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Lentzen MP, Riekert M, Grozinger P, Zirk M, Nickenig HJ, Zöller JE, Kreppel M. Anatomical and volumetric analysis of fibro-osseous lesions of the craniofacial skeleton. J Craniomaxillofac Surg 2021; 49:1113-1118. [PMID: 34563422 DOI: 10.1016/j.jcms.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/31/2021] [Accepted: 09/13/2021] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Our study aimed to provide volumetric data relating to fibro-osseous lesions of the craniofacial skeleton, in order to highlight risk factors due to the different entities, and to guide clinical decisions for jeopardized patients. METHODS Volumetric measurements of osteomas and ossifying fibromas were performed by applying the open-source software ITK-Snap to cone-beam computed tomography images. DICOM datasets were imported, identified, and delineated using semiautomatic segmentation; this was then verified using manual segmentation. The volumes of the lesions were computed automatically in cubic millimeters using the program. For statistical investigations, descriptive statistics and independent Student t-tests were performed. Additionally, Pearson's correlation was applied as a bivariate analysis. Values of p < 0.05 were considered significant. RESULTS 45 patients (11 male and 34 female) were included in this study. The mean volumes were 10.02 ± 18.79 cm3 for osteomas and 4.80 ± 5.71 cm3 for ossifying fibromas (p = 0.016). Males (12.81 ± 20.38 cm3) presented significantly larger volumes than females (5.43 ± 10.32 cm3) (p = 0.042). With regard to shape, morphology, and affection of surrounding anatomical structures, irregular shape (p = 0.001; p = 0.037), multilocular morphology (p = 0.001; p = 0.037), nerve affection (p = 0.001; p = 0.002), tooth affection (p = 0.001; p = 0.594), cortical bone exceedance (p = 0.033; p = 0.001), and clinically visible symptoms (p = 0.004; p = 0.001) were statistically significantly associated with a larger volume of both entities. CONCLUSION Volumetric analysis revealed that osteomas significantly exceeded the mean size of ossifying fibromas, supporting the argument that special attention should be paid to this entity. In cases of difficult histopathological examination, lesions with irregular shape, multilocular morphology, nerve and tooth affection, cortical bone exceedance, and clinically visible symptoms should be considered for close clinico-radiological follow-up, irrespective of the entity.
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Affiliation(s)
- Max-Philipp Lentzen
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany.
| | - Maximilian Riekert
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| | - Philipp Grozinger
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| | - Matthias Zirk
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| | - Hans-Joachim Nickenig
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| | - Joachim E Zöller
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
| | - Matthias Kreppel
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University Hospital Cologne and Faculty of Medicine, University of Cologne, Germany
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Turek B, Górski K, Drewnowska O, Buczkowska R, Kozłowska N, Sapierzyński R. Ossifying Fibroma in the Nasal Cavity of a 2-Year-Old Horse. Animals (Basel) 2021; 11:ani11020317. [PMID: 33513907 PMCID: PMC7911738 DOI: 10.3390/ani11020317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/08/2021] [Accepted: 01/20/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary This article reports on the clinical features, diagnosis, and management of ossifying fibroma in the nasal cavity of a 2-year-old horse. Ossifying fibromas (OFs) are rare, benign, fibro-osseous neoplasms that occur more frequently in the rostral mandible of young horses (termed equine juvenile mandibular ossifying fibromas) but rarely in older horses. The occurrence of OF in young animals suggests developmental disorders or trauma as etiological factors. The local recurrence of OFs is common if they are not completely surgically excised, but metastatic spread is unusual. The presented case remained clinically asymptomatic until the mass obliterated the whole nasal cavity, causing severe breathing difficulties. The exact mass location was revealed using diagnostic images—namely, radiographs and computed tomography (CT) images. A concurrent problem of an underdeveloped and hypoplastic last premolar tooth of the maxilla was diagnosed. Because the mass was well-demarcated, the horse underwent standing surgery to remove the mass and the tooth. Histopathological diagnosis of ossifying fibroma was confirmed. The patient recovered uneventfully and remained free of disease at the 2-year postoperative follow-up. Abstract A 2-year-old mare of an unknown breed was referred to the clinic due to undetermined breathing difficulties. Physical examination revealed painless swelling rostral to the nasoincisive notch and a large, firm mass protruding from the left nostril. Radiographic examination of the head revealed a mass occupying the left nasal cavity and a displaced and hypoplastic last premolar of the left maxilla. The CT scan showed a well-demarcated heterogeneous mass measuring 22 × 9 × 5 cm (length × height × width) in the left nasal cavity attached to the roots of the displaced tooth and conchae. The surgery was performed on the standing horse. Firstly, due to the oblique position of the displaced tooth, the extraction was performed extra-orally through the trephination and repulsion of the maxillary bone. In the next step, a direct surgical approach was chosen for the caudal part of the mass via the osteotomy of the left nasal bone. The mass was bluntly separated from the conchae and removed through the nostril using Fergusson forceps. The histopathological characteristics of the mass led to the diagnosis of ossifying fibroma. The horse recovered completely in seven months, without recurrence after two years.
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Affiliation(s)
- Bernard Turek
- Department of Large Animals Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences (SGGW), Nowoursynowska 159, 02-776 Warsaw, Poland; (K.G.); (O.D.); (R.B.)
- Correspondence: (B.T.); (N.K.); Tel.: +48-604-247-640 (B.T.)
| | - Kamil Górski
- Department of Large Animals Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences (SGGW), Nowoursynowska 159, 02-776 Warsaw, Poland; (K.G.); (O.D.); (R.B.)
| | - Olga Drewnowska
- Department of Large Animals Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences (SGGW), Nowoursynowska 159, 02-776 Warsaw, Poland; (K.G.); (O.D.); (R.B.)
| | - Roma Buczkowska
- Department of Large Animals Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences (SGGW), Nowoursynowska 159, 02-776 Warsaw, Poland; (K.G.); (O.D.); (R.B.)
| | - Natalia Kozłowska
- Department of Large Animals Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences (SGGW), Nowoursynowska 159, 02-776 Warsaw, Poland; (K.G.); (O.D.); (R.B.)
