Forehead osteomas are benign tumors commonly excised for cosmetic and functional reasons. However, removing osteomas from the anterior table of the frontal sinus presents specific challenges, particularly in determining the appropriate removal thickness. Inaccurate resection depth may result in fracture or perforation of the anterior table of the frontal sinus, or incomplete resection. The authors propose a novel drilling and groove-cutting technique to ensure safe and complete excision while minimizing risks of fracture or perforation of the anterior table. In this study, the authors present a 51-year-old female patient with a recurrent osteoma. Preoperative computed tomography (CT) imaging-guided depth-limiting drilling at the osteoma's center, followed by groove-cutting to establish excision boundaries. Then divided osteoma blocks were excised completely. Postoperatively, the patient showed no sensory deficits or forehead asymmetry and achieved pleasing frontal contour with minimal scarring. This technique effectively safeguards the anterior table and ensures complete removal, demonstrating its utility in craniofacial surgery.

To question the value of drilling the site of the stalk ("insertion site" or "stalk" drilling) of a pedunculated external auditory canal osteoma (EACO) in reducing recurrence.

A retrospective medical chart review of all patients treated for EACO in one tertiary medical center, a systematic literature review using Medline via "PubMed", "Embase", and "Google scholar" search, and a meta-analysis of the proportion for recurrence of EACO with and without drilling.

The local cohort included 19 patients and the EACO origin was the anterior EAC wall in 42% and the superior EAC wall in 26%. The most common presenting symptoms were aural fullness and impacted cerumen (53% each), followed by conductive hearing loss (42%). All patients underwent post-excision canaloplasty, and one sustained EACO recurrence. Six studies suitable for analysis were identified (63 EACOs). Hearing loss, aural fullness, otalgia, and cerumen impaction were the most common clinical presentations. The most common EACO insertion site was the anterior EAC wall (37.5%), followed by the superior EAC and posterior walls (25% each). The inferior EAC wall was least affected (12.5%). There was no significant difference in recurrence between EACOs whose stalk insertions were drilled (proportion 0.09, 95% confidence interval [CI] 0.01-0.22) to the ones whose insertion was not drilled (proportion 0.05, 95% CI 0.00-0.17). The overall recurrence proportion was 0.07 (95% confidence interval 0.02-0.15).

EACO insertion site drilling does not reduce recurrence and should be avoided in the absence of a definite pedicle projecting to the EAC lumen.

Forehead osteoma is a commonly encountered benign facial bone tumor. Endoscopic excision of benign forehead masses is widely performed. Here, we report a rare case of recurrent forehead osteoma that disseminated after a previous osteoma excision.

A 54-year-old female patient had previously undergone endoscopic removal of a single forehead osteoma at 30 years of age. However, she had a recurrent osteoma around the same site and underwent another endoscopic resection at 40 years of age. During her first visit to our outpatient clinic, she presented with a cobblestone-like irregular surface on the forehead and a 3D facial bone computed tomography scan revealed a widely ragged surface of the inoculated osteoma on the outer table of the frontal bone. Under general anesthesia, we performed a radical complete excision of the disseminated osteoma through a bicoronal incision using an osteotome, chisel, mallet, and rasping. We hypothesized that the recurrence may have been caused by the inoculation of residual osteoma remnants from the previous procedure. Craniofacial surgeons should be cautious when removing osteoma particles, particularly when using an endoscopic approach.

To prevent recurrence, it is essential to conduct additional meticulous burring and a thorough inspection of the surface after copious irrigation.

This study presents a new case of solitary osteochondroma (SOC) identified on the proximal tibia of a 4th-century BCE individual from Pontecagnano (Salerno, Italy) with an aim to contribute to differential diagnosis of bone tumors in archeological contexts.

Paleopathological assessment of a male individual with an estimated age-at death of 45.9-62.9 years brought to light during the archaeological excavations in the funerary sector of 'Sica de Concillis' within the necropolis of Pontecagnano.

Macroscopic and radiographic analyses were performed for diagnostic purposes.

The proximal portion of the right tibia exhibited a large exophytic bone formation extending from the anteromedial to the posteromedial portion of the diaphysis. The x-ray confirmed the lesion being characterized by regular trabecular bone tissue with cortico-medullary continuity.

The lesion observed is diagnostic of sessile SOC, a neoplasm that must have had aesthetic and, possibly, neurovascular complications due to its large size.

By offering a detailed description of a case of tibial osteochondroma and discussing the possible complications the individual might have experienced during life, this study highlights the role and importance of benign bone tumors in paleo-oncology.

Histological analysis was not carried out in order to preserve the integrity of the affected tibia.

More attention should be devoted to benign tumors in paleopathology as their occurrence and manifestations in the past will lead to a better understanding of their impacts on the quality of life of affected individuals and to greater knowledge of their natural history.

