Case Report
Pediatric cemento-ossifying fibroma of the anterior mandible: A case report

https://doi.org/10.1016/j.ajoms.2020.03.007Get rights and content

Abstract

Cemento-ossifying fibroma (COF) is a clinicopatological variant of ossifying fibroma which is benign fibro-osseous neoplasm affecting jaw or cranial skeletons. It is also called central ossifying fibroma. COF is a slow-growing tumor and occurs exclusively in the tooth bearing areas of the jaws. This tumor particularly affects adult female and rarely occurs in children. Here we show a rare case of COF involving the anterior mandible in an 8-year-old girl. She was referred to our department with painless and hard swelling of the mandibular symphysis. Computed tomography (CT) showed that well circumscribed and mainly radiodense lesion with radiolucent areas expanded the inferior border of the mandible. The size of this lesion is 35 × 30 × 24 mm. Pathological diagnosis was COF. She had underwent two times of surgery for tumor enucleation through an intraoral approach, and after that, we removed bilateral central incisors with residual tumor around the roots. There has been no sign of recurrence 1 years after the last surgery. We have continued follow-up observation.

Introduction

According to the WHO classification of head and neck tumors 2017, cemento-ossifying fibroma (COF) is classified into fibro-osseous lesions, and is also categorized into odontogenic tumor [1]. This tumor mainly affects adult female, and pediatric COF affecting jaws is extremely rare. It occurs exclusively in the tooth bearing areas of the mandibular premolar and molar area [[1], [2], [3], [4], [5]].

Radiographic examination almost commonly shows a well-defined radiolucent area containing radiopaque material, and this tumor sometimes surrounded by a sclerotic border [1,6].

Histopathologically, this type of tumor is derived from the mesenchymal blast cells of the periodontal ligament, and have a potential to form fibrous tissue, cement and bone or a combination of such elements [1,7,8]. Eversole et al. has reported that these cementum-like structures are associated with membranous bone [9].

The first choice of treatment is conservative surgery with long-term follow-up [1,2,6]. It has recently reported that the range of recurrence rate of ossifying fibroma (OF) were from 12 % to 28 % [7,9,10].

As far as we investigated, there have been no case with COF involving the anterior mandible in children under the age of 10. The following report presented a rare case of COF of anterior mandibular region in an 8-year-old girl.

Section snippets

Case report

An 8-year-old girl was referred to our department for examination of painless swelling of the mandibular symphysis. The swelling has seemed to be gradually growing for 1 year since she had been noted to have the localized lesion. She had facial asymmetry, and there was a palpable bony hard swelling without redness or infection. There was no trismus, numbness, toothache, past history of facial trauma or previous similar swelling (Fig. 1A and B).

Panoramic radiography showed well-defined,

Discussion

COF is classified into fibro-osseous and osteochondromatous lesion, and is also categorized into benign mesenchymal odontogenic tumors. COF is one of the three clinicopathological variants of OF, which have been identified as COF, juvenile trabecular ossifying fibroma (JTOF) and juvenile psammomatoid ossifying fibroma (JPOF). The synonyms for COF are central OF, cementifying fibroma and periodontoma [1]. Epidemiology, it has proposed that the peak incidence of COF has been in the third and

Ethical approval

Written informed consent was obtained from the patient and her parents.

Declaration of Competing Interest

Nothing to disclose.

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