- Correspondence: (B.T.); (N.K.); Tel.: +48-604-247-640 (B.T.)
| | - Rafał Sapierzyński
- Department of Pathology and Veterinary Diagnostic, Institute of Veterinary Medicine, Warsaw University of Life Sciences (SGGW), Nowoursynowska 159, 02-776 Warsaw, Poland;
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Jih MK, Kim JS. Three types of ossifying fibroma: A report of 4 cases with an analysis of CBCT features. Imaging Sci Dent 2020; 50:65-71. [PMID: 32206622 PMCID: PMC7078407 DOI: 10.5624/isd.2020.50.1.65] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 12/06/2019] [Accepted: 12/17/2019] [Indexed: 11/18/2022] Open
Abstract
Ossifying fibroma is a slow-growing benign neoplasm that occurs most often in the jaws, especially the mandible. The tumor is composed of bone that develops within fibrous connective tissue. Some ossifying fibromas consist of cementum-like calcifications, while others contain only bony material; however, a mixture of these calcification types is commonly seen in a single lesion. Of the craniofacial bones, the mandible is the most commonly involved site, with the lesion typically inferior to the premolars and molars. Ossifying fibroma of the jaw shows a female predominance. Some reports of ossifying fibroma have been published in the literature; however, this report continues the research on this topic by detailing 3 types of ossifying fibroma findings on panoramic radiographs and cone-beam computed tomographic images of 4 patients. The radiographs of the presented cases could help clinicians understand the variations in the radiographic appearance of this lesion.
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Affiliation(s)
- Myeong Kwan Jih
- Department of Pediatric Dentistry, College of Dentistry, Chosun University, Gwangju, Korea
| | - Jin Soo Kim
- Department of Oral and Maxillofacial Radiology, College of Dentistry, Chosun University, Gwangju, Korea
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4
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Kaur T, Dhawan A, Bhullar RS, Gupta S. Cemento-Ossifying Fibroma in Maxillofacial Region: A Series of 16 Cases. J Maxillofac Oral Surg 2019; 20:240-245. [PMID: 33927492 DOI: 10.1007/s12663-019-01304-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 11/02/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction Cemento-ossifying fibroma is considered as a benign osseous tumour, closely related to other lesions such as fibrous dysplasia and cementifying periapical dysplasia. These lesions occur in the second to the fourth decade of life. It is a bony tumour of maxilla and mandible of possibly odontogenic origin with aggressive behaviour and high tendency for recurrence. Radiologically, the lesion appearances varied ranging from radiolucent cyst-like appearance to mixed and/or radiopaque areas. Aims and objectives The article attempts to highlight the importance of clinical, imaging aspects and histopathology in diagnosis of cemento-ossifying fibroma along with management and long-term follow-up. Materials and methods This retrospective study was done on histologically diagnosed 16 fibro-osseous lesions. These patients were treated under general anaesthesia at our institute. The demographic data, radiographic features, and histopathologic findings were analysed and compared. The treatment and follow-up data were also recorded. Results Cemento-ossifying fibroma showed higher predilection for female than for male patients and with an equal number of cases reported in maxilla and mandible with no signs of recurrence in long-term follow-up of 15 years. Conclusion Complete surgical excision of cemento-ossifying fibroma comes out to be only effective treatment that gave satisfactory results and can be considered as a definitive treatment modality.
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Affiliation(s)
- Tejinder Kaur
- Department of Oral and Maxillofacial Surgery, Sri Guru Ram Das Institute of Dental Sciences and Research, Mall Mandi, GT Road, Amritsar, 143001 India
| | - Amit Dhawan
- Department of Oral and Maxillofacial Surgery, Sri Guru Ram Das Institute of Dental Sciences and Research, Mall Mandi, GT Road, Amritsar, 143001 India
| | - Ramandeep Singh Bhullar
- Department of Oral and Maxillofacial Surgery, Sri Guru Ram Das Institute of Dental Sciences and Research, Mall Mandi, GT Road, Amritsar, 143001 India
| | - Sakshi Gupta
- Department of Oral and Maxillofacial Surgery, Sri Guru Ram Das Institute of Dental Sciences and Research, Mall Mandi, GT Road, Amritsar, 143001 India
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Abstract
Benign fibro-osseous lesions (BFOLs) are a particularly challenging set of diagnoses for the pathologist. This diverse collection of diseases includes fibrous dysplasia, ossifying fibroma and cemento-osseous dysplasia. While all three conditions have similar microscopic presentations, their treatment and prognosis differ, demanding an accurate and definitive diagnosis. A practical and systematic approach considering the patient's history, demographics, intraoperative presentation, and gross appearance with an emphasis on radiology and histology will be discussed.
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6
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Central Osteoma of Maxilla Associated with an Impacted Tooth: Report of a Rare Case with Literature Review. Head Neck Pathol 2018; 13:554-561. [PMID: 30564996 PMCID: PMC6854353 DOI: 10.1007/s12105-018-0994-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 12/08/2018] [Indexed: 12/16/2022]
Abstract
Osteomas are benign osteogenic neoplasms caused by proliferation of mature compact or cancellous bone. Clinically they may be classified as peripheral, central or extraskeletal. Osteomas usually involve the craniofacial region with mandible being the most common site. Central osteoma of the jaws is a very rare entity with only 13 cases reported in the literature till date of which only five cases occurred in the maxilla. Here we present a case of a large central osteoma of anterior maxilla associated with an impacted tooth, the first of its kind and a review of literature.
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7
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Abtahi J, Ajan A. Malignant Transformation of Ossifying Fibroma into Parosteal Osteosarcoma with High-grade Component: Presentation of an Unusual Case and Review of the Literature. Open Dent J 2018. [DOI: 10.2174/1874210601812011059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Parosteal Osteosarcoma of the Jaw (POSJ) is a rare entity that is associated with a high survival rate. Several case reports and case series of POSJ have been published in the literature, but few authors have described development of this tumor by possible transformation from a fibro-osseous neoplasm.
