Synchronous ossifying fibromas of the jaws: a review

doi:10.1016/j.oooo.2011.08.007

Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Volume 114, Issue 5, Supplement, November 2012, Pages S120-S125

Presented as a poster at the 18th International Congress of the Turkish Association of Oral and Maxillofacial Surgery, October 2-6, 2011, Antalya, Turkiye.

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According to the World Health Organization, it is proposed that benign fibro-osseous lesions be divided into 3 categories, including fibrous dysplasia, ossifying fibroma (OF), and osseous dysplasia. OF arises from the periodontal ligament, which contains multipotential cells. These benign tumors may become large and aggressive. Slow growth and lack of symptoms are the cardinal features. OF tends to occur in the second and third decades of life, with predilection for women and for the mandibular premolar-molar area. The method of treatment used for large or rapidly expanding lesions is surgical removal (enucleation). Rarely, OFs occur multifocally. We report a 20-year-old man with synchronous OFs of his maxilla and mandible and review other synchronous cases reported. Such lesions can be properly diagnosed and treated by correlating radiographic, clinical, surgical, and histopathologic findings.

Section snippets

Case Report

A 20-year-old man was referred to Gülhane Military Medical Academy with a painless swelling involving mandible and maxilla. Especially maxillary swelling had rapidly increased in the past 4 months.

Clinical examination showed a diffuse and hard swelling on the lateral side of the left mandible and maxilla with facial asymmetry. There was no accompanying cervical lymphadenopathy. The overlying mucosa was normal in color but was stretched. A complete blood count, urinalysis, routine blood

Discussion

Fibro-osseous lesions, particularly OFs, are relatively uncommon lesions. To the best of our knowledge, the occurrence of synchronous OFs of the maxilla and mandible is rare, with only 7 previously reported cases (Table III).22, 24, 25, 26, 27, 28, 29 Based on the published cases of synchronous occurrence of ossifying fibromas of the jaws, 6 patients (85.7%) were female and 1 (14.3%) male. The mean age was 27.85 years (ranging from 6 to 37 years). All cases had a well circumscribed radiolucent

Conclusion

The present case represents an unusual presentation of OF and highlights the potential for variable clinical, radiographic, and histopathologic findings.

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Cited by (16)

