Management of juvenile ossifying fibroma in the maxilla and mandible

Maxillary Ossifying Fibroma Managed Using Cosmetically Acceptable Facial Degloving Approach with Iliac Bone Graft Reconstruction

Ossifying fibroma is benign, slowly expansile, painless, well defined fibro-osseous tumour composed of calcified products such as bone, cementum, or both [1]. We opted for a novel approach for the management of ossifying fibroma of maxillary region through scarless midfacial degloving approach with iliac bone graft reconstruction. A 20 years old young female presented with left sided facial swelling involving anterior wall of maxilla and lifting the ala of nose. CT and FNAC suggested a benign lesion. Surgery was performed to remove the tumour completely and managed with scarless midfacial degloving approach with iliac bone graft reconstruction. The iliac crest free flap is an optimal method for maxillary defect reconstruction. The main advantages of the flap are the large amount of bone provided, its height, and the possibility of including the internal oblique muscle [2].

S, Mohideen K, Balasubramaniam M, Ghosh S, Dhungel S. Juvenile psammomatoid ossifying fibroma of the maxilla and mandible: A systematic review of published case reports

OBJECTIVE

The aim of this study is to evaluate recent evidence-based data that summarize the clinicopathological findings and treatment along with follow-up measures taken in terms of published cases of Juvenile psammomatoid ossifying fibroma (JPOF) of the maxilla and mandible by a systematic review. MATERIALS AND METHODS: The databases searched were PubMed, MEDLINE, Scopus, Google scholar, and Cross references. Only those case reports of JPOFs published in the English language from 2000 to 2022 were considered. All cases included confirmed JPOF lesions histopathologically. The SR-included details like clinical and radiographic data, follow-up details such as recurrence, and the presence of any adverse outcome.

RESULTS

The database search produced 595 articles from 2000 to 2022, among which 22 case reports were included in the systematic review. The mean age of JPOF occurrence in patients was 18 ± 16 years. A male predilection was noted among patients younger than 14 years of age, whereas a female predilection was noted in patients older than 14 years of age. Frequent involvement of the mandible (56%) compared to the maxilla (44%) was reported. The posterior mandible was the most commonly affected site involving numerous adjacent structures. The expansile nature of the JPOF displayed 57% buccolingual expansion, 50% downward displacement or erosion of the lower border of the mandible and 81% of  involvement of the maxillary antrum/pterygoid plate/orbital floor. Among the 20 cases reported, the treatment provided included surgical excision in 45% of the patients, jaw resection in 35% of the patients, and enucleation and curettage in 18% of the patients. Follow-up details were provided in 80% of the reports that showed recurrence.

CONCLUSIONS

The diagnosis of JPOF requires correlation of the clinical and radiographic features with key histopathological features. Although long-term follow-up of the case reports has been reported, the data lack information about the long-term outcomes of JPOF.

Management of juvenile trabecular ossifying fibroma of bone of the maxilla in a child: A case report at a tertiary hospital in Northern Tanzania

INTRODUCTION AND IMPORTANCE

Juvenile trabecular ossifying fibroma (JTOF) is a rare variant of ossifying fibroma. Though it is benign, it has aggressive clinical behavior. JTOF may pose diagnostic and therapeutic difficulties due to their clinical, radiological and histological variability. Herein, we describe our experience in encountering this unusual disease entity in terms diagnostics as well as surgical procedure and the differential diagnoses to be considered.

CASE PRESENTATION

An 8-year old female child presented to our facility because of a rapidly growing right maxillary swelling. Clinical examination revealed facial asymmetry resulted from the swelling on the right side of her face extra-orally, especially in her posterior upper jaw which was about 12 cm × 7 cm in dimension. Intra-oral examination revealed solitary mass, well-defined, firm in consistency and non-tender. There were no palpable lymph nodes. Infra- orbital nerves were bilaterally intact. Based on the clinical findings and history, the differential diagnoses of ossifying fibroma, ameloblastoma and fibrous dysplasia were given. Clinico-pathological and radiological correlation confirmed the diagnosis of JTOF. Hemimaxillectomy and reconstruction of maxilla with a rib were performed. Afterwards, the child reported with normal facial appearance, acceptable aesthetics and better chewing function.

