Rare benign fibroosseous lesion in the mandibular angulus: a case presentation

Abstract

Fibro-osseous lesions are a poorly defined group of processes affecting the jaws and craniofacial bones characterized by the replacement of normal bone with fibrous tissue containing a newly formed mineralized product, and include developmental lesions, reactive or dysplastic lesions and neoplasms. Fibro-osseous lesions of the jaws frequently include fibrous dysplasia, cemento osseous dysplasia and ossifying fibroma. Although the histological appearance and clinical and radiographic features of most of these lesions are similar, they show a wide range of biological behaviours. Therefore, the treatment varies. The case described in this article presents a 50-year-old male patient with a fibroosseous lesion located in the right mandibular angulus. Based on the histologic findings, fibroosseous the lesion was diagnosed. The patient was referred to surgery. No invasive procedure was performed for treatment and regular clinical and radiological follow-up was recommended. Fibroosseous lesions in this region is very rare in the literature. This situation makes the case valuable.

Keywords

• Fibroosseous lesion
• cone-beam computed tomography
• mandibular angulus

References

1. Mosier, K.M. Lesions of the jaw. Semin Ultrasound CT MRI. 2015; 36(5):444-450.
2. Mainville GN, Turgeon DP, Kauzman A. Diagnosis and management of benign fibro-osseous lesions of the jaws: a current review for the dental clinician. Oral Dis. 2017;23(4):440-450. doi:10.1111/odi.12531
3. Fenerty S, Shaw W, Verma R, et al. Florid cemento-osseous dysplasia: review of an uncommon fibro-osseous lesion of the jaw with important clinical implications. Skeletal Radiol. 2017;46(5): 581-590. doi:10.1007/s00256-017-2590-0
4. Wright JM, Vered M. Update from the 4th Edition of the World Health Organization classification of head and neck tumours: odontogenic and maxillofacial bone tumors. Head Neck Pathol. 2017;11(1):68-77. doi:10.1007/s12105-017-0794-1
5. Chauhan I, Roy S, Garg V, Manchanda K. Fibro-osseous lesions of the jaws: an insight. Int J Contemp Dent Med. 2014,828-835.
6. Worawongvasu R, Songkampol K. Fibro-osseous lesions of the jaws: an analysis of 122 cases in Thailand. J Oral Pathol Med. 2010;39(9):703-708. doi:10.1111/j.1600-0714.2010.00932.x
7. Izzetti R, Nisi M, Aringhieri G, Crocetti L, Graziani F, Nardi C. Basic knowledge and new advances in panoramic radiography imaging techniques: a narrative review on what dentists and radiologists should know. Appl Sci. 2021;11(17):7858.
8. Różyło-Kalinowska I. Panoramic radiography in dentistry. Clin Dent Rev. 2021:5(1):26.

