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Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
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CASE REPORT
Year : 2011  |  Volume : 29  |  Issue : 6  |  Page : 44-47
 

Cemento-ossifying fibroma of maxillary antrum in a young female patient


1 Department of Oral Pathology and Microbiology, HP Government Dental College, Shimla, Himachal Pradesh, India
2 Department of Oral and Maxillofacial Surgery, HP Government Dental College, Shimla, Himachal Pradesh, India
3 Department of Pedodontics and Preventive Dentistry, HP Government Dental College, Shimla, Himachal Pradesh, India
4 Jodhpur Dental College General Hospital, Jodhpur, Rajasthan, India
5 Former Dean, VS Dental College and Hospital, Bangalore, Karnataka, India

Date of Web Publication12-Dec-2011

Correspondence Address:
P Singhal
Department of Pedodontics and Preventive Dentistry, HP Government Dental College, Shimla, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.90740

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   Abstract 

The cemento-ossifying fibroma is classified as a fibro-osseous lesion of the jaws. It commonly presents as a progressively growing lesion that can attain an enormous size with resultant deformity if left untreated. The cemento-ossifying fibroma is a central neoplasm of bone as well as periodontium which has caused considerable controversy because of controversy regarding terminology and the criteria for its diagnosis. This case report describes a female patient with cemento-ossifying fibroma involving maxillary antrum. The clinical, radiographic and histological features as well as the surgical findings are presented.


Keywords: Cementifying fibroma, fibro-osseous lesion, jaw tumor


How to cite this article:
Singhal A, Ram R, Singhal P, Bhatnagar S, Das U M. Cemento-ossifying fibroma of maxillary antrum in a young female patient. J Indian Soc Pedod Prev Dent 2011;29, Suppl S1:44-7

How to cite this URL:
Singhal A, Ram R, Singhal P, Bhatnagar S, Das U M. Cemento-ossifying fibroma of maxillary antrum in a young female patient. J Indian Soc Pedod Prev Dent [serial online] 2011 [cited 2017 Jul 26];29, Suppl S1:44-7. Available from: http://www.jisppd.com/text.asp?2011/29/6/44/90740



   Introduction Top


The concept of 'fibro-osseous lesions' of bone has evolved over the last several decades and now includes two major entities: Fibrous dysplasia and ossifying fibroma, as well as the other less common lesions such as florid osseous dysplasia, periapical dysplasia, and focal sclerosing osteomyelitis. Fibro-osseous lesions of the jaws are classified by Waldron [1] and Kramer et al.[2] In the nomenclature by Kramer et al[2] the cemento-ossifying fibroma is described as an osteogenic neoplasm and the fibrous dysplasia as a non-neoplastic bone lesion. The cemento-ossifying fibromas or ossifying and cementifying fibromas have been described as well demarcated or rarely, encapsulated neoplasms consisting of fibrous tissue containing varying amounts of mineralized material resembling bone and/or cementum. [2] These benign fibro-osseous lesions can arise from any part of the facial skeleton and skull with over 70 per cent of cases arising in the head and neck region principally in jaws. [3],[4] In year 1872 Menzel gave the first description of a variant of ossifying fibroma, calling it a cemento-ossifying fibroma. [5] It is benign fibro-osseous neoplasm. In 1992 WHO revised the nomenclature and named the separate lesion of cementifying fibroma and ossifying fibroma as a single entity named cement-ossifying fibroma. [6] Large lesions increasing in size to over 80 mm in their greatest diameter have been termed as 'giant ossifying fibroma'. [7],[8] The recurrence of these benign tumors following surgery is considered rare. But Eversole and his co workers in a study of 64 cases of cemento-ossifying fibroma reported a recurrence rate of as high as 28 per cent following surgical curettage of these lesions. [9] Radiologically, cemento-ossifying fibroma shows a number of patterns depending on the degree of mineralization of the lesion. The lesion manifests as a well delimited unilocular lesion containing variable amounts of radio-opaque material. [2],[3],[4]


