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.

Central odontogenic fibroma, hyperplastic dental follicle, or dentigerous cyst? A diagnostic dilemma: A case report

Central odontogenic fibroma (COF) is an extremely rare benign odontogenic tumor, which is associated with an unerupted tooth in one-third of the cases. Hyperplastic dental follicle (HDF) is an odontogenic hamartomatous lesion associated with delayed or tooth eruption failure in young patients. Dentigerous cyst (DC) is an epithelial-lined developmental cyst surrounding the crown of an unerupted or impacted tooth. Here, we present a case of 13-year-old boy with pericoronal radiolucency around impacted right maxillary canine tooth, which detected during routine dental examination on panoramic radiograph. The size of radiolucency was varied between 5 and 10 mm and was asymmetrical. Lesion was underwent biopsy with suspicion to a dentigerous cyst. On microscopic examination, the lesion was composed of a cellular fibrous connective tissue with odontogenic epithelium in the form of strands or nests throughout the lesion and calcifications in the form of basophilic cementum-like material and dentinoid. Due to its nonspecific histological features, we encountered a diagnostic dilemma. In this case report, we discuss the clinical and radiologic features of COF, DC, and HDF. We preferred COF for this lesion. By combining surgical and orthodontic treatments, the impacted tooth was directed to its correct position in the maxilla. This case report highlights the importance of clinicopathological correlation in the diagnosis of pericoronal radiolucencies.