A large maxillary cemento-ossifying fibroma superimposed with solitary bone cyst documented over 18 years: A case report

Abstract

Introduction: Cemento-ossifying fibromas are rare, benign lesions of the head and neck regions. The origin of these lesions can be traced to the periodontal ligament, because its cells are able to form cement, lamellar bone, or fibrous tissue.

Case presentation: A rare case report of a young Caucasian female with a COF is described including follow-ups. She remained untreated for several years despite early radiographic findings of the lesion without a definitive diagnosis. The patient ultimately underwent radical surgery and the whole lesion was removed. The subsequent histological examination confirmed the clinical diagnosis of a COF. Since then, the patient has been under regular clinical and radiological follow-ups.

Discussion: This rare case report of a COF, documented over 18 years, shows the importance of consecutive therapy after radiologic and clinical findings, as such lesions continue growing and may subsequently lead to severe medical conditions. Therefore, complete surgical resection of COFs is advised to achieve good results in terms of health and recurrence.

Conclusion: Long-term follow-up of patients is required as recurrences can occur for up to 10 years following treatment. Well-planned radical and wide surgical resection of these lesions has proven not only to be effective in eliminating the aetiological factors, but can also achieve decent bone regeneration and aesthetic results with almost no deformation in the surgical site.

Keywords: Case report; Cemento-ossifying fibroma; Fibrous dysplasia; Juvenile ossifying fibroma; Solitary bone cyst.

Fig. 1

A, orthopantomogram revealing a cystic lesion between teeth 23-26. B, preoperative orthopantomogram in year 2007. E, Postoperative orthopantomogram in year 2007. C, Postoperative orthopantomogram showing adequate removal of the lesion in 2010. D, orthopantomogram obtained in 2017 showing no signs of recurrence and good bone remodelling. E, orthopantomogram obtained in 2019. It is clear to see that the situation hasn’t changed during the years 2017 and 2019.

Fig. 2

A, Preoperative Computer tomography in 2007 showed a large distension within the left sinus maxillaris in size of 3,4 × 3,2 × 2 cm. Signs of sclerosis are clear within the marginal edges of the cystic lesion. B, Computer Tomography during a follow up appointment revealed cystic changes in operated region, prompting another operative removal of the recurrent cyst. C and D, Computer Tomography taken in 2017 and 2019 showed no signs of recurrence and good bone remodeling.

Fig. 3

A, vestibulo-palatal distention in the 2nd quadrant, 2007. B, Cystectomy in year 2007. C, Cystectomy in year 2009. D, a palatinal view of the lesion in year 2017 during a follow-up appointment. E, a palatinal view of the lesion in year 2019 during a follow-up appointment, it is clear to see that the lesion has not changed between year 2017 and year 2019. F, frontal view of the lesion in year 2019.

Fig. 4

A, Histological specimen showing SBC and COF (enlargement 100 μm). B, Histological specimen (enlargement 200 μm). C, Histological specimen showing COF in detail (enlargement 200 μm).