Juvenile ossifying fibroma of the jaws and paranasal sinuses: a systematic review of the cases reported in the literature

The aim was to compare clinical and radiological features of the two juvenile ossifying fibroma (JOF) variants, trabecular (JTOF) and juvenile psammomatoid ossifying fibroma (JPOF). An electronic search was undertaken in March 2019. Eligibility criteria included publications having sufficient clinical, radiological, and histological information to confirm the diagnosis. A total of 185 publications and 491 cases were included. Most JOFs, including both variants, showed bone expansion, were painless, presented no cortical perforation and no secondary aneurysmal bone cyst, did not cause tooth root resorption, and had a mixed unilocular radiodensity appearance and well-defined limits on radiological examination. Patients with JPOF were on average older than those with JTOF. Enucleation and curettage was associated with a considerably high recurrence rate, regardless of the anatomical location or variant type of the lesion. Enucleation followed by either curettage or peripheral osteotomy showed lower recurrence rates than enucleation only. When resection was performed, only one case of JTOF presented recurrence. In conclusion, JOF lesions presented high rates of recurrence after treatment by curettage and enucleation only. Although surgical resection of JOFs resulted in the virtual absence of recurrence, enucleation followed by peripheral osteotomy/curettage should be the treatment of choice for both JOF variants to avoid the disfigurement usually associated with surgical resection.

Diagnosis and management of benign fibro-osseous lesions of the jaws: a current review for the dental clinician

Benign fibro-osseous lesions of the maxillofacial skeleton constitute a heterogeneous group of disorders that includes developmental, reactive (dysplastic) and neoplastic lesions. Although their classification has been reviewed multiple times in the past, the most common benign fibro-osseous lesions are fibrous dysplasia, osseous dysplasia and ossifying fibroma. For the dental clinician, the challenges involve diagnosis and treatment (or lack thereof). A careful correlation of all clinical, radiologic and microscopic features is essential to establish a proper diagnosis and a clear treatment plan. This article aimed to review the clinical, radiologic and histopathologic characteristics of benign fibro-osseous lesions of the jaws, with emphasis on their differential diagnoses. With a deeper understanding of benign fibro-osseous lesions, clinicians will be better prepared to manage these lesions in their practice.

Psammomatoid and trabecular variants of juvenile ossifying fibroma-two case reports

Juvenile ossifying fibroma (JOF) is an uncommon fibro-osseous lesion occurring in the facial bones. It is highly aggressive and has a strong tendency to recur. It has been recognized as a separate histopathological entity among the fibro-osseous group of lesions. Surgical resection is the preferred line of treatment. Here we report two cases of JOF who reported to the oral medicine and radiology department; the two cases had different clinical features, history, radiological appearance, and aggressiveness. Under the recent classification system, both cases were recognized as histopathological variants of JOF: one psammomatoid and the other trabecular.

Trabecular and psammomatoid juvenile ossifying fibroma of the skull base mimicking psammomatoid meningioma

Ossifying fibroma (OF) is a fibro-osseous tumor that usually occurs in young people and arises in the craniofacial bones. We report a case of a 15-year-old boy who developed progressive proptosis and hypertelorism and was found to have a mid-face and skull base tumor, initially diagnosed as psammomatoid meningioma. The tumor recurred and the resected specimen revealed a unique OF having trabecular and psammomatoid features. The clinical, radiographic, histopathologic findings and differential diagnoses of the case are presented.

Psammomatoid juvenile ossifying fibroma of the jaws

Juvenile ossifying fibroma is an uncommon, benign, bone-forming neoplasm with aggressive local growth that is distinguished from other fibro-osseous lesions primarily by its age of onset, clinical presentation and aggressive behavior. Although a benign entity, juvenile ossifying fibroma is known to be locally aggressive and has a high tendency to recur. Two distinctive microscopic patterns have been described: A trabecular variant and a psammomatoid variant. This latter variant is predominantly a craniofacial lesion and occurs rarely in the jaws. We present herein two cases of psammomatoid juvenile ossifying fibroma involving the jaws. The first case was a mandibular lesion in a 31-year-old female whereas the second case presented with maxillary involvement in a 46-year-old female. In addition, the pathology of the lesion was analyzed with confocal laser scanning microscopy.