The aim of this paper is to evaluate a case of osteoma of the zygomatic bone in a post-medieval individual in the context of a paleoepidemiological approach.

Forty-five skulls from the plague cemetery of Alghero (Sardinia, Italy), dating back to the end of the 16th century, were evaluated for the presence of osteomata on the outer surface of the cranial vault and facial bones.

Macroscopic examination was performed using standard anthropological methods. The bone presenting the lesion was submitted to radiological examination through cone beam; a 3D reconstruction was obtained with a surface 3D scanner.

Only one case of osteoma was observed in an adolescent aged 13-15 years, located on the right zygomatic bone. The lesion consisted of a rounded mass of 0.5 cm in diameter composed of compact bone, as also the radiographic study demonstrates. The prevalence of osteoma on the outer surface of the cranial vault and facial bones in the population of Alghero was 2.2 %.

This case offers the opportunity to enrich the knowledge about the presence of benign tumors among past populations and to evaluate this lesion in dry bone.

This study provides paleoepidemiological data on the scarce area of benign tumors in paleo-oncology and presents the first documented osteoma of the zygomatic bone in paleopathology.

Histological study was not performed for conservative issues.

Increasing the attention to benign tumors is essential to deepen our knowledge about paleoepidemiology of neoplastic lesions.

To present clinical ocular manifestations, radiological features and surgical results of giant paranasal osteomas involving the orbit.

Retrospective, interventional, case series.

The study included patients treated for giant paranasal osteoma involving the orbit. Total or subtotal excision of the tumor was performed via external approach. Clinical characteristics including presenting symptoms, radiologic investigation, histopathology and details of the surgery were recorded.

Of the six patients included; four were male and two were female. Mean age was 46.8 years (range 12-70 years). Five patients had unilateral, one patient had bileteral disease. The presenting complaints included complete (n = 2/6) or partial (n = 4/6) limitation of eye movements depending on the location and size of the tumor, diplopia (n = 5/6), vision loss (n = 2/6) exophthalmos (n = 6/6) and reduced pupillary light reflex (n = 2/6). The presumed origin of the tumor was frontoethmoidal region (n = 2/6), frontal sinus (n = 3/6) and ethmoid sinus (n = 1/6). Total resection was achieved in three of the patients whereas partial resection was achieved in remaining three patients due to risk of incremental neurological damage. Mild ptosis was observed in all patients during the postoperative period (temporary, n = 4; permanent, n = 2).

Despite the benign nature of osteomas, severe functional impairment including vision loss due to compression of the optic nerve and diplopia might occur in case of orbital involvement. Osteomas with an orbital extension > %50 of the bony orbit volume are more prone to cause irreversible visual loss. Surgical resection is still the mainstay of therapy.

Osteomas are benign osteogenic neoplasms that usually occur as solitary craniofacial lesions. Multiple osteomas are rare, particularly those that do not occur as part of an associated syndrome. We report a case of a 72-year-old woman who presented with multiple bony protrusions over the forehead and scalp. She denied any diagnosis of syndromes that are known to be associated with osteomas. Surgical excision was performed by endoscopically resecting more than 30 osteomas of the frontal and bilateral parietal bones. Compared with conventional surgical excision through a direct incision, endoscopic-assisted surgery is a simple and effective method for the treatment of multiple craniofacial osteomas and is associated with excellent cosmetic outcomes and no neurovascular complications.

This research is designed to evaluate the occurrence of external auditory exostoses (EAEs) in skeletal remains from the oldest known water wells in the world (Kissonerga-Mylouthkia, Cyprus, 8,200-7,200 BCE).

Six individuals (MNI = 6), five fragmentary temporalia, two preserved auditory canals.

Macroscopic and microscopic (up to x30) observation, with illumination; presence, type, side, severity, occlusion, number, and position of bony growths recorded.

Bony growths within two auditory canals were discovered. Differential diagnosis includes osteomata and external auditory exostoses, with the latter consistent with the bony growths (Grade 1 EAEs, two adult males, one with single, another with two EAEs).

The emergence of the Neolithic in Southwest Asia is thought to involve increases in dietary breadth among foraging societies (Broad-Spectrum Revolution). EAEs likely indicate maritime activity in this context, given the lack of freshwater bodies, and zooarchaeological evidence points to dietary and other uses of maritime organisms.

This EAE evidence is the oldest known in maritime contexts in Eastern Mediterranean and the Middle East, and first in Cyprus. It contributes towards understanding the initial colonization events by Neolithic farming communities in the 9th millennium BC, and the emergence of broad-spectrum economies at the dawn of the Neolithic in Southwest Asia, crucial for re-considerations of paradigms on the transition to the Neolithic way of life in the Near East.

Only a few skeletal remains from these prehistoric contexts were available for observation.

