ReviewOssifying fibroma of the jaws: Report of two cases and literature review
Introduction
The term, fibro-osseous lesions, refers to a diverse process in which the normal bone architecture is replaced by fibroblasts and collagen fibers containing variable amounts of mineralized material. The term is not a specific diagnosis but only indicates a broad group of several entities. Although there is no completely satisfactory classification, it is generally accepted that benign fibro-osseous lesions in the oral and maxillofacial region can be divided into three categories including fibrous dysplasia, benign fibro-osseous neoplasms, and reactive (dysplastic) lesions.1 In 1872, Menzel gave the first description of a variant of OF, calling it a cemento-ossifying fibroma, in a 35 year old woman with a long standing large tumor of the mandible.2 In 1927, Montgomery3 first used the term OF, by which the lesion is currently known. The name has subsequently also been used by other authors.[4], [5], [6] Until 1948, it was believed that fibrous dysplasia and OF were either the same entity or variants of one same lesion.5 That year, Sherman and Sternberg7 published a detailed description of the clinical, radiological and histological characteristics of OF, and since then most researchers coincide in considering the two lesions to be different clinical entities.[5], [7], [8] A number of authors have suggested that ossifying and/or cementifying fibromas are benign fibro-osseous lesions originating in the periodontal ligament – as a result of which they would constitute histological variants of one same pathological process.[4], [9], [10] The lesions are designated differently, depending on the type of tissue identified.8 Thus, the term OF is used if the predominant component is bone, while cementifying fibroma is defined by the presence of curvilinear trabecular structures or spherical calcifications. In turn, lesions characterized by the presence of bone and cementum are referred to as cemento-ossifying fibroma. However, the terms OF and cementifying fibroma are merely academic designations.[5], [8]
Ossifying fibroma (OF) is a fibro-osseous lesion that arises from the periodontal membrane.4 The periodontal membrane is a layer of fibrous connective tissue surrounding the roots of the teeth. It contains multipotential cells that are capable of forming cementum, lamellar bone and fibrous tissue.[11], [12] OF is a destructive, deforming, benign tumor that can occur almost anywhere in the facial skeleton. This uncommon tumor can present a diagnostic dilemma for the clinician and the pathologist, owing to overlapping clinical and histomorphologic features. Many synonymous nomenclatures exist for a single entity and the controversy in classification and staging of the subtypes in the literature has added to the confusion. Hence, there is a need to highlight the points of controversy existing for this tumor so that they could be avoided through a consensus in future. Although central OF of the mandible are common, they are unusual in the maxilla.13 The tumor can produce sinus obstruction, infection, facial deformity, proptosis and intracranial complications, even though it can remain asymptomatic in the early stage. In general, this tumor is relatively slow-growing,[14], [15], [16], [17] as a result of which the overlying cortical bone layer and mucosa remain intact,18 and thus the tumor may be present for a number of years before a diagnosis is made. The treatment of OF consists of surgical excision with extended resection depending on the size and location of the lesion.[17], [19] We present herein two cases of central OF of the jaws with a literature review.
Section snippets
Case report – 1
A 35-year-old systemically healthy male patient referred to our division, complaining of an asymptomatic nodular growth over left side of the palate, perceived 5 years before consultation as a small peanut sized growth and increased in size slowly. An intraoral clinical examination revealed a painless, roughly rounded hard sessile nodule of size approximately 4 × 3 cm, extending mediolaterally from midline of the palate to just short of palatal gingival margin of upper left 2–6 and
Case report – 2
A 27-year-old female without antecedents of interest was referred to our division by his dentist, for evaluation of an asymptomatic swelling in the vestibular zone of the lower jaw located in premolar region. At the time of the first visit, the lesion had been present for the previous 4 months. The clinical examination revealed painless bulging of the buccal and vestibular cortical bone of the lower jaw, measuring approximately 3 cm in diameter, with a hard consistency and extended from lower
Discussion
Benign fibro-osseous lesions (FOLs) are a poorly defined and to some extent controversial group of lesions affecting the jaws and craniofacial bones. FOL refers to a group of pathologic processes in which normal bone is replaced by fibroblasts and collagen fibers containing variable amounts of mineralized material. This group encompasses fibrous dysplasia, benign fibro-osseous neoplasms (central ossifying fibroma), and a heterogeneous group of reactive lesions (osseous dysplasias). Because of
Conclusion
Ossifying fibroma is an uncommon benign fibro-osseous tumor of the craniofacial region that is diagnosed with a combination of clinical, radiological and pathological criteria. Cosmetic and dental occlusal problems are often the first manifestations of these lesions. Due to the possibility of the presence of hybrid lesions in this tumor, it is preferable to excise it enmass and take multiple sections for histopathological reporting. This would avoid missing a particular subtype of the tumor
Conflict of interest statement
None declared.
