Jr.of Orofac. Scie.

1(1)2009

Journal of

OROFACIAL SCIENCES
Original Research

Fibro Osseous Lesions Of The Jaw; Study Of 6 Cases

S. Sumanth Krishnaa*, M. Sridhara, P.S . Chakravarthia, Ratnakumari. Ba, L. Krishna Prasada
a

Department of Oral & Maxillofacial Surgery, SIBAR Institute of Dental Sciences, Guntur, India.

ARTICLE INFO
Article History : Received : 7 July 2009 Received in revised form : 22 July 2009 Accepted : 31 July 2009 Key Words : Fibro Osseous Lesions Jaw Lesions Fibrous Dysplasia

ABSTRACT
OBJECTIVE: To outline the clinical aspect of symptomatic Cranio facial fibro osseous lesions and to study appropriate surgical management with follow up results. STUDY DESIGN : Retrospective review of 6 patients who underwent surgical management during 2002 to 2008 in our Maxillofacial center at Sibar Institute Of Dental Sciences, Guntur, Andhra Pradesh,India. RESULTS: Most cases were of fibrous dysplasia and with age group less than 25 years. Maxilla was the most common site. All cases are managed by surgical recontouring, 2 cases had recurrences that were managed by total maxillectomy and decortcation of the mandible. CONCLUSION : Treatment of fibro osseous lesions highly individualized. A conservative approach may not be able to treat all cases of fibro osseous lesions of the jaws. A more radical approach that includes a maxillectomy and decortcation of the mandible is recommended.
2009 SIDS.All Rights Reserved

INTRODUCTION Fibro osseous lesions are common in routine ENT and Oral &Maxillofacial practice. The term Fibrous dysplasia was introduced by Lichtenstein8 in 1938, although the condition had been known previously by a variety of names osteitis fibrosa, fibrous osteoma, osteodystrophia, ossifying fibroma, unilateral Vonrecklinghausens disease and many others. Fibrous dysplasia is a benign lesion characterized by developmental abnormality of the bone-forming mesenchyme in which fibrous tissue gradually expands and replaces the bone .It is believed to be non neoplastic hamartamous developmental lesions of bone of an * Corresponding author : Dr.S. Sumanth Krishna Reader,
Department Of Oral & Maxillo Facial Surgery, SIBAR Institute of Dental Sciences, Takkellapadu, Guntur - 522 509.

unknown origin. Ahmed2 et all 2008 concluded fibrous dysplasia clinically manifest as a localized process involving one bone, as a condition involving multiple bones, or as multiple bone lesions in conjunction with cutaneous and endocrine abnormalities. An association between multiple bone lesions, skin pigmentation, and endocrine dysfunctions that results in sexual precocity in females has been described as MacCune Albright Syndrome. Reeds definition states that fibrous dysplasia is an arrest of bone maturation, woven bone with ossification resulting from metaplasia of a nonspecific fibro osseous type. Treatment for these lesions are usually sought for cosmetic or functional reasons The surgical approaches vary from watchful expectancy for the lesion to stop growing after puberty to conservative resection to radical resection. This article presents our experience in the treatment of fibro osseous lesions of the jaw.
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METHODS : The clinical records of 6 patients from 2002 to 2008 were reviewed .Prior permission from the institution review board was taken for the study. The relevant details about patients age, sex, presentation radiological extent of tumor, treatment, and subsequent follow up were recorded. RESULTS : In our study Mean age of 6 patients (described in table 1)was 24.2 years (range 14 to 35 years),4 patients are under 25 years(66.6%),2 patients are over 30 years(33.3%).The male to female ratio is 2:1.The presenting feature of the disease is facial deformity in all patients .The duration of symptoms varies from 6 months to 15 years, the involved bones are frontal, occipital bone, nasal ,maxilla &mandible. The radiological examinations of the craniofacial bones were pagetoid (33%) cystic (33%) &sclerotic

(33%).Surgical shaving is the treatment of choice in all 6 cases, 2 cases underwent maxillectomy and decortication of mandible after recurrence. DISCUSSION : Fibro osseous lesions have been reported to be more common in females; maxilla is the most commonly affected bone. In general, fibro osseous lesions are more common in membranous bones, less common in ethmoid, sphenoid bone as these bones are cartilaginous in nature. Radiological features are varying, depending on the stage of development and amount of bony matrix within the lesion. In general, changes in the involved bone vary from radiolucent zones to large areas of sclerosis. In early stages the lesion appears radiolucent and well defined. At later stages it changes into smudged, mottled radio -opacity with ill defined border. In general fibrous osseous lesions of jaws are classified 3 parts. Pagetoid, Cystic and Sclerotic.

