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A remarkable form of unilateral hypertrophy and diffuse osteoma of the skull, following the distribution of the fifth nerve, has seen described by Jonathan Hutchinson and Alexis Thomson. #Chondroma.# Cartilaginous tumours, apart from those giving rise to multiple exostoses, grow from the long bones and from the scapula, ilium, ribs, or jaws.
Clinically, the osteoma forms a hard, indolent tumour attached to a bone. The symptoms to which it gives rise depend on its situation. In the vicinity of a joint, it may interfere with movement; on the medial side of the knee it may incapacitate the patient from riding. It incapacitates the patient from wearing a boot. When it presses on a nerve-trunk it causes pains and cramps.
CLASSIFICATION OF TUMOURS: I. Connective-tissue tumours: Innocent: Lipoma, Xanthoma, Chondroma, Osteoma, Odontoma, Fibroma, Myxoma, Endothelioma, etc.; Malignant: Sarcoma II. Epithelial tumours: Innocent: Papilloma, Adenoma, Cystic Adenoma; Malignant: Epithelioma, Glandular Cancer, Rodent Cancer, Melanotic Cancer III. Dermoids IV. Teratoma.
The multiple variety of osteoma is considered with the diseases of bone. The bony outgrowth from the terminal phalanx of the great toe known as the subungual exostosis is described and figured on p. 404. Bony projections or "spurs" sometimes occur on the under surface of the calcaneus, and, projecting downwards and forwards from the greater process, cause pain on putting the heel to the ground.
#Primary Tumours Osteoma.# When the tumour projects from the surface of a bone it is called an exostosis. When growing from bones developed in membrane, such as the flat bones of the skull, it is usually dense like ivory, and the term ivory exostosis is employed. When derived from hyaline cartilage for example, at the ends of the long bones it is known as a cartilaginous exostosis.
An osteoma which does not cause symptoms may be left alone, as it ceases to grow when the skeleton is mature and has no tendency to change its benign character. If causing symptoms, it is removed by dividing the neck or base of the tumour with a chisel, care being taken to remove the whole of the overlying cartilage.
The enlargement of adventitious bursæ over the head of the first metatarsal in hallux valgus; over the tarsus, metatarsus, and digits in the different forms of club-foot; over the angular projection in Pott's disease of the spine; over the end of the bone in amputation stumps, and over hard tumours such as chondroma and osteoma, are described elsewhere.
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