[A painful periapical radiopacity in the lower jaw]. / Een pijnlijke periapicale radiopaciteit in de onderkaak.

A periapical radiopacity is frequently encountered by chance on a conventional periapical or panoramic x-ray. However, local pain and/or swelling in the area of a radiopacity is seldom seen. Here, we report on 2 cases of patients referred to the oral and maxillofacial surgeon with a painful periapical radiopacity in the lower jaw. The clinically and radiologically assumed diagnosis was a cementoblastoma, which was confirmed by histopathological examination following its surgical removal. A cementoblastoma is a rare, benign odontogenic tumor, mostly found in patients younger than 30. Treatment consists of surgical removal of the tumor, almost always together with the attached tooth. The recurrence rate after complete removal is approximately 12%. A cementoblastoma is clinically distinguished from other periapical radiopacities by local pain and sometimes swelling and radiologically by a relationship with the roots of a (pre)molar, a radiolucent rim surrounding the opacity, bone and/or root resorption and expansive growth.

Protection of Inferior Alveolar Neurovascular Bundle in Alveolar Bone Operation.

PURPOSE: The aim of this study was to investigate the protection of the inferior alveolar neurovascular bundle in alveolar bone operation in conditions such as chronic osteomyelitis and cementoma. PATIENTS AND METHODS: The study enrolled 7 cases, 4 with chronic osteomyelitis and 3 with cementoma with pain. Computed tomography scan and 3-dimensional reconstruction were performed for the diseases. Data were processed by ProPlan CMF 1.3 software. The edge of lesion was defined and the inferior alveolar nerve was marked. Template was designed to guide the osteotomy line. Piezosurgery was used for osteotomy, with the avoidance of nerve canal. Current perception threshold (CPT) was performed to evaluate the nerve function after operation. RESULTS: The CPT difference of the affected side before and after operation showed no statistically significant differences compared with that of the unaffected side (P = 0.0556). CONCLUSIONS: Digital template protects the inferior alveolar neurovascular bundle with the aid of piezosurgery during alveolar bone resection, which obtained satisfying clinical results. As powerful assistive tools of functional surgery, digital template and piezosurgery achieve both the purposes of treatment and function.

Cementoma of the calcaneus: a case report.

BACKGROUND: The cementoma is a common disease of the dental root apex, which generally occurs in the maxilla and the mandible, but the cementoma occurring in the long bone is rare. Moreover, the incidence of cementoma in the calcaneus is extremely infrequent. CASE PRESENTATION: The present study reports an unusual case of a 19-year-old girl, who complained of pain in the left heel. Subsequent radiographs and computed tomography (CT) were used in the diagnosis. The imaging features of the lesion included a radiopaque matrix and radiolucent tissue, particularly an arc-shaped fat band. An excisional biopsy was performed. Histopathological examination confirmed the diagnosis of cementoma in the calcaneus. After the operation, the patient was followed up without recurrence. CONCLUSIONS: Imaging examination plays an important role in the differential diagnosis of cementoma of the calcaneus.

Giant Cementoblastoma Of Left Maxilla Involving A Deciduous Molar.

Cementoblastoma is a relatively rare benign tumour. The clinicopathologic features, radiological findings, treatment and prognosis are reported here in a 10-year-old girl who presented to us from Afghanistan. The tumor was managed surgically and the histopathology confirmed the diagnosis of cementoblastoma. There was no evidence of recurrence at one year of follow up.

High-grade osteosarcoma arising in DCIA flap reconstruction after a prior resection of maxillar cemento-ossifying fibroma: A case report.

Cemento-ossifying fibroma is a rare benign odontogenic tumour of the tooth-bearing jaws. Its concomitant occurrence with osteosarcoma, a malignant maxillofacial bone tumour, has never been described before. We present an uncommon case of a 43-year-old woman in whom a cemento-ossifying fibroma in the right maxilla was treated by resection and reconstruction using a deep circumflex iliac artery flap. During surgical prosthetic rehabilitation one-year post-operative, an osteosarcoma extending from the contralateral maxilla was coincidentally discovered in the deep circumflex iliac artery flap. The aim of this case report is to raise awareness on the extremely rare but possible simultaneous and independent occurrence of a cemento-ossifying fibroma and an osteosarcoma.

Ossifying fibroma mimiking jaw tumour: A radiographic dilema.