References (56)
- et al.
Central ossifying fibroma of the anterior maxilla. Report of a case
J Am Dent assoc
(1988) - et al.
Ossifying fibroma: a clinicopathologic study of sixty-four cases
Oral Surg Oral Med Oral Pathol
(1985) - et al.
Multiple familial ossifying fibromas: relationship to other osseous lesions of the jaws
Oral Surg Oral Med Oral Pathol
(1989) - et al.
Cement-ossifying fibroma of the maxilla
Oral Surg Oral Med Oral Pathol
(1968) - et al.
Ossifying fibroma of the jaws. Review of the literature and report of 16 cases
Int J Oral Surg
(1984) - et al.
Radiographic characteristics of central ossifying fibroma
Oral Surg Oral Med Oral Pathol
(1985) - et al.
Maxillofacial fibro-osseous lesions
Curr Diagn Pathol
(2006) - et al.
Focal cemento-osseous dysplasia: a clinicopathologic study of 221 cases
Oral Surg Oral Med Oral Pathol
(1994) - et al.
Distinguishing features of focal cemento-osseous dysplasia and cemento-ossifying fibromas II. A pathologic spectrum of 316 cases
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
(1997) - et al.
Distinguishing features of focal cemento-osseous dysplasia and cemento-ossifying fibromas II. A Clinical and radiologic spectrum of 316 cases
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
(1997)
The natural course of an ossifying fibroma: a case report
Int J Oral Maxillofac Surg
Multiple cement-ossifying fibroma
Int J Maxillofac Surg
Juvenile ossifying fibroma: report of four cases
J Craniomaxillofac Surg
Sublabial approach to sinonasal juvenile ossifying fibroma
Int J Pediatr Otorhinolaryngol
HRPT 2 gene alteration in ossifying fibroma of the jaws
Oral Oncol
Mixed radiolucent/radiopaque lesion of the mandible
J Oral Maxillofac Surg
Ossifying fibroma vs fibrous dysplasia of the jaw: molecular and immunological characterization
Mod Pathol
An immunohistochemical evaluation of BMP-2,-4, osteopontin, osteocalcin and PCNA between ossifying fibromas of the jaws and peripheral cemento-ossifying fibromas on the gingiva
Oral Oncol
Fibro-osseus lesions of the jaws
J Oral Maxillofac Surg
Benign fibro-osseous jaw lesions of periodontal membrane origin: An analysis of 249 cases
Cancer
Ossifying fibroma of the jaw
Arch Surg
Aggressive ossifying fibroma of the maxilla: review of the literature and report of case
J Oral Surg
Ossifying fibroma of the mandible and maxilla: review of 18 cases
J Oral Pathol Med
Roentgen appearance of ossifying fibroma of bone
Radiology
The role of computed tomography in the evaluation of cemento-osseous lesions
Oral Surg Oral Med Oral Pathol
Juvenile aggressive cemento-ossifying fibroma: case report and review of the literature
Laryngoscope
Cement-ossifying fibroma of the maxilla
Indian J Radiol Image
Cited by (27)
Ossifying fibroma of the maxilla: A case report with literature review
2024, Radiology Case ReportsJuvenile psammomatoid ossifying fibroma in a patient with osteogenesis imperfecta: A case report
2023, Journal of Oral and Maxillofacial Surgery, Medicine, and PathologyCitation Excerpt :In 2017, the World Health Organization included ossifying fibroma (OF) inside the maxillofacial fibro-osseous and osteochondromatous lesions group. Literature is still controversial on the origin, nomenclature, diagnosis, and appropriate treatment approach for these lesions, because of shared similar histopathological features, variable recurrence range, and a stringent clinical and radiographic correlation to determine the final diagnosis [5,6]. Currently, the most accepted theory suggests an origin from the periodontal ligament fibers, which contain multipotent cells with the potential to differentiate into cementoblasts, osteoblasts, and fibroblasts.
Ossifying fibroma of the jawbones: Epidemiology and management in the Yalgado ouedrago university hospital
2022, Advances in Oral and Maxillofacial SurgeryAnatomical and volumetric analysis of fibro-osseous lesions of the craniofacial skeleton
2021, Journal of Cranio-Maxillofacial SurgeryA large maxillary cemento-ossifying fibroma superimposed with solitary bone cyst documented over 18 years: A case report
2020, International Journal of Surgery Case ReportsMicrovessel density and cell proliferation in juvenile ossifying fibroma: A comparative study with central ossifying fibroma
2018, Annals of Diagnostic Pathology