CLINICAL DISCUSSION

The clinical presentation of JTOF, and its rapid growth, can cause alarm of other pathologies such as osteosarcoma. The radiological features should reassure the practitioner and a histological examination confirmed the diagnosis.

CONCLUSION

JTOF is a benign tumor and it should be operated at an early stage because of its rapid growth.

Simultaneous presentation of juvenile ossifying fibroma in the maxilla and mandible: a case report

INTRODUCTION

Juvenile ossifying fibroma (JOF) is a controversial and uncommon lesion that has been distinguished from the larger group of ossifying fibromas because of distinct clinical features and some morphological peculiarities. Furthermore, JOF shows an aggressive biological behavior that has led researchers to consider it a benign neoplasm, resulting in its differential diagnosis with important benign and malignant bone neoplasms.

PRESENTATION OF CASE

This study describes a case of synchronous presentation of JOF in the mandible and maxilla of a young patient. In addition, the literature was reviewed to identify clinical-pathologic features and possible factors that could help establish the correct diagnosis. A 26-year-old male patient presented simultaneously a lesion affecting the body, angle and ramus of the left mandible and another lesion in the left maxilla. Both lesions were well delimited and radiolucent, being unilocular in the maxilla and multilocular in the mandible. The mandibular lesion was partially resected and the maxillary lesion was submitted to curettage. The diagnosis was JOF.

DICUSSION

A delay in seeking medical care and a late diagnosis can have serious consequences for the postoperative functional and esthetic outcome. Much care should be taken during establishment of this diagnosis since an equivocal diagnosis can have serious consequences for the patient in terms of treatment.

CONCLUSION

After 1 year, the patient shows no signs or symptoms of recurrence of the lesions and was referred for reconstructive surgery of the mandible. An early and correct diagnosis is necessary to permit the best therapeutic management.

A large maxillary cemento-ossifying fibroma superimposed with solitary bone cyst documented over 18 years: A case report

INTRODUCTION

Cemento-ossifying fibromas are rare, benign lesions of the head and neck regions. The origin of these lesions can be traced to the periodontal ligament, because its cells are able to form cement, lamellar bone, or fibrous tissue.

CASE PRESENTATION

A rare case report of a young Caucasian female with a COF is described including follow-ups. She remained untreated for several years despite early radiographic findings of the lesion without a definitive diagnosis. The patient ultimately underwent radical surgery and the whole lesion was removed. The subsequent histological examination confirmed the clinical diagnosis of a COF. Since then, the patient has been under regular clinical and radiological follow-ups.

DISCUSSION

This rare case report of a COF, documented over 18 years, shows the importance of consecutive therapy after radiologic and clinical findings, as such lesions continue growing and may subsequently lead to severe medical conditions. Therefore, complete surgical resection of COFs is advised to achieve good results in terms of health and recurrence.

CONCLUSION

Long-term follow-up of patients is required as recurrences can occur for up to 10 years following treatment. Well-planned radical and wide surgical resection of these lesions has proven not only to be effective in eliminating the aetiological factors, but can also achieve decent bone regeneration and aesthetic results with almost no deformation in the surgical site.

Fibrous Dysplasia and Juvenile Psammomatoid Ossifying Fibroma: A Case of Mistaken Identity

Juvenile psammomatoid ossifying fibroma (JPOF) is a rare benign osseous tumor, usually presenting in the midface. There are many similarities in location, presentation, and radiographic appearance between fibrous dysplasia (FD) and JPOF. Awareness of this entity is important for craniofacial surgeons, as surgical timing and intraoperative management differ between these tumors. Findings that should raise suspicion of JPOF preoperatively include rapid growth, a shell of cortical bone surrounding the lesion, and clearly demarcated borders of the lesion on imaging, as opposed to a gradual transition between normal and abnormal bone. Definitive excision is the treatment of choice, and earlier surgery may provide better results by addressing the lesion at the smallest size possible. In contrast to FD, JPOF is not known to "burn out," so there is minimal benefit to be gained from delay. We present a summary of the evidence for diagnosis and treatment of JPOF as well our experience with JPOF in an 11-year-old female who was initially diagnosed with FD. We aim to draw attention to the similar presentations of these entities so the reader will be able to more accurately manage these patients.