Fibro-osseous lesions (FOLs) of the craniomaxillofacial region comprise a group of developmental, dysplastic, and neoplastic alterations. FOLs include ossifying fibromas (OF), cemento-ossifying fibroma (COF), familial gigantiform cementoma (FGC), fibrous dysplasia (FD), and cemento-osseous dysplasia (COD). Evidence suggests that some FOL, especially FD and OF may have a risk of spontaneous malignant transformation. This report documents a rare case of malignant transformation of ossifying fibromas of the jaw and the probable cause for same. Although it is rare, the clinician should have a complete follow up to observe such changes among the patients having FOLs.

Cemento-ossifying fibroma resection combined with heterotopic canine autotransplantation: a case report.

Cemento-ossifying fibroma (COF) is a mesenchymal benign odontogenic tumor, which may lead to impacted or ectopic permanent teeth. Autotransplantation of teeth is a surgical process, in which a tooth is transplanted from one position to another in the same individual. This method can effectively restore the patient's mastication and aesthetics and is feasible in replacing missing teeth. This study reports a case of simultaneous COF resection combined with heterotopic canine autotransplantation to repair dentition defect, which effectively promotes the restoration of bone continuity and stability and achieves immediate and long-term aesthetic function requirements.

Giant cementoblastoma of the impacted mandibular incisor.

The cementoblastoma is a relatively rare type of all odontogenic tumors. The incisor and impacted or unerupted tooth involvement by a cementoblastoma is extremely rare. We present a case report of a giant cementoblastoma that involved an impacted mandibular incisor.

Cementoblastoma in the maxilla: a case report.

The cementoblastoma is a rare, benign odontogenic tumour. It is generally asymptomatic and usually occurs in young adults. It is more common in males. It is most often associated with mandibular molar teeth and has a characteristic radiographic appearance. This case report is of a young male patient who presented with a cemento blastoma associated with a maxillary second molar. The initial presentation was to his dentist with pain, which was assumed to be of dental origin. This case highlights the importance of adequate radiographic investigation and appropriate interpretation in forming a diagnosis. It also serves as a reminder that rare odontogenic tumours may present initially in primary care and it is essential that all practitioners are aware of them.

[Maxillary cementoblastoma. A case report]. / Cémentoblastome maxillaire. A propos d'un cas.

Cementoblastoma is a rare benign odontogenic neoplasm. Its cause is unknown. It represents less 6 % of all odontogenic tumors. The aim of our work is to present a rare case of maxillary cementoblastoma involving an included central incisor. A 32-year old man consulted for a left maxillary swelling to projection under nostril. A panoramic radiographic examination revealed an included tooth 21 with a radiopaque lesion around its root. The computed tomography revealed the included tooth 21 with a process around its root. This process is well-defined, high-dense and is surrounded by a radiolucent halo. The treatment should consist of complete removal of the lesion with the tooth 21. Histological examination concluded to the diagnosis of a cementoblastoma. The cementoblastoma occurs most frequently in young persons and predominantly among men. The mandibular premolar and molar are the more frequently reached. The maxillary localization remains rare. This tumor occurs around the roots of the posterior and lower teeth. Radiographically, the lesion is well-defined and attached to the root of the tooth, radiopaque dense and surrounded by a radiolucent halo. The cementoblastoma evolves slowly and has the tendency to blow the cortical. The prognosis is good.

[Benign epithelial odontogenic tumors]. / Benigne epitheliale odontogene Tumoren.

The group of benign epithelial odontogenic tumors consists of the four member types of the ameloblastoma family (solid/multicystic, extraosseous/peripheral, desmoplastic, unicystic), squamous odontogenic tumors, calcifying odontogenic tumors, adenomatoid odontogenic tumors, and keratocystic odontogenic tumors, the former "keratocysts" that were recently reclassified by the World Health Organization and are now regarded as tumors. The latter are by far the most frequent tumors in this group, followed by solid/multicystic ameloblastoma. Although the etiology of these lesions is still unknown, a close relationship to normal tooth development is obvious, which is partially imitated by some tumors. Despite some similarities to each other, at least in part, the biological behavior of these lesions is quite different, as are treatment modalities. The diagnosis is essentially based on localization (intraosseous vs. extraosseous/peripheral) and histology, whereupon the correlation of histological findings with radiographic morphology may be of additional diagnostic value. Because of the range of variation, immunohistochemical investigations are not helpful in diagnosing a particular case.

[Benign odontogenic ectomesenchymal tumors]. / Benigne odontogene ektomesenchymale Tumoren.

