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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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Papargyriou GE, Oostra A, Georgalas C. Benign bony lesions of paranasal sinuses and skull base: from osteoma to fibrous dysplasia. Curr Opin Otolaryngol Head Neck Surg 2024; 32:81-88. [PMID: 38116853 DOI: 10.1097/moo.0000000000000955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
PURPOSE OF REVIEW Benign bony lesions of the craniofacial complex are relatively common. However, their location close to critical neurovascular structures may render their treatment, if required, highly challenging.This article reviews the current literature on their pathophysiology, diagnosis, natural course and treatment, with a focus on most recent findings. RECENT FINDINGS A new classification has been suggested concerning endoscopic resectability. The ratio of lateral frontal to interorbital distance can accurately and reliably predict the endoscopic reach to lateral frontal sinus, while orbital transposition can assist us in reaching lateral frontal sinus when anatomy is unfavorable. New and combined endoscopic transnasal and transorbital approaches are now in the surgical armamentarium. Prophylactic optic nerve decompression in fibrous dysplasia is absolutely contraindicated as it leads to worse visual outcomes. Radiotherapy of such lesions is of no benefit and may lead to a higher risk of malignant transformation. The presence of Guanine Nucleotide binding protein Alpha Stimulating (GNAS) mutation in chromosome 20 is universally present in fibrous dysplasia and can differentiate them from ossifying fibromas. SUMMARY Diagnosis and therapeutic management of benign craniofacial bone lesions remains challenging. If surgical treatment is contemplated, the morbidity of the intervention should always be weighed against the potential benefits. Evolution of extended endoscopic endonasal and transorbital surgery means that more lesions can be reached purely endoscopically with better oncological and cosmetic results.
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Affiliation(s)
| | - Amanda Oostra
- Neurosurgeon Metropolitan General Hospital. Athens, Greece
| | - Christos Georgalas
- Professor of Head and Neck Surgery, Medical School, University of Nicosia, Nicosia, Cyprus
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Tompodung LM, Sensusiati AD. Ossifying fibroma of the maxilla: A case report with literature review. Radiol Case Rep 2024; 19:915-921. [PMID: 38188957 PMCID: PMC10767277 DOI: 10.1016/j.radcr.2023.10.059] [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: 08/28/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 01/09/2024] Open
Abstract
Ossifying fibroma is a benign fibro-osseous lesion arising from the periodontal ligament cells. The lesion may progressively enlarge with the mass affecting the mandible or maxilla, resulting in facial deformities and tooth displacement despite its benign nature. Here, we presented a case of an 18-year-old female with ossifying fibroma in the maxilla extending to the maxillary sinus, infraorbital area, and skull base, resulting in considerable facial asymmetry. Since the primary treatment of ossifying fibroma is surgical resection, it is essential to determine the areas where the lesion has expanded, where a 3-dimensional computed tomography scan could play a critical role in providing such information. A complete surgical excision and histopathologic examination in treating this patient are crucial, made possible by a meticulous preoperative radio imaging technique.
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Affiliation(s)
- Linda M. Tompodung
- Department of Radiology, Faculty of Medicine, Airlangga University/Universitas Airlangga Hospital, Surabaya, East Java, Indonesia
| | - Anggraini Dwi Sensusiati
- Department of Radiology, Faculty of Medicine, Airlangga University/Universitas Airlangga Hospital, Surabaya, East Java, Indonesia
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Tidke P, Agarwal MC, Kini VV, Singh S, Patel HJ, Kumar S, Vasant J. Peripheral Ossifying Fibroma of Maxillary Gingiva with Calcification: A Case Report. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S963-S965. [PMID: 38595507 PMCID: PMC11001151 DOI: 10.4103/jpbs.jpbs_690_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 08/20/2023] [Accepted: 08/23/2023] [Indexed: 04/11/2024] Open
Abstract
Peripheral ossifying fibroma is presented as an exophytic growth with a smooth surface. It is located mostly on the gingiva, and it is an unusual growth of gingiva that occurs after irritational trauma. It is seen in the later decade of life, with the calcifications in the lesion in advanced stages seen on radiographic images. In the present case, a 50-year-old male reported with a huge gingival growth in the left maxillary posterior gingival region; when radiograph was taken, it showed calcifications. The patient was treated by surgical excision of the growth.
