IADR Abstract Archives
Cemento-Ossifying Fibroma of the Mandible - an Unusual Presentation in a Child
Objectives: To raise awareness of the presence of rare lesion in a child in the differential diagnoses of mandibular swellings. To understand the histopathological features of cemento-ossifying fibroma and its significance for accurate diagnosis. To understand the importance of early intervention and management of the lesion and its need of long-term follow-up. To appreciate the importance of different inputs from multi-disciplinary teams throughout the care pathway of the patient.
Methods: A 14-year old fit and well girl of Black African-Caribbean background was referred from the Paediatric Dentistry department to the Oral Surgery department in July 2019 with a complaint of left mandibular swelling. The swelling had been present for two years with gradual increase in size. Clinical examination revealed a firm, painless bony expansion encompassing the LL3 to the LL6 which measured 30mm x 15mm in size. Differential diagnoses of fibrous dysplasia and cemento-ossifying fibroma were made based on radiological findings. An incisional biopsy of left mandible was undergone in April 2020. Surgical excision of lesion, removal of LL4, LL5, LLD, ULD and ULE and placement of synthetic bone graft were carried out under general anaesthesia in June 2020.
Results: Histopathological analyses revealed fragments of a fibro-osseous lesion composed of dense fibro-cellular connective tissue and spherules of cementum-like material displaying ossification and mineralisation, entrapped with trabecular bone. The specimens confirmed the diagnosis of cemento-ossifying fibroma of the left mandible. The patient made an uneventful recovery from the surgery with no loss of sensation or paraesthesia on the left mental region. Further follow-ups necessitating CBCT images are required. The patient was also referred to the Orthodontic department for assessment of gaps post-surgery and general malocclusion. Regular inputs from the patient’s general dental practitioner are crucial for monitoring of teeth vitality and oral hygiene up-keeping.
Conclusions: Prompt management of the lesion is imperative to ensure good prognosis with less complications. Long term follow-ups are pivotal due to the likelihood of recurrence for lesions of this nature. The involvement of multi-disciplinary care of a patient before, during and after treatment cannot be overemphasized.
Methods: A 14-year old fit and well girl of Black African-Caribbean background was referred from the Paediatric Dentistry department to the Oral Surgery department in July 2019 with a complaint of left mandibular swelling. The swelling had been present for two years with gradual increase in size. Clinical examination revealed a firm, painless bony expansion encompassing the LL3 to the LL6 which measured 30mm x 15mm in size. Differential diagnoses of fibrous dysplasia and cemento-ossifying fibroma were made based on radiological findings. An incisional biopsy of left mandible was undergone in April 2020. Surgical excision of lesion, removal of LL4, LL5, LLD, ULD and ULE and placement of synthetic bone graft were carried out under general anaesthesia in June 2020.
Results: Histopathological analyses revealed fragments of a fibro-osseous lesion composed of dense fibro-cellular connective tissue and spherules of cementum-like material displaying ossification and mineralisation, entrapped with trabecular bone. The specimens confirmed the diagnosis of cemento-ossifying fibroma of the left mandible. The patient made an uneventful recovery from the surgery with no loss of sensation or paraesthesia on the left mental region. Further follow-ups necessitating CBCT images are required. The patient was also referred to the Orthodontic department for assessment of gaps post-surgery and general malocclusion. Regular inputs from the patient’s general dental practitioner are crucial for monitoring of teeth vitality and oral hygiene up-keeping.
Conclusions: Prompt management of the lesion is imperative to ensure good prognosis with less complications. Long term follow-ups are pivotal due to the likelihood of recurrence for lesions of this nature. The involvement of multi-disciplinary care of a patient before, during and after treatment cannot be overemphasized.