Juvenile trabecular ossifying fibroma in association with multiple mandible deciduous teeth: an atypical case report

Ossifying fibroma is a benign fibro-osseous lesion characterized by the formation of a cellular fibrous connective tissue stroma with cementum-like material and/or osseous components. The juvenile variant is reported to be an aggressive lesion in paediatric patients. Its poor symptomatology contrasts with its highly aggressive behaviour in maxillary or mandibular region. Objective: The aim of the present study is to report a case of an atypical ossifying fibroma in association of multiple deciduous teeth. Case report: A nine years-old girl was referenced to the Oral and Maxillofacial Surgery Service at Positivo University by the Paediatric Service after radiographic confirmation of a round lesion in lower left mandible region. Imaginological examination revealed a well-defined, round, with multiple radiopaque foci associated with the roots of deciduous molars and with root of first permanent mandibular molar of the left side. Lesion embedded the root and crown of the unerupted second left premolar, suggesting that the tumour arouse from it. After incisional biopsy, histopathological analysis suggested the trabecular pattern of juvenile ossifying fibroma. Surgery was conducted through an intra-oral approach. Incision was drawn in gingiva from the left lateral inferior incisor region until the unerupted second molar region, finished with a relaxing incision. A round tumour in association with the unerupted permanent premolars, which were also extracted, was removed in its entire extent by enucleation. Histopathological analysis confirmed the previous diagnosis of juvenile trabecular ossifying fibroma. Peripheral ostectomy was conducted to diminish chances of lesion relapse. Conclusion: 16 months follow-up showed no lesion recurrence.