The group of odontogenic ectomesenchymal tumors consists of odontogenic fibroma (epithelium-rich and epithelium-poor types), odontogenic myxoma, and cementoblastoma. Whereas odontogenic fibromas and cementoblastomas are very rare lesions, odontogenic myxoma is the fourth common odontogenic tumor, preceded only by keratocystic odontogenic tumor, the odontomas, and ameloblastoma. The diagnosis of cementoblastoma rests on its connection to the root of a tooth. The differentiation of odontogenic fibroma and myxoma from other lesions, especially from normal structures such as dental follicles and papillae, may be challenging if the X-ray appearance (localized osteolysis containing a tooth) is not appreciated and subtle histological clues (remainders of inner enamel epithelium at the surface of the lesion, dentin fragments) are not properly recognized. While odontogenic fibromas have almost no tendency for recurrence and are treated by enucleation or local excision, cementoblastomas and especially odontogenic myxomas have a high percentage of recurrence if intralesional procedures are applied. Hence, complete resection with free margins is recommended--at least for larger odontogenic myxomas and, especially, lesions in the maxilla--to prevent further extension to the orbita or base of the skull.

Florid cemento-osseous dysplasia: a report of three cases.

Florid cemento-osseous dysplasia (FCOD) is a non-neoplastic condition of the jaws that is not associated with inflammation of the pulp or periodontal tissue. This article reports on three cases that were diagnosed as FCOD, demonstrating the importance of both clinical and radiographic diagnosis and the clinical management of these lesions.

Latissimus-serratus-rib free flap for oromandibular and maxillary reconstruction.

OBJECTIVE: To review complications and outcomes associated with latissimus-serratus-rib free flap oromandibular and midface reconstruction. DESIGN: Retrospective medical record review. SETTING: Two academic tertiary care medical centers. PATIENTS: Twenty-eight patients with segmental resection of the mandible and 1 patient with combined resection of the mandible and maxilla after excision of neoplasms of the oral cavity, who were believed to be poor candidates for fibula free flap reconstruction, were identified. INTERVENTIONS: Twenty-seven latissimus-serratus-rib osteomusculocutaneous free flap reconstructions and 2 serratus-rib osteomuscular free flap reconstructions were performed. MAIN OUTCOME MEASURES: The outcome of microvascular free tissue transfer as well as short- and long-term complications were recorded. RESULTS: There were no perioperative free flap failures. Delayed partial rib graft resorption occurred in 1 patient 33 months after free flap transfer for maxillary reconstruction. Among 28 cases of mandibular reconstruction, 1 case of bone graft nonunion was noted after a postoperative period of 57 months. All other cases achieved successful restoration of mandibular continuity. Donor site morbidity was well-tolerated in all patients. CONCLUSION: Latissimus-serratus-rib osteomusculocutaneous free flaps are effective for reconstruction of composite defects of the mandible in patients who are not candidates for more commonly used vascularized bone-containing free flaps.

Calcified tumours of the paranasal sinuses in three horses.

Three horses, a 10-year-old Thoroughbred mare, a 9-year-old Thoroughbred gelding and a 6-year-old Arab gelding, with calcified tumours of the paranasal sinuses, are described. All horses presented with purulent nasal discharges and facial distortion. Exophthalmos, blepharospasm and ocular discharge were also a feature in individual horses. A presumptive diagnosis of a calcified tumour was made on the basis of clinical signs and radiographic and endoscopic findings. The tumours ranged from 15 to 25 cm in diameter. A large frontonasal bone flap was used to expose the tumours, which were cleaved into several pieces with an osteotome and removed. Histological examination of the masses identified cementomas in two cases and an osteoma in the third. Long term follow up from 18 months to 5 years after surgery indicated that there was no recurrence. This case series demonstrates that, although calcified tumours of the paranasal sinuses are rare in horses, they should be considered in the differential diagnosis of purulent nasal discharge, facial swelling and ocular distortion, and are amenable to surgical treatment.

Peripheral cemento-ossifying fibroma in a child: a case report.

Peripheral cemento-ossifying fibroma is a gingival lesion of reactive nature and unknown etiology. Such a lesion can either interfere with normal tooth eruption or become a factor in plaque development, which usually results in caries formation in newly erupted teeth. Therefore, the objective of the present article was to report a case of peripheral cemento ossifying fibroma occurring in the mandibular posterior region of a 11-year-old girl in association with both absence of premolar eruption and presence of severely caried first permanent molar.

[Multiple cemento-ossifying fibromas of the jaw: a very rare diagnosis]. / Multiple zemento-ossifizierende Fibrome der Kiefer: Der seltene Fall.