Objective:
We present a rare occurrence of parosteal osteosarcoma with involvement of the posterior maxilla, orbit floor, and infra-temporal fossa in a 20-year-old man. Furthermore, we performed a literature review regarding clinical, radiological, and histological features; treatment strategies; and etiology/pathophysiology.
Methods:
A PubMed search yielded a total of 74 articles and the articles were sorted according to their corresponding key area of focus.
Results:
This was a case of POSJ with high-grade component in the maxillofacial region of a 20-year old male. Co-expression of MDM2 and CDK4 was confirmed. At 2.5-year follow-up, the patient had died. The literature review revealed 18 articles including 20 cases of POSJ. Four cases represent the possible development of this tumor by transformation from a fibro-osseous neoplasm: Two cases of fibrous dysplasia, one case of cemento-ossifying fibroma, and the case of Ossifying Fibroma (OF) in the present study.
Conclusion:
In conclusion, we found an unusual case of POSJ of the midface in a patient with a previous diagnosis of OF in the same region. To our knowledge, there have been no previous reports of development of POSJ in OF. Furthermore, this is the first described case of high-grade surface osteosarcoma in the craniofacial region.
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8
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Kharsan V, Madan RS, Rathod P, Balani A, Tiwari S, Sharma S. Large ossifying fibroma of jaw bone: a rare case report. Pan Afr Med J 2018; 30:306. [PMID: 30637089 PMCID: PMC6320444 DOI: 10.11604/pamj.2018.30.306.15877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/10/2018] [Indexed: 11/17/2022] Open
Abstract
Ossifying fibroma (OF) is classified as, and behaves like, a benign bone neoplasm. It is often considered to be a type of fibro-osseous lesion (FOL). It can affect both mandible and the maxilla, particularly the mandible. This bone tumour consists of highly cellular, fibrous tissue that contains varied amounts of bone or cementum resembling calcified tissue. Present case is an unusual report of central ossifying fibroma involving the left side of mandible in an 18 year old female patient, who presented to the department with a painless hard swelling. The lesion was treated by surgical resection and reconstruction.
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Affiliation(s)
- Vinay Kharsan
- Department of Oral and Maxillofacial Surgery, New Horizon Dental College and Research Institute, Bilaspur, Chhattisgarh, India
| | - Ramnik Singh Madan
- Department of Oral and Maxillofacial Surgery, New Horizon Dental College and Research Institute, Bilaspur, Chhattisgarh, India
| | - Pankaj Rathod
- Department of Oral and Maxillofacial Surgery, New Horizon Dental College and Research Institute, Bilaspur, Chhattisgarh, India
| | - Abhishek Balani
- Department of Oral and Maxillofacial Surgery, New Horizon Dental College and Research Institute, Bilaspur, Chhattisgarh, India
| | - Sumit Tiwari
- Department of Oral and Maxillofacial Surgery, New Horizon Dental College and Research Institute, Bilaspur, Chhattisgarh, India
| | - Saurabh Sharma
- Department of Oral and Maxillofacial Surgery, New Horizon Dental College and Research Institute, Bilaspur, Chhattisgarh, India
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9
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Rosebush M, Schultz K. Clinical Pathologic Conference Case 3. Oral Surg Oral Med Oral Pathol Oral Radiol 2018. [DOI: 10.1016/j.oooo.2018.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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10
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Abstract
Fibroosseous lesions in the jaws have similar histologic and radiographic features. Despite their similarity, management varies significantly. In this article, common fibroosseous lesions and key radiographic features are described. Many of the fibroosseous lesions are diagnosed radiographically, without performing histologic examinations. For some of the fibroosseous lesions, for example, periapical osseous dysplasia, histologic examination is contraindicated. Cherubism and fibrous dysplasia have specific radiographic findings; these conditions can be diagnosed radiographically. Accurate diagnosis conditions is essential; some conditions do not require any intervention, while others require surgical resection. Patient demographics, for example, age, gender, and race, play important roles in diagnosis.
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Affiliation(s)
- Mansur Ahmad
- Department of Diagnostic and Biological Sciences, University of Minnesota School of Dentistry, Minneapolis, MN 55455, USA.
| | - Laurence Gaalaas
- Department of Diagnostic and Biological Sciences, University of Minnesota School of Dentistry, Minneapolis, MN 55455, USA
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11
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Mainville GN, Turgeon DP, Kauzman A. Diagnosis and management of benign fibro-osseous lesions of the jaws: a current review for the dental clinician. Oral Dis 2016; 23:440-450. [PMID: 27387498 DOI: 10.1111/odi.12531] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 06/28/2016] [Accepted: 07/02/2016] [Indexed: 02/07/2023]
Abstract
Benign fibro-osseous lesions of the maxillofacial skeleton constitute a heterogeneous group of disorders that includes developmental, reactive (dysplastic) and neoplastic lesions. Although their classification has been reviewed multiple times in the past, the most common benign fibro-osseous lesions are fibrous dysplasia, osseous dysplasia and ossifying fibroma. For the dental clinician, the challenges involve diagnosis and treatment (or lack thereof). A careful correlation of all clinical, radiologic and microscopic features is essential to establish a proper diagnosis and a clear treatment plan. This article aimed to review the clinical, radiologic and histopathologic characteristics of benign fibro-osseous lesions of the jaws, with emphasis on their differential diagnoses. With a deeper understanding of benign fibro-osseous lesions, clinicians will be better prepared to manage these lesions in their practice.
