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
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
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).
Case
Discussion
Discussion
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)
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.
Foto klinis
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