Osteoid osteoma in mandibular condyle

Editorial Note, Osteoid osteoma is a rare entity, and a clinical presentati on in the mandibular condyle leading to misdiagnosis as temporomandibular d ysfunction would not be entirely unexpected. However, the authors go about their management in a manner open to question. Diagnostic arthroscopy and arthroscopic sweeping and lavage (whether in a s ingle or two separate procedures is not quite clear from the case report) w ere performed without adequate workup of the patient. The additional poster oanterior plain radiograph (Fig. I). taken after the arthroscopic treatment , indicated the extra-articular nature of the as yet undiagnosed lesion, an d should have prevented the unnecessary arthroscopic intervention(s) had it been taken earlier. The CT scan. also taken after all the arthroscopic tre atment. of course will have demonstrated the lesion well (surprisingly the CT image was not used as an illustration in the case report). Scintigraphy was not performed. The tomographic picture alone (albeit late in the course of patient management) may well have been sufficient to permit a less inva sive approach to the problem. such as biopsy or excision of the lesion but without sacrificing the condyle in the first instance. The authors instead opt for a condylectomy as a means of resecting an undiagnosed extraarticula r lesion, using preauricular and intraoral incisions. It is at best difficu lt to understand the need for the latter incision. While it is widely held that immediate replacement of the resected condyle with an autogenous graft is the best option in the young patient, the autogenous costochondral graf t is generally preferred to the iliac crest for this purpose. This case report is published in the journal because the reader will benefi t from the reported presentation of this rare lesion, and will learn from t he diagnostic pitfall. However, the reader would be well advised to look at the authors' clinical management of this patient with some reservation.