Diagnosis and management of benign fibro-osseous lesions of the jaws: a current review for the dental clinician.

Benign fibro-osseous lesions of the maxillofacial skeleton constitute a heterogeneous group of disorders that includes developmental, reactive (dysplastic) and neoplastic lesions. Although their classification has been reviewed multiple times in the past, the most common benign fibro-osseous lesions are fibrous dysplasia, osseous dysplasia and ossifying fibroma. For the dental clinician, the challenges involve diagnosis and treatment (or lack thereof). A careful correlation of all clinical, radiologic and microscopic features is essential to establish a proper diagnosis and a clear treatment plan. This article aimed to review the clinical, radiologic and histopathologic characteristics of benign fibro-osseous lesions of the jaws, with emphasis on their differential diagnoses. With a deeper understanding of benign fibro-osseous lesions, clinicians will be better prepared to manage these lesions in their practice.

Conservative Management of Central Cemento-Ossifying Fibroma.

Central cemento-ossifying fibroma is characterized by the combined production of osteoid and cementoid tissue. Radiographically, this lesion is presented as an outlined cortical and variable radiopaque spots, also can be present complete radiolucent or different degrees of radiopacity. The recommended treatment is curettage or enucleation, and the recurrence rate is less than 5%. Considering that surgical treatment is invasive, mainly in large lesions, this study aims to report a patient in whom conservative treatment was carried out by involving the preservation of teeth, with a long-term follow-up. A 48-year-old black female patient, diagnosed with central cemento-ossifying fibroma in mandible, treated conservatively and a 2 years of follow-up. It was concluded that the conservative treatment with a long term of follow-up for maintaining teeth was satisfactory.

Management of fibro-osseous lesions of the craniofacial area. Presentation of 19 cases and review of the literature.

INTRODUCTION: Fibro-osseous lesions constitute a rare benign type of pathology with a non-odontogenic lineage that affect the craniofacial area. According to Waldrom's classification, these lesions are divided into: fibrous dysplasia (FD), cemento-ossifying fibroma (COF) and desmoplastic fibroma (DF). MATERIAL AND METHODS: A retrospective study was performed on patients diagnosed with fibro-osseous lesions of the craniofacial area at the Hospital Universitario La Fe, Valencia, during 1987-2009. A total of 19 cases were collected: 15 cases compatible with an FD diagnosis, 3 cases with a COF diagnosis and 1 case with a DF diagnosis. RESULTS: In the differential diagnosis, entities having similar clinical manifestations in the maxillofacial area with possible involvement of teeth or manifestations present as an asymptomatic radiolucent image should be ruled out. We hereby present the management and development of patients treated in our hospital for fibro-osseous lesions. CONCLUSIONS: Fibro-osseous lesions share many clinical and radiological characteristics in common, with histological features confirming the nature of the lesion. Management of patients should be individualized and case-specific, assessing the clinical evolution of each case and taking into account the benign nature and growth behavior of this type of tumors.

Giant Peripheral Ossifying Fibroma Treated With Piezosurgery and Platelet-Rich Fibrin: A Rare Case Report.

INTRODUCTION: The peripheral ossifying fibroma (POF) is a benign reactive lesion that exclusively arises from gingiva. The lesion may gain considerably large sizes and present peculiar clinical and radiographic features that would then allow it to be called a giant POF; in that case, its otherwise simple surgical extraction could create a challenge. Thus, we elect here, for the very first time, a plausible alternative for treating giant POF: piezosurgery followed by placement of platelet-rich fibrin (PRF). CASE PRESENTATION: A 31-year-old black male presented a large asymptomatic nodule on the lower gingiva; the lesion had caused vestibular displacement of teeth and had been present for 18 years. Following the diagnostic hypothesis of a giant POF, an excisional biopsy was performed under local anesthesia using piezosurgery (microvibration of 36,000 times/sec was used in a bone cortical working mode), which confirmed the diagnosis. The surgical procedure was facilitated with the use of piezosurgery followed by placement of PRF, being the trans- and postoperative periods occurred with no complications. One year after the treatment, the patient shows no signs of disease recurrence and remains under follow-up. CONCLUSIONS: Giant POF is a rare gingival reactive lesion that can reach large dimensions, causing teeth displacement, functional, and esthetic impairments. The lesion can be successfully managed with piezosurgery and PRF, as illustrated herein, avoiding extensive bone loss and damage to the surrounding soft tissues.

