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Introduction: Cemento-ossifying fibroma is a benign fibro-osseous maxillary tumor belonging to the same category as fibrous dysplasia and cement-ossifying dysplasia. The aim of present study was report a case of cement-ossifying mandibular fibroma and offers a review of the literature on this disorder. Case report: A 41-year-old woman presented for...
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Context 1
... 41-year-old woman presented for conventional den- tal treatment. A control panoramic X-ray study (Fig. 1) revealed a rounded, mixed-type image in the mandible, located in the periapical zone from tooth 4.3 to 3.3. The patient reported having suffered trauma in that same area years ago. She presented no symptoms, had no me- dical history of interest, and reported no toxic habits or drugs ...
Context 2
... condi- tions to be taken into account are lesions appearing as a mixed periapical image such as calcifying odontogenic cysts or cementoblastomas, which are seen to be asso- ciated to the roots of vital permanent teeth. Likewise, fo- cal cemento-osseous dysplasia appears as a radiotrans- parency associated to the dental apexes, and in more advanced stages presents extensive radiopaque areas surrounded by a radiotransparent halo (1,2,6). Since our patient had a history of trauma in the affected zone, con- sideration is likewise required of other lesions that can also be associated with antecedents of trauma, such as central giant cell granulomas. ...
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Ossifying fibroma (OF) is a benign, non-odontogenic tumor of the jaw, a type of fibro-osseous lesion. Traditionally, this type of lesion was subclassified histologically into ossifying fibroma and cementifying fibroma according to the hard tissues formed, but both types are now known by the unified term, ossifying fibroma. It is generally accepted...
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p class="abstract">Osseous tumors in the craniofacial skeleton of young patients are not very frequent, and tumors involving the walls of the orbital cavity are even more infrequent. Despite being usually slow-growing, even small neoformations can have a local aggressive behavior, displacing and compressing vital structures, and so it is important...
Citations
... However, the management usually is governed by clinical and radiological presentation. Due to clear delimitation of the tumour, surgical removal and curettage is the treatment of choice [11,18]. Conservative management is particularly indicated for smaller lesions in young individuals since employing this option enables a comprehensive removal of the lesion permitting a satisfactory clinical outcome to prevent its recurrence and hence is considered as definitive treatment modality [10]. ...
... However, it necessitates a long-term follow-up to evaluate recurrences [10]. Complete surgical removal of the lesion during its initial active stage results in minimal or no recurrence [11,18]. However, studies revealed a high recurrence rate of up to 5-28% following surgical curettage [20,21]. ...
Cemento-ossifying fibroma (COF) is one of the rare forms of benign fibro-osseous lesions. Establishing a differential diagnosis for COF could be an arduous task considering its resemblances with other fibro-osseous lesions like the Paget’s disease and fibrous dysplasia with regards to their clinical and radiographic presentation. Thus, the need for precise details pertaining to this entity. We report a case of mandibular COF in a young individual whose clinical and radiographic presentation was similar to any other routinely encountered odontogenic cyst or tumour. This edifies us that the microscopic examination undoubtedly remains the key modality for the final diagnosis of a COF where the clinical and radiographic presentation does not facilitate a clear-cut precise diagnosis. Thus, necessitating the need for a correlation between the clinical, radiological, and histological presentation to establish a definitive diagnosis.
... A crevicular incision was placed over the 13 to 23 region and mucoperiosteal flap was elevated and excision and curettage of the mass were performed followed by thorough debridement. This was followed by extraction of teeth associated with the lesion (14,13,12,24). Teeth that were infected root stumps (15,16,25,26,36,46) were also extracted along with teeth with poor prognosis (47, 48). ...
... COF depends on the degree of mineralisation. It appears radiolucent in the initial stages; calcific flecks increase with maturity of the lesion and, finally, progress to a complete radiopaque mass [12]. A few studies have reported that a radiolucent pattern is more common in the younger age group whereas a mixed radiolucent-radiopaque appearance is seen in older patients [13]. ...