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Affiliation(s)
- G N Mainville
- Department of Stomatology, Faculty of Dentistry, Université de Montréal, Montreal, QC, Canada
| | - D P Turgeon
- Department of Stomatology, Faculty of Dentistry, Université de Montréal, Montreal, QC, Canada
| | - A Kauzman
- Department of Stomatology, Faculty of Dentistry, Université de Montréal, Montreal, QC, Canada
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12
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Which Patients With Ossifying Fibroma of the Jaws Would Be Suitable for Radical Ablative Surgery? J Craniofac Surg 2016; 27:927-31. [PMID: 27192645 DOI: 10.1097/scs.0000000000002653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of authors' study was to present their 10-year experience in the treatment of giant ossifying fibroma (GOF), and to prove if GOF can be totally excised preventing recurrence. The authors' secondary goal was to study the aesthetic and functional outcomes after radical resection of GOF followed by immediate reconstruction. METHODS Eighteen patients who underwent radical ablative surgery of GOF of the jaw followed by immediate reconstruction with vascularized fibula flap or ilium flap between May 2003 and May 2013 were taken. Recurrence rate was statistically observed and 2-year postoperative aesthetic and functional outcomes were evaluated. RESULTS The average length of follow-up was 4.5 years. There was no residual tumor or tumor recurrence observed in any patient during the mean follow-up of 4.5 years, and good cosmesis and functional outcome was noted after ablative surgery of GOF followed by computer-assisted reconstruction. CONCLUSIONS For giant OF, if it is mainly located in the jaws without invasion of the skull base and/or pterygoid process, radical surgical treatment should be performed for prevention of tumor recurrence. And good aesthetic and functional results can be achieved by immediate computer-assisted reconstruction and dental rehabilitation.
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13
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da Silveira DT, Cardoso FO, E Silva BJA, E Alves Cardoso CA, Manzi FR. Ossifying fibroma: report on a clinical case, with the imaging and histopathological diagnosis made and treatment administered. Rev Bras Ortop 2015; 51:100-4. [PMID: 26962494 PMCID: PMC4767835 DOI: 10.1016/j.rboe.2015.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 01/14/2015] [Indexed: 11/21/2022] Open
Abstract
The aim was to report on a case of ossifying fibroma, consisting of a benign fibro-osseous lesion characterized by slow growth and proliferation of fibrous cellular tissue, bone, cement or a combination. A 29-year-old male patient was attended at a hospital, after he had suffered a car accident. During the clinical examination, increased volume in the region of the right side of the mandible was observed, and a fracture in the middle third of the face was suspected. The tomographic examination showed an image suggestive of fracturing of the left-side zygomatic complex, without displacement, and with a well-delimited radiopaque image of the mandible. The patient was sent to a hospital where panoramic radiography, posteroanterior radiography of the face and teleradiography were performed in order to better document the case. An incisional biopsy was performed. Histopathological examination showed the presence of a benign bone lesion suggestive of ossifying fibroma. Surgery was performed in order to completely remove the lesion, with fixation using a reconstruction plate. A new anatomopathological examination confirmed the diagnosis.
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Affiliation(s)
| | | | | | | | - Flávio Ricardo Manzi
- Pontifícia Universidade Católica de Minas Gerais (PUC-MG), Belo Horizonte, MG, Brazil
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14
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Tyagi A, Chaudhary S, Gupta V. Ipsilateral maxillo-mandibular ossifying fibroma. J Maxillofac Oral Surg 2015; 14:127-32. [PMID: 25838685 DOI: 10.1007/s12663-012-0366-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 03/05/2012] [Indexed: 12/01/2022] Open
Abstract
Ossifying fibroma is a benign fibro-osseous lesion which occurs at various locations in maxillofacial region. A synchronous presentation of this lesion in both, the maxilla and the mandible is a rare occurrence. The present article reports a case of ossifying fibroma in a 45-year-old woman who manifested lesions in the right maxilla and mandible. The clinico-radiologic and histopathologic modalities of diagnosing this entity are evaluated and discussed.
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Affiliation(s)
- Amit Tyagi
- I.P. Dental College, Ghaziabad, UP India
| | | | - Vineet Gupta
- Krishna Dental College and Hospital, Mohan Nagar, Ghaziabad, UP India
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15
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Bhargava P, Khan S, Sharma R, Agwani K, Gupta S. A swelling of the maxilla: a case report and differential diagnosis. J Korean Assoc Oral Maxillofac Surg 2015; 40:308-12. [PMID: 25551097 PMCID: PMC4279968 DOI: 10.5125/jkaoms.2014.40.6.308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 09/02/2014] [Indexed: 12/03/2022] Open
Abstract
Ossifying fibromas are benign fibro-osseous tumors of mesenchymal origin. Although ossifying fibromas have principally been found in the jaw, they have also been reported in the frontal, ethmoid, sphenoid, and temporal bones, as well as the orbit and anterior cranial fossa. Ossifying fibromas affecting the jaw exhibit variable behaviors ranging from slow growth to occasionally aggressive local destruction. In the present article, we discuss a differential diagnosis considered for maxillary swellings and report a rare case of ossifying fibroma occurring in the maxilla.
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Affiliation(s)
- Puneet Bhargava
- Department of Oral Medicine and Radiology, NIMS Dental College and Hospital, NIMS University, Jaipur, India
| | - Saba Khan
- Department of Oral Medicine and Radiology, NIMS Dental College and Hospital, NIMS University, Jaipur, India
| | - Rohit Sharma
- Department of Oral Medicine and Radiology, NIMS Dental College and Hospital, NIMS University, Jaipur, India
| | - Khalid Agwani
- Department of Oral and Maxillofacial Surgery, Darshan Dental College, Udaipur, India
| | - Sahil Gupta
- Department of Oral Medicine and Radiology, NIMS Dental College and Hospital, NIMS University, Jaipur, India
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El-Mofty SK. Fibro-osseous lesions of the craniofacial skeleton: an update. Head Neck Pathol 2014; 8:432-44. [PMID: 25409854 PMCID: PMC4245413 DOI: 10.1007/s12105-014-0590-0] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 11/05/2014] [Indexed: 10/24/2022]
Abstract
Benign fibro-osseous lesions of the craniofacial skeleton (BFOL) are a variant group of intraosseous disease processes that share similar microscopic features characterized by hypercellular fibroblastic stroma containing various combinations of bone or cementum-like tissue and other calcified structures [1-6]. Whereas some are diagnosable histologically, most require a combined assessment of clinical, microscopic and radiologic features. Some BFOL of the craniofacial complex are unique to that location whereas others are encountered in bones from other regions. Reactive, neoplastic, developmental and dysplastic pathologic processes are included under the rubric of BFOL and treatment varies from disease to disease. This review will discuss the clinical, microscopic and radiologic aspects of the more important types of BFOL of the craniofacial complex with updated information on underlying genetic and molecular pathogenic mechanisms of disease. Four main groups of BFOLs will be addressed.
