Central odontogenic fibroma: An updated systematic review of cases reported in the literature with emphasis on recurrence influencing factors

Central odontogenic fibroma: report of 29 cases in a Korean population with tooth management

This study presents the behavioural findings of central odontogenic fibroma (COF) in a specific ethnic group, analysing treatment methods and demonstrating how involved teeth should be managed in detail. Clinical, radiographic, and histological findings were gathered for 29 patients who visited our clinic, with all patients' data carefully examined by radiologists and reviewed microscopically. The cohort comprised 29 patients, with 16 females and 13 males, having a mean (SD) age of 33.1 (16.0) years. Among them, 19 patients were affected in the maxilla, with 15 showing anterior preference, and palatal depression was observed in six patients. Tooth resorption was evident in 15 patients, while 10 patients showed tooth displacement. Within the cohort, 13 patients underwent tooth extraction and resection, while the remaining 16 did not have teeth extracted. Notably, there was no significant difference in recurrence observed between these two groups. This study represents the largest study to date of COF within a single ethnic group and institution. A subset of cases exhibited noteworthy features of COF. However, intriguingly, despite these characteristics, the preservation of contiguous teeth did not demonstrate a significant impact on recurrence rates.

Central Odontogenic Fibroma of the Mandible in a 9-year-old Child: A Case Report with 24-month Follow-up

Background

Central odontogenic fibroma (COF) is a rarely benign tumor with an incidence of only 0.1% among all odontogenic tumors, which commonly involve the mandible.

Case description

A 9-year-old child reported with asymptomatic bony expansion of the mandible, showing an unilocular radiolucency on an orthopantomogram. The tumor was managed surgically by enucleation, and the surgical stent was placed, which was later modified as a removable functional space maintainer. The patient was followed up for 24 months with the complete healing of periapical radiolucency and the eruption of displaced permanent tooth to the proper position.

Conclusion

This case report discusses the importance of the dentist in assessing and diagnosing COF, especially in the pediatric age group.

Prominent osteolysis in the maxilla: case report of an odontogenic fibroma mimicking a cyst

BACKGROUND

Odontogenic fibroma (OF) is a rare benign odontogenic tumor of ectomesenchymal origin, mostly affecting the tooth-bearing portions of the jaws in middle-aged patients. Whilst small lesions tend to be clinically asymptomatic, varying unspecific clinical symptoms occur with an increase in size and may mimic odontogenic or other maxillofacial bone tumors, cysts, or fibro-osseous lesions of the jaws.

CASE PRESENTATION

A 31-year-old female patient presented with a hard, non-fluctuating protrusion in the vestibule of the upper right maxilla. It was visualized on cone beam computed tomography (CBCT) as space-occupying osteolysis with the displacement of the floor and facial wall of the maxillary sinus, mimicking a cyst-like lesion. The tissue was surgically removed and identified as an OF in the histopathological examination. One year after the surgery, restitution of regular sinus anatomy and physiological intraoral findings were observed.

CONCLUSIONS

This case report emphasizes that rare entities, like the maxillary OF presented, often demonstrate nonspecific clinical and radiological findings. Nevertheless, clinicians need to consider rare entities as possible differential diagnoses and plan the treatment accordingly. Histopathological examination is essential to conclude the diagnosis. OF rarely recur after proper enucleation.

Aggressive central odontogenic fibroma in the maxilla: A case report

A central odontogenic fibroma is a rare benign tumor composed of mature fibrous connective tissue with variable amounts of odontogenic epithelium. It appears at similar rates in the maxilla and mandible. In the maxilla, it usually occurs anterior to the molars. Radiographically, central odontogenic fibroma commonly presents as a multilocular or unilocular radiolucency with a distinct border. This paper reports a case of an aggressive central odontogenic fibroma involving the right posterior maxilla of a 53-year-old man. Radiographs showed an extensive soft tissue mass involving the entire right maxilla with frank bone resorption. The patient had a history of 2 operations in the region, both more than 2 decades ago. Although it was impossible to confirm the previous diagnoses, it was presumed that this case was a recurrent lesion.

Anatomical and volumetric analysis of fibro-osseous lesions of the craniofacial skeleton

PURPOSE

Our study aimed to provide volumetric data relating to fibro-osseous lesions of the craniofacial skeleton, in order to highlight risk factors due to the different entities, and to guide clinical decisions for jeopardized patients.

METHODS

Volumetric measurements of osteomas and ossifying fibromas were performed by applying the open-source software ITK-Snap to cone-beam computed tomography images. DICOM datasets were imported, identified, and delineated using semiautomatic segmentation; this was then verified using manual segmentation. The volumes of the lesions were computed automatically in cubic millimeters using the program. For statistical investigations, descriptive statistics and independent Student t-tests were performed. Additionally, Pearson's correlation was applied as a bivariate analysis. Values of p < 0.05 were considered significant.