"Hybrid" lesion of the maxilla

Juvenile ossifying fibroma is an uncommon benign but aggressive fibroosseous lesion that affects the craniofacial skeleton. Their distinct clinical and histopathological features warrant the lesion to be considered as a separate entity from other fibro-osseous group of lesions such as fibrous dysplasia and cemento ossifying fibroma. Concomitant development of secondary aneurysmal bone cyst may rarely occur, which makes the lesion more aggressive and difficult to treat. We report a case of a 6 year old girl who was diagnosed with aneurysmal bone cyst during her earlier presentation at a private hospital and was treated for the same. The lesion recurred within 6 months. The second incisional biopsy specimen revealed features of trabecular variant of juvenile ossifying fibroma along with areas of aneurysmal bone cyst.

Fibro-Osseous Lesions of the Skull Base in the Pediatric Population

Fibro-osseous lesions of the skull base include a variety of lesions with different biologic behavior. The most common lesions include fibrous dysplasia, osteoma, aneurysmal bone cyst, and juvenile ossifying fibroma. The diagnosis can usually be established with radiographic imaging. In the absence of symptoms, slow-growing lesions can often be observed. When surgery is indicated for relief of symptoms, endoscopic endonasal techniques are well suited for all age groups.

Psammomatoid variant of juvenile ossifying fibroma involving mandible: A rare case report

The term juvenile ossifying fibroma (JOF) is used in literature in naming two microscopically distinct fibro-osseous lesions of the craniofacial skeleton. One is characterized by small uniform spherical ossicles resembling psammoma bodies (psammomatoid JOF [PsJOF]). The other is distinguished by trabeculae of fibrillary osteoid and woven bone (trabecular JOF). Psammomatoid ossifying fibromas represent a unique subset of fibro-osseous lesions of the craniofacial region. PsJOF has been distinguished because of its location, clinical behavior, and age of occurrence. They have distinctive histomorphologic features and a tendency toward locally aggressive behavior, including invasion and destruction of adjacent anatomic structures. It is generally seen in the younger age group, and the most common site is paranasal sinuses, orbits, and frontoethmoidal complex. We report a case of JPOF involving mandible which is rarely been described in literature. An insight into the radiographic progression of this rare entity along with the clinical feature and surgical management is discussed.

Trabeculae type of juvenile aggressive ossifying fibroma of the maxilla: Report of two cases

Juvenile ossifying fibroma (JOF) is a rare controversial fibroosseous lesion affecting the craniofacial skeleton and occurring commonly in children and young adults. It is highly aggressive and has a high tendency to recur. It is distinguished from the adult variant of ossifying fibroma on the basis of age, site, clinical behavior and microscopic appearance. Because of its high recurrence rate, which is 30–58%, complete excision is essential. Early diagnosis will circumvent the necessity of radical treatment. We report a rare case of trabecular JOF of maxilla where a computed tomography scan was taken to further support the characteristic feature of the lesion.

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.

Trabecular variant of juvenile aggressive ossifying fibroma of anterior mandible

Juvenile ossifying fibroma (JOF) is an expansile intra-osseous lesion of the jaw that emulate odontogenic lesions frequently seen in patients under 15 years of age. They are histologically characterized by the presence of fibrous stromal cells along with mineralized tissues. Clinically, these are characterized by early age of onset, histological patterns, high rate of recurrence and the aggressive local behavior. The differential diagnosis of JOF with other fibro-osseous lesions of the jaw should be made along with an essential microscopic examination and be largely based on the character of the calcified products of the tumor. The purpose of this article is to present a rare clinical case of the trabecular type of JOF and to describe its clinical, radiological and histological characteristics. The clinician should be aware of this type of lesion in order to be able to distinguish this it from other fibrous lesions if encountered in routine practice and for appropriate treatment to be carried out.

Juvenile ossifying fibroma: Psammamatoid variant

Juvenile ossifying fibroma is a rare fibro-osseous lesion containing variable amount of calcified masses, which resembles bone or cementum within a fibrocellular connective tissue stroma. It has variable clinical behavior, highly aggressive in nature including invasion and destruction of adjacent anatomic structures with a strong tendency to recur. We reported a 28-year-old female patient with a growth in the upper left vestibule region extending from canine to molar region with clinical, histopathological, and radiological features are presented. Surgical management was done, and regular follow-up was advised.