Juvenile Ossifying Fibroma in the Mandible

Juvenile ossifying fibroma is a rare benign fibroosseous tumor which involves maxilla more than mandible. It usually occurs in children below 15 years of age. This article reports a case occurring in the mandible with the surgical treatment followed by us.

Radiotherapy for juvenile ossifying fibroma of the maxillary sinus: Case report and literature review

BACKGROUND

Juvenile ossifying fibroma (JOF) is a benign fibro-osseous lesion that can be locally aggressive. It is typically treated with surgical excision. A few cases using adjuvant radiotherapy have been reported in the literature.

METHODS

We report a case of JOF treated with surgical excision and adjuvant radiotherapy to minimize the risk of local recurrence. We also review the literature.

RESULTS

Our patient tolerated radiotherapy without complication and had not experienced a local recurrence at the time of writing this manuscript.

CONCLUSIONS

This is one of the first reports of adjuvant radiotherapy after surgical excision to improve local control in patients with JOF. Radiotherapy should be considered in patients for whom reexcision after a recurrence would result in unacceptable morbidity.

Ossifying fibroma of the maxilla and sinonasal tract: Case series

BACKGROUND

Head and neck ossifying fibroma (OF) is a rare, benign, locally aggressive, fibro-osseous tumor. The mandible is the most common site of involvement, followed by the maxilla, and, less frequently, the sinonasal cavities, orbit, skull base, and calvarium. In this study, we aimed to expand our understanding of this entity by presenting a case series of OF that involved the maxilla and sinonasal tract.

METHODS

A multicenter retrospective review was performed on all the patients with a diagnosis of OF from 2004 to 2013. Data were collected with respect to age, sex, clinical presentation, treatment, and outcome.

RESULTS

A total of 13 patients were identified. The mean age was 37 years, with a female predominance (69%). The maxillary sinus was most frequently involved site (46%). Eighty-five percent underwent open surgical resection. After a mean follow-up time of 47.3 months, three patients (23%) developed recurrent disease; all of whom were treated with an open approach.

CONCLUSION

OF of the maxilla and sinonasal tract is an uncommon clinicopathologic entity. Although a timely diagnosis may obviate the need for external approaches, open surgical resection is often still necessary for management of extensive lesions. Close follow-up and additional surgery may also be required to treat recurrent disease.

Juvenile Trabecular Ossifying Fibroma of the Maxilla: a Case Report

Introduction:

Juvenile ossifying fibromas are uncommon benign tumors. Their aggressiveness added to their high tendency to recur, provoke real diagnostic and therapeutic challenges for the dental practitioner and make a postoperative follow-up over the years indispensable.

Case report:

In this report, we present a case of a seven-year-old girl presented with a swelling in the face at the upper right maxillary region. After clinical, radiological, and histopathological examinations the diagnosis of trabecular juvenile ossifying fibroma was made. The lesion was surgically excised and followed up for two years with no evidence of recurrence.

Juvenile Psammomatoid Ossifying Fibroma: Findings on Bone Scan

Juvenile psammomatoid ossifying fibroma is a rare bone-forming tumor seen in craniofacial bones, which affects mainly young patients. We report scintigraphic and SPECT/CT findings of 2 patients diagnosed with this disease. One patient presented with suspicion of fibrous dysplasia and the other with suspected malignancy in the setting of a rapidly growing mass. Both cases highlight the importance of recognizing this type of tumor in young patients with abnormal uptake in paranasal bones and sinuses within the range of potential differential diagnoses including sarcomas, fibrous dysplasia, and odontogenic tumors.

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.

Polyostotic Juvenile Ossifying Fibroma: An Exceptionally Rare Case

Accurate and early diagnosis of benign fibroosseous lesions is important because the treatment and resulting outcomes of each differ. Juvenile ossifying fibromas typically occur in young patients and grow rapidly with a high recurrence rate. Their monostotic nature has previously differentiated these tumors from other fibroosseous lesions. We describe an interesting and extremely rare case of polyostotic juvenile ossifying fibromas in a 14-year-old boy with involvement of the maxilla and mandible. The available literature on juvenile ossifying fibromas is also briefly reviewed. When diagnosing a polyostotic fibroosseous lesion, it is important to not exclude the possibility of juvenile ossifying fibromas because this may warrant a different treatment.