9. Mao WY, Lei J, Lim LZ, Gao Y, Tyndall DA, Fu K. Comparison of radiographical characteristics and diagnostic accuracy of intraosseous jaw lesions on panoramic radiographs and CBCT. Dentomaxillofac Radiol. 2021;50(2):20200165. doi:10.1259/dmfr. 20200165
10. Kolomvos N, Theologie-Lygidakis N, Christopoulos P, Iatrou I. Benign fibro-osseous lesions of the jaws in children. A 12-year retrospective study. J Craniomaxillofac Surg. 2013;41(7):574-580. doi:10.1016/j.jcms.2012.11.029
11. de Noronha Santos Netto J, Machado Cerri J, Miranda AM, Pires FR. Benign fibro-osseous lesions: clinicopathologic features from 143 cases diagnosed in an oral diagnosis setting. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;115(5):e56-e65. doi:10.1016/j.oooo.2012.05.022
12. MacDonald DS. Classification and nomenclature of fibro-osseous lesions. Oral Surg Oral Med Oral Pathol Oral Radiol. 2021;131(4): 385-389. doi:10.1016/j.oooo.2020.12.004
13. Sarmento DJ, Monteiro BV, de Medeiros AM, da Silveira EJ. Severe florid cemento-osseous dysplasia: a case report treated conservatively and literature review. Oral Maxillofac Surg. 2013; 17(1):43-46. doi:10.1007/s10006-012-0314-0
14. White SC, Pharoah MJ. White and pharoah’s oral radiology: principles and interpretation. Elsevier Health Sciences. 2018.
15. Fitzpatrick KA, Taljanovic MS, Speer DP, et al. Imaging findings of fibrous dysplasia with histopathologic and intraoperative correlation. AJR Am J Roentgenol. 2004;182(6):1389-1398. doi:10. 2214/ajr.182.6.1821389
16. Feller L, Wood NH, Khammissa RA, Lemmer J, Raubenheimer EJ. The nature of fibrous dysplasia. Head Face Med. 2009;5:22. doi:10.1186/1746-160X-5-22
17. Liu Y, Wang H, You M, et al. Ossifying fibromas of the jaw bone: 20 cases. Dentomaxillofac Radiol. 2010;39(1):57-63. doi:10.1259/dmfr/96330046
18. Kaur H, Verma S, Jawanda MK, Sharma A. Aggressive osteoblastoma of the mandible: a diagnostic dilemma. Dent Res J (Isfahan). 2012;9(3):334-337.
19. Matthies L, Rolvien T, Pakusa TJ, et al. Osteoid osteoma of the mandible-clinical and histological findings. Anticancer Res. 2019; 39(1):291-296. doi:10.21873/anticanres.13110
20. Chaudhary M, Kulkarni M. Osteoid osteoma of mandible. J Oral Maxillofac Pathol. 2007;11(2):52-55.
21. Jones AC, Prihoda TJ, Kacher JE, Odingo NA, Freedman PD. Osteoblastoma of the maxilla and mandible: a report of 24 cases, review of the literature, and discussion of its relationship to osteoid osteoma of the jaws. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102(5):639-650. doi:10.1016/j.tripleo.2005.09. 004
22. Liu CJ, Chang KW, Chang KM, Cheng CY. A variant of osteoid osteoma of the mandible: report of a case. J Oral Maxillofac Surg. 2002;60(2):219-221. doi:10.1053/joms.2002.29830
23. Soluk-Tekkesin M, Sinanoglu A, Selvi F, Cakir Karabas H, Aksakalli N. The importance of clinical and radiological findings for the definitive histopathologic diagnosis of benign fibro-osseous lesions of the jaws: study of 276 cases. J Stomatol Oral Maxillofac Surg. 2022;123(3):364-371. doi:10.1016/j.jormas.2021. 04.008
24. Eversole R, Su L, ElMofty S. Benign fibro-osseous lesions of the craniofacial complex. Head Neck Pathol. 2008;2(3):177-202. doi: 10.1007/s12105-008-0057-2
25. Kato CNAO, Nunes LFM, Chalub LLFH, Etges A, Silva TA, Mesquita RA. Retrospective study of 383 cases of fibro-osseous lesions of the jaws. J Oral Maxillofac Surg. 2018;76(11):2348-2359. doi:10.1016/j.joms.2018.04.037
26. MacDonald DS. Maxillofacial fibro-osseous lesions. Clin Radiol. 2015;70(1):25-36. doi:10.1016/j.crad.2014.06.022
27. MacDonald-Jankowski DS. Fibro-osseous lesions of the face and jaws. Clin Radiol. 2004;59(1):11-25. doi:10.1016/j.crad.2003.07.003
28. Speight PM, Carlos R. Maxillofacial fibro-osseous lesions. Curr Diagnos Pathol. 2006;12(1):1-10.
29. Crane H, Walsh H, Hunter KD. Fibro-osseous lesions of the jaws. Diagnos Histopathol. 2024.
30. Makkad RS, Naidu GS, Nagi R, Sagtani A, Patil S, Shrivastava S. Multiple fibro-osseous lesions of the jaws: a report of a rare case with a literature review. Imaging Sci Dent. 2021;51(4):461-466. doi:10.5624/isd.20210021
31. Akashi M, Matsuo K, Shigeoka M, et al. A case series of fibro-osseous lesions of the jaws. Kobe J Med Sci. 2017;63(3):E73-E79.
32. Suarez-Soto A, Baquero-Ruiz de la Hermosa MC, Minguez-Martínez I, et al. Management of fibro-osseous lesions of the craniofacial area. Presentation of 19 cases and review of the literature. Med Oral Patol Oral Cir Bucal. 2013;18(3):e479-e485.
33. Phattarataratip E, Pholjaroen C, Tiranon P. A clinicopathologic analysis of 207 cases of benign fibro-osseous lesions of the jaws. Int J Surg Pathol. 2014;22(4):326-333. doi:10.1177/106689 6913511985
34. Qian J, Rubio A, Powers JM, et al. Fibro-osseous lesions of the central nervous system: report of four cases and literature review. Am J Surg Pathol. 1999;23(10):1270-1275. doi:10.1097/00000478-199910000-00013
35. Albu G, Deák G, Mencser Z, Vajtai I. Fibro-osseous lesion of the central nervous system. Orv Hetil. 2001;142(22):1165-1167.
36. Reia VCB, de Toledo Telles-Araujo G, Peralta-Mamani M, Biancardi MR, Rubira CMF, Rubira-Bullen IRF. Diagnostic accuracy of CBCT compared to panoramic radiography in predicting IAN exposure: a systematic review and meta-analysis. Clin Oral Investig. 2021;25(8):4721-4733. doi:10.1007/s00784-021-03942-4
37. Neves FS, Souza TC, Almeida SM, Haiter-Neto F, Freitas DQ, Bóscolo FN. Correlation of panoramic radiography and cone beam CT findings in the assessment of the relationship between impacted mandibular third molars and the mandibular canal. Dentomaxillofac Radiol. 2012;41(7):553-557. doi:10.1259/dmfr/ 22263461
38. MacDonald D. Lesions of the jaws presenting as radiolucencies on cone-beam CT. Clin Radiol. 2016;71(10):972-985. doi:10.1016/j.crad.2016.05.018