Juvenile ossifying fibroma of the maxillofacial region: analysis of clinico-pathological features and management.

BACKGROUND: The diagnosis and management of juvenile ossifying fibroma (JOF) remains a highly debated topic with paucity of studies with long-term follow-up, hence the aim of this study was to report on the clinico-pathological features and management of these neoplasms. MATERIAL AND METHODS: A retrospective analysis was performed on all histopathologically confirmed JOF presenting at two tertiary hospitals in Cape Town, South Africa over a period of 39 years. Clinical, demographic, histopathological and radiological features were analyzed. Surgical methods were documented and a minimum post-operative follow-up of 12 months was a prerequisite. RESULTS: Seventeen patients met the inclusion criteria and were included in this study. Overall, the ages of patients ranged from 3-31 years (mean= 13 years) with male to female ratio of 1.8:1. The ages of patients diagnosed with Trabecular JOF were significantly younger than patients with Psammomatoid JOF (P = 0.01). The majority of patients presented with marked swelling (88.2%). Interestingly, most neoplasms occurred in the mandible (76.5%) with all Psammomatoid JOF uncharacteristically occurring in the mandible. There was only one case of Trabecular JOF occurring in the sinonasal area. Most neoplasms appeared as unilocular (76.5%) and well-defined (82.4%) with mixed radio-density (70.6%) on radiographs and computed tomography. Curettage with peripheral ostectomy was shown to be the least invasive method with an acceptable recurrence rate (10%). Six lesions underwent resection without any recurrences however caused high morbidity to these young patients. CONCLUSIONS: The high number of lesions occurring in the mandible for both variants of JOF demonstrates that site should not be a major determining factor in the diagnosis of JOF. Moreover, curettage with peripheral ostectomy should be used as the first line of management to minimize morbidity to the patient and that resection should be reserved for large and recurrent lesions.

Osteoma of the mandibular condyle: a rare case report and review of the literature.

INTRODUCTION: Osteoma is a rare slow-growing benign neoplasm which is often asymptomatic and composed of mature bone. Only 21 cases were previously reported in the mandibular condyle. OBSERVATION: A 60 year old male presented with gross asymmetry of the lower jaw and reduced function. He mentioned that he was involved in an accident to the head about 16 years ago. Upon examination, it was noticed that the chin deviated to the left with some discomfort during function. Computed tomography revealed a radiopaque mass medial to the left condylar pole. The lesion was gradually increasing in size and in close proximity to the middle cranial fossa. A condylectomy was performed using a pre-auricular approach. A diagnosis of osteoma was confirmed histopathologically. The defect was reconstructed with stock TMJ prostheses. DISCUSSION: Osteomas affecting the condyle have significant functional implications and should be considered when deviation of the mandible is present.

Dental management of children with special healthcare needs.

INTRODUCTION: Dental caries is a common condition amongst young children that negatively impacts on their quality of life, It is an added burden on children with special healthcare needs (CSHCN) who have an increased risk of developing caries due to the high sugar contents in their medications, regular consumption of cariogenic foods and a poor salivary flow. AIMS AND OBJECTIVES: to analyse the management of dental caries in CSHCN at a tertiary public hospital in South Africa. METHODS: A retrospective analysis was conducted of the dental and medical records of 374 medically compromised children presenting with dental caries. Dental treatment and anaesthetic techniques used were reviewed. RESULTS: Results indicated that the majority of CSHCN presenting with caries were managed by extractions (96.5%) under either local anaesthesia (73.3%) or general anaesthesia (26.7%). There was a lack of restorative care provided to these compromised children, CONCLUSIONS: Treatment by extractions may relieve discomfort and pain; however, early loss of teeth leads to functional, psychological, aesthetic and orthodontic problems, which can result in a further decline in the quality of life of these already compromised patients, Restorative treatment and prevention strategies are critical in managing caries in CSHCN in order to improve their quality of life,