growth after skeletal maturity, or suspected malignant transformation 1.
- Pain management with over-the-counter analgesics or NSAIDs may be appropriate for mild discomfort, but patients should be educated about warning signs that warrant immediate medical attention, including new or worsening pain, rapid growth of the lesion, or neurological symptoms 1.
From the Research
Initial Approach to Managing Osteochondroma
The initial approach to managing osteochondroma involves a combination of diagnostic methods and treatment strategies.
- Diagnosis is typically made using radiological methods, including computed tomography (CT) and magnetic resonance imaging (MRI) 2, 3, 4.
- Clinical evaluation is also crucial, as patients may present with symptoms such as pain, swelling, and neurological symptoms 2, 5, 6, 3.
- Treatment options vary depending on the location and size of the tumor, as well as the presence of symptoms.
- Surgical treatment is often necessary to relieve symptoms and prevent further complications, such as spinal cord compression or malignant transformation 2, 5, 6, 3, 4.
- Conservative management may be considered for asymptomatic patients or those with small tumors, but close monitoring is essential to detect any changes in tumor size or symptoms 2.
Treatment Strategies
Different treatment strategies are employed depending on the location and characteristics of the osteochondroma.
- For spinal osteochondromas, surgical treatment typically involves marginal excision of the tumor, as well as decompression of the spinal canal and nerve roots 3, 4.
- For osteochondromas of the mandibular condyle, conservative surgery may be an option, aiming to preserve the condyle and maintain functional and aesthetic results 5, 6.
- Orthodontic treatment may also be necessary to address any dental or occlusal issues resulting from the tumor 6.
Importance of Radiological Examination
Radiological examination plays a critical role in the diagnosis and management of osteochondroma.