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CASE REPORT
Year : 2018  |  Volume : 7  |  Issue : 1  |  Page : 66-69

Ossifying fibroma of maxilla: A rare case report


1 Department of Dentistry, Rajiv Gandhi Institute of Medical Sciences, Ongole, Prakasam, Andhra Pradesh, India
2 Department of Oral Maxillofacial Surgery, St. Joseph Dental College, Eluru, India
3 Department of Prosthodontics, St. Joseph Dental College, Eluru, India
4 Private Practitioner, Prasad's Superspeciality Dental Clinic, Rajahmundry, Andhra Pradesh, India
5 Department of Oral Maxillofacial Surgery, Dr. Sudha and Nageswara Rao Pinnameneni Siddhartha Institute of Dental Science, Vijayawada, Andhra Pradesh, India

Date of Web Publication22-Mar-2018

Correspondence Address:
Dr. Namineni K Kumar
Department of Dentistry, Rajiv Gandhi Institute of Medical Sciences, Ongole, Prakasam, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JDRNTRUHS.JDRNTRUHS_96_17

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  Abstract 


A 32-year-old male patient reported with a painless swelling over right cheek and is slowly growing in size for the past 2 years. Incisional biopsy revealed the lesion as Ossifying fibroma (OF), which is not very common in the maxilla. Surgical excision and primary closure was successfully carried out with no postoperative complications. The case was followed for a period of 3 years with no evidence of recurrence.

Keywords: Fibro-osseous; ossifying fibroma; surgical excision


How to cite this article:
Kumar NK, Raja Kumar S R, Prasad K S, Ramprasad V, Sekhar G P. Ossifying fibroma of maxilla: A rare case report. J NTR Univ Health Sci 2018;7:66-9

How to cite this URL:
Kumar NK, Raja Kumar S R, Prasad K S, Ramprasad V, Sekhar G P. Ossifying fibroma of maxilla: A rare case report. J NTR Univ Health Sci [serial online] 2018 [cited 2020 Mar 29];7:66-9. Available from: http://www.jdrntruhs.org/text.asp?2018/7/1/66/228158




  Introduction Top


Ossifying fibroma (OF) is classified as benign osteogenic neoplasm of the jaws presenting as a progressively growing lesion that can attain an enormous size with resultant deformity if left untreated.[1] The neoplasm is composed of fibrous tissue that contains a variable mixture of bony trabeculae, cementum like spherules or both.[2] The neoplasm is more common in third and fourthdecade of life with a definitive female predilection in the ratio of 5:1 and mandible is more commonly involved than maxilla.


  Case Report Top


A 32-year-old male patient reported with a chief complaint of painless swelling over right cheek. The swelling appeared 2 years before and is progressively growing in size. On examination a diffuse swelling measuring 8 cm × 5 cm in diameter was found over the right cheek with obliteration of the right nasolabial fold [Figure 1]. Skin over the swelling appears normal. Intraoral examination revealed expansion of the buccal and palatal cortical plates involving from the lateral incisor tooth on the left side to the second molar tooth on the right side [Figure 2]. The swelling is painless and firm on palpation. The involved teeth are loose and displaced.
Figure 1: Photomicrograph showing diffuse swelling over the right cheek with obliteration of the right nasolabial fold

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Figure 2: Photomicrograph shows expansion of the buccal and palatal cortical plates involving from the lateral incisor tooth on the left side to the second molar tooth on the right side

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The patient was subjected to routine presurgical investigations consisting of a complete hemogram, Paranasal sinus (PNS) view skull, and CT scan of maxillofacial region. PNS view of the skull showed haziness of the right maxillary sinus [Figure 3]. CT scan revealed a mixed mass occupying the right maxillary sinus with extension medially to the right nostril [Figure 4] without involving the nasal septum. As the lesion is large, incisional biopsy was taken after extraction of the premolar teeth on the right side. Histopathology report confirmed the diagnosis as OF.
Figure 3: Paranasal sinus view of the skull shows haziness on the right maxillary sinus region

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Figure 4: CT scan showed mass conquering the right maxillary sinus with extension medially to the right nostril

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Surgical technique

A high intraoral labial and buccal vestibular incision was placed extending from the lateral incisor on the left side to the second molar on the right side of the maxilla. The mucoperiosteal flap was raised and the buccal and palatal cortical expansion was clearly noticed. The expanded cortical plates were removed with a bone rongeur to identify the tumor. The tumor mass is excised in toto and it is found to be well encapsulated and lobulated [Figure 5].
Figure 5: Photomicrograph shows excised lesion