Ossifying fibroma of the maxilla: A case report with literature review
2024, Radiology Case Reports
Ossifying fibroma is a benign fibro-osseous lesion arising from the periodontal ligament cells. The lesion may progressively enlarge with the mass affecting the mandible or maxilla, resulting in facial deformities and tooth displacement despite its benign nature. Here, we presented a case of an 18-year-old female with ossifying fibroma in the maxilla extending to the maxillary sinus, infraorbital area, and skull base, resulting in considerable facial asymmetry. Since the primary treatment of ossifying fibroma is surgical resection, it is essential to determine the areas where the lesion has expanded, where a 3-dimensional computed tomography scan could play a critical role in providing such information. A complete surgical excision and histopathologic examination in treating this patient are crucial, made possible by a meticulous preoperative radio imaging technique.
Simultaneous presentation of juvenile ossifying fibroma in the maxilla and mandible: a case report
2020, International Journal of Surgery Case Reports
Citation Excerpt :
In the present case, the material collected during the incisional biopsy may have corresponded exactly to the myxoid areas found in JOF, resulting in the diagnosis consistent with myxoma. The differential diagnosis of JOF includes fibrous dysplasia, COD, conventional ossifying fibroma, and even low-grade osteosarcoma [16,17]. JOF have been distinguished from the large group of conventional ossifying fibroma based on the age of the patient, the site affected, and biological behavior [12].
Juvenile ossifying fibroma (JOF) is a controversial and uncommon lesion that has been distinguished from the larger group of ossifying fibromas because of distinct clinical features and some morphological peculiarities. Furthermore, JOF shows an aggressive biological behavior that has led researchers to consider it a benign neoplasm, resulting in its differential diagnosis with important benign and malignant bone neoplasms.
This study describes a case of synchronous presentation of JOF in the mandible and maxilla of a young patient. In addition, the literature was reviewed to identify clinical-pathologic features and possible factors that could help establish the correct diagnosis. A 26-year-old male patient presented simultaneously a lesion affecting the body, angle and ramus of the left mandible and another lesion in the left maxilla. Both lesions were well delimited and radiolucent, being unilocular in the maxilla and multilocular in the mandible. The mandibular lesion was partially resected and the maxillary lesion was submitted to curettage. The diagnosis was JOF.
A delay in seeking medical care and a late diagnosis can have serious consequences for the postoperative functional and esthetic outcome. Much care should be taken during establishment of this diagnosis since an equivocal diagnosis can have serious consequences for the patient in terms of treatment.
After 1 year, the patient shows no signs or symptoms of recurrence of the lesions and was referred for reconstructive surgery of the mandible. An early and correct diagnosis is necessary to permit the best therapeutic management.
A large maxillary cemento-ossifying fibroma superimposed with solitary bone cyst documented over 18 years: A case report
2020, International Journal of Surgery Case Reports
Citation Excerpt :
A distinguishable difference between COFs and FDs was described by the first edition of the WHO classification, in which COFs presented with clear and well-defined margins in the jaws and a transition zone less than 1 mm, while FDs had poorly defined margins [29]. COFs are either uni- or multicystic lesions or mixed-density lesions [30]. The radiographic features depend on the age.
Cemento-ossifying fibromas are rare, benign lesions of the head and neck regions. The origin of these lesions can be traced to the periodontal ligament, because its cells are able to form cement, lamellar bone, or fibrous tissue.
A rare case report of a young Caucasian female with a COF is described including follow-ups. She remained untreated for several years despite early radiographic findings of the lesion without a definitive diagnosis. The patient ultimately underwent radical surgery and the whole lesion was removed. The subsequent histological examination confirmed the clinical diagnosis of a COF. Since then, the patient has been under regular clinical and radiological follow-ups.
This rare case report of a COF, documented over 18 years, shows the importance of consecutive therapy after radiologic and clinical findings, as such lesions continue growing and may subsequently lead to severe medical conditions. Therefore, complete surgical resection of COFs is advised to achieve good results in terms of health and recurrence.
Long-term follow-up of patients is required as recurrences can occur for up to 10 years following treatment. Well-planned radical and wide surgical resection of these lesions has proven not only to be effective in eliminating the aetiological factors, but can also achieve decent bone regeneration and aesthetic results with almost no deformation in the surgical site.
Ossifying Fibroma: Analysis of Treatment Methods and Recurrence Patterns
2016, Journal of Oral and Maxillofacial Surgery
Ossifying fibroma (OF) is one of the most frequent of the 3 fibro-osseous lesions of the jaws and has had an inconstant recurrence rate. A definitive surgical protocol has not yet been published. The aim of the present study was to determine the clinical and radiologic features of OF at a tertiary hospital in South Africa, assess its management and recurrence patterns, and develop a surgical protocol.
A retrospective case-series analysis was performed of all histopathologically diagnosed OF cases from 1976 to 2014. The demographic data, clinical presentation, and radiographic features were analyzed. The management of each case and follow-up data were also documented. A surgical protocol was developed using these findings.
A total of 61 cases were included in the present study. Most of the patients were female (63.9%) and younger than 40 years old (73.9%), and only few cases were symptomatic (29.5%). The mandibular posterior region was affected most often (55.5%), and most lesions were radiopaque (49.2%) and had well-defined margins (93.6%). Most cases were managed by surgical curettage (68.2%). After an average follow-up period of 20 months, only 1 case had recurred for a recurrence rate of 6.7%.
The lesions in our population were more radiopaque and larger than those in the published data. Surgical curettage is an acceptable management protocol with a low rate of recurrence, and resection should be reserved for aggressive and recurrent lesions.
GNAS1 mutations are hallmark expressions of fibrous dysplasia
2012, Journal of Oral and Maxillofacial Surgery
Synchronous jawbone diseases: a multicenter retrospective study
2023, Brazilian Oral Research

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Oral and maxillofacial surgerySynchronous ossifying fibromas of the jaws: a review

Section snippets

Case Report

Discussion

Conclusion

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

J Oral Surg

Oral Surg Oral Med Oral Pathol

J Oral Maxillofac Surg

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Curr Diagn Pathol

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

J Formos Med Assoc

J Cranimaxillofac Surg

J Craniomaxillofac Surg

J Oral Maxillofac Surg

Int J Oral Maxillofac Surg

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

J Oral Maxillofac Surg

Int J Oral Maxillofac Surg

Cystic cemento-ossifying fibroma of the ethmoidal cells

J Laryngol Otol

Central ossifying fibroma: an analysis of 20 cases and review of the literature

Quintessence Int

Oral and maxillofacial surgery
Synchronous ossifying fibromas of the jaws: a review