Large mandibular central odontogenic fibroma documented over 20 years: A case report

Abstract

IntroductionCentral odontogenic fibroma (COF) is a rare, benign, slow-growing intraosseous odontogenic tumor, and accounts for 0.1% of all odontogenic tumors. It is often confused with other entities, such as keratocysts, ameloblastomas, and odontogenic myxomas. Complete enucleation followed by curettage is the treatment of choice for COF to ensure the lowest possible chance of recurrence.Case presentationWe report the case of a young Caucasian woman with COF that went undiagnosed for several years despite repeated radiologic examinations. Finally, a massive tumor was surgically removed and the wound was curetted. The specimen was histologically confirmed to be a COF. The patient remains under regular follow-up, and thus far there have been no clinical or radiologic signs of recurrence.DiscussionThis rare case of COF, which was documented over a period of 20 years, has helped us to describe the features of this tumor. It also confirms that adequate surgical treatment can lead to impressive bone regeneration in healthy individuals, as evident from the radiologic findings acquired before, during, and after enucleation of the COF in our patient. Our findings also confirm the view that COF has a favorable prognosis regardless of its final size.ConclusionEarly diagnosis is key to successful treatment of COF. The slow but steady increase in the size of a COF with no accompanying symptoms has not been reported previously. To our knowledge, this is the only documented case of a COF that has been under continuous radiologic observation for over 20 years.

Central Odontogenic Fibroma: characteristics and management

“…These signs might be physical in 41% of cases (facial asymmetry and/or intraoral swelling in 34.1% of cases , dental mobility in 2.2% [30][31][32], trismus in 0.7% [33], tooth displacement in 0.7% [34], or delayed eruption in 0.7% [35]). These clinical signs might also be functional with pain in 6.7% of cases [7,12,32,[36][37][38][39][40]. COF might also be discovered incidentally on standard radiograph in 23% of cases [33,[36][37][38][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56].…”

“…They were absent in 74.8% of cases [11,24,36,47,50,[57][58][59][60][61][62][63][64][65]. Facial asymmetry was observed in 23.7% of cases [5,[7][8][9][12][13][14][15][16][17][18][20][21][22]25,26,31,33,40,58,60,63,[66][67][68][69][70][71][72][73][74]. This facial asymmetry was isolated in 20.7% of cases and associated with other extraoral clinical signs in 3% of cases (lymphadenopathy in 1.5% of cases [12,66], trismus in 0.7% [33] and paraesthesia in 0.7% [73] depression could also be associated in 2.2% of cases…”

“…The histological subtype of COF was indeterminate in 37% of cases. Otherwise the distribution between the complex type and the simple type appeared to be almost equivalent with 34.1% of cases [8,15,21,23,26,[28][29][30][34][35][36][37]39,40,46,47,[50][51][52][53][54]56,57,60,61,63,65,[70][71][72][73][74]76,78,80,82,85] and 28.9% of cases respectively [6,7,[11][12][13][14]17,18,20,22,24,25,27,31,…”

“…4). Other conservative surgical approaches were less frequently practised: curettage of the lesion (14.1% of cases) [7,12,19,43,47,48,50,52,65,69,72,80,84] or even non-interruptive resection (1.5% of cases) [15,85]. Enucleation is the process by which the entire cystic lesion is removed in one surgical piece [86].…”

“…Finally, therapeutic abstention was decided in only one case because of the patient's advanced age, the extent of the lesion and its non-aggressive nature (0.7%) [50]. In addition to COF treatment, tooth extractions were performed in 19.3% of cases to facilitate access to the lesion or because the adjacent teeth were not retainable due to external root resorptions [6,7,10,14,25,29,30,32,37,44,46,50,51,53,56,57,66,68,71,78,79,82,83,85]. More rarely, in 3% of cases, endodontic treatments were performed [6,23,54,83], of which 3/4 were associated with apical surgery (2.2% of cases) [6,54,83]).…”