Ossifying fibroma of the mandible and craniofacial bones
Diagnostic Histopathology, Volume 21, Edition 9, 2015, Pages 351-358
Fibrobone lesions encompass a variety of pathological processes in which normal bone is replaced by fibrous tissue containing varying amounts of mineralized material. As the characteristics are quite similar, the definitive diagnosis of these lesions requires an accurate correlation of clinical, radiological and histopathological findings.
Ossifying fibroma is a fibrous bone tumor that usually affects the mandible and consists of three distinct entities, all with overlapping characteristics. We examined the clinicopathological and imaging features of cementum ossifying fibroma (COF), juvenile trabecular ossifying fibroma (JTOF) and juvenile psamous ossifying fibroma (JPOF).(Video) Ossifying fibroma of mandible. | નીચલા જડબાની ગાંઠ| #oralandmaxillofacialsurgeon
Mixed peripheral giant cell granuloma and peripheral ossifying fibromatous lesions: rare case report and literature review
Journal of Oral and Maxillofacial Surgery, Medicine and Pathology, Bd. 29, No. 6, 2017, S. 587–593
Mixed lesions with a giant cell granuloma (GCG)-like component associated with central odontogenic fibroma (CFO) and fibroskeletal lesions have been reported in the literature since 1992; Marginal cases, on the other hand, are extremely rare. Therefore, the objective of this manuscript is to report a case of mixed lesion composed of peripheral giant cell granuloma (PGCG) and peripheral ossifying fibroma (POsF), highlighting the clinical, radiological, histopathological, therapeutic and prognostic aspects of this type of lesion . Thus, our case presentation included a 31-year-old dermatology patient who presented with a large, asymptomatic exophytic lesion in the alveolar mucosa of the left mandible, with radiographic evidence of an irregular opaque lesion within the area of soft-tissue injury. An excisional biopsy is performed under local anesthesia. Histopathological analysis revealed fragments of oral mucosa lined by parakeratotic and atrophic stratified squamous epithelium with areas of ulceration; lamina propria showed dense connective tissue with numerous inflammatory multinucleated giant cells (MGCs), spindle cells, blood vessels, hemorrhage, and hemosiderin infiltration; in addition, deposits of trabecular bone matrix mixed with MGCs, proliferation of fibroblasts and collagen fibers were observed. If this association between PGCG and POsF occurs, the possibility that PGCG presents bone formation must be ruled out. Therefore, a mixture of PGCG and POSF may pose a diagnostic challenge for pathologists, and more cases with histopathological features similar to our case should be reported to clarify the suspected histogenesis of this lesion.
SATB2 is commonly expressed in ossified and non-ossified perioral fibromas in the gingival region, but not in reactive fibromatous lesions in other intraoral sites.
Annals of Diagnostic Pathology, Band 46, 2020, Artikel 151510(Video) Ossifying Fibroma
Ossified and non-ossified perioral fibroids (POF) of the gingival and alveolar mucosa are small localized fibronodular, cellular lesions that can be caused by various external/internal physical and chemical stimuli or injuries. Central foci of metaplastic bone tissue characterize and define ossification variants. The intrinsic tendency of these lesions to ossify remains unclear. Here we analyzed SATB2 expression as an osteoblast transcription and differentiation factor in 28 gingival POFs (10 of which are ossified) and compared with 28 fibrotic lesions from different non-gingival intraoral sites. SATB2 strong to moderate diffuse nuclear immunoreactivity was detected in all ossified (10/10; 100%) and 8/18 (44%) non-ossified gingival FOPs, but only in 1/28 (3%) of nodular fibrous lesions observed in non-ossified gingival POFs - gingival oral reactivity. This study is the first to demonstrate consistent expression of the osteoblastic marker SATB2 in ossified and non-ossified FOPs in the gingival area, but this marker is absent in reactive fibrous lesions at other oral sites. This finding is compatible with the suspected formation of gingival FOP in the periodontal ligament and could explain the frequent ossification observed there. This finding should be taken into account when evaluating SATB2-positive oral tumor biopsies in order to avoid misinterpretations.