Cemento-ossifying fibroma (COF) is a benign odontogenic neoplasm. It is considered an ossifying fibroma with traces of interspersed cementum fragments. Here we present a case report of the occurrence of COF in the maxillary anterior region of an elderly woman. A 61-year-old female reported with a painless, progressive, slow-growing swelling on the upper front jaw region for the past five years. A single, localized, swelling on the anterior region of the maxilla which was non-tender and bony hard in consistency. Radiological examination consisting of orthopantomagram (OPG) and cone-beam computed tomography (CBCT) revealed increased thickness of bone over frontal, parietal and maxilla with alteration of trabecular pattern - cotton wool/ground glass. Serum alkaline phosphatase level was found to be 865 U/l, however, serum calcium level and other routine blood investigations (hemogram) were within normal limits. The above radiological and laboratory findings are more in favour of primary bone pathology and with a biopsy later correlating with histopathological findings; it was diagnosed as COF. Under conscious sedation, surgical excision of the bony mass was done along with extraction of associated teeth. The patient is currently on regular follow-up and planning for a dental prosthesis is in progress.
... Cemento-ossifying fibroma is a benign FO tumor. [5][6][7][8][9][10] According to the WHO, it is a delimited or infrequently encapsulated neoplasm made up of fibrous tissue with various levels of mineralized material such as bone and cementum. It affects people of all ages, with the majority of instances occurring in the third and fourth decades of life with a distinct female predilection. ...
... Thus, this points to trauma as a possible triggering factor, postulating the lesion to be a connective tissue reaction rather than a benign neoplasm. [6] Due to the good delimitation of the tumor, surgical removal and curettage are the treatment of choice. The prognosis is usually good, since recurrences are <25%. ...
Cemento-ossifying fibromas are benign fibro-osseous neoplasm that involves the jaws. These tumors are a rare group of mesodermal odontogenic tumors occurring in the maxilla. Most of the lesions are centrally within the jaw as a slow and progressively growing lesion. If left untreated, they achieve vast size with consequent malformation. Radiographically, they are presented as well-defined unilocular or multilocular intraosseous masses. They are less sensitive to radiotherapy and recurrences are unusual. A rare occurrence of cemento-ossifying fibroma of the anterior maxilla is noted in a 42-year-old male patient. Clinically, they manifested as a well-demarcated swelling in the right anterior region of the maxilla. Radiographic characteristics, histological, and surgical findings are enlisted and the several differential diagnoses are mentioned.
... Initially, it manifests as a radiolucent lesion. The calcified foci gradually increase as the lesion matures until a completely radiopaque appearance is created [6,42,43]. The main characteristic feature of COF is its eccentric growth pattern, which results in its expansion in all directions and eventual formation of a prominent spherical mass, which is easily differentiable from the adjacent tissues [3,43]. ...
Background:
Cemento-ossifying fibroma (COF) is a type of benign fibro-osseous tumor that mainly occurs in the maxillofacial region. Bone reconstruction after the surgery is often performed with bone transplantation. However, the present case report describes the accurate diagnosis and successful surgical resection of a COF with periosteum preservation, after which the defect was completely and spontaneously filled with the newly formed bone through a natural process. Case Presentation. A 32-year-old Iranian female patient presented with a history of gradual development of painful swelling, spontaneous pain, and lower lip and chin hypoesthesia in the lower third of the left side of her face. The dome-shaped swelling was tender. The patient was suffering from renal infection and urethral prolapse and was taking folic acid. She also mentioned a positive family history of similar swellings in her mother and uncle. Intraoral examination indicated a lesion in buccal and lingual vestibules extending from the first premolar to the third molar teeth. It had a firm consistency, and the covering mucosa was normal in terms of color and texture. The aspiration test was negative. The lesion had caused severe mobility of the second premolar and first and second molar teeth. Panoramic radiography revealed an extensive well-defined unilocular radiolucency. Significant knife-edge resorption of the first and second molar roots at the involved site and thinning of the alveolar crest and inferior border of the mandible were also clear. Cone-beam computed tomography showed severe expansion in the buccal and moderate expansion in the lingual aspect, causing thinning of both the buccal and lingual cortical plates. Histopathological analysis revealed neoplastic tissue mixed with fibrous connective tissue and several round and oval-shaped calcification foci. Immunohistochemical analysis confirmed the final diagnosis (COF) with the presence of SMA-8. The lesion was removed by enucleation and curettage, while the periosteum was carefully preserved. Fixation with screw and plate was also performed.