RESULTS

45 patients (11 male and 34 female) were included in this study. The mean volumes were 10.02 ± 18.79 cm³ for osteomas and 4.80 ± 5.71 cm³ for ossifying fibromas (p = 0.016). Males (12.81 ± 20.38 cm³) presented significantly larger volumes than females (5.43 ± 10.32 cm³) (p = 0.042). With regard to shape, morphology, and affection of surrounding anatomical structures, irregular shape (p = 0.001; p = 0.037), multilocular morphology (p = 0.001; p = 0.037), nerve affection (p = 0.001; p = 0.002), tooth affection (p = 0.001; p = 0.594), cortical bone exceedance (p = 0.033; p = 0.001), and clinically visible symptoms (p = 0.004; p = 0.001) were statistically significantly associated with a larger volume of both entities.

CONCLUSION

Volumetric analysis revealed that osteomas significantly exceeded the mean size of ossifying fibromas, supporting the argument that special attention should be paid to this entity. In cases of difficult histopathological examination, lesions with irregular shape, multilocular morphology, nerve and tooth affection, cortical bone exceedance, and clinically visible symptoms should be considered for close clinico-radiological follow-up, irrespective of the entity.

What factors differentiate dentigerous cysts from other pericoronal lesions?

OBJECTIVE

To evaluate the histopathologic outcomes of pericoronal radiolucencies and identify factors predictive of diagnosis.

STUDY DESIGN

A retrospective cohort study of 258 patients with 280 radiolucent pericoronal lesions undergoing treatment at our institution between 2005 and 2019. The primary predictor variable was lesion size (≥2 cm and <2 cm). The primary outcome variable was histopathologic diagnosis (dentigerous cyst vs other pathologic entity). Descriptive, bivariate, and multiple logistic regression statistics were computed to measure the association between clinical and radiographic variables and histopathologic diagnosis.

RESULTS

The study sample was composed of 258 patients with 280 histopathologic specimens. There were 218 dentigerous cysts (77.9%) and 62 other pathologic entities (22.1%). Lesions ≥2 cm were 3.20 times more likely to be diagnosed as a nondentigerous cyst pathologic entity (P ≤ .001). After adjusting for jaw (maxilla vs mandible), pain, history of infection, cortical perforation, expansion, and multiple lesions, younger age (P ≤ .001, odds ratio [OR] = 0.950, 95% confidence interval [CI] = 0.929-0.972) and lesion size as a continuous variable (P = .007, OR = 1.06, 95% CI = 1.02-1.11) were independent predictors of other pathologic entities.

CONCLUSIONS

The majority of pericoronal radiolucent lesions were dentigerous cysts. Younger age and larger lesions were independent predictors of other pathologic entities.

Central odontogenic fibroma of simple type: An original observation

Central odontogenic fibroma is an uncommon, benign, slow-growing intraosseous mesenchymal odontogenic tumour. It presents a diagnostic dilemma to the clinician and the pathologist because its clinical and radiological features resemble other odontogenic and/or non-odontogenic tumours, and the differential diagnosis is based on histological examination. In this report, we describe our experience with a case of a 23-year-old female patient with central odontogenic fibroma of the mandible that was diagnosed as 'simple type'. Highlighting a subtype that was dropped from the last World Health Organization classification of head and neck tumours is important to accumulate more information about this lesion and to show its different features. Despite its rarity, central odontogenic fibroma should be included in the differential diagnosis of intrabony tumours of the jaws. These findings can better educate oral and maxillofacial surgeons about the unusual nature of this lesion, help establish a correct diagnosis and give the appropriate therapeutic management.

Enucleation of Recurrent Central Odontogenic Fibroma and Bone Regeneration of the Osseous Defect with Enamel Matrix Derivative and Bone Allograft: Case Report with 5-year Follow-up

INTRODUCTION

Odontogenic fibroma is a rare benign neoplasm of mature fibrous connective tissue with variable amounts of inactive-looking odontogenic epithelium. Few recurrences of central odontogenic fibroma (COF) have been reported in the literature. This manuscript reports the enucleation of a recurrent COF and bone regeneration of the osseous defect with enamel matrix derivative and bone allograft.

CASE PRESENTATION

A 28-year-old Asian female presented in 2015 with a palatal depression between #10 and 11. The patient previously had an odontogenic fibroma between #10 and 11 removed in 2008. Cone beam computed tomographic evaluation revealed a well-defined, multiloculated radiolucency centered between #10 and 11 that extended from #9-12, and from the alveolar crest to the anterior border and floor of the maxillary sinus. The lesion resulted in splaying of the roots of #10 and 11, external root resorption on #10, loss of crestal and palatal bone cortices, and thinning of labial cortex between #10 and 11. The patient was referred to an oral surgeon for biopsy, and the lesion was diagnosed as odontogenic fibroma. The lesion was enucleated. Enamel matrix derivative was applied to the affected teeth and defect, which was subsequently grafted with bone allograft. At the 5-year follow-up, bone was regenerated to the midroot of #10 and coronal third of #11, with reestablishment of crestal and palatal bone cortices.

