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International Journal of Oral Health Dentistry 2023;9(1):57–60
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International Journal of Oral Health Dentistry
Journal homepage: www.ijohd.org
Case Report
Ossifying fibroma of maxilla – A pediatric case
Kanchan M Shah1, Tejal Badhan1,*, Jayant S Landge1, Sindhuja K1
1Dept. of Oral & Maxillofacial Surgery, Government Dental College and Hospital, Aurangabad, Maharashtra, India
ARTICLE INFO
Article history:
Received 24-12-2022
Accepted 30-01-2023
Available online 15-04-2023
Keywords:
Ossifying fibroma
Benign
Fibro-osseous lesion
Maxilla
Enucleation
Curettage
ABSTRACT
Background: Ossifying fibroma (OF) is classified as, and behaves like, a benign bone neoplasm. It is
often considered to be a type of fibro-osseous lesion (FOL). It can affect both mandible and the maxilla,
particularly the mandible. This bone tumour consists of highly cellular, fibrous tissue that contains varied
amounts of bone or cementum resembling calcified tissue. Present case is an unusual report of ossifying
fibroma involving the left side of maxilla in a 13-year old male patient, who presented to the department
with a painless hard swelling. The lesion was treated by surgical enucleation and curettage.
Materials and Methods: Surgical enucleation and curettage was performed.
Results: Healing was uneventful, patient has been kept on a regular follow-up regimen.
Conclusions: The case report and treatment of an unusual case of Ossifying fibroma in the maxilla of a
paediatric patient has been described. Based on our experience, we suggest that proper correlation of the
clinical, radiological and histological features is necessary to establish a definitive diagnosis, as well as for
proper surgical intervention. As reported in the literature, the rate of recurrence is not very high, but long
term periodic follow-up is warranted.
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1. Introduction
Ossifying fibroma (OF) is a benign bone neoplasm. It is
repeatedly thought to be a type of fibro-osseous lesion
(FOL). It can affect both the jaws. However, it is more
commonly seen in the mandible with an incidence of
70-90% of the cases.1–3 It consists of highly cellular,
fibrous tissue that encloses unpredictable amounts of
calcified tissue which resembles bone, cementum or both.4
It is frequently seen in the third as well as fourth
decades of life. In 1968, Hamner et al.5studied and
categorised 249 cases of fibro-osseous jaw lesions which
had periodontal membrane origin. In 1973, Waldron and
Giansanti described 65 cases and established that this group
of lesions was best considered as a range of processes
that arises from cells in the periodontal ligament. In 1985,
* Corresponding author.
E-mail address:tejalbadhan@gmail.com (T. Badhan).
Eversole et al. defined the radiographic features of central
ossifying fibroma, and described two chief radiographic
patterns:- expansile unilocular radiolucent arrangement and
multilocular arrangement. The recurrence rate is usually
low.1,6
2. Case Report
A 13 year-old male patient, was brought by his parents with
the principal complaint of swelling in left upper jaw since
2 years. The patient was apparently alright 2 years back
when suddenly his mother started noticing slight swelling
which was seen on left side of his face. The swelling was of
peanut size initially. The swelling enlarged in size rapidly
to the present size. The swelling was not accompanied
by pain or difficulty in mastication. The patient had no
history of trauma. The patient had no history of any recent
hospitalization or did not have any infectious disease in the
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58 Shah et al. / International Journal of Oral Health Dentistry 2023;9(1):57–60
last 2 years.
On extraoral examination, the face was asymmetrical.
Swelling was noted over the left side. On intraoral
inspection, a diffuse hard swelling was noted labially and
buccally in the second quadrant which was continuous
with maxilla and was non-tender and non-fluctuant. Teeth
present in the second quadrant were 21, 63, 25, 26,
27, 26 which were carious; 23, 24, 28 were impacted;
22 was missing. The provisional diagnosis was a fibro-
osseous lesion of maxilla based on the history and clinical
examination. CBCT was done for the patient which showed
a radiopaque lesion extending from 63 to 26 buccally and
was continuous with maxillary bone. Incisional biopsy was
done, the result came back as ossifying fibroma. All routine
investigations were done and the patient was planned for
surgical enucleation and curettage.
Under general anesthesia, under all aseptic precautions,
the patient was intubated orally. Throat pack was inserted.