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Affiliation(s)
- Samir K El-Mofty
- Department of Pathology and Immunology, Washington University School of Medicine, 660 Euclid Ave., Campus Box 8118, St. Louis, MO, USA,
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17
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Massive expansile ossifying fibroma of the mandible with osteomyelitis. Oral Radiol 2014. [DOI: 10.1007/s11282-013-0164-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mohanty S, Gupta S, Kumar P, Sriram K, Gulati U. Retrospective Analysis of Ossifying Fibroma of Jaw Bones Over a Period of 10 Years with Literature Review. J Maxillofac Oral Surg 2013. [PMID: 26225029 DOI: 10.1007/s12663-013-0545-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The purpose of this retrospective analysis is to document and discuss the features, treatment rendered and result of 25 histologically proven cases of ossifying fibromas of jaw bones operated by a single surgeon over a period of 10 years. MATERIALS AND METHODS The records of ossifying fibroma were obtained from the archives of Oral and Maxillofacial Surgery at Maulana Azad Institute of Dental Sciences (MAIDS) from 2001 to 2011. Only those cases were included in the study where definitive surgery was performed based on clinical, radiological & histopathological features. RESULTS Twenty-five patients were analyzed with a final diagnosis of ossifying fibroma comprising of 14 males (56 %) and 11 females (44 %). The age range was 11-45 years with a mean of 24.12 years. Mandible was involved in 72 % and maxilla in 28 % cases with a predominance of mandibular posterior [19 (76 %)] cases. The study showed similar findings in regard to clinical, radiographic & histological features of ossifying fibroma as compared to other studies. It also showed that the treatment rendered in the form of eneucleation, curettage or resection of the lesion depending on its stage and extent were adequate, as no recurrence has been reported till date. CONCLUSION Enucleation is preferred in small and well demarcated lesions. Curettage should be done in relatively large lesions with ill defined borders, not involving basal bone of mandible or cortical perforation. Resection should be reserved for aggressive and extensive cases with involvement of basal bone or perforation of cortices.
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Affiliation(s)
- Sujata Mohanty
- Department of Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, MAMC Campus, New Delhi, 110002 India
| | - Sunita Gupta
- Department of Oral Medicine, Diagnosis and Radiology, Maulana Azad Institute of Dental Sciences, MAMC Campus, New Delhi, 110002 India
| | - Priya Kumar
- Department of Oral and Maxillofacial Pathology, Maulana Azad Institute of Dental Sciences, MAMC Campus, New Delhi, 110002 India
| | - K Sriram
- Department of Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, MAMC Campus, New Delhi, 110002 India
| | - Ujjwal Gulati
- Department of Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, MAMC Campus, New Delhi, 110002 India
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Gerlach RC, Dixon DR, Goksel T, Castle JT, Henry WA. Case presentation of florid cemento-osseous dysplasia with concomitant cemento-ossifying fibroma discovered during implant explantation. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 115:e44-52. [PMID: 22858018 DOI: 10.1016/j.oooo.2012.05.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 05/13/2012] [Accepted: 05/17/2012] [Indexed: 11/18/2022]
Abstract
A 39-year-old African American woman presented for treatment of a symptomatic mandibular right first molar with a large, periapical radiolucency. After initial attempts at endodontic therapy, this tooth was ultimately extracted owing to unabated symptoms. The extraction site underwent ridge preservation grafting, implant placement, and restoration. After 26 months of implant function, the patient returned with clinical symptoms of pain, buccal swelling, and the sensation of a "loose" implant. This case report details a diagnosis of 2 distinct disease entities associated with the implant site, a cemento-ossifying fibroma and florid cemento-osseous dysplasia of the mandible. This diagnosis was determined from clinical, surgical, radiographic, and histopathologic evidence after biopsy and removal of the previously osseointegrated implant following postinsertion failure by fibrous encapsulation. Before implant therapy, it is essential to conduct a thorough radiographic evaluation of any dental arch with suspected bony lesions to prevent implant failure.
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Affiliation(s)
- Robert C Gerlach
- US Army Advanced Education Programs in Periodontic, Oral Surgery, and Oral Pathology, Fort Gordon, Georgia 309058, USA.
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20
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Agarwal N, Gupta P, Gupta P, Naik S, Upadhyay N. Recurrent bimaxillary radiopacities: A rare case report. Contemp Clin Dent 2012; 3:S103-8. [PMID: 22629047 PMCID: PMC3354797 DOI: 10.4103/0976-237x.95117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Cemento-ossifying fibroma (COF) is considered a benign osseous tumor. Herewith, we present a case of multiple central ossifying fibroma in a 35-yeaold woman. Intraorally, there was swelling in the left upper posterior teeth region and another diffused swelling in the fourth quadrant. Radiographs revealed the presence of well-defined mixed radiolucent–radiopaque area having thin radiolucent rim followed by thick sclerotic margin. No genetic correlation could be established. As bilateral COF is a rare entity, we present such a case with different radiographic appearance, using various radiographic techniques.
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Affiliation(s)
- Nupur Agarwal
- Department of Oral Medicine and Radiology, Teerthankar Mahaveer Dental College & Research Center, Moradabad, Uttar Pradesh, India
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21
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Abstract
This article describes the clinical, radiographic, and pathologic features of tumors and tumorlike lesions affecting the bones of the head and neck region. Emphasis is placed on common bone lesions affecting the craniofacial skeleton, particularly those that occur with more frequency or those that are unique to this part of the skeleton. Several of these lesions pose a diagnostic challenge to the pathologist. To ensure that a correct diagnosis is rendered, it is of utmost importance that accurate and detailed clinical and radiographic information is available.