   Case Report Top


A 17 years old female patient reported with a complaint of swelling on right cheek for past 1 year [Figure 1]a and b. The swelling had gradually increased in size. It was present on zygomatic buttress area. Size of the swelling was approximately 4 × 5 cm. It was associated with sharp pain; occurred mainly on applying pressure. Swelling was tender on palpation and hard in consistency. Intraorally -swelling involved buccal vestibule, alveolar ridge and palate. On radiographic examination OPG shows a mixed lesion present in maxillary antrum area [Figure 2]. Teeth roots within the lesion showed signs of resorption. Computed tomography (CT) scan report shows a large periapical expansile lesion of size 42.9 × 32.7 mm involving maxilla on right side [Figure 3]. There was loss of maxillary bone on right side with extension into maxillary antrum and its complete obliteration. There is evidence of scatterd calcified mass throughout the lesion. Provisionally the lesion was diagnosed as fibrous dysplasia, pindborg's tumor, desmoplastic ameloblastoma, cement-ossifying fibroma. Surgical enucleation with curettage of the lesion was done with extraction of the involved teeth [Figure 4]a and b. Histopathological picture had shown highly cellular fields with few calcified areas. Cellular component were composed of fibroblasts arranged in different patterns like storiform. Calcified areas appeared to be composed of cementum like material [Figure 5]. The lesion was diagnosed as cemento-ossifying fibroma. Patient is being reviewed after every two months of surgery. Size of the swelling had decreased and healing was taking place at the first two month post operative follow up.
Figure 1: (a)Extra oral swelling on right side of cheek
Figure 1b: Intra oral swelling i.r.t. right side buccal vestibule and palate


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Figure 2: OPG showing the mixed lesion in the right maxillary antrum area

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Figure 3: CT scan showing the extent of the lesion

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Figure 4: (a)Intraoperative picture showing enucleation site
Figure 4b: Surgically enucleated lesional mass with extracted teeth


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Figure 5: Histopathological picture showing cementum like mass in hypercellular areas

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   Discussion Top


Cemento-ossifying fibroma is a benign fibro-osseous- tumor, they are thought to arise from the periodontal ligament and are composed of varying amounts of cementum, bone, and fibrous tissue. [10] Eversole et al reported that the production of these cementum like structures may be associated with membranous bone and may not only be related to cementogenesis. [9] The World Health Organization classifies cemento-ossifying fibroma as a fibro-osseous neoplasm, included among the non-odontogenic tumors derived from the mesenchymal blast cells of the periodontal ligament, with a potential for fibrous tissue, cement and bone, or a combination of such elements to exist in the lesion. [11] However, there is controversy over such an origin, since tumors of similar histology have been reported in bone lacking periodontal ligament and not located in the maxillary region, such as ethmoid bone, frontal bone or even long bones of the body (cementiform fibrous dysplasia). [12] The hybrid name central cement-osifying fibroma is used because there is a spectrum of fibro-osseous lesions that arise from the periodontal ligament, ranging from those with only deposition of cementum to those with only deposition of bone. [13] It is a slow-growing lesion most often seen in women between the third and fourth decades of life. [1],[3] While one-half of all cases are asymptomatic, the growth of the tumor over time may lead to facial asymmetry, with the appearance of mass causing discomfort or mandibular expansion, and the possible displacement of dental roots. [14] Although the underlying cause is not known, there have been reports of past trauma in the area of the lesion. [15] In coincidence with the data found in the literature; the present patient was reported to have suffered trauma in the affected area seven years ago. This indicates trauma as a possible triggering factor in some presentations of this lesion, postulating the later as representing a connective tissue reaction rather than a genuine neoplasm. [16] The recommended treatment of the central cementoossifying fibroma is excision. Due to the good delimitation of the tumor, surgical removal and curettage is also the treatment of choice. [17] Regular follow-ups are necessary, as recurrence of this lesion is reported.

