Exostosis

Osteon is the basic cell element of the bone. Osteosis is meant the process of formation of bone tissue. 'Exostosis' is medically meant for benign (non-cancerous) bone tumour i.e., extra bone growth on a bony surface (here “exo” refers for outward). Exostosis is otherwise called 'Osteocartilaginous exostosis' named after its contents. Basically, it is a connective tissue tumour with proliferation of bone tissue (lamellar osteon). It appears as a localised round or oval hard bony mass with or without pain.

 

There are many things in the world which are less understood, one among them in the medical world is exostosis. The reason for formation of extra bone in exostosis still remains obscure. Most of the time, it seems / remains worthless and creates nuisance with its pressure symptoms. This extra (?) bone formation cannot be even related with complementary work of nature to provide extra strength on requirement or to support. In case of fractures, unions of fracture ends will be attained with new bone formation - osteophyte formation. These ostephytes formations will also be seen in all deterioration process of bone with infection or disease or strain or with improper friction, loss for supporting the weakening tissues (bone tissues), for example - osteo arthritis, ankylosing spondylitis. Here osteophytes formation occurs to support the deteriorating bones. But in case of exostosis, there won’t be any infection or friction loss or any other diseases to trigger the bone tissue to grow. In spite of all this, exostosis seems to occur in the sufferer.

 

Incidence – Even though it can occur in any age group, exostosis is most commonly seen in adolescent females and people in the fourth decade. It is also commonly noted in congenitally disabled persons.

Causes – Even though injury, deformities, mechanical stress and strain with pressure changes and change of postures or gait are claimed to be the cause, nothing has been proven.

Common sites - Exostosis can occur anywhere in the body, but it is very commonly seen in toes, fingers, jaw, long bones, heel and scalp. It can also arise inside the nasal sinus cavity, eye orbits, etc.

Types – It is often named according to the site(s) of origin.

• Subungal exostosis are named for the exostosis which is often seen in the distal end of the finger or toes under the nails. This is the commonest type. It often mimics whitlow or nail bed infection. It can also cause deformity and ulcerations.

• Buccal exostosis – exostosis arising in oral cavity is named as buccal exostosis. It can be seen both in the maxillary (upper jaw) or mandibular (lower jaw) area.

• Multiple exostosis – is named for increased or increasing number of exostosis. It is mostly seen in long bones especially the growing ends (especially in growth spurt period). Studies reveal that it has a tendency to occur as hereditary.
  It can also be classified as

• Compact osteomas (ivory osteomas) – hard nodes occuring in skull 
  Cancellour osteomas – for slender growths occuring in growing end of long bones

• Diaphyseal aclasis – for rare inherited multiple exostosis

   

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• Symptoms – Exostosis symptoms vary according to the site and size. The common symptoms are

  • Occurrence of round / oval dense bony hard protuberance on the surface of bone(s)

  • Slowly growing bony mass or tubercle

  • Single or may be multiple in nature

  • Discomfort and pain (rarely)

  • Aggravation of pain and discomfort on pressure or tight fittings

  • Ulcers on the spot of exostosis

    Complications – When exostosis remains small, mostly there won’t be any complication at all. But as it grows and gives pressure to adjacent nerves or vessles or muscles or bones it causes complications. Complication usually varies according to the site, involved structures and pressure intensity. Anyway, there need not be fear of it transforming into cancer. If it compresses

    • Nerve – it often causes neuralgia (nervous shooting pains)

    • Blood vessels – causes reduced blood supply to distal organs which can cause cramps and numbness

    • Muscles – it can cause cramps, fascitis (inflammation), etc.

    • Bone – bone pain, restriction of movement and sometimes even fracture may result

    • Other than these, exostosis can cause disfigurement and disability in severe cases.

      Diagnosis – Any abnormal growth usually requires timely professional advice / attention to root out the disease. Even though hard, firm texture and immovable character confirms the swelling as exostosis, it is better to fix diagnosis with X-ray or CT / MRI scan and rarely with biopsy under the guidance of qualified professional. Presence of lamellar pattern with fibro cartilaginous covering confirms the condition as exostosis. The covering will be thin in case of matured one and thick in case of immature one (will be replaced with dense bone tissue on maturity). In particular, it needs to be ruled out from other serious malignant disorders or tumours.

      General treatment – In general, exostosis will be kept under observation or left untreated due to its harmless nature or without knowing what to do. Doctors and patients opt for surgical removal, only when it disturbs functionally and more cosmetically with its large size, since, even then, when removed, arrest of recurrence in same spot or in a different spot cannot be guaranteed. Surgical procedure involves shaving off the extra growth in bones or excise it completely with surrounding bone tissues (since exostosis as such will be hard). In addition, one should avoid tight-fitting shoes, repeated stress and strain in same spot and avoid calcium supplements.

      Homeopathic Approach – Even though nobody thinks of Homeopathy for exostosis, considering it as a pure surgical disorder, Homeopathy can do wonders in cases of exostosis (in the initial stages). Since surgical excision also cannot guarantee prevention of new formation, it is better not to opt for surgery.

      In Homeopathy, surgical removal of exostosis is considered the removal of effects of the disease and not the removal of cause or disease itself. Homeopathy treats the patient (not disease) by enhancing his/her immune mechanism to expel the disease as such on its own. This enhancement of immune mechanism further prevents new formation or recurrence.

      In Homeopathy, treatment should be started as early as possible to arrest the growth of the exostosis and get disappearance or reduction in size. It will be easy to treat exostosis in the immature stage where exostosis has minimal core bone covered with thick fibrous cartilaginous sheath. Here exostosis can be made to disappear or reduced in size to near normal. In the case of matured exostosis, most of the cartilaginous material will be replaced with dense bone tissues leaving a thin cartilaginous sheath as cover. Here Homeopathic treatment could not help in making it vanish or reduce its size due to hard structural deformity, but can only provide arrest of further growth.

      Homeopathic medicines commonly used in case of exostosis are Acid flour, Anti-crud, Asafoetida, Calc carb, Calc fluor, Calc Phos, Colchicum, Hecla lava, Mezereum, Natrum Mur, Phosphorus, Radium brom, Rhus tox, Ruta, Silicea, Sulphur, Symphytum. Thuja etc. These medicines should be taken under the advice and diagnosis of a Qualified Homeopath.