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Affiliation(s)
- Samir K El-Mofty
- Department of Pathology and Immunology, Washington University School of Medicine, 660 Euclid Avenue, Campus Box 8118, St Louis, MO 63110, USA
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22
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Gondivkar SM, Gadbail AR, Chole R, Parikh RV, Balsaraf S. Ossifying fibroma of the jaws: report of two cases and literature review. Oral Oncol 2011; 47:804-9. [PMID: 21741877 DOI: 10.1016/j.oraloncology.2011.06.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 06/11/2011] [Accepted: 06/14/2011] [Indexed: 11/28/2022]
Abstract
Ossifying fibromas are uncommon benign tumors of the craniofacial skeleton thought to originate from the periodontal ligament. Most are small and incidentally diagnosed with routine dental radiographs. With larger lesions, patients may complain of an abnormal bite or an enlarging mass. This tumor involves slow-evolving growth with deforming swelling generally arising in the mandible, with possible early tooth displacement. From the radiological perspective, more than 50% of the lesions exhibit an expansion of the jaws and 53% shows well-defined unilocular radiolucencies and 40% are mixed radiolucent-radiopaque lesions. The lesions exceptionally can be radiopaque. Ossifying fibroma presents several variant histopathological subtypes. The overlapping clinical and histopathological features of these subtypes have led to diagnostic dilemma and confusion. Complete excision of this tumor has become a necessity since it is notorious for recurrence. We present here two cases of ossifying fibroma of the jaws along with insight into the literature review.
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Affiliation(s)
- Shailesh M Gondivkar
- Department of Oral Diagnosis, Medicine and Radiology, MGV's K.B.H. Dental College and Hospital, Nashik, Maharashtra, India.
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Khan SA, Sharma NK, Raj V, Sethi T. Ossifying fibroma of maxilla in a male child: Report of a case and review of the literature. Natl J Maxillofac Surg 2011; 2:73-9. [PMID: 22442615 PMCID: PMC3304240 DOI: 10.4103/0975-5950.85859] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Ossifying fibroma is a rare benign fibro-osseous neoplasm of the jaw characterized by substitution of normal bone by fibrous tissues and newly formed calcified products such as bone, cementum or both. It is a well-demarcated lesion that differentiates it from fibrous dysplasia. This case report describes a rare case of ossifying fibroma arising in the maxilla of an 11-year-old child treated with enucleation. The clinical, radiographical, surgical and histological findings are presented. Controversies regarding the terminology and classification along with the differential diagnosis are discussed and a review is provided of the literature on the subject.
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Affiliation(s)
- Suleman Abbas Khan
- Department of Pedodontics and Preventive Dentistry, Saraswati Dental College and Hospital, Lucknow, India
| | - Naresh Kumar Sharma
- Department of Oral and Maxillofacial Surgery, Saraswati Dental College and Hospital, Lucknow, India
| | - Vineet Raj
- Department of Oral and Maxillofacial Pathology, Saraswati Dental College and Hospital, Lucknow, India
| | - Tarun Sethi
- Department of Pedodontics and Preventive Dentistry, Saraswati Dental College and Hospital, Lucknow, India
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24
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Araki M, Matsumoto K, Matsumoto N, Honda K, Ohki H, Komiyama K. Unusual radiographic appearance of ossifying fibroma in the left mandibular angle. Dentomaxillofac Radiol 2010; 39:314-9. [PMID: 20587656 DOI: 10.1259/dmfr/81820042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Ossifying fibroma is usually a unilocular lesion with a well-defined, thinly corticated margin radiographically, although various patterns have been noted. The patient was a 27-year-old woman with a painless radiolucent lesion demonstrated on panoramic radiography to involve the root-apex area of the left lower second and third molars. Radiographically, the lesion had some features of a benign tumour, such as an odontogenic myxoma. However, the deep invaginations towards the interalveolar septa suggested a simple bone cyst, whereas the irregular margin and lack of expansion or mandibular canal displacement were consistent with a malignant lesion. A hard tissue component was confirmed only by soft-tissue mode CT. Although this lesion was histopathologically diagnosed as ossifying fibroma, the conflicting imaging findings were challenging and very intriguing.
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Affiliation(s)
- M Araki
- Department of Oral and Maxillofacial Radiology, Dental Research Centre, Nihon University School of Dentistry, 1-8-13 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8310, Japan.
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25
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Abstract
OBJECTIVES The aim was to evaluate the principal features of ossifying fibroma (OF) by systematic review (SR), and to compare their frequencies among four global groups. METHODS The databases searched were the PubMed interface of MEDLINE and LILACS. Only those reports of OFs that occurred in a series in the reporting authors' caseload were considered. All cases were confirmed fibro-osseous lesions histopathologically. The SR-included series had also to have used radiographs. RESULTS Of the 64 reports (including the Hong Kong report) considered, 32 reports and a total of 781 cases were included in the SR. Ten SR-included series were in languages other than English. OF affected females more frequently, but was three times more prevalent in the mandible. The mean age at first presentation was 31 years. The decade with the greatest frequency was the fourth. Females were in the majority except in the first decade. The main symptom in 66% of all SR-included cases was swelling (including deformation of the jaws). 31% were found incidentally. 84% of cases displayed buccolingual expansion; half of the mandibular cases exhibited downward displacement of the lower border of the mandible and 90% of maxillary cases involved the maxillary antrum. Only 28% of reports included follow-up; 12% of cases recurred or were reactivated. CONCLUSIONS Although long-term follow-up of large series that would have revealed the long-term outcomes of OF was lacking, a 12% recurrence rate is clinically significant and suggests that OFs should be considered for long-term follow-up.
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Affiliation(s)
- D S MacDonald-Jankowski
- Division of Oral & Maxillofacial Radiology, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada.
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26
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Liu Y, Wang H, You M, Yang Z, Miao J, Shimizutani K, Koseki T. Ossifying fibromas of the jaw bone: 20 cases. Dentomaxillofac Radiol 2010; 39:57-63. [PMID: 20089746 PMCID: PMC3520406 DOI: 10.1259/dmfr/96330046] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2008] [Revised: 01/11/2009] [Accepted: 02/06/2009] [Indexed: 11/05/2022] Open
Abstract
The purpose of this article is to report 20 cases of ossifying fibroma involving the jaw bone and to review the literature of this lesion. All the cases had adequate radiographs and clinical information. Varying shapes of the lesion including cystic lesion and mixed density lesion are presented, including two massive expansile lesions, which measured more than 10 cm.