 
   References Top

1.Waldron CA. Fibro-osseous lesions of the jaws. J Oral Maxillofac Surg 1993;51:828-35.  Back to cited text no. 1
    
2.Kramer IR, Pindborg JJ, Shear M. Histological typing of odontogenic tumors. 2 nd edn. Berlin: Springer-Verlag; 1992. p. 27-33.   Back to cited text no. 2
    
3.Cakir B, Karaday N. Ossifying fibroma in the nasopharynx: A case report. Clin Imag 1991;15:290-2.  Back to cited text no. 3
    
4.Mitrani M, Remsen K, Lawson W, Biller H. Giant ossifying fibroma of the naranasal sinuses. Ear Nose Throat J 1988;67:186-92.  Back to cited text no. 4
    
5.Hamner JE 3 rd , Scofield HH, Cornyn J. Benign fibro-osseous jaw lesions of periodontal membrane origin: An analysis of 249 cases. Cancer 1968;22:861-78.  Back to cited text no. 5
    
6.Ghom AGR. Text book of Oral medicine. 2 nd ed. New Delhi: Jaypee Brothers Medical Publishers; 2010. p. 308  Back to cited text no. 6
    
7.Van Heerden WF, Raubenheimer EJ, Weir RG, Kreidler J. Giant ossifying fibroma: A clinicopathologic study of 8 tumors. J Oral Pathol Med 1989;18:506-9.  Back to cited text no. 7
    
8.Khanna JN, Andrade NN. Giant ossifying fibroma: Case report on a bimaxillary presentation. Int J Oral Maxillofac Surg 1992;21:233-5.  Back to cited text no. 8
    
9.Eversole LR, Leider AS, Nelson K. Ossifying fibroma: A clinicopathologic stidy of sixty-four cases. Oral Surg Oral Med Oral Pathol 1985;60:505-11.  Back to cited text no. 9
    
10.Galdeano-Arenas M, Crespo-Pinilla JI, ´Alvarez-Otero R, Espeso-Ferrero A, Verrier-Herna´ndez A. Fibroma cemento-osificante gingival mandibular. presentacio´n de un caso. Med Oral 2004;9:176-9.  Back to cited text no. 10
    
11.Liu Y, Wang H, You M, Yang Z, Miao J, Shimizutani K, et al. Ossifying fibromas of the jaw bone: 20 cases. Dentomaxillofac Radiol 2010;39:57-63.   Back to cited text no. 11
    
12.Goh EK, Cho KS, Lee IW, Chon KM. A case of isolated ossifying fibroma of the mastoid cavity of the temporal bones. Am J Otolaryngol 2006;27:358-61.  Back to cited text no. 12
    
13.Tamiolakis D, Thomaidis V, Tsamis I. Cemento-ossifying Fibroma of the Maxilla: A case report. Acta Stomatol Croat 2005;39:319-21.  Back to cited text no. 13
    
14.Sanchis JM, Peñarrocha M, Balaguer JM, Camacho F. Fibroma cemento-osificante mandibular: Presentación de dos casos y revision de la literatura. Med Oral 2004;9:69-73.  Back to cited text no. 14
    
15.Brademann G, Werner JA, Janig U, Mehdorn HM, Rudert H. Cemento-ossifying fibroma of the petromastoid region: Case report and review of the literature. J Laryngol Otol 1997;111:152-5.  Back to cited text no. 15
    
16.Feller L, Buskin A, Raubenheimer EJ. Cemento-ossifying fibroma: Case report and review of the literature. J Int Acad Periodontol 2004;6:131-5.  Back to cited text no. 16
    
17.Rangil JS, Silvestre FJ, Bernal JR. Cemento-ossifying fibroma of the mandible: Presentation of a case and review of the literature. J Clin Exp Dent 2011;3:e66-9.  Back to cited text no. 17
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]


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