Ossifying fibromyxoid tumor: a study of 6 cases of atypical and malignant variants.

Ossifying fibromyxoid tumors (OFMT) of soft parts are rare, slow-growing tumors that have potential for local recurrence and may metastasize. While OFMT originally was considered benign, several cases of malignant OFMT have been documented. There is no universally accepted risk stratification, although this study emphasizes the importance of utilizing histology, immunohistochemistry and FISH in establishing the diagnosis. Herein, we describe six cases of atypical and malignant OFMT with differences in morphologic features, 5 of which display the proposed morphological criteria for malignancy. The patients were mostly male (M=5, F=1) with an age range of 33-69 years. The tumors arose from the extremities (3 cases), the shoulder (1 case), the head and neck area (1 case), and the paraspinal area (1 case). One tumor had high grade and overtly sarcomatous changes, while another invaded the underlying clavicle. Two cases showed cytological atypia and necrosis. Fluorescence in situ hybridization (FISH) detected rearrangement of the PHF1 gene in 5 cases. All cases were positive for EAAT4 and actin by immunohistochemistry, while negative for desmin. Three tumors were immunoreactive for S100 protein. INI-1 immunohistochemical staining was conserved in all but 2 cases in which a mosaic loss of expression was noted. All but two patients are currently alive and free of disease.

Juvenile ossifying fibroma of the jaw: a retrospective study of 15 cases.

The management of patients with juvenile ossifying fibroma (JOF) remains controversial. To explore the correlations between different treatments and the patient prognosis, 15 cases of JOF of the jaw were reviewed. Five patients were male and 10 were female. Patient age at the time of disease onset ranged from 7 to 18 years (mean 10.9 years). Nine tumours were located in mandible and six in the maxilla. These cases typically manifested clinically as painless swelling of the jaw (9/15, 60%); 40% (6/15) of the cases were associated with pain, diplopia, stuffy nose, and/or rapid growth. Images of JOF can show a radiolucent, mixed, or ground glass-like appearance. Pathological examinations revealed 10 cases of juvenile trabecular ossifying fibroma (JTOF) and five cases of juvenile psammomatoid ossifying fibroma (JPOF). In terms of the treatment plan, six patients initially received radical surgery; nine patients underwent conservative treatment, among whom six (6/9, 66.7%) had one or more recurrence. At the end of the follow-up period, 12 patients had no evidence of tumour recurrence and three cases were alive with a tumour. In summary, surgeons should develop the surgical plan according to the extent of the lesion, relapse status, growth rate, and family choice, and these patients should be followed up closely.

[Cemento-ossifying fibroma--case report and review of the literature]. / Cemento-ossifying fibroma--opis dwóch przypadków i przeglad literatury.

Authors report two cases of benign, osteogenic neoplasms of the maxilla in children which defined as cemento-ossifying fibroma and juvenile cemento-ossifying fibroma. Difficulty in diagnosis of the tumor is indicated. The importance of clinical data as well as radiology and histopathology examination for a proper diagnosis is indicated. Review of literature is presented.

Ossifying fibroma of the skull: clinical and therapeutic study.

AIMS AND BACKGROUND: Ossifying fibroma is a tumor with benign course that rarely affects the cranial bones. METHODS: The authors report 5 cases of ossifying fibroma of the skull and analyze the clinical course and treatment of this lesion. RESULTS: 3 patients were females and 2 males. The mean clinical history was 3.2 years. 4 patients underwent total removal and 1 partial. At mean follow-up of 19 years, all patients who underwent total removal showed improvement of neurological deficit, whereas the patient who underwent partial removal had clinical regrowth. CONCLUSION: The authors conclude that total removal of fibroma should be extended to normal bone and in cases in which total removal is not possible the residue should be checked for regrowth by serial MRI.

Fibro-osseous lesions of the head and neck.

In recent years the term "fibro-osseous lesions" has gained wide acceptance as a general designation for certain pathological processes of the craniofacial bones. These lesions comprise a challenging group of pathologic conditions that cause difficulty in classification and treatment. Common to all of these pathologic entities is the replacement of normal bone architecture by a benign fibrous tissue composed of fibroblasts and collagen and which contains varying amounts of mineralized material. Categorization of the fibro-osseous lesions is dependent upon correlation of the patient's history, clinical findings, radiographic criteria, and histopathologic determination. This article discusses two of the most commonly confused benign fibro-osseous lesions: fibrous dysplasia and ossifying fibroma.