Further intensive review of Cypriot skeletal collections for EAEs is advised.

To explore the possible etiology of multiple osteomata on a skull and long bones from an individual from a medieval site in Tuscany, Italy.

Human skeletal remains dating to the 10^th-12^th century AD from the parish church of S. Pietro in Pava, in the province of Siena (Tuscany, Central Italy).

Macroscopic and imaging analyses (Cone Beam Computed Tomography).

Nine round-shaped new bone formations are observed on a female individual aged 40-50 years. The lesions have a smooth surface and range from 2.2-6 mm in diameter.

Cone Beam Computed Tomography confirmed that the lesions were composed of compact bone. Macroscopic and radiological features suggest the presence of nonsyndromic multiple osteomata.

Single cranial osteomata are commonly observed in osteoarchaeological remains, but multiple osteomata are rare and might assist in our understanding of neoplastic conditions in the past.

The lack of soft tissues prevents the diagnosis of complex disorders, such as the Gardner syndrome, which is characterised by multiple osteomata and polyposis of the colon.

Careful investigation and reporting of all neoplastic lesions in ancient human remains in order to increase our knowledge about the etiology in past human populations.

The reported incidence of neoplasia in the extinct hominin record is rare. We describe here the first palaeopathological analysis of an osteogenic lesion in the extinct hominin Homo naledi from Dinaledi Cave (Rising Star), South Africa. The lesion presented as an irregular bony growth, found on the right lingual surface of the body of the adult mandible U.W. 101-1142. The growth was macroscopically evaluated and internally imaged using micro-focus x-ray computed tomography (μCT). A detailed description and differential diagnosis were undertaken using gross and micromorphology, and we conclude that the most probable diagnosis is peripheral osteoma - a benign osteogenic neoplasia. These tumours are cryptic in clinical expression, though they may present localised discomfort and swelling. It has been suggested that muscle traction may play a role in the development and expression of these tumours. The impact of this lesion on the individual affected is unknown. This study adds to the growing corpus of palaeopathological data from the South African fossil record, which suggests that the incidence of neoplastic disease in deep prehistory was more prevalent than traditionally accepted. The study also highlights the utility of micro-computed tomography in assisting accurate diagnoses of ancient pathologies.

This article focuses on the application of dry bone histology in the diagnosis of a series of different bone tumours. It provides a short introduction on bone tumour classification and how tumours may affect the skeleton. To illustrate the value of dry bone histology in the diagnostic process we studied the 'fresh' and 'dry' bone histology of a series of well-documented, recent clinical cases of various benign and malignant bone tumours. We show that histology is a valuable instrument to assess bone tissue architecture, which provides information on the biological behaviour of a tumour. Though histology may reveal the specific 'tumorous' bone deposition of high-grade conventional osteosarcomas, all other bone tumours display common, unspecific features. This holds for the following tumours: osteochondroma, hyperostotic meningioma, high-grade angiosarcoma, grade 2 chondrosarcoma, myoepithelial carcinoma, high-grade osteosarcoma and four carcinoma metastases. We conclude that histology is useful in cases where the biological behaviour of a tumour is to be defined, and is particularly an aide in the diagnosis of high-grade conventional osteosarcomas. Nevertheless, the differential diagnosis on the bone tumours in our series should primarily be based on a combination of physical anthropological patient data (age, sex), gross anatomy (e.g. tumour morphology and location), and radiography.

An absence of ancient archaeological and palaeontological evidence of pneumonia contrasts with its recognition in the more recent archaeological record. We document an apparent infection-mediated periosteal reaction affecting the dorsal ribs in a Middle Triassic eosauropterygian historically referred to as 'Proneusticosaurus' silesiacus. High-resolution X-ray microtomography and histological studies of the pathologically altered ribs revealed the presence of a continuous solid periosteal reaction with multiple superficial blebs (protrusions) on the visceral surfaces of several ribs. Increased vascularization and uneven lines of arrested growth document that the pathology was the result of a multi-seasonal disease. While visceral surface localization of this periosteal reaction represents the earliest identified evidence for pneumonia, the blebs may have an additional implication: they have only been previously recognized in humans with tuberculosis (TB). Along with this diagnosis is the presence of focal vertebral erosions, parsimoniously compared to vertebral manifestation of TB in humans.

In addition to the previous 5 cases of skull base osteoma with radiologic information reported in the English literature, this is the sixth case report of this rare disease.

This is the first report of a skull base osteoma with concurrent intracranial tumors.

A satisfactory 1-stage resection of the 2 contiguous lesions via a modified anterior transpetrous approach was performed.

Since its birth in 1895, radiology has been used to study ancient mummies. The purpose of this article is to present paleoradiological investigations conducted on several medieval human remains in Varese province. Anthropological (generic identification) and paleopathological analyses were carried out with the support of diagnostic imaging (X-ray and CT scans).

