Rapidly maturing juvenile ossifying fibroma: a case report

Abstract

This report describes an unusual case of juvenile ossifying fibroma (JOF) in a 16-year-old female patient with a clinical presentation of a single large, well-circumscribed swelling on left side of the palate. Ossifying fibromas are normally slow growing benign lesions. Radiographically they can present as radiolucent, mixed or radiopaque lesions depending on the degree of maturity. A period of at least 6 years is required for the lesion to pass from the radiolucent to radiopaque stage. All previously reported cases of JOF have been either radiolucent or mixed density lesions, but our case is unusual because the lesion had shown apparently rapid transformation into an almost complete radiopaque stage at a very early age. Dentomaxillofacial Radiology (2011Radiology ( ) 40, 195-198. doi: 10.1259 Keywords: ossifying fibroma; radiopaque lesion; palate; osteoblastic rimming; cellular stroma A 16-year-old female reported to the Department of Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital, Wardha, India, with the chief complaint of swelling on left side of the palate, which had been present for 1 year. The swelling was insidious in onset and gradually increased to its present size over a period of 1 year. The swelling was initially painless but pain had developed in the last 15 days. The pain was gradual in onset, moderate, localized and intermittent in nature. Pain was aggravated by touch, chewing and swallowing. As a result of the swelling the patient had difficulty chewing, swallowing and speaking. The patient had no history of trauma or discharge from the swelling. The patient was of moderate build and a healthy weight. Dental history was not significant. The general systemic examination did not reveal any major illness.Intraoral examination revealed a single large ovoid and well-circumscribed swelling of approximately 3 6 4 cm on the left side of the hard palate. It extended anteroposteriorly from the palatal surface of the left canine to the mesial surface of the left first molar and mediolaterally from the midline of palate to the palatine gingival margins of the upper left canine, premolars and first molar (Figure 1). The overlying mucosa was smooth and intact. The swelling was hard in consistency, tender on palpation and was fixed to underlying structures. There was no evidence of mobility, caries or tenderness of the teeth in the affected region of the jaw.Intraoral periapical radiographs of the upper left canine and premolar region showed a single large radioopaque lesion at the periapical region of the upper left canine, and first and second premolars of approximately 2.0 6 2.5 cm in size. The lamina dura was intact. A panoramic radiograph ( Figure 2) and a lateral maxillary occlusal view (Figure 3) revealed a single large radiopaque lesion in the upper left posterior region extending anteroposteriorly from the upper left central incisor to the first molar and superoinferiorly 0.5 cm away from the cervical line of the upper left lateral incisor, canine, first and second premolars to a...

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