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Cemento-Ossifying Fibroma

Ossifying fibroma is an uncommon lesion that tends to occur during the third and fourth decades of life, and in women more commonly than men. Uncommonly, rapid growth may be seen in children (juvenile ossifying fibroma).

Cementifying fibroma and cemento-ossifying fibroma are terms occasionally used when the bony islands in these jaw tumors are round or spheroidal. They are, for all practical purposes, the same lesions as ossifying fibroma, with recent classification schemes merging these entities under ossifying fibroma.

These occur in similar age groups and locations, exhibit comparable clinical characteristics, and have the same biological behaviour.

Clinical & radiographic features

 It is a generally slow-growing, asymptomatic, and expansile lesion.

In the head and neck, ossifying fibroma may be seen in the jaws, craniofacial bones, and anterior cranial fossa. Lesions of the jaws characteristically arise in the tooth-bearing regions, most often in the mandibular premolar-molar area

The most important radiographic feature of this lesion is the well-circumscribed, sharply defined border, with a generally expansile profile.

Ossifying fibromas, present a variable appearance, depending on the density of calcifications present. Lesions may be relatively radiolucent because of evenly dispersed, calcified new bone. Lesions may also appear as unilocular or multilocular radiolucencies that bear a resemblance to odontogenic lesions. A mixed radiolucent-radiopaque image is seen when islands of tumor bone are densely calcified.

 The roots of teeth may be displaced; less commonly, tooth resorption is seen.

Differential diagnosis

Distinguishing between ossifying fibroma and fibrous dysplasia is the primary diagnostic challenge. These lesions may exhibit similar clinical, radiographic, and microscopic features. The most helpful clinical feature in distinguishing the two is the well-circumscribed radiographic appearance of ossifying fibroma and the ease with which it can be separated from normal bone. In most cases, the well-defined appearance of ossifying fibroma is evident radiographically.

Treatment and prognosis

Treatment of ossifying fibroma is most often accomplished by surgical removal using curettage or enucleation. In cases where there is aggressive behavior marked by rapid growth and enlargement, resection may be necessary. The lesion is typically separated easily from the surrounding normal bone. Recurrence is described only rarely after removal.

OPG view in a case  shows well-defined mixed radiopaque-radiolucent lesion with radiolucent band at periphery in 46 to 48 tooth region. Inferior border of the mandible is intact

 A very large cemento-ossifying fibroma is located in the right aspect of the mandible with a radiolucent rim around the lesion (arrow) Copyright © 2015 by Korean Academy of Oral and Maxillofacial Radiology

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