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 Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 2  |  Issue : 1  |  Page : 14-16

Juvenile ossifying fibroma of mandible


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 Publication28-Apr-2014

Correspondence Address:
Anand Kumar
272 Eldico 1, Basant Vihar, Lucknow 226 003, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2348-1471.131558

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  Abstract 

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

How to cite this URL:
Ram K S, Kumar A, Ali I, Wadhwani P, Saxena A, Ali MI. Juvenile ossifying fibroma of mandible. Dent Med Res [serial online] 2014 [cited 2019 Mar 25];2:14-6. Available from: http://www.dmrjournal.org/text.asp?2014/2/1/14/131558


  Introduction Top


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. [1],[2] 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. [3],[4] 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. [5],[6]


  Case Report Top


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].
Figure 1: Front view of mass

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Figure 2: Side view of tumor mass

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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 4: Size of tumor mass after removal

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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.
Figure 6: Showing side profile of the patient 3 years after the surgery

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  Discussion Top


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. [3] 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. [7]

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. [5],[8] The presence of more mature lamellar bone is believed to be characteristic of ossifying fibroma. [9]

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. [10]

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. [11] 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. [5],[6]

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. [2],[12] Our patient was managed with surgical enucleation and curettage. The patient remained recurrence free on follow up.


  Conclusion Top


The key to success in JOF lies in early detection, complete surgical excision, and a long-term follow up.


  Acknowledgement Top


The authors sincerely thank Prof. Shadab Mohammad and Dr. R. K. Singh for giving advice and cooperation in this case.

 
  References Top

1.Mohsenifar Z, Nouhi S, Abbas FM, Farhadi S, Abedin B. Ossifying fibroma of the ethmoid sinus: Report of a rare case and review of literature. J Res Med Sci 2011;16:841-7.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Yadav N, Gupta P, Naik SR, Aggarwal A. Juvenile psammomatoid ossifying fibroma: An unusual case report. Contemp Clin Dent 2013;4:566-8.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.Pindborg JJ, Kraner IR. Histologic typing of odontogenic tumors. Jaw Cysts and allied lesions. Geneva: WHO; 1971.  Back to cited text no. 3
    
4.Eversole LR, Leider AS, Nelson K. Ossifying fibroma: A clinicopathological study of sixty-four cases. Oral Surg Oral Med Oral Pathol 1985;60:505-11.  Back to cited text no. 4
[PUBMED]    
5.Marx RE. Diaene stern. A Rationale for Diagnosis and Treatment. 2 nd ed. Oral Maxillofac Pathol 2003. p. 789-95.  Back to cited text no. 5
    
6.Regezi JA, Sciubba, James J, Richard CK. Oral pathology: Clinical pathologic correlation. 4 th ed. St Louis Missouri: W B Saunders. Co.; 2003. p. 115.  Back to cited text no. 6
    
7.El-Mofty S. Psammomatoid and trabecular juvenile ossifying fibroma of the craniofacial skeleton: Two distinct clinicopathologic entities. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;93:296-304.  Back to cited text no. 7
[PUBMED]    
8.Hamner JE 3 rd , Scofield HH, Cornyn J. Benign fibro-osseous jaw lesions of periodontal membrane origin. Cancer 1968;22:861-78.  Back to cited text no. 8
    
9.Harrison DF. Osseous and fibro-osseous conditions affecting the craniofacial bones. Ann Otol Rhinol Laryngol 1984;93:199-203.  Back to cited text no. 9
[PUBMED]    
10.Reaume CE, Schmid RW, Wesley RK. Aggressive ossifying fibroma of the mandible. J Oral Maxillofac Surg 1985;43:631-5.  Back to cited text no. 10
[PUBMED]    
11.Noffke CE. Juvenile ossifying fibroma of the mandible. An 8 year radiological follow-up. Dentomaxillofac Radiol 1998;27:363-6.  Back to cited text no. 11
[PUBMED]    
12.Sciubba JJ, Younai F. Ossifying fibroma of the mandible and maxilla: Review of 18 cases. J Oral Pathol Med 1989;18:315-21.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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Abstract
Introduction
Case Report
Discussion
Conclusion
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References
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