7/28/2019 jdsr4_17

1/3

INTRODUCTION

Juvenile ossifying fibroma (JOF) is a fibro-osseousneoplasm described as an actively growing lesionconsisting of a cell-rich fibrous stroma, containing bandsof cellular osteoid without osteoblastic lining, togetherwith trabeculae of more typical woven bone. Small fociof giant cells may also be present. The lesion is non-encapsulated but well demarcated from surrounding

[1]bone (WHO) .

Although JOF was described in the past as a variant ofossifying Fibroma, but more recently it is segregated intwo distinct sub types. 1) Trabecular - WHO type2) psammomatoid variety, with varied clinical and

[2]

histological features the maxilla, paranasal sinus, orbitand fronto- ethmoid bone are the predilicted sites for theinvolvement of the JOF. Very few cases of mandibular

[3]JOF have been reported .

Clinically in most instances JOF is slowly growingasymptomatic swelling causing facial asymmetry, buttumor can progress to considerable size and behaves, asaggressive lesion. Less commonly, pain and parasthesia

Juvenile Ossifying Fibroma

CASE REPORT

ABSTRACT

Within the confusing ray of fibro-osseous lesions, the so called juvenile ossifying Fibroma (JAOF)is perhaps the most enigmatic. Pathologists considering such a diagnosis are faced with a plethora

of subjective and arbitrary criteria and will find lit tle consolidation in the literature. Occupying asubset within the spectrum of ossifying Fibroma. JAOF is considered by many to be a unique lesionbecause of its reported tendency to occur in children and adolescents, it's more complexhistological features, and its purported tendency for locally aggressive growth. Because of thislesion's aggressive nature and high recurrence rate, early detection and complete surgical excisionare essential. Reported here is a case of a massive juvenile ossifying fibroma of the maxil la in a 12-year-old male child.

Keywords: fibro-osseous lesions, juvenile ossifying Fibroma

are noted. Depending upon anatomical site involvement,nasal obstruction, epistaxis and exopthalamus are

observed. Slight male predominance with age rangingfrom 2- 15 years has been reported. The appearance ofJOF radiographically varies from unilocular tomultilocular radiolucency with well defined borders andoccasionally opacification depending upon the stage andtime of radiographic examination. The presence ofcortical thinning, perforation, tooth displacement androot resorption, are suggestive of feature of aggressiveJOF. The advanced imaging modalities like CT and MRIhave show to reveal more invasive and destructivefeatures of JOF apart from conventional radiographic

[4]features .

Histopathalogically both sub- types are typically non-encapsulated but well demarcated from surroundingbone. The tumor consists of varying neoplastic cellularstroma formed by spindal or oval shaped fibroblast cells.The mineralized component in the both patterns isdistinct. The trabecular variant shows irregular strandsof highly cellular osteoid encasing plump and irregularosteocytes. The plump osteoblasts often line the strandsand focal areas of multinucleated giant cell are alsoobserved. In contrast psammomatoid pattern formsconcentric laminated and spherical ossicles that vary inshape and typically have basophilic centers with

[5]peripheral eosinophilic osteoid rims .

Address for correspondence:Dr Jithender Reddy KubbiE-mail: reddy_jittu@yahoo.co.in

Access this article online

Website: http://www.ssdctumkur.org/jdsr.php.

64

1 Department of OralMedicine and RadiologySVS Institute of DentalSciencesMahabubnagar, A.P., India

1 1 1 1Jithender Reddy Kubb i , Navadeepak Kumar K , Vivekanandh Reddy , Ramlal G

Journal of Dental Sciences and ResearchVol. 2, Issue 2, Pages 1-5

7/28/2019 jdsr4_17

2/3

65

The overall clinical, imaging and histopathologicalfeatures are required to label the diagnosis of JOF.Because of unpredictable rapid and progressive growth

of some JOF, the management and the prognosis of JOFare uncertain. Non- aggressive JOF are treated bycurettage and local excision. Aggressive JOF require thecomplete surgical excision, en-bloc or hemi-maxillectomy to prevent recurrences.6 Reported here is acase of JOF WHO type of maxilla occurring in a 14 yrsold boy.

CASE REPORT

A 14 yrs old boy who reported to the department of oralmedicine and radiology in S.V.S Institute of Dentalsciences Mahabubnagar Andhrapradesh INDIA. Had a

chief complaint of painless, slowly progressive swellingof left side of face with 3 yrs duration. Initially to beginwith swelling was of areca nut size and increasedprogressively to attain final size causing significantfacial asymmetry without any associated symptoms.Other medical and dental histories were non-contributory.

