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Gennaro P, Gennari L, Latini L, Cavati G, Vannucchi M, Giovannetti F, Cascino F. Maxillofacial Bone Involvement in Fibro-Osseous Lesions: Emphasizing the Significance of Differential Diagnosis. J Clin Med 2024; 13:3233. [PMID: 38892944 PMCID: PMC11173233 DOI: 10.3390/jcm13113233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 05/22/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
The World Health Organization's (WHO) 2022 update on the classification of odontogenic and maxillofacial bone tumors has revolutionized diagnostic and treatment paradigms by integrating novel molecular insights. Fibro-osseous lesions of the maxillo-facial bones constitute a heterogeneous group encompassing fibrous dysplasia, Psammomatoid Ossifying Fibroma (PSOF), Juvenile Trabecular Ossifying Fibroma (JTOF), and other variants. Despite histological similarities, their distinct clinical manifestations and prognostic implications mandate precise differentiation. The intricacies of diagnosing fibro-osseous lesions pose challenges for pathologists, maxillofacial surgeons, dentists and oral surgeons, underscoring the importance of a systematic approach to ensure optimal patient management. Herein, we present two cases, fibrous dysplasia and Cemento-Ossifying Fibroma, detailing their clinical encounters and management strategies. Both patients provided informed consent for publishing their data and images, adhering to ethical guidelines.
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Affiliation(s)
- Paolo Gennaro
- Maxillofacial Surgery Unit, Department of Mental Health and Sense Organs, Santa Maria Le Scotte, University Hospital of Siena, Viale Mario Bracci, 16, 53100 Siena, Italy
| | - Luigi Gennari
- Department of Medicine Surgery and Neuroscience, University of Siena, Viale Mario Bracci, 16, 53100 Siena, Italy
| | - Linda Latini
- Maxillofacial Surgery Unit, Department of Mental Health and Sense Organs, Santa Maria Le Scotte, University Hospital of Siena, Viale Mario Bracci, 16, 53100 Siena, Italy
| | - Guido Cavati
- Department of Medicine Surgery and Neuroscience, University of Siena, Viale Mario Bracci, 16, 53100 Siena, Italy
| | - Margherita Vannucchi
- Section of Pathology, Department of Medical Biotechnology, University of Siena, 53100 Siena, Italy
| | - Filippo Giovannetti
- Maxillofacial Surgery, San Salvatore Hospital, Department of Life Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Flavia Cascino
- Maxillofacial Surgery Unit, Department of Mental Health and Sense Organs, Santa Maria Le Scotte, University Hospital of Siena, Viale Mario Bracci, 16, 53100 Siena, Italy
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Nnko KA, Pima RT, Damas S, Mremi A. Management of ossifying fibroma of the bone of the maxilla: a case report and review of the literature. J Surg Case Rep 2024; 2024:rjae198. [PMID: 38572287 PMCID: PMC10984833 DOI: 10.1093/jscr/rjae198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 03/11/2024] [Indexed: 04/05/2024] Open
Abstract
Ossifying fibroma (OF) is a slow-growing benign fibro-osseous neoplasm. It is mostly odontogenic in origin, and it arises in the jaws, particularly the mandible. OF is characterized by the production of bone and cementum-like calcifications in a fibrous stroma. OF reports of the bone of the maxilla are uncommon. Diagnosing OF can be challenging due to the considerable overlap of clinico-pathological characteristics with those of other neoplasms. Herein, the authors describe a case report OF in a 26-year-old male who presented with a huge fibro-osseous tumor of the maxilla. Histopathology established the diagnosis of maxillary OF. The tumor was surgically removed via a Weber-erguson approach with satisfactory functional and cosmetic results. No recurrence has been found after one year of follow-up. Clinical, radiological, and pathological characteristics, as well as surgical treatment approaches, are further discussed. This is one of a few documented cases of maxillary OF in our setting.