Conglomeration of Trabecular and Psammomatoid variants of juvenile ossifying fibroma - a rare case report

Juvenile ossifying fibroma is an uncommon benign fibro-osseous lesion occurring in the craniofacial skeleton with a high recurrence rate. It has two distinct histopathologic variants: one trabecular and the other which are exclusive to each other. This case reveals a rare and unique combination of both the patterns in the same lesion.

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.

Psammomatoid juvenile ossifying fibroma of mandible in a 6-year-old child

Juvenile ossifying fibroma (JOF) is a rare fibro-osseous lesion of the jaw occurs at the early age of onset frequently under 15 years with a propensity to recur. It appears as a unilobulated/multilobulated lesion at an early stage followed by radiopaque appearance surrounded by radiolucent rimming at advanced stages. The psammomatous type of JOF (PsJOF) principally involves the bones of the orbit and paranasal sinuses. However in some cases, maxilla or rarely the mandible may be pretentious. Here, we report a challenging case of PsJOF in a 6-year-old child with a complaint of swelling imitating a cystic lesion in left back region of the lower jaw for 2 months. The authors propose that a careful examination and correlations of clinical, radiological, and histopathological features are essential to arrive at correct diagnosis and play a vital role in management of such patients.

Fibro-osseous Lesions of the Jaw: A Report of Two Cases

Fibro-osseous lesions of the maxillofacial bones comprise a diverse group of pathologic conditions that include developmental lesions, reactive or dysplastic diseases, and neoplasms. The concept of fibro-osseous lesions has evolved over the last several decades and now includes two major entities: fibrous dysplasia and ossifying fibroma. The less common lesions include florid osseous dysplasia, periapical dysplasia, focal sclerosing osteomyelitis, proliferative periostitis of Garre, and osteitis deformans. We report two cases, the first, a craniofacial polyostotic fibrous dysplasia, and the second, a juvenile ossifying fibroma of maxilla.

Juvenile ossifying fibroma diagnosed on fine needle aspiration cytology: a diagnostic challenge

Preoperative diagnosis of jaw lesions is not always possible on the basis of clinico-radiological findings alone and needs to be confirmed before attempting any surgical intervention. Fibro-osseous lesions of the jaw comprise a spectrum of diseases which include cement-osseous dysplasia, fibrous dysplasia, and ossifying fibroma. The cytomorphological distinction between these individual entities is difficult. We present a case of maxillary fibro-osseous lesion in an adolescent girl diagnosed and categorized as juvenile ossifying fibroma preoperatively on cytology and confirmed on histopathology. Although aspirates are usually paucicellular in fibro-osseous lesions, certain cytological features if present in cellular cytosmears can offer further categorization and a definitive diagnosis may be possible in light of clinico-radiological correlation.

Psammomatoid juvenile aggressive ossifying fibroma of mandible

A female patient, aged 14 years, came to dental OPD, with a large swelling of the right mandibular region, progressing since 4-5 years. The swelling initially started with a small size and later it became a large swelling extending from left lower premolar region to right mandibular angle region. Inferiorly, the swelling was extending below the inferior border in the symphysis region. No paresthesia was experienced by the patient. There was quite a marked facial disfigurement of the right mandibular body and symphysis region extending to left side. No other bones were involved and no other abnormalities were found on general physical examination. The medical history was noncontributory. There was no family history of skeletal disease. The case was surgically treated by segmental resection of the mandible and reconstruction was done using stainless steel reconstruction plate. With the follow-up period of 1 year, there was no recurrence.

Juvenile aggressive ossifying fibroma of the maxilla: a case report

Juvenile ossifying fibroma is an uncommon fibro osseous neoplasm at a younger age. It is a well-defined clinical and histological lesion. This lesion is locally invasive and spreads quickly. Early detection and complete surgical excision of this lesion is essential since it has high recurrence rate.

Immunohistochemical analysis of osteoclastic and osteoblastic activity in ossifying fibroma and juvenile ossifying fibroma: A comparative study

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.

