Juvenile Ossifying Fibroma and Socioeconomic Barriers to Specialty Care: A Pediatric Case Study

Abstract

Juvenile ossifying fibroma (JOF) is a rare benign neoplastic fibro-osseous tumor commonly found in the maxilla and mandible of children usually between the ages of five and 15. Patients often present with aggressive, painless growth which is well demarcated from surrounding bone resulting in severe facial asymmetry. JOFs have high recurrence rates if not completely resected and should therefore be treated by a multidisciplinary team of physicians including a neurosurgeon to assess cranial nerve function. This case describes a child who presented to the ED after being referred by his primary care provider for facial swelling. The patient was diagnosed with JOF and had a delay in care due to a lack of access to multidisciplinary specialties to provide care due to payer difficulties which placed the patient at high risk of complications.

Keywords: delayed diagnosis; juvenile trabecular ossifying fibroma; medicaid population; multidisciplinary approach; paediatric otolaryngology; socioeconomic; socioeconomic disparities; telemedicine.

Figure 1. CT head without contrast. Arrow demonstrates large heterogeneous sclerotic and lytic mass involving the left sphenoid, ethmoid, and maxillary sinuses with bony erosion and distortion of the face.

Figure 2. CT-maxillofacial. Large left facial mass with cystic and calcified sclerotic components resulting in severe deformation of face with left proptosis.

Figure 3. MR-brain sagittal view.

Figure 4. MR-brain. Post-surgical resection of large sinonasal mass.