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Affiliation(s)
- Kanankira A Nnko
- Department of Dental Surgery, Kilimanjaro Christian Medical Centre, Box 3010, Moshi, Tanzania
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Box 2240, Moshi, Tanzania
| | - Raphael T Pima
- Department of Dental Surgery, Kilimanjaro Christian Medical Centre, Box 3010, Moshi, Tanzania
| | - Sosthenes Damas
- Department of Dental Surgery, Kilimanjaro Christian Medical Centre, Box 3010, Moshi, Tanzania
| | - Alex Mremi
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Box 2240, Moshi, Tanzania
- Department of Pathology, Kilimanjaro Christian Medical Centre, Box 3010, Moshi, Tanzania
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Lavoie V, Somers GR, Mobini A, Lam E, Bradley G, Bubola J. An expansile radiolucent lesion of the maxilla in an 11-year-old male. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:323-330. [PMID: 38290956 DOI: 10.1016/j.oooo.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/08/2023] [Accepted: 12/05/2023] [Indexed: 02/01/2024]
Affiliation(s)
- Vincent Lavoie
- Oral and Maxillofacial Pathology & Oral Medicine, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Gino R Somers
- Division of Pathology, SickKids Hospital, Department of Laboratory Medicine and Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Ashkan Mobini
- Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Ernest Lam
- Oral and Maxillofacial Radiology, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Grace Bradley
- Oral and Maxillofacial Pathology & Oral Medicine, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Justin Bubola
- Oral and Maxillofacial Pathology & Oral Medicine, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.
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Akintoye SO, Adisa AO, Okwuosa CU, Mupparapu M. Craniofacial disorders and dysplasias: Molecular, clinical, and management perspectives. Bone Rep 2024; 20:101747. [PMID: 38566929 PMCID: PMC10985038 DOI: 10.1016/j.bonr.2024.101747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
There is a wide spectrum of craniofacial bone disorders and dysplasias because embryological development of the craniofacial region is complex. Classification of craniofacial bone disorders and dysplasias is also complex because they exhibit complex clinical, pathological, and molecular heterogeneity. Most craniofacial disorders and dysplasias are rare but they present an array of phenotypes that functionally impact the orofacial complex. Management of craniofacial disorders is a multidisciplinary approach that involves the collaborative efforts of multiple professionals. This review provides an overview of the complexity of craniofacial disorders and dysplasias from molecular, clinical, and management perspectives.
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Affiliation(s)
- Sunday O. Akintoye
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Akinyele O. Adisa
- University of Ibadan and University College Hospital Ibadan, Ibadan, Nigeria
| | - Chukwubuzor U. Okwuosa
- Department of Oral Pathology & Oral Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria
| | - Mel Mupparapu
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
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Ide F, Sakamoto S, Nishimura M, Miyazaki Y, Kikuchi K. Historical Notes on Ossifying Fibroma of the Mandible. Head Neck Pathol 2023; 17:1021-1025. [PMID: 37943466 PMCID: PMC10739633 DOI: 10.1007/s12105-023-01599-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023]
Affiliation(s)
- Fumio Ide
- Division of Pathology, Department of Diagnostic and Therapeutic Sciences, Meikai University School of Dentistry, 1-1 Keyakidai, Sakado, Saitama, 350-0283, Japan.