A rare occurrence of peripheral ossifying fibroma in the first decade of life and its management.

Localised growths are commonly seen on the gingiva. Many of these enlargements are considered to be reactive rather than neoplastic in nature. Clinically, differentiating one from the other as a specific entity is often not possible. Clinical knowledge and histopathological examination is needed to positively identify the lesion. The peripheral ossifying fibroma is one such lesion. We report a rare case in a 10-year-old female patient with a peripheral ossifying fibroma in the mandible exhibiting a significant increase in size within a short duration of 6 months.

Ossifying fibroma of the nose and paranasal sinuses.

BACKGROUND: The purpose of this work was to perform a systematic review regarding ossifying fibroma and its multiple variants of the paranasal sinuses, and to identify any clinical differences between the multiple variants. METHODS: A search of the U.S. National Library of Medicine (PubMed) database was performed for the non­Medical Subject Heading (MeSH) search term "ossifying fibroma." The bibliographies of the retrieved manuscripts were searched to identify additional potentially relevant articles. Finally, textbooks of head and neck pathology were searched to identify peer-reviewed literature that addresses the histopathology of ossifying fibroma and its variants. Abstracts were screened by 2 of the authors to identify reports of ossifying fibroma lesions (and its variants) that involved the paranasal sinuses. Extracted data from case reports or case series included the clinical presentation, age, gender, site of involvement, surgical approach, treatment outcome, follow-up period, and recurrence rate. Information derived from cases is summarized in tables, and simple descriptive statistics were applied to the data. RESULTS: A total of 137 distinct patients were identified in 103 reports. Extracted data did not show any appreciable difference in clinical presentation or outcomes. Data on recurrence of these lesions was often limited by a lack of follow-up. CONCLUSION: Although differentiation between the subtypes of ossifying fibroma can be made histologically, and a diverse nomenclature exists, there does not appear to be any overriding clinical significance to the histopathologic differentiation of OF variants.

Malignant ossifying fibromyxoid tumor of the parapharyngeal space.

Ossifying fibromyxoid tumor (OFMT) is a rare, recently described entity. As such, there is a paucity of information in the literature regarding this neoplasm. According to most reports, the tumor usually develops subcutaneously in the soft tissues of the extremities. Malignant forms of the tumor are far more rare than their benign counterparts. We present a new case of a malignant OFMT of the parapharyngeal space in a 33-year-old Pakistani man. The tumor was excised, and the patient did well with no complications. This case represents a rare occurrence of OFMT of the parapharyngeal space.

Fibroma osificante periférico diagnóstico y tratamiento / Ossifying fibroma peripheral treatment diagnosis and case report

Las lesiones de encía, y otras lesiones nodulares que se presentan en la cavidad bucal son muy importantes para el odontólogo en la práctica general, conocer las características para su identificación desde el punto de vista clínico e histológico es de interés sobre todo en esta región donde hay pocos aportes en lo que respecta a patología oral. El presente reporte de caso muestra la evidencia clínica de una paciente femenina de 22 años con una lesión en tumoral de aproximadamente 1cm sobre la zona de 1.2, y una evidencia histopatológica para lo cual se hace la remoción del tumor, el cual es colocado en formaldehido al 10% para ser procesado para su análisis histopatológico cuyos resultados muestran las características de una lesión compatible de fibroma osificante periférico (FOP), concluimos que es importante determinar el diagnóstico diferencial con el granuloma piógeno y otras lesiones parecidas con un análisis histopatológico. (AU)

Injuries gum and other nodular lesions that occur in the oral cavity are very important for the dentist in general practice, knowing the characteristics for identification from clinically and histologically is of interest especially in this region there are few contributions regarding oral pathology. The aim of this paper is to show clinical evidence of a female patient of 22 years with an injury tumor of approximately 1 cm on the area of 1.2 and have a histopathologic evidence for which the removal of the lesion is made and placed in formaldehyde 10% to be processed for histopathological analysis and the results show the characteristics of a compatible peripheral ossifying fibroma (POF), We conclude it is important to determine the differential diagnosis with pyogenic granuloma and other similar injures a histopathological analysis. (AU)

Fibroma ossificante periférico ­ Relato longitudinal de dois casos clínicos / Long-term follow-up of peripheral ossifying fibroma ­ report of two cases

O fibroma ossificante periférico é uma lesão não neoplásica proliferativa, não patognomônico, de evolução lenta e indolor, que acomete os tecidos gengivais. O presente trabalho teve como objetivo relatar dois casos clínicos desta lesão em um acompanhamento em longo prazo, ressaltando os aspectos clínicos e histopatológicos, bem como seu tratamento e prognóstico.