Orthokeratotic odontogenic cyst (OOC): clinicopathological and radiological characteristics of a series of 48 cases
Pathology - Research and Practice, Volume 236, 2022, Article 153969
To demonstrate the clinicopathological and radiological characteristics of orthokeratotic odontogenic cysts (COOs) and to analyze the proliferative activity of epithelial cells between COOs and keratotic odontogenic cysts (COCs).(Video) Ossifying Fibroma (Complete Lecture) | For NBDE, NDEB, MDS & FCPS
Clinicopathological and radiological analyzes were performed in all cases of OOC. Expression of cell proliferation markers Ki-67 and cyclin D1 was detected by immunohistochemistry.
A total of 48 OOC patients were included, including 28 men and 20 women. The mean age was 33.50 years, ranging from 13 to 61 years. The mandible was affected five times more often than the maxilla (40 in the mandible, 8 in the maxilla). All OOCs were unilocularly radiolucent with well-defined margins, and 30 of 36 showed loss of buccal or lingual cortical continuity on computed tomography (CT) images. Root resorption occurred in three cases and tooth displacement occurred in four cases. CT showed that the mean volume of the cyst was 7794.25 ± 6952.98 mm3.All cysts underwent enucleation or decompression after enucleation. The mean follow-up time was 32.50 ± 27.58 months (6-65 months) and the overall recurrence rate was 4.44% (2 cases out of 45). Ki-67 and cyclin D1 expression was significantly decreased in OOCs compared to OKCs (P<0.001).
OOCs were more common in the mandible, were slightly masculine, and had less proliferative activity than COCs. On radiographs, OOC is more likely to be associated with buccolingual expansion and destruction of cortical bone. Due to the low invasiveness and recurrence rate, enucleation or decompression in combination with enucleation is the treatment of choice for OOC.
A retrospective study of 15 cases of juvenile ossified fibroids of the mandible
International Journal of Oral and Maxillofacial Surgery, Volume 45, Issue 3, 2016, pages 368-376
The treatment of patients with juvenile ossifying fibroma (JOF) remains controversial. Fifteen cases of JOF in the mandible were reviewed to explore the association between different treatments and patient outcomes. Five patients were male and 10 patients were female. Patients' age at baseline was between 7 and 18 years (mean 10.9 years). Nine tumors were in the mandible and six in the maxilla. These cases usually present clinically with painless swelling of the jaw (9/15, 60%); 40% (6/15) of cases are associated with pain, diplopia, nasal congestion and/or rapid growth. JOF images can appear radiolucent, blended, or matte. Pathological examination revealed 10 cases of juvenile trabecular ossifying fibroma (JTOF) and 5 cases of juvenile psamous ossifying fibroma (JPOF). Regarding treatment options, 6 patients initially received radical surgery; 9 patients received conservative treatment, of which 6 patients (6/9, 66.7%) had one or more relapses. At the end of follow-up, 12 cases had no evidence of tumor recurrence and 3 cases survived with tumor. In summary, surgeons must formulate surgical plans based on lesion extent, recurrence, growth rate, and family selection and monitor these patients closely.
Ossifying fibroma: analysis of treatment approaches and recurrence patterns
Journal of Oral and Maxillofacial Surgery, Volume 74, Issue 12, 2016, Pages 2409–2419(Video) peripheral ossifying fibroma-English
Ossifying fibroma (OF) is the most common of the three fibroskeletal lesions of the mandible and has a variable rate of recurrence. The final operational plan has yet to be announced. The aim of this study was to determine the clinical and radiological features of OP, assess its treatment patterns and recurrence, and develop a surgical protocol in a tertiary hospital in South Africa.
A retrospective series of all histopathologically diagnosed cases of OC from 1976 to 2014 was performed. Demographic, clinical presentation, and radiological characteristics were analyzed. Management and follow-up data were also recorded for each case. Based on these findings, an operation plan was developed.
A total of 61 cases were included in this study. Most patients were female (63.9%) and younger than 40 years (73.9%) and only a few cases were symptomatic (29.5%). The posterior region of the mandible was the most affected (55.5%) and most of the lesions were radiopaque (49.2%) and well defined (93.6%). Surgical curettage was used in most cases (68.2%). After a mean follow-up of 20 months, there was only one case of recurrence, with a recurrence rate of 6.7%.
Lesions in our population were more radiopaque and larger than those in published data. Surgical curettage is an acceptable treatment option with a low recurrence rate, and resection should be reserved for invasive and recurrent lesions.
Copyright © 2022 Published by Mosby Corporation.