| | - Shinnichi Sakamoto
- Division of Pathology, Department of Diagnostic and Therapeutic Sciences, Meikai University School of Dentistry, 1-1 Keyakidai, Sakado, Saitama, 350-0283, Japan
| | - Michiko Nishimura
- Division of Pathology, Department of Diagnostic and Therapeutic Sciences, Meikai University School of Dentistry, 1-1 Keyakidai, Sakado, Saitama, 350-0283, Japan
| | - Yuji Miyazaki
- Division of Basic Biology, Department of Oral Biology and Tissue Engineering, Meikai University School of Dentistry, Saitama, Japan
| | - Kentaro Kikuchi
- Division of Pathology, Department of Diagnostic and Therapeutic Sciences, Meikai University School of Dentistry, 1-1 Keyakidai, Sakado, Saitama, 350-0283, Japan
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Nedelec M, Pouget C, Etienne S, Brix M. Juvenile trabecular ossifying fibroma: A case of extensive lesion of the maxilla. Int J Surg Case Rep 2023; 111:108620. [PMID: 37703694 PMCID: PMC10502336 DOI: 10.1016/j.ijscr.2023.108620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 09/15/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Juvenile trabecular ossifying fibroma is a rare benign tumor of childhood affecting the facial bones rarely described in literature. Its aggressive growth and high tendency of recurrence make it a real challenge for diagnosis and care. CASE PRESENTATION This article presents a case of an extensive juvenile trabecular ossifying fibroma of the maxilla in a 14-year-old boy, which required surgical intervention with immediate bone reconstruction using an autogenous graft (iliac crest). No recurrence has been found after two and a half years of follow-up. CLINICAL DISCUSSION Common symptoms of juvenile trabecular ossifying fibroma include painless swelling, facial asymmetry, jaw deformity and teeth displacement. Differential diagnosis should consider other forms like psammomatoid ossifying fibroma, osteofibrous dysplasia, fibrous dysplasia, ameloblastoma, odontoma, or even poorly differentiated carcinoma. CONCLUSION Currently, there is no recommendation or consensus for the treatment of juvenile trabecular ossifying fibroma. The objective of treatment is also to preserve growth and development and conserve the nervous structure and the function, as mastication, vision. Early diagnosis and appropriate care are essential to prevent morphological and functional defects in young patients. Regular and long-term follow-up is essential due to the high recurrence rate.
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Affiliation(s)
| | - Celso Pouget
- Dept of anatomopathology, University Hospital, Nancy, France
| | - Simon Etienne
- Medical Professor Dept. of Oral and Maxillofacial Surgery, and plastic surgery, University Hospital, Nancy, France
| | - Muriel Brix
- Medical Professor Dept. of Oral and Maxillofacial Surgery and plastic surgery, university hospital, Nancy, France
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Tater J, Diajil AR. Immunohistochemical analysis of osteoclastic and osteoblastic activity in ossifying fibroma and juvenile ossifying fibroma: A comparative study. J Med Life 2023; 16:1369-1374. [PMID: 38107708 PMCID: PMC10719798 DOI: 10.25122/jml-2023-0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/15/2023] [Indexed: 12/19/2023] Open
Abstract
Cemento-ossifying fibroma (COF) and juvenile ossifying fibroma (JOF) have been considered distinct entities within the category of fibro-osseous lesions. This study aimed to assess osteoblast and osteoclast activity in COF and JOF by investigating bone resorption markers, specifically receptor activator of nuclear factor-kB (RANK), RANK ligand (RANKL), and its inhibitor osteoprotegerin (OPG). A comparative analysis of these markers was performed on all lesions. Immunohistochemistry was employed to evaluate and quantify the expression of these biomarkers in a sample of 20 cases of cemento-ossifying fibroma (COF), 15 cases of psammomatoid juvenile ossifying fibroma (PsJOF), and 10 cases of trabecular juvenile ossifying fibroma (TrJOF). The expression of osteoprotegerin was significantly higher in cemento-ossifying fibroma (33.9±13.0) compared to trabecular juvenile ossifying fibroma (27.3±9.2) and psammatoid ossifying fibroma (25.2±14.9), with the COF showing the highest expression followed by the latter two (p=0.037). There was a higher percentage (80%) of stromal fibroblast cells that showed positive expression of RANKL in cemento-ossifying fibroma (COF) compared to psammomatoid juvenile ossifying fibroma (PsJOF) (33.3%) and trabecular juvenile ossifying fibroma (TrJOF) (30.0%) when considering a positive expression score of 3 (p=0.024). Cemento-ossifying fibroma demonstrated the highest expression of osteoprotegerin and RANKL-positive stromal fibroblast cells, followed by psammomatoid juvenile ossifying fibroma and trabecular juvenile ossifying fibroma. These findings provide valuable insights into the pathogenesis of these lesions.
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Affiliation(s)
- Jawaher Tater
- Department of Oral and Maxillofacial Pathology, College of Dentistry, University of Baghdad, Baghdad, Iraq
| | - Ameena Ryhan Diajil
- Department of Oral Medicine, College of Dentistry, University of Baghdad, Baghdad, Iraq
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