Patient: Male, 35-year-old Final Diagnosis: Central odontogenic fibroma Symptoms: Asymptomatic Medication:— Clinical Procedure: Enucleation • surgery removal Specialty: Dentistry Objective: Rare disease Background: Odontogenic fibroma is a rare mesenchymal odontogenic tumor. It can be classified as central odontogenic fibroma (COF) or peripheral odontogenic fibroma (POF) based on clinical features. There are several variants of COF, including amyloid, ossifying, and giant cell. It grows slowly and exhibits painless cortical expansion of the jawbone. Radiographically, COF appears as a radiolucent unilocular or multilocular lesion with well-defined borders. COF may be associated with unerupted or displaced teeth and root resorption. Case Report: A 35-year-old man was referred to our hospital for submandibular swelling. Panoramic radiography and contrast-enhanced computed tomography revealed a unilocular area of bone resorption with a well-defined border and equal enhancement from the canine to first molar on the right side of the mandible. Root resorption of the first premolar and root separation of the first and second premolars were also evident. The lesion was asymptomatic. Histopathological examination of a biopsy of the lesion was suggestive of OF. Enucleation of the tumor, curettage of the bone around the tumor, and extraction of the premolar were then performed. Histopathological examination of the tumor showed fibrous connective tissue with inactive-looking odontogenic epithelial islands and strands, amyloid deposit, intercalation of Langerhans cells into the tumor epithelium, and no calcification. The final diagnosis of amyloid variant of COF was made. The postoperative course is going well. Conclusions: Herein we describe and discuss the clinical, radiological, and pathological features of the amyloid variant of COF. This report will enhance understanding of this extremely rare variant.

Congenital fibrinogen disorder is rare and is responsible for the difficulty in achieving hemostasis following surgery. A 75-year-old man was referred to our hospital for the management of gingival hemorrhage. He had a medical history of congenital hypofibrinogenemia, right internal carotid stenosis, hypertension, brain infarction, and Alzheimer's disease. A diagnosis of gingival hemorrhage due to periodontitis of the maxillary left second molar and severe periodontitis necessitating extraction in the maxillary second molars bilaterally, mandibular left second molar, and mandibular right first and third molars was made. A pre-operative hematological examination revealed a fibrinogen level of 53.7 mg/dl. Fibrinogen (3 g) was administered and reached a concentration of 92.8 mg/dl before the surgery. Several episodes of postoperative hemorrhages in the sockets were managed with local hemostatic treatment and splint adjustment. Fibrinogen levels were maintained at 72.5-92.8 mg/dl, until hemostasis was achieved. This case report illustrates the appropriate management of patients with congenital hypofibrinogenemia requiring extraction of multiple teeth.

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