Scrubbing, draping and painting was done. 2% lignocaine
with adrenaline infiltration was done. Anterior releasing
incision was taken distal to 13 with crevicular incision
extending from 13 to 26 with a 15 No. blade. A full
thickness triangular mucoperiosteal flap was reflected. The
lesion was exposed. It was completely separated from the
overlying tissue. The entire boundary of the lesion was
marked with chisel and mallet. Its separation from the
maxillary alveolus was completed with 702 straight fissure
bur. The bony hard lesion was surgically removed and
sent for histopathological examination. 23 was identified
and preserved. 63 was extracted. Complete curettage was
done. The surgical site was irrigated thoroughly with normal
saline and betadine solution. The flap was closed with
non-resorbable simple interrupted sutures. Pressure pack
was placed on the surgical site. Throat pack was removed.
The patient was extubated. The procedure went uneventful.
The patient was kept on intravenous antibiotics for 3 days
postoperatively as per pediatrician’s recommendations. The
patient is recalled regularly.
3. Discussion
In 1971, World Health Organization (WHO) categorised
four types of cementum-including lesions; fibrous
dysplasia, ossifying fibroma, cementifying fibroma
and cement- ossifying fibroma. Based on the second WHO
classification, benign fibro-osseous lesions in the oral
and maxillofacial region were separated in two discrete
groups, osteogenic neoplasm and non-neoplastic bone
lesions in which cementifying ossifying fibroma fitted
to the previous group. However, the word "cementifying
ossifying fibroma" was changed to ossifying fibroma in the
current classification in 2005.1,7,8
The source of Ossifying Fibroma is believed to be the
periodontal membrane. Few OFs comprise predominantly
Fig. 1: Asymmetry seen on left side
Fig. 2: Swelling over left side of maxilla buccally
Fig. 3: A, B: Buccal cortical expansion noted
Shah et al. / International Journal of Oral Health Dentistry 2023;9(1):57–60 59
Fig. 4: Intraop – Exposure of the lesion
Fig. 5: Excised tissue sent for histopathological examination
Fig. 6: Closure done with 3-0 vicryl sutures
Fig. 7: Histopathological feature
cementum-like calcifications and the rest show just bony
material, but a combination of the two categories of
calcification is frequently seen in a solitary lesion.4There
is comprehensive uniformity of belief with location of these
lesions. The bulk of lesions (76-100%) are located in the
posterior mandible. The premolar-molar region is the most
common location.9It is crucial to know that Ossifying
Fibroma of the jaw bone has more predilection for females.
Radiographically, these tumours are seen with variable
arrangements on the basis of the amount of mineralization.
Based on the volume of calcified material formed in
the tumour, it may seem as unilocular or multilocular
radiopaque image or a radiolucency with varied density
of opacified material. In some cases, it is related with
60 Shah et al. / International Journal of Oral Health Dentistry 2023;9(1):57–60
root resorption. It may also be related with displacement
of neighbouring teeth.1The radiographic features have
two simple patterns: cystic lesion (might be unicystic or
multicystic) and mixed-density lesion. The radiographic
boundaries of the tumour seem comparatively smooth, well
defined and corticated. The outline is regular. The lesion has
a tendency to be concentric in the medullary part of the
bone with noticeable expansion identical in all directions.
A noteworthy fact is that the outer cortical plate, even if
displaced and thinned out, stays intact.
Ossifying Fibroma necessitates radical surgery as it has
propensity for recurrence and likelihood of conversion to
malignancy. It is well-known that most Ossifying Fibromas,
do not recur after thorough excision.4,10
4. Conclusion
We described and managed a rare case of Ossifying Fibroma
in a pediatric patient in maxilla. Based on our knowledge
and experience, we advise that proper association of the
clinical, radiological and histological features is needed to
formulate a final diagnosis, and also for appropriate invasive
intervention. As described in the literature, the recurrence
rate is low, nonetheless regular follow-up is warranted for a
long duration.
5. Source of Funding
None declared.
6. Conflict of Interest
None.
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Author biography
Kanchan M Shah, HOD
Tejal Badhan, PG Student
Jayant S Landge, Associate Professor
Sindhuja K, PG Resident
Cite this article: Shah KM, Badhan T, Landge JS, Sindhuja K.
Ossifying fibroma of maxilla – A pediatric case. Int J Oral Health Dent
2023;9(1):57-60.