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Affiliation(s)
- Priyanka Tidke
- Department of Oral Medicine and Radiology, MGM Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Manvi C. Agarwal
- Department of Periodontology and Implantology, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
| | - Vineet V. Kini
- Department of Periodontology, MGM Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Subhasini Singh
- Department of Oral Pathology and Microbiology, Awadh Dental College and Hospital, Jamshedpur, Jharkhand, India
| | - Hetul J. Patel
- Department of Oral Medicine and Radiology, Faculty of Dental Sciences, Dharmsinh Desai University, Nadiad, Gujarat, India
| | - Santosh Kumar
- Department of Periodontology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, Gujarat, India
| | - Jill Vasant
- BDS, MHA, Muhlenberg Dental Associates, Reading, PA, USA
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Thi HN, Manh CP, Tuan LT, Le Thi LA, Thanh NN, Vilaiyuk S. Tumor-induced Osteomalacia in a Boy with Maxillary Ossifying Fibroma. J Clin Res Pediatr Endocrinol 2023; 15:421-425. [PMID: 35135186 PMCID: PMC10683546 DOI: 10.4274/jcrpe.galenos.2022.2021-8-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 01/12/2022] [Indexed: 12/01/2022] Open
Abstract
Tumor-induced osteomalacia (TIO) is a rare, paraneoplastic disorder of hypophosphatemia associated with elevated tumor-produced fibroblast growth factor 23 (FGF23). Maxillofacial tumors are rarely involved in TIO, especially maxillary TIO in children. We present a 14-year-old boy with osteomalacia and high serum levels of FGF23, a hormone associated with decreased phosphate resorption, due to a maxillary tumor. The patient was treated with oral phosphorus and calcitriol, and surgical removal of the tumor was performed. After 21 months follow-up, he was pain free and had returned to full activity. We review the reported pediatric cases of TIO in the maxillofacial and oral region and discuss the management of these patients considering the published evidence.
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Affiliation(s)
- Ha Nguyen Thi
- Hanoi Medical University, Bach Mai Hospital, Clinic of Pediatrics, Hanoi, Vietnam
| | - Cuong Pham Manh
- Bach Mai Hospital, Diagnostic Imaging Central, Hanoi, Vietnam
| | - Linh To Tuan
- Viet Duc Hospital, Maxillofacial, Department of Plastic and Aesthetic Surgery, Hanoi, Vietnam
| | - Lan Anh Le Thi
- Hanoi Medical University, Bach Mai Hospital, Clinic of Pediatrics, Hanoi, Vietnam
| | | | - Soamarat Vilaiyuk
- Mahidol University Faculty of Medicine; Ramathibodi Hospital, Department of Pediatrics, Division of Rheumatology, Bangkok, Thailand
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Trifonova KZ, Slaveykov KS, Dzhelebov DN, Valkanov SP. A unique case of a recurrent extraosseous ossifying fibroma of the orbit: A diagnostic dilemma. Oman J Ophthalmol 2023; 16:561-564. [PMID: 38059106 PMCID: PMC10697272 DOI: 10.4103/ojo.ojo_36_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 08/28/2023] [Accepted: 09/08/2023] [Indexed: 12/08/2023] Open
Abstract
The aim is to present a unique clinical case of a 62-year-old male with an ossifying fibroma (OF) in the left orbit. He presented with a slow-growing mass with bone consistency which easily shifted with palpation. After removal, it was given the histopathological diagnosis of osteoma. However, the lesion grew back rapidly and it became even larger 4 months later. After a computed tomography scan with a contrast medium, another surgery was performed. The histopathological diagnosis of the recurrent lesion was an epidermal cyst with secondary degenerative changes. As both diagnoses did not fit the clinical picture, we sent the material from both surgeries for a secondary assessment. The final histopathological diagnosis was OF. OF should be included in the differential diagnosis of benign lesions in the orbit with aggressive behavior.
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Affiliation(s)
| | - Kiril S. Slaveykov
- Department of General Medicine, Medical Faculty, Trakia University, Stara Zagora, Bulgaria
| | - Dimitar N. Dzhelebov
- Department of Ophthalmology, Medical Faculty, Trakia University, Stara Zagora, Bulgaria
| | - Stefan P. Valkanov
- Department of Neurosurgery, Medical Faculty, Trakia University, Stara Zagora, Bulgaria
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Dudeck D, Warmusz O, Reichman-Warmusz E, Kurtzman GM. Treatment of an ossifying fibroma of the mandible with endodontic microsurgery and grafting with a biphasic calcium sulfate material: a case report. Ann Med Surg (Lond) 2023; 85:4167-4173. [PMID: 37554914 PMCID: PMC10406028 DOI: 10.1097/ms9.0000000000001068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 07/01/2023] [Indexed: 08/10/2023] Open
Abstract
UNLABELLED A significant percentage of lesions of endodontic origin require surgical management due to the possible diagnosis of odontogenic cysts and tumors in the maxilla and mandible. Ossifying fibroma is a benign fibro-osseous lesion that typically presents as a painless, slow-growing, and expansile lesion that appears as a well-demarcated lesion with a variable degree of internal calcification on radiography. Treatment results in a large osseous defect, utilization of a graft to fill the void accelerates healing and prevents complications that may result from failure to fill by the host response. CASE PRESENTATION Following endodontic surgery placement of osseous graft material via Guided Tissue Regeneration to fill the defect aids to accelerate fill of the defect on a healthy 26-year-old female patient. A case discussing the one-step treatment of an ossifying fibroma of the anterior part of the mandible following endodontic microsurgery with associated retrograde fill of the apex, then site grating with biphasic calcium sulfate (Bond Apatite®) used in regeneration of the osseous defect related to the lesion and resulting surgery. CLINICAL DISCUSSION Histologically, the ossifying fibroma is dominated by connective tissue containing cell rich areas with a few fragments of fibrosis. Moreover, in the connective tissue numerous small fragments of spongy and compact bone with areas of partial necrosis present and a significant number of inflammatory cells are observed. Surgical removal of the cyst with thorough curettage of the osseous walls and grafting of the defect provides predictable healing and the desired clinical results sought. Utilization of the biphasic calcium sulfate graft material allows the elimination of the need to overlay the area with a membrane before the flap due to its hard set and the prevention of soft tissue ingrowth into the graft material during the healing phase. Additionally, the hard set of the material allows tenting of the area to maintain the desired volume and ridge contour. Conversion of the graft material depending on the volume placed to host bone occurs over a 3-6 month period. CONCLUSION The case report presented, as well as the authors experience mimics the literature on biphasic calcium sulfate in its use as an osseous graft material and is an effective method for the repair of osseous defects that result from the removal of tumors and cysts of the maxilla and mandible. Treatment of an ossifying fibroma is an ideal application of the use of this biphasic calcium sulfate material allowing tenting of the surgical site over the defect created after cyst removal without the need for resorbable collagen membranes. This simplifies its use and decreases material costs that may hamper patient acceptance of treatment without a decrease in expected clinical results.
