Juvenile Ossifying Fibroma of the Maxilla: A Case Report

Abstract

Clinical examination revealed a swelling with normal appearing skin on the right side of the face localized to the maxilla. No cervical lymphadenopathy was noted and the mouth opening was normal. Oral examination revealed gross expansion of the right maxillary alveolar process and bulging of the hard palate. There was no tenderness on palpation. CT scan demonstrated a well-defined, mixeddensity mass filling the right maxillary sinus. The mass causing destruction of adjacent upper jaw, inferior orbital plate, medial and lateral wall of right maxilla. The clinical and radiological features were in favour of a fibroosseous lesion. So a diagnosis of right maxillary ossifying fibroma was made. Under general anaesthesia, a maxillary right buccal vestibular incision was made and surgical excision of the tumour was performed. The tumour (about 5x5 cm) was removed completely; a clear demarcation was evident between the tumour and healthy bone. Bony defects were filled with absorbable gelatin sponge. Histopathologically, excised specimen was identical with fibro-osseous lesion. IntroductionJuvenile ossifying fibroma (JOF) is a rare fibro osseous neoplasm that arises within the craniofacial bones in individuals under 15 years of age 1 . It is usually asymptomatic, achieving a large size and exhibiting aggressive behavior 2 . It affects both males and females equally. It has the potential for excessive growth, bone destruction, and recurrence. It is more aggressive than ossifying fibroma. Recurrence rate ranges from 30% to 58% 3,4 . Radiological changes are of a discrete mass with a distinct boundary and thinning of the cortical bone, resulting in an egg-shell appearance 3 . The lesion is non-encapsulated but well demarcated from surrounding bone. Microscopically, juvenile ossifying fibroma is highly cellular and contains trabeculae or spheroids of new bones. Juvenile ossifying fibroma has also been termed Juvenile aggressive ossifying fibroma, Juvenile active ossifying fibroma 4 .

An Alternative Surgical Approach to Cemento-Ossifying Fibroma of the Maxilla

“…6 Characteristics of aggressive lesions include rapid growth, cortical bone thinning or perforation, orbital involvement and tooth displacement. 17 These tumors can exhibit early recurrence, therefore a more radical approach is warranted. 17 A B DISCUSSION Ossifying fibroma is a rare, benign neoplasm of the maxilla and mandible, occurring mostly in patients in the 2nd to 4th decade of life, with a higher incidence in females compared to males.…”