|Year : 2014 | Volume
| Issue : 1 | Page : 14-16
Juvenile ossifying fibroma of mandible
K Srivastava Ram1, Anand Kumar1, Iqbal Ali1, Puneet Wadhwani1, Anurag Saxena1, Mariyam Iqbal Ali2
1 Department of Oral and Maxillofacial Surgery, Career Postgraduate Institute of Dental Sciences and Hospital, Ghaila, Lucknow, Uttar Pradesh, India
2 Department of Prosthodontics, Career Postgraduate Institute of Dental Sciences and Hospital, Ghaila, Lucknow, Uttar Pradesh, India
|Date of Web Publication||28-Apr-2014|
272 Eldico 1, Basant Vihar, Lucknow 226 003, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Ossifying fibroma is a benign, slow growing, and expansile lesion of the jaws. It is classified as one of the benign fibro-osseous lesions of the jaws. The juvenile ossifying fibroma (JOF) is commonly found in children and young adults. The juvenile variety of ossifying fibroma is more aggressive and requires a more extensive therapy because it might recur after curettage. It usually occurs in the mandibular premolar-molar area. The slow growth of the tumor may produce expansion and thinning of the buccal and lingual cortical plates. The treatment of the JOF is conservative surgical contouring either using curettage or enucleation. The lesion can be separated easily from the surrounding normal bone. Large ossifying fibroma requires surgical resection to reestablish normal facial symmetry. A long-term follow up is required for the lesion.
Keywords: Enucleation, juvenile ossifying fibroma, mandible
|How to cite this article:|
Ram K S, Kumar A, Ali I, Wadhwani P, Saxena A, Ali MI. Juvenile ossifying fibroma of mandible. Dent Med Res 2014;2:14-6
| Introduction|| |
Ossifying fibromas are well-demarcated benign fibro-osseous tumors of craniofacial skeleton, most often the jaws. It has two types, conventional and juvenile ossifying fibroma (JOF). JOF is a benign, osteogenic, and non-odontogenic tumor, which is a slow growing expansile lesion of the jaws. JOF is considered a separate entity from ossifying fibroma due to its locally aggressive behavior and propensity to occur at an adolescent age. , It is classified under the benign fibro-osseous lesions. The most distinguishing feature of the ossifying fibroma is the well-circumscribed appearance of the ossifying fibroma radiographically, clinically, and the ease with which it can be separated from normal bone surgically. , The juvenile variety of ossifying fibroma is usually present in children and young adults. This lesion has a more aggressive behavior than does the ossifying fibroma and may require extensive therapy. Microscopically it has a characteristic feature of irregularly mineralized cellular osteoid strands lined by plump osteoblasts. ,
| Case Report|| |
A 10-year-old patient reported with a complaint of a large expanding lesion in the lower jaw of about 3 years duration. The tumor was expanding slowly and asymptomatically. Extraoral examination revealed a large bony hard non-tender swelling extending from anterior part of the mandible to the ramus area. The skin overlying the swelling was stretched but normal in appearance. Intraoral examination revealed cortical expansion. All the teeth on the affected side were mobile.
Its expansion was symmetrical from the epicenter of the tumor creating a spherical or egg-shaped mass [Figure 1] and [Figure 2].
Orthopantmogram (OPG) showed spherical heterogeneous mass. The calcified material was of the density of bone. The lesion consisted of a dense radiopaque mass surrounded by a well-defined radiolucent rim. The tumor expanded in bone, remained encapsulated and well demarcated [Figure 3].
|Figure 3: Occlusal view of mandible showing expansion of both the cortical plates from canine area to anterior border of ramus of mandible of the left side|
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The surgery was carried under general anesthesia. The lesion was approached intraorally with incision extending from the canine area of the opposite side to the ramus area of the same side of the lesion. The flap was raised carefully to prevent damage to the mucoperiosteum. The bony part of the tumor was found well encapsulated. The lesion was removed as it easily separated from the adjacent normal tissues [Figure 4]. The whole lesion was curetted, the margins of the uninvolved bone and lower border of mandible was left intact to prevent fracture of mandible. An air tight closure was achieved. The lesion scattered osteoid mass in fibrous tissue stroma [Figure 5].
|Figure 5: Histo-pathological picture of ossifying fibroma showing scattered osteoid mass in fibrous tissue|
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Correlating clinical and surgical behavior of the lesion, it was diagnosed as JOF. Postsurgical follow up of 3 years [Figure 6] showed no recurrence.
| Discussion|| |
Ossifying fibroma was first described by Menzel in 1842 as slow growing benign neoplasm most commonly found in the jaws. It was included in the group of fibro-osseous lesions of the jaws. The exact etiology of ossifying fibroma remains unknown. It is usually considered to develop from undifferentiated cells of the periodontal ligament origin. Chromosomal translocations have been identified in a few cases. Sometimes, localized dysplastic process and a history of trauma inducing stimulation of progenitor cells could be a cause.  In our case, patient had no history of trauma.
JOF is a variant of ossifying fibroma usually seen in children and young adults. Mostly individuals younger than 15 years of age are affected. It represents a tumor of high cellularity, rapid growth and displays aggressive, benign, or low-grade malignant behavior. Histologically the psammomatoid (Ps) and trabecular (Tr) subtypes of JOF have been well documented. The average age of occurrence of Tr JOF is 8-12 years, whereas that of Ps JOF is 16-33 years. 
JOF exhibits multiple recurrences and disfigurement. Microscopically the tumor contains trabeculae or spheroids of new bone. JOF behaves in a more aggressive fashion than ossifying fibroma, and it may require extensive surgery. , The presence of more mature lamellar bone is believed to be characteristic of ossifying fibroma. 
Cemento-ossifying fibroma is lesions with round or spherical bony islands along with calcified material. These occur in similar age groups and locations, exhibit similar clinical characteristics, and have the same biological behavior as ossifying fibroma. 
Radiographically the tumor is well-demarcated, unilocular, or multilocular radiolucency with a variable amount of radiopacity, usually manifesting as fine specks or ground glass opacification.  Our case presented as a dense radiopaque mass surrounded by a well-defined radiolucent rim.
Early tumors that are small, well demarcated, and clinically encapsulated are treated by enucleation and curettage. If the tumor attains an enormous size, resection is usually required. ,
Aggressive forms show expansile form of growth pattern but retain the sharp demarcation from normal adjacent bone. It appears locally aggressive with cortical disruption and involvement of adjacent anatomical structures. Management is surgical with complete resection, as partial removal is associated with recurrence. , Our patient was managed with surgical enucleation and curettage. The patient remained recurrence free on follow up.
| Conclusion|| |
The key to success in JOF lies in early detection, complete surgical excision, and a long-term follow up.
| Acknowledgement|| |
The authors sincerely thank Prof. Shadab Mohammad and Dr. R. K. Singh for giving advice and cooperation in this case.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]