Introduction: The peripheral ossifying fibroma is a slow growth benign tumor that may induce recurrence after removal. It is of fibro-osseous origin and it is commonly found on maxillary bone. It is of asymptomatic growth that may induce facial asymmetry.How do you treat a peripheral ossifying fibroma? ›
Treatment. The peripheral ossifying fibroma should be completely excised and sent for histology examination. Extraction of teeth is rarely required. In addition, any predisposing causes should be treated such as plaque or irritation from a dental prosthesis.What is ossifying fibroma of maxilla? ›
Ossifying fibromas are benign tumors of bone, commonly involving the posterior dentate mandible in middle-aged individuals with a female predilection. Clinical manifestations are an asymptomatic expansion of the dentate mandible, with infrequent maxillary lesions.Can ossifying fibroma be cancerous? ›
Ossifying fibroma is a rare, non-cancerous tumor that occurs in the jawbones.What is the cause of peripheral ossifying fibroma? ›
Peripheral ossifying fibroma - Oral Mucosal Lesion
It is thought to be related to poor gingival and periodontal health where chronic inflammation causes differentiation of pluripotent cells to bone-producing cells that are native to the area. It develops over weeks, months, and years and is slow growing.
Outlook / Prognosis
Recurrence rates vary depending on the type: Cemento-ossifying fibromas: Almost 30% recurrence rate. Juvenile ossifying fibroma: 30% to almost 60% recurrence rate. Peripheral ossifying fibromas: Up to 20% recurrence rate.
Enucleation and curettage are the treatment of choice in small, well-circumscribed tumor. In very large lesions, the tumor infiltrate into the surrounding structures, anatomic location and tumor size will guide the surgical approach than by histologic subtype shields.Can an ossifying fibroma cause pain? ›
The tumor itself is not painful. If it grows big enough, it may cause some swelling and tenderness under your skin, especially during activities that may irritate it. Most non-ossifying fibromas don't grow big enough to cause any symptoms.What syndrome is associated with ossifying fibroma? ›
Hyperparathyroidism-jaw tumor syndrome is a rare autosomal dominant disease characterized by parathyroid tumors and ossifying fibroma of the jaw. Disease-causing mutations have been localized in the tumor suppressor gene CDC73.How rare is ossifying fibroma? ›
Ossifying fibroma is an uncommon lesion that tends to occur during the third and fourth decades of life, and in women more than men. It is a slow-growing, asymptomatic, and expansile lesion. In the head and neck, ossifying fibroma may be seen in the jaws and craniofacial bones.
A peripheral ossifying fibroma, also known as ossifying fibrous epulis, is “a gingival nodule which is composed of a cellular fibroblastic connective tissue stroma which is associated with the formation of randomly dispersed foci of mineralised products, which consists of bone, cementum-like tissue, or a dystrophic ...What age group is ossifying fibroma? ›
Psammomatoid Ossifying Fibroma
POF is reported in a wide age range from 3 months to 72 years and although they may be found in the jaws, they have a predilection for the craniofacial skeleton and are found in the bones of the paranasal sinuses [3, 15,16,17,18,19].
While many benign tumors do not need treatment, some do, especially if they are causing symptoms. Usually if a benign tumor requires treatment, we remove it surgically. Whenever possible, we use minimally invasive techniques, which require small incisions and have minimal recovery time.Is ossifying fibroma hereditary? ›
The exact underlying cause is currently unknown; however, most cases occur sporadically in people with no family history of the condition."Where is peripheral ossifying fibroma most common? ›
It has been described with various synonyms and is believed to arise from the periodontal ligament comprising about 9% of all gingival growths. The size of the lesion is usually small, located mainly in the anterior maxilla with a higher predilection for females, and it is more common in the second decade of life.Is ossifying fibroma genetic? ›
A rare genetic bone disease characterized by multifocal, painless, benign fibrocemento-osseous lesions of the jaws which expand progressively and can cause severe facial deformity.What is the size of a peripheral ossifying fibroma? ›
The size of peripheral ossifying fibroma, as reported in the literature, ranges from 0.4 to 9.0 cm with an average lesion measuring approximately 1.0–2.5 cm at its greatest dimension.What is the differential diagnosis of peripheral ossifying fibroma? ›
The clinical differential diagnosis of POF includes all the nodular lesions which occur on gingiva (as mentioned before). Histopathologically, it is very important to understand the difference between the similar sounding lesions, i.e. POF, POdF, central ossifying fibroma (COF) and central odontogenic fibroma (COdF).How do you fix maxilla bone? ›
- Orthodontic headgear. Orthodontic headgear is a device worn outside the mouth to correct jaw and bite irregularities. ...
