Intraoral Approach for Surgical Treatment of Psammomatoid Juvenile Ossifying Fibroma

Abstract

Psammomatoid juvenile ossifying fibroma (PJOF) is a rare benign tumor that usually affects the paranasal sinuses, orbit, and skull. In most cases, extensive incisions are necessary for full access to the tumor site. The aim of this paper is to report a case of extensive PJOF in which an intraoral surgical approach was performed with complete excision of the tumor. A female patient, 18-year old had a deforming volume increase in the region of the left facial middle third with an approximate evolution time of 2 years. She complained of headache, epiphora in the left eye, and total obstruction of the left nostril. Extraoral examination showed facial asymmetry with dystopia, ocular proptosis, and considerable sclera exposition of the left eye. Tomography examination showed a mixed aspect lesion on the left side of the face, well delimited. The intraoral surgical approach was chosen for the excision of the lesion. Under general anesthesia and nasotracheal intubation, total resection was performed, followed by exodontia of the directly involved teeth. In the definitive histopathological examination, the diagnosis was confirmed. The patient is currently with 2 years and 6 months of postoperative follow-up and has good healing of intraoral surgical wounds and stable occlusion. Extraoral examination showed harmonic projection of the facial middle third, but still with excessive exposure of the sclera of the left eye due to the defect in the orbital floor. The surgical treatment of PJOF was possible by intraoral approach, even taking into account the limitations of the access and the complexity of the anatomy of the facial bones involved.

Juvenile psammomatoid ossifying fibroma of the maxilla

“…In contrast, JOF exhibits rapid short-term growth [1]. JPOF usually occurs in adolescence, but adults can also be affected [2][3][4][5]. In general, age at the time of JPOF onset (3 months to 72 years) is later than that at the time of juvenile trabecular OF (16 to 33 years) [1].…”

“…Therefore, complete resection could prove challenging in terms of reconstruction of the continuity defect, both esthetically and functionally. Depending on the lesion, minimally invasive surgery may be possible via smaller incisions using an intraoral approach or endonasal endoscopy [2,3,7]. If the lesion has clear borders with limited range, conservative methods such as curettage, enucleation, or partial resection can achieve acceptable results.…”

“…In growing patients, reconstruction should be delayed until the cessation of growth. In some cases, in which the remaining JPOF is stable and can be preserved safely, reconstruction may be not performed at all [2,8].…”

“…OF is classified into cemento-OF, juvenile trabecular OF and juvenile psammomatoid OF (JPOF) [ 1 ]. JPOF usually occurs before the age of 15 years, but it can also reportedly occur in adults [ 2 - 5 ]. It has a predilection for the paranasal sinuses and can occur in the maxilla, mandible, orbit, fronto-ethmoid complex, and frontal bone [ 2 - 8 ].…”

“…JPOF usually occurs before the age of 15 years, but it can also reportedly occur in adults [ 2 - 5 ]. It has a predilection for the paranasal sinuses and can occur in the maxilla, mandible, orbit, fronto-ethmoid complex, and frontal bone [ 2 - 8 ]. The diagnosis of JPOF is based on characteristic clinical manifestations, histological examination, and radiological characteristics.…”