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Affiliation(s)
- Y Liu
- Department of Oral Radiology, West China College of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - H Wang
- Department of Oral Radiology, West China College of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - M You
- Department of Oral Radiology, West China College of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Z Yang
- Department of Oral Radiology, West China College of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - J Miao
- Department of Oral Radiology, West China College of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - K Shimizutani
- Department of Oral Radiology, Osaka Dental University, Osaka, Japan
| | - T Koseki
- Department of Oral Radiology, Osaka Dental University, Osaka, Japan
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27
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MacDonald-Jankowski DS, Li TK. Ossifying fibroma in a Hong Kong community: the clinical and radiological features and outcomes of treatment. Dentomaxillofac Radiol 2009; 38:514-23. [DOI: 10.1259/dmfr/51064053] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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28
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Crusoé-Rebello I, Torres MGG, Burgos V, Oliveira C, Santos JND, Azevedo RA, Campos PSF. Hybrid lesion: central giant cell granuloma and benign fibro-osseous lesion. Dentomaxillofac Radiol 2009; 38:421-5. [PMID: 19700537 DOI: 10.1259/dmfr/44753298] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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29
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Mohd Jamal Alsharif, Sun ZJ, Chen XM, Wang SP, Zhao YF. Benign Fibro-Osseous Lesions of the Jaws: A Study of 127 Chinese Patients and Review of the Literature. Int J Surg Pathol 2008; 17:122-34. [PMID: 18480400 DOI: 10.1177/1066896908318744] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study is to analyze all the cases of benign fibro-osseous lesions treated at School and Hospital of Stomatology, Wuhan University, to compare the results obtained in this study with those previously documented by other authors. The 127 cases diagnosed as a fibro-osseous lesion were retrieved, and information about these lesions was documented. In all, 127 cases of benign fibro-osseous lesions were surgically treated. Of these, 55 were cemento-ossifying fibroma, 43 ossifying fibroma, and 29 fibrous dysplasia. Cemento-ossifying fibromas mostly occur in men of the second decades, mostly in the mandible. Ossifying fibromas had almost equal sex predilection and age distribution peaked in the second decades, mostly in the mandible. Fibrous dysplasia also had equal sex predilection, and age distribution peaked in the second and third decades, with equal occurrence in both jaws. The tumors needed to have a regular follow-up after the surgery.
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Affiliation(s)
- Mohd Jamal Alsharif
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology
| | - Zhi-Jun Sun
- Department of Oral and Maxillofacial Surgery, Key Laboratory of Oral Biomedical Engineering, Ministry of Education
| | - Xin-Ming Chen
- Department of Oral Pathology, School and Hospital of Stomatology Wuhan University, Wuhan, Hubei, China
| | - Shi-Ping Wang
- Department of Oral Pathology, School and Hospital of Stomatology Wuhan University, Wuhan, Hubei, China
| | - Yi-Fang Zhao
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology
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30
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Ogunsalu CO, Lewis A, Doonquah L. Benign fibro-osseous lesions of the jaw bones in Jamaica: analysis of 32 cases. Oral Dis 2008. [DOI: 10.1034/j.1601-0825.2001.70304.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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31
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Godt A, Gülicher D, Kalwitzki M, Kröber SM. Dislocation of an upper third molar by an ossifying fibroma--case report. J Craniomaxillofac Surg 2008; 36:360-4. [PMID: 18403213 DOI: 10.1016/j.jcms.2008.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The occurrence of ossifying fibromas (OFs) in childhood and adolescence has been described in the literature, along with different courses of the disease due to different growth rates. CASE REPORT In the case of the 15-year-old female patient presented here, an OF resulted in displacement of a maxillary third molar far into the maxillary sinus. It is assumed that the tumour originated coronal to the affected tooth 18. Radiographs document an initial rapid growth of this tumour over a period of 2 years, while its growth almost completely ceased in the next 2 years immediately prior to diagnosis and surgical treatment. The operation was complicated by unexpected profuse bleeding from the tumour tissue. CONCLUSION The peculiarity of the OF in the case presented here is its similarity, in terms of clinical and radiological appearances, with a follicular cyst, its unusual place of origin that resulted in the migration of the tooth 18 into the maxillary sinus, its different growth dynamics, and the pronounced haemorrhage encountered as the tumour was surgically removed.
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Affiliation(s)
- Arnim Godt
- Department of Orthodontics, University Tübingen, Osianderstrasse 2-8, Tübingen, Germany.
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32
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33
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Gurol M, Uckan S, Guler N, Yatmaz PI. Surgical and reconstructive treatment of a large ossifying fibroma of the mandible in a retrognathic patient. J Oral Maxillofac Surg 2001; 59:1097-100. [PMID: 11526587 DOI: 10.1053/joms.2001.25858] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M Gurol
- Department of Oral and Maxillofacial Surgery, Ankara Hospital, Ankara, Turkey.
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34
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Abstract
The benign fibro-osseous lesions (BFOL) represent a clinically diverse group of disorders of bone that share similar histopathologic features. As a group, they are relatively common in the craniofacial complex, especially the jaws. Although the general concept of BFOL is relatively well known, specific diagnostic interpretation of individual cases is often challenging. New concepts and controversies have arisen over the past 10 to 15 years regarding classification and diagnostic criteria. However, among the new theories and contentions, there is now essential agreement that the osseous dysplasias represent a single disease process, while the so-called "juvenile active ossifying fibroma" and other "aggressive," "active," "psammomatoid" ossifying/cementifying fibromas remain controversial. This review is presented to update the surgical pathologist on the various entities comprising the spectrum of BFOL and to examine the criteria for their diagnosis.
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Affiliation(s)
- R B Brannon
- Department of Oral and Maxillofacial Pathology, Louisiana State University Health Sciences Center, Dental School, New Orleans 70119, USA.
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35
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Abstract
A 4.5-year-old llama was admitted for evaluation of a firm mass rostral and ventral to the medial canthus of the left eye. Mucopurulent nasal discharge and absence of airflow through the left nostril were noted. Radiographs of the skull revealed a sharply demarcated soft tissue mass with faint mineralization. Endoscopy of the nasal passages revealed a mucosa-covered mass originating in the area of the second premolar, extending to the edge of the soft palate, and obstructing the airway. Examination of the oral cavity revealed a missing second molar and a mass protruding 2-cm from the empty alveolus. An ossifying fibroma, a previously unreported tumor in llamas, was diagnosed at postmortem examination.