TABLE-1

CLINICAL DETAILS OF CASES Number 1 2 3 4 5 6 Age 30y 25y 35y 14y 20y 35y Sex M M M F M F Symptoms Cosmetic deformity Cosmetic deformity Cosmetic deformity Cosmetic deformity Cosmetic deformity Cosmetic deformity Disease Fibrous dysplasia Fibrous dysplasia Fibrous dysplasia Cemento osseous dysplasia Cemento osseous dysplasia Cementifying fibroma Radiological features Sclerotic Pagetoid Pagetoid Sclerotic Cystic Cystic

TABLE-1 (CONTINUED) Histopathological Fibrous dysplasia Disease extent Frontal bone, occipital bone, maxilla Maxilla, mandible Maxilla Primary surgery Recontouring Follow-up 1 year Recurrence No recurrence

Fibrous dysplasia Fibrous dysplasia

Recontouring Recontouring Recontouring Recontouring Recontouring

2 years 4years 3 years 4 years 1 year

Cemento osseous Maxilla dysplasia Cemento osseous Mandible dysplasia Cementifying fibroma Maxilla

Recurrence after 1 year Recurrence after 2 year No recurrence No recurrence No recurrence

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The sclerotic form preferentially involves the facial bones and base of skull. In earlier years, surgeons were advised to wait until puberty before operating in the hope that the disease might become arrested at that age. Numerous examples of the disease continuing beyond that period and the continuing dangers to be formed and function of young children during interim period have made such procrastination unacceptable. The surgical procedures do not adversely alter growth rates of the normal tissue, should not precipitate the development of malignancy. Although conservative resection is ideal in fibrous osseous lesions, the radical approach is ideal in Cranio fibrous dysplasia lesions which are present at unusual locations. Our series, all cases underwent primary surgical shaving procedures and 2 cases underwent radical surgery for recurrences .All cases are survived with good cosmetic results. Conclusion : Treatments of fibro osseous lesions highly individualized and range from wait and watch policy to timely surgery. Conservative approach may not be able to treat all cases of fibro osseous lesions of the jaws. A more radical approach may be warranted for extensive lesions that may be in the form of maxillectomy and decortcation of the mandible.

References
1. Fibrous dysplasia of bone and McCune Albright syndrome, Roland et al, vol.22, No.i, pp.55-69, 2008 2. 2Craniofacial polyostotic fibrous dysplasia: a case report and review of the literature, Ahmed et al,doi;10.1016/ j.O.O.O.2008.03.023 3. A clinicoradiological analysis of symptomatic craniofacial fibro-osseous lesions, Naresh k.panada et al,doi:10.106/ j.otohons.2007.01.031 4. Fibrous dysplasia of the mandible :surgical treatment with platelet rich plasma and a corticocancellous iliac crest graft report of a case ,Jose Joaquin et al,doi:10.1016/j. ORAL MEDICINE,ORAL SURGERY,ORAL PATHOLOGY 2007.10.016 5. Endoscopic treatment of fibrous dysplasia confined to the frontal sinus , Simon etal,doi:10.1016/j.otohons.2006.10.025 67Albright F, Butler AM, Hampton AO, et al.Symptoms characterized by osteitis fibrosa disseminate, area of pigmentation and endocrine dysfunction .N Engl j Med 1973; 216:7/27-746 8. Reed Rj Fibrous dysplasia of bone .Arch Pathol 1963; 75:48095. 9. Lichtenstein L.Polyostotic fibrous dysplasia .Arch surg1938; 368:874-98

Fig1- Intraoral examination of swelling of mandible

Fig2- OPG shows Fibrous dysplasia of the mandible

Fig3-Histopathological slide shows Chinese letter pattern

Fig4- Slide Shows Recontouring of the bone

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