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Oral Pathology - 15 - Fibro-Osseous Lesions

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Oral Pathology1

Clinical Classifications and Disease Categories2

  • Developmental Conditions
  • Mucosal Lesions—Reactive
  • Mucosal Lesions—Infections
  • Mucosal Lesions—Immunologic Diseases
  • Mucosal Lesions—Premalignant
  • Mucosal Lesions—Malignant
  • CT Tumors—Benign
  • CT Tumors—Malignant
  • Salivary Gland Diseases—Reactive
  • Salivary Gland Diseases—Benign
  • Salivary Gland Diseases—Malignant
  • Lymphoid Neoplasms
  • Odontogenic Cysts
  • Odontogenic Tumors
  • Bone Lesions—Fibro-Osseous
  • Bone Lesions—Giant Cell
  • Bone Lesions—Inflammatory
  • Bone Lesions—Malignant
  • Hereditary Conditions

Fibro-Osseous Bone Lesions

Clinical Characteristics and Variants3

  • Composed of a fibroblastic stroma containing foci of mineralized products.
  • Definition: Benign tumors composed of fibrous tissue (connective tissue) in which new bony islands or mineralized products develop.
  • Radiographic Features: These lesions typically contain a radiopaque component due to the osseous and mineralized tissue, distinguishing them from many other cysts and tumors that appear radiolucent.
  • Central variant: Occurs within the bone as a well-circumscribed radiolucency.
    • Central variant detail: It appears as a well-circumscribed radiolucency with radiopaque specks of ossification at the center.
  • Peripheral variant: Occurs on the gingiva (gum).
    • Peripheral variant detail: Occurs in the gum tissue and does not present with the iconic radiolucent bone appearance.
  • Juvenile variant: An aggressive form characterized by rapid growth in younger patients.
  • Similar in clinical appearance and biological behavior to cementifying fibroma (an odontogenic tumor).

Central Ossifying Fibroma

Treatment

  • Treatment consists of surgical excision.

Fibrous Dysplasia

Clinical Presentation and Growth4

  • Characterized by a classic “ground-glass” radiographic appearance.
  • Radiographic Appearance detail: The "ground glass" appearance is a soft radiopaque appearance throughout the lesion.
  • Growth Patterns: The lesion can be very expansile and cause facial distortions.
  • Lesion growth typically stabilizes and stops after puberty.

McCune-Albright Syndrome

  • A systemic condition involving:
    • Polyostotic fibrous dysplasia (involvement of more than one bone).
    • Cutaneous café au lait spots.
    • Endocrine abnormalities, such as precocious puberty.

Treatment

  • Treatment involves surgical recontouring for cosmetic purposes.
  • Timing: It is recommended to wait until after puberty or until the lesion stops growing to prevent recurrence.

Periapical Cemento-Osseous Dysplasia

Clinical Features and Demographics5

  • A reactive process of unknown origin.
  • Most commonly located at the apices of mandibular anterior teeth.
  • Highest prevalence in middle-aged Black females.
  • Associated teeth remain vital.
  • Vitality Significance: Despite the appearance of lesions at the apex, the associated teeth are vital (the pulps are not necrotic), which distinguishes it from endodontic or periodontal infections.

Radiographic Progression and Management

  • Radiographic appearance progresses from radiolucent to radiopaque over time.
  • Progression detail: The lesion often retains a radiolucent border as it becomes more radiopaque.
  • Treatment: None required.

Osteoblastoma

Clinical Definition6

  • A circumscribed opaque mass consisting of bone and osteoblasts.

Treatment

  • Treatment consists of surgical excision.

Radiographic Appearance

The radiographic presentation typically shows a well-defined radiopaque mass, often observed in the mandible.

Radiographic Appearance

Appears radiopaque due to the presence of mineralized tissue.

Footnotes

  1. Original PDF page 1: Oral Pathology - 15 - Fibro-Osseous Lesions, p.1 ↩

  2. Original PDF page 2: Oral Pathology - 15 - Fibro-Osseous Lesions, p.2 ↩

  3. Original PDF page 3: Oral Pathology - 15 - Fibro-Osseous Lesions, p.3 ↩

  4. Original PDF page 4: Oral Pathology - 15 - Fibro-Osseous Lesions, p.4 ↩

  5. Original PDF page 5: Oral Pathology - 15 - Fibro-Osseous Lesions, p.5 ↩

  6. Original PDF page 6: Oral Pathology - 15 - Fibro-Osseous Lesions, p.6 ↩

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