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The postsurgical defect was thoroughly examined. The posterior wall and roof of the maxillary sinus (i.e., floor of the orbit) are found to be intact. Wound closure done with 3.0 vicryl. The patient was advised not to forcefully sneeze for 2 weeks postoperatively. Ryle's tube feeding was given for 3 days. The postoperative period was uneventful [Figure 6]. Excisional biopsy confirmed the diagnosis to be OF.
Figure 6: Photomicrograph showing postoperative surgical area

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  Discussion Top


Fibro-osseous lesions are a heterogeneous group of benign lesions of unknown etiology affecting the jaws and other craniofacial bones. Lesions in this category include fibrous dysplasia (FD), focal cement osseous dysplasia (FCOD), and cemento-ossifying fibroma (COF) or OF. This group often exhibits resemblance in clinical presentation, radiographic appearance, and histological criteria, therefore pose difficulties in diagnosis and management.[3]

Of all the benign tumors of head and neck area, the OF is one of the few allowed by the patients to reach the largest and most distinguishing size, probably because of its persistently steady but slow rate of growth and its painless character. It is more common in the jaws and is related to the vast amount of mesenchymal cellular induction in to bone and cementum. As the tumor initially expands in the bone, it remains encapsulated and therefore well demarcated radiologically. But when it reaches certain large size, it may lose its encapsulation and infiltrates beyond its margins for a few millimeters.[4] It will also induce reactivity with adjacent bone, making it difficult to determine the tumor edge both radiographically and visually at the time of surgery. Most of these large, mature, and much mineralized OFs in the past have been termed gigantiform cementoma.

The most common site for this tumor is mandibular premolar–molar region. Lesions involving maxilla and other skull bones are relatively uncommon. Early cases are small and may be radiolucent. As they enlarge and mature, they will become mixed radiolucent-radio opaque and then completely radio opaque. They are heterogenous because of inconsistent distribution of their osseous and fi brous components. Their expansion is symmetric from the epicenter of the tumor, creating a spherical or egg-shaped mass on CT scan images.[6]

OF must be distinguished from FD. OFs will be spherical, expand cortices equally, will displace adjacent structures and will be well delineated from surrounding tissues.[5] On the other hand FD will be fusiform, will expand bone but will remodel the cortex to make it indistinct, will not be well demarcated and will form around adjacent structures rather than displacing them. The other differential diagnosis includes chondrosarcoma or osteosarcoma, calcifying odontogenic cyst (Gorlin cyst and calcifying epithelial odontogenic tumor (Pindborg tumor).[7]

The case reported here involved right maxilla which is relatively uncommon. The tumor has extended to occupy entire right maxillary sinus. Though there is a medial extension towards the nose, the nasal septum was found to be uninvolved. The tumor is of large size measuring 8 cm × 5 cm in diameter, but did not lose its encapsulation and is lobulated. This property of tumor made surgical excision easier as a single mass. The postsurgical wound was thoroughly inspected to confirm any involvement towards medial (nasal), roof (floor of the orbit), and posterior wall of the maxillary sinus. Postoperative follow-up was done for 3 years with no evidence of recurrence.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Waldron CA. Fibro-osseous lesions of the jaws. J Oral Maxillofac Surg 1993;51:828-35.  Back to cited text no. 1
[PUBMED]    
2.
Rosenberg A, Mokhtari H, Slootwej PJ. The natural course of an ossifying fibroma. A case report. Int J Oral Maxillofac Surg 1999;28:454-6.  Back to cited text no. 2
    
3.
Mac Donald-Jankowski DS. Fibro-osseous lesions of the face and jaws. Clin Radiol 2004;59;11-25.  Back to cited text no. 3
    
4.
Marx RE, Stern D. Benign neoplasms of bone. In: Marx RE, Stern D. Oral and Maxillofacial Pathology: A Rationale for Diagnosis and Treatment. 1st edition. Hong Kong: Quintessence; 2003. p. 789.  Back to cited text no. 4
    
5.
Barberi A, Cappabianca S, Colella G. Bilateral cemento-ossifying fibroma of the maxillary sinus. Br J Radiol 2003;76:279-80.  Back to cited text no. 5
[PUBMED]    
6.
Wenig BM, Mafee MF, Ghosh L. Fibro-osseous, osseous, cartilaginous lesions of the orbit and paraorbital region. Correlative clinicopathologic and radiographic features, including the diagnostic role of CT and MR imaging. Radiol Clin North Am 1998;36:1241-59.  Back to cited text no. 6
[PUBMED]    
7.
Tamiolakis D, Thomaidis V, Tsamis I, Alexiadis G, Seretis K. Cemento- ossifying fibroma of the maxilla. Internet J Dent Sci 2004;2:2-6.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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