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Riani Sieman*, Peter Agus**

8th Feb 2008

Introduction
Ossifying Fibroma :
Neoplasm composed of fibrous tissue contains a
variable mixture of bony trabeculae,
cementum-like spherules, or both (Neville,
2002)
= cemento-ossifying fibroma = cementifying
fibroma
Osteogenic neoplasm

Introduction
Clinical & Radiographic
features :
3rd 4th decades of life
Female >
Mandible >
Premolar & Molar area
Asymptomatic
Most often well defined &
unilocular

Introduction
Clinical & Radiographic features :
May completely radiolucent, or in varying
degrees of radiopacity. Completely radiopaque
with a radiolucent rim uncommon
Root divergence & resorption of rooots of teeth
Large lesion in mandible downward bowing
of inferior cortex

Introduction
Histopathologic
features :
Well demarcated
With or without fibrous
capsule
Fibrous tissue exhibits
varying degrees of
celularity, contains
osteoid (woven bone) &
spherules resembling
cementum

Introduction

Treatment & Prognosis :


Enucleation
Large lesions & considerable bone
destruction surgical resection & bone
grafting
Prognosis : very good
Recurrence is rare
No evidence of malignant transformation

Case
16 y.o. white girl with a very large
ossifying fibroma in the mandible :
treated with resection followed by
reconstruction by using iliac crest
microvascular flap
Purpose : to overcome aesthetic &
functional problems

Case
Painless swelling
Firm & fixed lesion
No pain on palpation
Distinct & regular
borders
Healthy covering skin
No lymphadenopathy
Paresthesia of
alveolar n.

Case

Well-circumscribed esion w/ mixed radiopaque &


radiolucent appearance

Case
Biopsy : giant cell
Tu

Case
To reduce the
intraoperative time :
Stereolithographic model
of the mandible

Surgical planning
Pre-plating of a titanium
plate

Case
Immediate reconstruction was performed w/ a
microvascular iliac bone flap harvested
from the right ilium :
Positioned through intraoral approach.
A small incision of the skin under the angle of
the mandible allowed the access the to the
facial vessel used for the anastomosis.

Case

WHO (1992) :
COF with aggressive growth in pxs < 15
y.o.
Juvenile OF
Not encapsulated, but well demarcated
High tendency to recurrence

Case

Post surgery
HPA :
active ossifying
fibroma

Case
Fibrocellular tissue containing thin
trabeculae of
newly formed bone (hematoxylin
and eosin stain. Original
magnification 100).

Multinucleated giant cells are seen


close to
osteoid formation in highly vascular
area (hematoxylin
eosin stain. Original magnification 250).

Case

6 months post surgery :


absence of recurrence
and an excellent reconstruction

Discussion

Juvenile OF has a more aggressive growth.


Most cases are symptomatic
Various localization :
> Slootweg et al. (1994) and Makek (1980)
maxilla
> Johnson et al. (1991) 90% occur in the
paranasal
sinuses; 10% in the mandible.
> Hamner et al. (1966), Brannon and Fowler
(2001) , and Sanchez Cuellar et al. (1999)
mandibular predominance.

Discussion

Lesions within the paranasal sinuses &


orbit (Waldron CA, 1993) :
Nasal obstruction, exophthalmos
intracranial extension

Discussion

Radiographic :
Unilocular or multilocular radiolucency, illdefined borders
Occasional central opacification.
Aggressive lesions may show cortical
thinning and perforation.

Discussion
DD/ with other benign lesions :
osteoblastoma
desmoplastic fibroma
fibrous dysplasia
central giant cell granuloma
cherubism.
Benign odontogenic
neoplasms and cysts
(ameloblastoma, ameloblastic
fibroma, ameloblastic fibroodontoma, adenomatoid
odontogenic tumor, and
calcifying odontogenic cyst)

DD/ with malignancy :


Osteosarcoma
Chondrosarcoma
Ewings Sarcoma
Burkitts lymphoma

Discussion
Active :
Agrressive growth
Recurrence : 30-58%
Zama et a. (2004) : immediate recurrence 15
days after conservative surgery
2nd op : second operation for
hemimandibulectomy & reconstruction.

Discussion

Choice of therapy :
Hoffmeister et al. (1989) :
defect < 5 cm & intact soft tissue
envelope free bone graft (iliac bone
graft, e.g.)
Defect > 5 cm & alteration of the covering
soft tissue microvascular graft

DAFTAR PUSTAKA
1.Toro C, Millesi W, Zerman N, Robiony M, Politi
M. A case of aggressive ossifying fibroma
with massive involvement of the mandible:
Differential diagnosis and management
options. International Journal of Pediatric
Otorhinolaryngology Extra (2006) 1, 167172
2. Waldron CA. Bone Pathology. In : Neville BW,
et. Al. editors. Oral & Maxillofacial Pathology.
2nd ed. China; Saunders: 2002.p.563-4.

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