Conclusions:
Correct diagnosis of COF and precise implementation of the periosteal osteogenesis technique, in this case, resulted in entirely and spontaneously bone regeneration, which was a rare and favorable outcome with minimum cost and complications for the patient.
... Cemento-ossifying fi broma or ossifying and cementifying fi broma described as well defi ned sharply marginated or uncommonly encapsulated benign neoplasms [1][2][3]. These lesions are predominantly seen in between 2 nd to 4 th decades of life more commonly in women than men with ratio of (4:1) [4][5][6][7]. It consist of fi brous tissue with varying amount of mineralizing or calcifi ed material resembling the bone, cementum or both [1][2][3]. ...
... It is commonly discovered as incidental fi nding on radiological imaging and asymptomatic [2,3]. However in symptomatic patients it becomes large enough in size and can cause enlargement of the affected bone resulting in clinically apparent swelling of involved region, intra-oral hard mass and disfi gurement of face with the passage of time [3,6]. Various investigation are used to diagnose the cemento-ossifying fi broma, these includes orthopantomography (OPG), CT scan, MRI and Histopathology [6,7]. ...
... However in symptomatic patients it becomes large enough in size and can cause enlargement of the affected bone resulting in clinically apparent swelling of involved region, intra-oral hard mass and disfi gurement of face with the passage of time [3,6]. Various investigation are used to diagnose the cemento-ossifying fi broma, these includes orthopantomography (OPG), CT scan, MRI and Histopathology [6,7]. Defi nitive diagnosis can be made correlation in between clinical history, radiological imaging fi ndings and histopathology [5]. ...
Cemento-ossifying fibroma is a rare benign fibro-osseous neoplasm commonly involving the jaws majority of lesions occur in mandible bone. It can be discovered as an incidental finding in radiological imaging. Symptomatic patients are presented with a slowly growing mass involving the jaws commonly in mandible bone and can attain a large size with the passage of time. It can cause facial deformity if left untreated. We present such a case of Cemento-ossifying fibroma involving the right hemi-mandible bone, and its radiological imaging findings, including X-ray (OPG), CT scan, and Histopathology.
... Generally, the individuals are asymptomatic in the early stages of the occurrence of cemento-ossifying fibroma. In advanced stages, the lesion gradually enlarges resulting in expansion of cortical bone, displacement of teeth and facial disfigurement 5 . In children, the lesion is termed as juvenile cemento-ossifying fibroma which is aggressive and is highly vascular. ...
The basis of the problem: Cemento-ossifying fibroma is a
benign fibro-osseous lesion ofthe jaw.It presents as a slow
growing swelling which progressively enlargesif not surgically
intervened. Cemento-ossifying fibroma revolves around the use
of different terminologies and diagnostic criteria in proposing a
strategic treatment plan.
Method: The current article describes a rare occurrence of
cement-ossifying fibroma affecting maxilla in a 44 year old
female patient.Clinically, the lesion was painless and slow
growing in nature. Computed tomography revealed a hypodense
area in the right posterior maxilla measuring 19.07mm X
27.11mm. The lesion was surgically resected under general
anesthesia and it was histopathologically confirmed to be
cemento-ossifying fibroma.
Results:Total enucleation/ resection of the osseous lesion must
be timely ensured to prevent recurrence and also to achieve
good prognosis which was done in the described case report.No
recurrence was reported in the present case which had a follow up
for 24 months.
Conclusion: Although numerous controversies exist in the use
of terminologies, a multi centric approach mandates to
correlate clinically, radiographically and histologically to
determine the treatment perspective.
... Three overlapping clinico-pathological entities are recognized: 1) conventional ossifying fibroma, 2) juvenile trabecular ossifying fibroma, and 3) juvenile psammomatoid ossifying fibroma. 8,9 Ossifying fibromas most frequently occur in female patients with an incidence peak in the third and fourth decades of life. Seventy percent of cases of ossifying fibroma involve the mandible, but a significant percentage (22%) is found in the molar region of the maxilla, in the ethmoidal and orbital regions, and rarely in the petrous bone. ...