On extra oral examination a solitary, bony hard, painless,diffused swelling of approximately 4x4 cm on the leftside of face. (Fig 1)

Intraorally a solitary swelling causing obliteration of leftbuccal vestibule with overlying normal mucosa with

palatal expansion noted. (Fig 2)

Lateral occlusal radiograph revealed a well defined,homogenous, complete radiopaque lesion occupying leftmaxillary sinus with evidence of complete sinusopacification and expansion of cortices. (Fig.3)

Computed tomography findings confirmed routineradiographic features and further showed evidence oferosion of maxillary bony wall and extension to cheekanterio-inferiorly.(Fig 4)

Based upon clinical and radiographic examination

provisional diagnosis of as JOF of left maxilla withdifferential diagnosis of fibrous dysplasia.

Pre-operative incisional biopsy was performed andhistopathological diagnosis of JOF- WHO type wasgiven. (Fig 5)

The lesion exposed and excision by partial maxillectomywith thoroughly curetted and closer was done using 3.0vicryl sutures and acrylic splint was placed.

Figure 1: Extra oral photograph showing facial asymmetry onthe left side of the Face.

Figure 2: Intraorally showing expansion of cortices.

Figure 3: showing expansile

lesion on the left maxillary Sinus with Ossifications.

Lateral occlusal radiograph

Journal of Dental Sciences and Research

7/28/2019 jdsr4_17

3/3

DISCUSSION

JOF commonly affects young children with slight malepredilection with a mean age of 11 years. The age of thepatient in this case was 14 years which is in-concurrentwith the previous reports. Clinically JOF isasymptomatic most of the time, however less commonlyit is aggressive and symptomatic. This asymptomaticnature, was also appreciated in this presentcase.8Although both maxilla and mandible are affectedwith slight predominance for maxilla has been suggestedby Pieter j.slootweg.9 In the present case swelling ofduration of six months was noted. The variation in theduration was reported from slowly growing over aperiods of years to rapid increase in weeks. The spectrumof radiographic features of JOF, varies from a welldefined unilocular to multilocular with centralopacification or ground glass appearance.2,9 Thisradiographic variation of JOF is due to stage, durationand histology of the neoplasm. The 50% of cases of sinusJOF are reported in multiple sinuses with remainingoccurring in single sinus.10 The JOF also was seen insingle sinus.

The clinical findings, radiographic features, durationand extension of the lesion in to soft tissue favours the

aggressive type of JOF as previously reported.3 Thefeatures like tooth displacement, resorption andperforation of cortices or bone in addition to rapid growthof the lesion favors the diagnosis of aggressive variety ofJOF. However in this case except tooth resorption allother features like tooth displacement and perforationwere noted.

CONCLUSION

Although juvenile ossifying Fibroma an uncommonclinical entity, its aggressive social behavior and highrecurrence rate means that is important to make an early

diagnosis, apply the appropriate treatment and long termand follow up.

REFERENCES

1. H.K.Williams, C. Mangham, P.M.Speight. Juvenile ossifyingfibroma. An analysis of eight cases and a comparison withother fibro-osseous lesions. J Oral Pathol Med 2000; 29: 13-18.

2. Samir EL- Mofty, ST Louis. Psammomatoid and trabecularjuvenile ossifying fibroma of craniofacial skeleton: Twodistinct clinic pathologic entities Oral Surg Oral Med OralPathol Oral Radiol Endod 2002; 93: 296-304.

3. Ritta Leimola- Virtanen, Kimmo Vaheatalo and StinaSyrjanen. Juvenile active Ossifying fibroma of the mandible:A report of two cases. J Oral Maxillofac Surg 2001; 59: 439-444.

4. Maria E. Papadaki, Maria J. Troulis, Leonard B. Kaban.Advances in diagnosis and Management of Fibro- osseouslesions. Oral Maxillofacial Surg Clin N Am 2005; 17: 415-434.

5. B.W. Neville, D.Damm, CM.Allen, J.E (2005). Bouquot.Oral and maxillofacial Pathology, (3rd ed.), W B Saunders,Philadelphia.

6. Regezi JA, Sciubba JJ (1989). Oral pathology: clinical-pathologic correlations,Genetic and metabolic diseases of thejaws, W B Saunder, Philadelphia.

7. G. Sun X. Chen, E. Tang, Z. Li, J.Li. Juvenile ossifying

fibroma of the maxilla. Int. J. Oral Maxillofac. Surg. 2007; 36:82-85.

8. James M. Walter, Jr., Bill C. Terry, Ernest W. Small, MS;Stephen R. Mattesson, Robert M. Howell, Chapel Hill.Aggressive ossifying fibroma of the maxilla: review of theliterature and report of case. J. ORAL SURGERY 1979; 37:276-286.

9. Pieter J. Slootweg, Hellmuth Muller. Juvenile ossifyingfibroma. Report of four cases.J. Cranio-Max-Fac . Surg. 1990;18:125-129.

10. Sheldon Mintz, Ines Velez. Central ossifying fibroma: AnAnalysis of 20 cases and Review of literature. QuintessenceInt 2007; 38: 221-227.

66

Figure 4: CT scan reveals large tumour involving left maxillaand maxillary sinus With ossifications.

Figure 5: Trabeculae of cellular woven bone are present.

Vol. 2, Issue 2, September 2011