[Clinical analysis and surgical discussion of juvenile ossifying fibroma in nasal root]

Objective:To analyze the clinical features of juvenile ossifying fibroma in nasal root and to compare different surgical methods. Methods:Seven cases of juvenile ossifying fibroma occurring in the nasal root were treated via surgery, 5 cases were resected under nasal endoscopy guided by Image Guidance System-based electromagnetic navigation, and 2 cases were resected by lateral nasal butterfly incision. Postoperative follow-up included endoscopy and CT scan of the sinuses. Results:The pathological results of 7 patients were consistent with juvenile ossifying fibroma. Follow-up period ranged from 6 to 45 months, and there were no recurrence or surgical complications. Conclusion:Surgery is the only effective treatment. Endoscopic sinus surgery with image navigation and lateral nasal butterfly incision resection has been deemed available. The external nasal butterfly incision has less bleeding and shorter operation time, but with mild nasal face swelling after surgery, and nasal endoscopy is a surgical method with less damage.

Trabecular Juvenile Ossifying Fibroma Involving the Maxilla: A Rare Case

Trabecular juvenile ossifying fibroma (TrJOF) is a rare, benign, fibro-osseous lesion that predominantly affects children and adolescents. The lesion is locally aggressive, has a high recurrence rate, and is often misdiagnosed due to its clinical and radiographic similarities to other lesions. A seven-year-old female presented with a history of swelling and pain on the right side of her face for the last month. Extraoral examination revealed facial asymmetry and exophthalmos of the right eye. Intraoral examination showed obliteration of the buccal vestibule, though the mucosal lining and teeth were intact. Cone-beam computed tomography (CBCT) demonstrated a large, expansile, osteolytic lesion occupying the right maxillary sinus and adjacent structures, suggesting a fibro-osseous lesion. The enucleated specimen showed a highly cellular connective tissue stroma with irregular bony trabeculae rimmed by osteoblasts, numerous multinucleated giant cells, and basophilic cementum-like calcifications. The histopathological evaluation confirmed the diagnosis of trabecular juvenile ossifying fibroma. This case highlights the diagnostic challenges of TrJOF due to its overlapping features with other fibro-osseous and giant cell lesions. Early diagnosis and surgical intervention are critical in preventing local destruction and recurrence.

Cranial Juvenile Psammomatoid Ossifying Fibroma: A Rare Entity

Juvenile ossifying fibroma (JOF) is an unusual fibro-osseous lesion primarily occurring in children and young adolescents. Anatomically, this lesion could predominantly arise from the bilateral orbits, paranasal sinuses, maxilla, or mandible. Although it is a benign lesion of osseous origin, it is an aggressive variant of ossifying fibroma of the jaw. Due to the aggressive nature of this lesion and its high tendency for recurrence, early radiological detection and prompt surgical treatment are required. The histologic diagnosis of this entity is purely based on hematoxylin and eosin (H&E), but immunohistochemistry and molecular diagnostic studies can also be performed in challenging cases. A thorough histopathological examination of this lesion is recommended because it can easily be mistaken for another benign fibrosis lesion arising at the same anatomical location. Here, we report the case of a juvenile psammomatoid ossifying fibroma (JPOF) occurring in a 12-year-old boy. The tumor is arising at an extracranial location behind the left anterior cranial fossa.

Psammomatoid juvenile ossifying fibroma of mandible in a 6-year-old child

Juvenile ossifying fibroma (JOF) is a rare fibro-osseous lesion of the jaw occurs at the early age of onset frequently under 15 years with a propensity to recur. It appears as a unilobulated/multilobulated lesion at an early stage followed by radiopaque appearance surrounded by radiolucent rimming at advanced stages. The psammomatous type of JOF (PsJOF) principally involves the bones of the orbit and paranasal sinuses. However in some cases, maxilla or rarely the mandible may be pretentious. Here, we report a challenging case of PsJOF in a 6-year-old child with a complaint of swelling imitating a cystic lesion in left back region of the lower jaw for 2 months. The authors propose that a careful examination and correlations of clinical, radiological, and histopathological features are essential to arrive at correct diagnosis and play a vital role in management of such patients.

Trabecular Variant Juvenile Ossifying Fibroma of the Maxilla

Juvenile ossifying fibroma (JOF) is a benign, bone-forming neoplasm occurring primarily in children and adolescents. JOF is an aggressive variant of ossifying fibroma of the jaw with a variable clinical behavior and a high tendency for recurrence. Early detection and prompt treatment are required to treat JOF successfully. This case report describes JOF in a 13-year-old girl presenting with a year-long, gradually progressive swelling on the right side of her face with typical clinical, radiological, and histopathological features.