The cemento-ossifying fibromas (COF) of the jaws are well circumscribed, generally slow-growing, benign lesions which enlarge in an expansive manner. On occasion, they may reach a large size and may result in considerable deformity. The histological pattern of these lesions varies with the stages. In most reported cases ossifying and cemento-ossifying fibromas occur as a solitary lesion. Multiple occurrence of such lesions is rare. The term"cemento-ossifying fibroma"is used to describe fibrous lesions containing calcifications with strong similarity between bone and cementum. Although WHO and some authors regard the cementifying fibroma (CF) as an odontogenic tumor and consider ossifying fibroma (OF) separately as non-odontogenic neoplasm, there is general agreement that CF and OF represent only histologic variants of the same lesion. The case of a 36-year old woman with multiple cemento-ossifying fibromas of the mandible and maxilla demonstrates the diagnostic procedures and a possible therapeutic strategy for this rare lesion.

Planificación digital en tratamiento de fibroma osificante juvenil psamomatoide maxilar. Presentación de un caso / Digital planning in the treatment of juvenile maxillary psamomatoid ossifying fibroma. Presentation of a case

Los fibromas osificantes son neoplasias fibro-óseas benignas que afectan al esqueleto craneofacial y mandibular. El fibroma osificante psamomatoide juvenil es una variante rara del fibroma osificante, la que puede ser localmente agresiva y con una alta tasa de recidiva. Se presenta el caso de una paciente de 15 años con antecedentes mórbidos de hipotiroidismo e hiperparatiroidismo, quien consulta por aumento de volumen y desplazamiento de dientes en maxilar derecho. El resultado histopatológico fue compatible con fibroma osificante psamomatoide juvenil. Dado el contexto hospitalario durante la pandemia de COVID-19, el tratamiento consistió en hemimaxilectomía con autoinjerto libre de cresta ilíaca mediante planificación digital. (AU)

Ossifying fibromas are benign fibro-osseous neoplasms that affect the craniofacial and mandibular skeleton. Juvenile psamomatoid ossifying fibroma is a rare variant of ossifying fibroma, which can be locally aggressive, and with a high recurrence rate. We present the clinical case of a 15-year-old patient with a morbid history of hypothyroidism and hyperparathyroidism, who consulted for increased volume and displacement of teeth in the right maxilla. The histopathological result was consistent with juvenile psamomatoid ossifying fibroma. Owing to the hospital situation during the COVID-19 the treatment consisted of hemimaxillectomy with iliac crest autograft using digital planning. (AU)

Management strategy in patient with familial gigantiform cementoma: A case report and analysis of the literature.

RATIONALE: Familial gigantiform cementoma (FGC) is a rare benign autosomal dominant fibrocemento-osseous lesion generally limited to the facial bones, typically in the anterior portion of the mandible; it is often associated with abnormalities of the long bones and prepubertal pathologic fractures. Owing to the small number of such patients, a uniform treatment criterion has not been established. This paper presents a patient with FGC who was treated in our department, and offers a systematic review of the patients reported in the literature. Our aim was to explore the treatment strategy for patients with FGC. PATIENT CONCERNS: Our patient, a 13-year-old boy, presented with a painless enlargement of the mandible first noted 2 years earlier. It had grown rapidly over the preceding 8 months, affecting both his appearance and ability to chew. DIAGNOSIS: Based on the pathologic, clinical, and radiographic features, FGC was diagnosed. INTERVENTIONS: Mandibuloectomy was performed. The mandibular defect was immediately reconstructed with his right vascularized iliac crest flap. At the same time, a PubMed search was conducted to identify studies reporting on other patients with FGC. OUTCOMES: A 3-dimensional computed tomography (3D-CT) scan demonstrated appropriate height of the new alveolar bone. Follow-up results showed recovery of the patient's appearance and mandibular function. He was free of recurrence at 4-year follow-up. LESSONS: FGC is a rare benign fibrocemento-osseous lesion of the jaws that can cause severe facial deformity. Incomplete removal leads to more rapid growth of the residual lesion. Therefore, extensive resection is a suitable strategy to avoid recurrence. Defects of the facial bones found intraoperatively should be repaired with resort to an appropriate donor site. However, it is important to be aware that patients with FGC always have concomitant abnormalities of skeletal metabolism and structure, as well as a vulnerability to fractures of the long bones of the lower extremity. Therefore, the optimal management strategy should include a review of treatment options for other patients as reported in the literature. An optimal protocol can not only provide sufficient high-quality bone suitable for the reconstruction of bone defects, but also minimize complications and maximize quality of life.