Human remains were discovered during excavations of medieval archaeological sites in northwest Lombardy. Classical physical anthropological methods were used for the macroscopic identification of the human remains. X-ray and CT scans were performed on the same scanner (16-layer Hitachi Eclos 16 X-ray equipment). Results Radiological analysis permitted investigating (1) the sex, (2) age of death, (3) type of trauma, (4) therapeutic interventions and (5) osteomas in ancient human remains. In particular, X-ray and CT examinations showed dimorphic facial traits on the mummified skull, and the same radiological approaches allowed determining the age at death from a mummified lower limb. CT analyses allow investigating different types of traumatic lesions in skulls and postcranial skeleton portions and reconstructing the gait and functional outcomes of a fractured femur. Moreover, one case of possible Gardner’s syndrome (GS) was postulated from observing multiple osteomas in an ancient skull.

Among the medical tests available to the clinician, radiology is the most appropriate first-line procedure for a diagnostic approach to ancient human remains because it can be performed without causing any significant damage to the specimen.

Button osteoma presents as small circumscribed ivory-like lumps on the skull vault. Although not rare, its diagnosis can be challenging for dermatologists.

To clarify the clinical characteristics of button osteoma by reviewing 10 cases.

Ten patients diagnosed with button osteoma at the Department of Dermatology, Kyungpook National University Hospital, between January 2011 and August 2014 were enrolled. We retrospectively reviewed medical records and analyzed demographic and clinical characteristics including sex, age, sites, number of lesions, symptoms, duration, histopathological finding, radiological findings, and treatment.

All patients presented with an asymptomatic small circumscribed hard lump fixed to a bony structure. There were 9 female and 1 male patient, and the mean age was 54 years (range, 28~61 years). The most common site was the forehead, and disease duration ranged from 2 weeks to more than 20 years. The differential diagnosis included cranial exostosis, ballooned osteoma, epidermal cyst, and lipoma. Simple radiography, ultrasonography, and computed tomography (CT) were used to make a confirmative diagnosis. Histopathological findings showed lamellated bony structures with poor vascularization. Ostectomy was performed for 5 patients, and no recurrence was detected within an average of 13.4 months after treatment.

This review characterized button osteoma. Surgical excision is a useful therapeutic modality after CT-based diagnosis. Further studies with more patients are required to confirm the findings.

Large intracranial calcifications are occasionally encountered in routine computed tomography (CT) scans of the brain. These calcifications, also known as "brain stones", can be classified according to location and aetiology. Combining imaging findings with relevant clinical history and physical examination can help narrow down the differential diagnosis and may allow confident diagnosis in certain situations.

This article provides a pictorial review illustrating various clinical entities resulting in brain stones.

Based on location, brain stones can be classified as extra- or intra-axial. Extra-axial brain stones comprise tumours and exaggerated physiological calcifications. Intra-axial brain stones can further be classified according to aetiology, namely neoplastic, vascular, infectious, congenital and endocrine/metabolic. Imaging findings combined with essential clinical information can help in narrowing the differential diagnosis, determining disease state and evaluating effect of therapy.

• Based on location, brain stones can be either extra- or intra-axial. • Extra-axial brain stones comprise tumours and exaggerated physiological calcifications. • Intra-axial aetiologies include neoplastic, vascular, infectious, congenital and endocrine/metabolic. • CT scan is the mainstay in identifying and characterising brain stones. • Certain MRI sequences (gradient echo T2* and susceptibility-weighted imaging) are considered adjunctive.

The aim of this study was to recognize the radiological characteristics of hyperostosis frontalis interna (HFI) and to establish a valid and reliable method for its identification and classification. A reliability test was carried out on 27 individuals who had undergone a head computerized tomography (CT) scan. Intra-observer reliability was obtained by examining the images three times, by the same researcher, with a 2-week interval between each sample ranking. The inter-observer test was performed by three independent researchers. A validity test was carried out using two methods for identifying and classifying HFI: 46 cadaver skullcaps were ranked twice via computerized tomography scans and then by direct observation. Reliability and validity were calculated using Kappa test (SPSS 15.0). Reliability tests of ranking HFI via CT scans demonstrated good results (K > 0.7). As for validity, a very good consensus was obtained between the CT and direct observation, when moderate and advanced types of HFI were present (K = 0.82). The suggested classification method for HFI, using CT, demonstrated a sensitivity of 84%, specificity of 90.5%, and positive predictive value of 91.3%. In conclusion, volume rendering is a reliable and valid tool for identifying HFI. The suggested three-scale classification is most suitable for radiological diagnosis of the phenomena. Considering the increasing awareness of HFI as an early indicator of a developing malady, this study may assist radiologists in identifying and classifying the phenomena.