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Affiliation(s)
- C T McCauley
- Department of Medicine and Surgery, College of Veterinary Medicine, Oklahoma State University, Stillwater 74078-2041, USA
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36
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Kawai T, Hiranuma H, Kishino M, Jikko A, Sakuda M. Cemento-osseous dysplasia of the jaws in 54 Japanese patients: a radiographic study. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1999; 87:107-14. [PMID: 9927089 DOI: 10.1016/s1079-2104(99)70303-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to describe the radiographic patterns of cemento-osseous dysplasia. STUDY DESIGN Fifty-four patients affected with benign fibro-osseous jaw lesions that showed periapical radiopacities and/or radiolucencies in a focal or a multiplex form were studied. The clinical, radiographic, and histopathologic features of the patients with cemento-osseous dysplasia were retrospectively studied. Radiographic features of the cemento-osseous dysplasia lesions were classified according to the appearance of calcified bodies. Radiographic visibility of periodontal ligament spaces of related teeth was assessed. RESULTS Forty-nine (91 %) of the 54 patients were women. The mean age of the total group was 50.8 years, and that of the male group was 64.6 years. The cemento-osseous dysplasia lesions could be classified into 6 types radiographically. Eighteen patients had at least 2 or more types of cemento-osseous dysplasia lesions. Of 147 related teeth, 142 had periodontal ligament spaces clearly visible. Six of 9 patients who had a total of 25 teeth with active hypercementosis showed concomitant occurrence of other types of cemento-osseous dysplasia lesions. Biopsy specimens showed various amounts of bonelike and cementumlike tissues. CONCLUSIONS It is likely that cemento-osseous dysplasia consists of 3 variations of a single entity, all with the same unknown cause. In one variation, the entity originates from the periodontium; in another, it is of medullary bone origin; and in the third it results from the simultaneous involvement of both tissues.
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Affiliation(s)
- T Kawai
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Osaka University, Japan
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37
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Affiliation(s)
- V F Chong
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
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38
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39
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Khanna JN, Andrade NN. Giant ossifying fibroma. Case report on a bimaxillary presentation. Int J Oral Maxillofac Surg 1992; 21:233-5. [PMID: 1402053 DOI: 10.1016/s0901-5027(05)80226-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Ossifying fibroma is a slow-growing, benign neoplasm, but some lesions behave aggressively, reaching massive proportions, thus demanding special treatment. The following case report holds particular interest, because of the simultaneous occurrence of an active ossifying-cementifying fibroma in the maxilla and mandible with the maxillary lesion attaining enormous size.
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Affiliation(s)
- J N Khanna
- Department of Maxillofacial Plastic and Oral Surgery, Nair Hospital and Dental College, Bombay, India
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40
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Burkhardt A. Dentin formation in so-called "fibro-osteo-cemental" lesions of the jaw: histologic, electron microscopic, and immunohistochemical investigations. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1989; 68:729-38; discussion 739. [PMID: 2594321 DOI: 10.1016/0030-4220(89)90163-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Two cases of the so-called fibro-osteo-cemental lesions of the jaws, containing unusual deposits of hard tissue, are described. There were peculiar spheroid calcifications or larger masses forming small cavities with a radial arrangement and discontinuous blasts extending with axonlike cell processes toward an acellular core. For further definition, electron microscopic and immunohistologic studies were done. The most conspicuous features were abundant intracytoplasmic vimentin filaments in the blasts, tight junctions, matrix vesicle formation, a globular accretion pattern, and so-called matrix maturation. These findings militate against an osseous or cementous nature of this hard tissue. Rather, both the light and electron microscopic findings are highly compatible with the assumption that the blasts are odontoblasts and that an immature type of dentin is formed. In addition to fibroblasts, osteoblasts, and cementoblasts, apparently also a further descendant of the ectomesenchyme--the odontoblasts with dentin formation--may participate in the so-called fibro-osteo-cemental lesions.
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Affiliation(s)
- A Burkhardt
- Institute of Pathology, University of Berne, Switzerland
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41
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Abstract
A clinical, radiographic, histologic and follow up study of 18 cases of ossifying fibroma involving the mandible and maxilla was performed. Differences in behavior and management according to age, location, radiographic appearance and histopathology were not evident. A wide range of microscopic findings within and between cases was evident, while the radiographic finding consisting of sharp delineation was consistent in all cases. The presence or absence of cementum or cementum-like material and various types of formed elements was likewise of little clinical significance. Finally, a potential source of the neoplastic cell from the periodontal apparatus may help explain the range of histologic findings.
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Affiliation(s)
- J J Sciubba
- Department of Dentistry, Long Island Jewish Medical Center, New Hyde Park, NY 11042
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42
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Koseki T, Itagaki K, Koseki Y. Eight cases of cementifying fibromas of the Jaws. Oral Radiol 1987. [DOI: 10.1007/bf02348542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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43
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Eversole LR, Leider AS, Nelson K. Ossifying fibroma: a clinicopathologic study of sixty-four cases. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1985; 60:505-11. [PMID: 3864113 DOI: 10.1016/0030-4220(85)90239-7] [Citation(s) in RCA: 217] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Sixty-four cases of neoplastic benign fibro-osseous lesions are presented, with clinical and radiographic follow-up in 23 instances. A marked predilection for female patients was observed, with the majority or cases arising in the molar-premolar region of the mandible. Radiographically, these neoplasms are well demarcated and may be radiolucent, radiolucent with central opacification (target appearance), or multilocular radiolucent. A benign fibro-osseous histopathologic pattern is observed with osseous, cemental, and/or ovoid-curvoid calcified deposits. This feature, along with confinement to tooth-bearing regions, supports a periodontal ligament origin. It appears that the distinction between cementifying and ossifying variants is academic, as no behavioral differences exist. The recurrence rate following curettage was found to be 28%.
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