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Affiliation(s)
- Damian Dudeck
- “Artmedica” Ambulatory Oral Surgery and Implantology, Thorn
| | - Oliwia Warmusz
- Department of Histology and Cell Pathology in Zabrze, School of Medicine with the Division of Dentistry, Medical University of Silesia in Katowice
| | - Edyta Reichman-Warmusz
- Department of Histology and Cell Pathology in Zabrze, School of Medicine with the Division of Dentistry, Medical University of Silesia in Katowice
- University of Technology, Department of Medicine, Katowice, Poland
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Muacevic A, Adler JR, Makunike-Mutasa R. Ossifying Fibroma in the Maxilla and Mandible: A Case Report With a Brief Literature Review. Cureus 2023; 15:e34257. [PMID: 36843790 PMCID: PMC9957536 DOI: 10.7759/cureus.34257] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2023] [Indexed: 01/28/2023] Open
Abstract
Fibro-osseous lesions in the jaw bones include fibrous dysplasia, ossifying fibroma (OF), cemento-ossifying fibroma, florid osseous dysplasia, and focal osseous dysplasia. OF is the most common fibro-osseous tumor that presents as a slow-growing well-encapsulated benign neoplasm composed of varying amounts of bone or cement-like tissue in a fibrous stroma well-demarcated from the adjacent normal bone. OF is most common in the jaw bones, with a predilection for the mandible. OF usually occur as solitary lesions and rarely as multiple lesions in a patient. We present clinical and radiologic features, histopathology, and surgical management of a rare case with large synchronous OFs in the mandible and maxilla and a brief review of the literature.
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Nardi C, Maraghelli D, Pietragalla M, Scola E, Locatello LG, Maggiore G, Gallo O, Bartolucci M. A practical overview of CT and MRI features of developmental, inflammatory, and neoplastic lesions of the sphenoid body and clivus. Neuroradiology 2022; 64:1483-1509. [PMID: 35657394 PMCID: PMC9271108 DOI: 10.1007/s00234-022-02986-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/18/2022] [Indexed: 11/28/2022]
Abstract
The sphenoid bone is an unpaired bone that contributes to the formation of the skull base. Despite the enormous progress in transnasal endoscopic visualisation, imaging techniques remain the cornerstones to characterise any pathological condition arising in this area. In the present review, we offer a bird’s-eye view of the developmental, inflammatory, and neoplastic alterations affecting the sphenoid body and clivus, with the aim to propose a practical diagnostic aid for radiologists based on clinico-epidemiological, computed tomography, and magnetic resonance imaging features.
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Affiliation(s)
- Cosimo Nardi
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit N. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy.
| | - Davide Maraghelli
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit N. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Michele Pietragalla
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit N. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Elisa Scola
- Department of Neuroradiology, Careggi University Hospital, Largo Piero Palagi 1, 50134, Florence, Italy
| | - Luca Giovanni Locatello
- Department of Otorhinolaryngology, Careggi University Hospital, Via Taddeo Alderotti, 50139, Florence, Italy
| | - Giandomenico Maggiore
- Department of Otorhinolaryngology, Careggi University Hospital, Via Taddeo Alderotti, 50139, Florence, Italy
| | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Via Taddeo Alderotti, 50139, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Maurizio Bartolucci
- Department of Radiology, Azienda USL Toscana Centro, Santo Stefano Hospital, Via Suor Niccolina Infermiera, 20/22, 59100, Prato, Italy
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Bhat SV, Kumar SP, Periasamy S, Krishna VK. An Uncommon Presentation of Ossifying Fibroma in the Maxilla. Cureus 2022; 14:e23638. [PMID: 35510009 PMCID: PMC9057319 DOI: 10.7759/cureus.23638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 11/05/2022] Open
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