Surgical correction of residual facial deformity following conservative excision of a giant maxillary ossifying fibroma

Abstract

Rationale: Ossifying fibroma (OF) is a benign fibro-osseous lesion that can develop in the oral and maxillofacial region. OF is more common in females and has a marked predilection for the mandible, occurring rarely in the maxilla. Lesions grow slowly and are usually asymptomatic until growth produces an obvious swelling, pain, paresthesia, and facial deformity. With low rates of recurrence, treatment is usually curettage or resection. Very large lesions that invade other organs and that cannot be completely removed should be excised conservatively. Patient concerns: We present a case of a 46-year-old female with a very large fibro-osseous lesion arising from the maxilla who was more concerned about the facial appearance and requested conservative treatment for economic reasons. Diagnoses: The pathological results based on conservative excision of the lesion confirmed the diagnosis of OF. Interventions: We chose conservative excision via the Weber–Ferguson approach and followed up every 6 months. Facial deformity correction was performed 2 years postoperatively and right lower eyelid ectropion correction 3 years after the primary excision. Outcomes: The ectropion deformity in the right lower eyelid improved dramatically with a better facial appearance and no obvious swelling. Lessons: Treatment programs for OF should be individualized based on the size, growth rate, invasion, and interference with facial function and esthetics. If lesions grow slowly, we suppose that it is feasible to excise conservatively when reconstruction cannot be performed due to esthetic and functional problems. Also regular postoperative follow-up is necessary to detect recurrence, and to improve facial appearance as required.

Ossifying fibroma in the mandibular angle mimicking metastatic clear cell renal cell carcinoma

“…Ossifying fibroma (OF) is an uncommon benign fibro-osseous neoplasm affecting the jaws and the craniofacial skeleton. [1,2,3] It is included in fibro-osseous and osteochondromatous lesions in the World Health Organization's classification of head and neck tumors [1] . OF is mainly composed of fibrous stroma and bone elements with various degrees of maturation [4] .…”

“…[2,3,4,5,6,7] Additionally, it has a female predilection with a male to female ratio of 1:5. [2,3,6,7] It is usually initially asymptomatic, and pain and paresthesia are rare [2] . Most cases are small and incidentally detected by routine dental radiographs, and there are few cases of multiple occurrences associated with familial inclination [2] .…”

“…However, it can cause facial deformity, displacement of the teeth, pathological fracture, and extend into the intracranial and intraorbital regions due to progressive and destructive growth. [2,3,4,5] Previous studies suggested that OF arises from the periodontal ligament. [2,4,7,8] Radiographically, OF is usually a well-defined unilocular lesion with or without a sclerotic margin overlapping the roots with or without root resorption, and the internal structure is often a mixture of radiolucent and radiopaque densities.…”

“…[2,4,7,8] Radiographically, OF is usually a well-defined unilocular lesion with or without a sclerotic margin overlapping the roots with or without root resorption, and the internal structure is often a mixture of radiolucent and radiopaque densities. [2,3,4,6] However, these radiographic findings are inconclusive [6] . The differential diagnosis of such lesions might include benign maxillofacial bone and cartilage tumors, benign epithelial odontogenic tumors, odontogenic and non-odontogenic developmental cysts, benign mesenchymal odontogenic tumors, chronic sclerosing osteomyelitis, primary and metastatic malignant tumors, and so on.…”

“…The differential diagnosis of such lesions might include benign maxillofacial bone and cartilage tumors, benign epithelial odontogenic tumors, odontogenic and non-odontogenic developmental cysts, benign mesenchymal odontogenic tumors, chronic sclerosing osteomyelitis, primary and metastatic malignant tumors, and so on. [3,6,7] In jaw lesions without significant expansion or destruction of the cortical bone and without displacement of the inferior mandibular canal, it is especially difficult to differentiate between benign and malignant lesions via radiological examinations [6] . In such cases, the lesions are often not easily accessible for biopsies due to soft tissues and thick cortical bone.…”