... Juvenile ossifying fibromas tend to be more radiopaque than conventional lesions and sometimes may have a "ground glass" appearance or may form dense lobulated masses. 8,10 However, ossifying fibroma is best visualized by CT in the sinonasal regions, where it tends to fill the paranasal sinuses and destroy bone -a feature noted in the left maxillary lesion in the case presented herein. Kashyap et al. 13 reported a case of ossifying fibroma of the maxilla involving the maxillary sinus and ethmoid sinus in a 40-year-old female patient, in which CT coronal sections showed an ill-defined expansile mass lesion completely occluding the right maxillary sinus, extending inferiorly up to the right maxillary alveolus. ...
Fibro-osseous lesions are a poorly defined category of conditions affecting the jaws and craniofacial bones, and include developmental lesions, reactive or dysplastic lesions, and neoplasms. Fibrous dysplasia and ossifying fibroma are the 2 main types of fibro-osseous lesions affecting the jaw, and ossifying fibroma is a true benign neoplasm of the bone-forming tissues with several well-recognized variants ranging from innocuous to extensively aggressive lesions. However, multiple simultaneous fibro-osseous lesions of the jaw bones involving all quadrants are exceedingly rare. One such case diagnosed by conventional radiography and computed tomography is discussed here.
... The most common location is mandible with predominance in the third and fourth decades of life. 3,4 These lesions are more frequent in women than in men (4:1). [4][5][6] Trauma or local irritation such as dental calculus, ill-fitting denture appliance and faulty restorations are known to precipitate the development of this lesion. ...
... Microscopically, OF often appears as a well-demarcated lesion consisting of a fibroblastic stroma containing plexiform and lamellar bone in addition to acellular mineralized material [12]. Lesions also contain hypercellular fibrous tissue with the randomly distributed islands of bony tissue or cementiform calcifications [13]. The definitive diagnosis is often challenging and usually requires a combined assessment of clinical, microscopic, and radiological features [8]. ...
Ossifying fibroma is a rare benign fibro-osseous neoplasm of the jaw characterized by the replacement of normal bone tissue by a combination of fibrous tissue and newly formed calcified tissues of bone and/or cementum-like material. Lesions often manifest at the 2nd to 4th decades of life with a predominant female predilection. The tumor is usually slow-growing and asymptomatic but can cause notable expansion of the jawbones. Definitive diagnosis of OF can be challenging and usually requires careful clinical, radiographic and histologic assessments. Treatment commonly depends on the size, location and aggressiveness of tumor and can accordingly vary from enucleation and curettage to resection and bone grafting. The prognosis is generally good when the lesion is completely removed, but recurrence is possible in some circumstances. The aim of this article is to present a case report of a recurrent ossifying fibroma in a 28-year-old female patient and to provide an update of the literature.
... It manifests as asymptomatic, slow-growing, and well-demarcated. Asymmetrical deformation of face, aesthetical and functional impairment results as a consequence of prolonged and slow growth of the tumor [1]. The lesion is more frequently reported in the second to fourth decades of life, and usually involves the mandible. ...
... Radiographic features depend on the duration of the lesion, initially well-defined radiolucent, later mixed radiolucent-radiopaque with opacities in the middle of the lesion and as the lesion matures, it appears with asymmetrical opacities forming concentric bony trabeculae with marginal sclerosis [2]. The pathogenesis remains unknown; it may be related to problems in the maturation of dental tissue mostly cementum and bone arising from the ectopic periodontal ligament or mesodermal germ layer or mesenchymal cells [1][2][3]. The histopathology of the tumor consists of highly cellular, fibrous tissue consisting of variable amounts of bone, cementum, or both. ...
... The histopathology of the tumor consists of highly cellular, fibrous tissue consisting of variable amounts of bone, cementum, or both. The treatment of choice is surgical excision with extended resection that depends on the size and location of the lesion [1,2]. This study aimed to describe its course on clinical, radiological, and histopathological characteristics of the tumor. ...