- Dermal fillers. ...
- Recessed maxilla surgery.
Oral squamous cell carcinoma (SCC) represents 90% to 95% of all malignant neoplasms of the oral cavity. It is classically regarded as an adult disease entity and has a high correlation with alcohol and tobacco consumption.
A maxilla surgery may be done if your maxilla or the surrounding bones are fractured, broken, or injured in some way. Your doctor may recommend alternatives if the fracture isn't serious enough to require surgery and will heal on its own.How do you remove a benign bone tumor? ›
The most common treatment for aneurysmal bone cyst and other benign tumors such as chondroblastoma, enchondroma, osteoblastoma, and chondromyxoid fibroma is marginal extracapsular excision using a high-speed drill and filling the cavity with autogenous bone graft or allograft.Can oral fibroma be left untreated? ›
When treatment is required, the only option is surgical excision of the fibroma with narrow margins. It may recur after surgery if the source of irritation continues. It is therefore also important to manage the source of the irritation. Oral fibromas do not disappear without treatment.What is a fibroma of the maxillofacial region? ›
It is a bony tumour of maxilla and mandible of possibly odontogenic origin with aggressive behaviour and high tendency for recurrence. Radiologically, the lesion appearances varied ranging from radiolucent cyst-like appearance to mixed and/or radiopaque areas.What is a peripheral ossifying fibroma jaw? ›
Peripheral ossifying fibroma (POF) is a localized reactive enlargement of the gingiva often associated with the papilla and originate from underneath the periodontium. POF occurs predominantly in females, especially in the anterior maxillary region of young adults.What are the 3 P's peripheral ossifying fibroma? ›
The classic “three Ps” of gingival swellings include: pyogenic granuloma, peripheral ossifying fibroma, and peripheral giant cell granuloma. Of the 3Ps, peripheral ossifying fibroma occurs more frequently than pyogenic granuloma (peripheral giant cell granuloma is least frequent).What is juvenile ossifying fibroma of the maxilla? ›
The JOF is a fibro-osseous lesion that occurs in the facial bones also called aggressive ossifying fibroma due to its aggressiveness and the high tendency to recur, unlike other fibro-osseous lesions, such as cemento-ossifying fibroma, which may resemble radiographically.What is the difference between fibrous dysplasia and ossifying fibroma? ›
The photomicrographs show that gnathic fibrous dysplasia shows thin irregular-shaped woven bone that resembles membranous ossification (b, c). Ossifying fibroma has a moderately cellular, dense fibrous stroma with prominent calcified spherules corresponding to ossicles and cementicles (e, f).What is a juvenile ossifying fibroma in the jaw? ›
Juvenile ossifying fibroma is a rare and non-cancerous overgrowth of bone in the face or jaw. There are two subtypes of juvenile ossifying fibroma called psammomatoid juvenile ossifying fibroma (PsJOF) and trabecular juvenile ossifying fibroma (TrJOF). Both subtypes primarily affect the bones of the face.What happens if a benign tumor is left untreated? ›
Benign tumors may grow and put pressure on organs like the brain. Endocrine tumors may not be cancerous but may cause your body to overproduce hormones. You may need surgery to remove the tumor. Cancer cells can break away from the original tumor.
Common types of benign tumors
Tumors called neuromas can also grow in nerves. The oncologist will likely operate on the patient to remove these. The oncologist will frequently see osteochondromas, which are a type of benign bone tumor.
Benign tumors are not usually problematic. However, they can become large and compress structures nearby, causing pain or other medical complications. For example, a large benign lung tumor could compress the trachea (windpipe) and cause difficulty in breathing. This would warrant urgent surgical removal.What is the most common site for ossifying fibroma? ›
In conclusion, ossifying fibroma is most commonly found in the mandible. Most cases are asymptomatic, but in some cases, swelling or expansion is observed. Radiographically, ossifying fibroma most frequently appears as a well-defined mixed radiolucent and radiopaque lesion.Do benign bone tumors need to be removed? ›
Benign bone tumors are bone tumors that are not cancerous. These tumors may cause pain that gets worse and not better. Some benign bone tumors may need treatment to stop them from destroying bone. Other noncancerous bone tumors may require no treatment at all.