CONCLUSION(S)

Enucleation of COF and regeneration of the osseous defect with enamel matrix derivative and bone allograft appear to be a viable treatment approach that allows for preservation of contiguous teeth.

Central Odontogenic Fibroma: characteristics and management

Introduction: Central Odontogenic Fibroma (COF) is a rare benign odontogenic tumour of the jaws. Until its recent change in classification by the WHO in 2017, this entity has gone without an agreed upon definition for many years. For this reason, COF would remain largely unknown to practitioners. Corpus: The pedagogical objectives of this article are, through a systematic review of the literature using the PRISMA methodology, to list the epidemiological, aetiological, clinical, radiological, histological, therapeutic and prognostic characteristics of COF. All the data collected made it possible to establish a COF management summary for practitioners in order to optimize it. Conclusion: Based on the 135 cases listed, it appears that surgical enucleation is the treatment of choice for COF. The recurrence rate is low and malignant transformation has never been reported. However, regular clinical and radiological follow-up of patients over several years seems to be a justified precaution.

A slow-growing anterior maxillary mass

A 43-year-old-male with no medical conditions presented to his dentist with a left maxillary swelling present for 1 year. His physical exam revealed a 2-cm × 2-cm, poorly demarcated, firm mass in the left anterior maxilla causing mobility of the associated teeth. He had a bluish discoloration of the anterior maxillary mucosa. A computed tomographic scan demonstrated a homogeneous and uniformly radiolucent, well-defined mass in the left anterior maxilla primarily involving the alveolus and the roots of teeth 7-12. The mass caused expansion and tooth displacement. An incisional biopsy was done and MUC 4 staining was diffusely positive so the diagnosis of low-grade fibromyxoid sarcoma (LGFMS) was made. He underwent wide local excision and reconstruction with a fibula free flap and a three-dimensionally printed, implant-retained prosthesis. The final pathology confirmed the diagnosis of LGFMS, stage pT4aN0M0, with negative margins. The patient had no evidence of recurrence at 1-year follow-up.

Central Odontogenic Fibroma with the Presence of Large Fibroblasts of Varying Morphology

A patient with an odontogenic fibroma (OF) with the presence of fibroblasts of varying morphology is presented, and the main microscopic differential diagnosis is discussed. Case report: a 51-year-old man complained of a swelling in the anterior region of the mandible. The panoramic radiograph showed a radiolucent, well-defined multilocular image, with displacement of the roots of the left mandibular incisors and canine. A cone beam computed tomography examination revealed a hypodense image, with delicate bone spicules inside, divergence of the tooth roots and destruction of the buccal cortical bone. Under the differential diagnosis of a desmoplastic ameloblastoma or a squamous odontogenic tumor, an incisional biopsy was made. Microscopically, deeply collagenized tissue with scarce odontogenic epithelium islands, large fibroblasts of varying morphology and calcified material was observed. A diagnosis of OF was made. Surgical removal was carried out, and the specimen was examined. Identical aspects were found, and the immunohistochemical reaction for pan-cytokeratin was carried out to identify the odontogenic epithelial cells. The definitive diagnosis of OF was confirmed, and we emphasize the importance of the correlation of all characteristics for a definitive diagnosis.

Amyloid Variant of Central Odontogenic Fibroma in the Mandible: A Case Report and Literature Review

Patient: Male, 35-year-old

Final Diagnosis: Central odontogenic fibroma

Symptoms: Asymptomatic

Medication:—

Clinical Procedure: Enucleation • surgery removal

Specialty: Dentistry

Oral radiation-induced sarcomas: Systematic review

BACKGROUND

The aim of this study was to integrate the available data published on radiation-induced sarcoma of the oral cavity into an analysis of its clinical features, treatment modalities and prognostic factors.

METHODS

An electronic search was undertaken in September 2019. The eligibility criteria included publications that had enough clinical and histological information to confirm the diagnosis.

RESULTS

Forty-two publications with 122 radiation-induced sarcoma of the oral cavities (RISOCs) were included. The mean latency period was 114 months and mean radiation total dose was 62.5 Gy. The tumors were more prevalent in males between 50 and 60 years old and the mandible was the most affected site. Osteosarcoma was the most prevalent histological type and patients were mostly treated with radical surgery.

CONCLUSIONS

RISOC showed a poor survival rate of 15.1% in 5-year follow-up. Gender and histological type were independently associated with survival.