The peripheral ossifying fibroma is a non-neoplasic, proliferative lesion of painless and slow evolutive character, which involves the gingival tissues. This paper reports on two clinical cases in a long-term follow-up highlightening their clinical and histopathologic aspects, treatment, and outcomes.

Ossifying fibromyxoid tumor of the orbit.

PURPOSE: This report describes the clinical, radiographic, and histopathologic features of the first known case of ossifying fibromyxoid tumor involving the orbit. METHODS: Case report and literature review. RESULTS: An 81-year-old woman presented with a 3-month history of diplopia, pain, and right upper eyelid swelling. CT and MRI of the orbit disclosed a 2.5-cm extra-conal mass superomedially in the right orbit, with displacement of the globe inferiorly and remodeling of the orbital roof. During surgery, the tumor was noted to be firm, gritty, and extra-periosteal in location, and the bone adjacent to the tumor was irregular and abnormal in consistency. The tumor was removed intact without difficulty. Histologic, immunohistochemical, and transmission electron microscopic examination disclosed features consistent with ossifying fibromyxoid tumor. Fourteen months after removal, the tumor recurred and the patient underwent a second excisional biopsy. The tumor recurred a second time 30 months after the first surgery. The patient underwent a third surgery to remove the tumor and received adjuvant radiation therapy. She has been free of disease for more than 18 months. CONCLUSIONS: This is the first known case of ossifying fibromyxoid tumor involving the orbit. Increased cellularity, nuclear atypia, and mitotic activity have been associated with metastatic and recurrent potential. The tumor in this case had moderate cellularity, low nuclear grade, and no mitotic figures. However, the close proximity of the tumor to important structures within the orbit precluded its excision with wide margins and may have predisposed the patient to the two episodes of local recurrence.

Unusual jaw lesions in the paediatric and adolescent patient: a management challenge.

While major maxillofacial pathology in the young patient is relatively uncommon, non-malignant conditions may pose a significant treatment dilemma due to their aggressive or unpredictable behaviour. Several such diseases managed by the Oral and Maxillofacial Surgery Unit at the Royal Children's Hospital of Melbourne have been selected for review. Illustrative case reports to highlight the principles of management are presented.

Adamantinoma, osteofibrous dysplasia and differentiated adamantinoma.

For just over 100 years, adamantinoma has been recognized as a primary bone tumor with epithelial characteristics and predominantly involving the tibia. Osteofibrous dysplasia is a fibro-osseous lesion also predominantly confined to the tibia with radiologic features similar to those of adamantinoma. This lesion has been shown by immunohistochemical studies to frequently contain cytokeratin-positive epithelial cells. More recently, a third group of cases with clinical and radiologic features similar to those of osteofibrous dysplasia have demonstrated more overt strands of epithelial cells within a fibro-osseous background and have been categorized as "differentiated", "regressive", "juvenile intracortical" or "osteofibrous dysplasia-like" adamantinoma. Cytokeratin subset immunohistochemical stains and cytogenetic studies performed in recent years suggest a common histogenesis for these three entities. This article reviews the clinical, radiologic and pathologic features of these entities as well as their prognostic significance. It also reviews the results of the immunohistochemical and cytogenetic studies which establish a common histogenetic relationship.

Ossifying fibromyxoid tumor resembling parosteal osteosarcoma.

Ossifying fibromyxoid tumor (OFMT) is a rare soft tissue neoplasm which varies in the amount of bone tissue laid down. We report on a case of OFMT in a 59-year-old male which mimicked a large parosteal osteosarcoma on radiography, MRI, and CT. T1-weighted MR images showed high-intensity areas which reflected fatty marrow. The metaplastic bone was connected to the cortex of the femur, but the tumor did not involve the medullary cavity. The tumor was irradiated and the patient was administered chemotherapy. Wide excision of the tumor and hip rotation plasty was performed. The patient has been disease free for 18 months.