Journal of the Louisiana State Medical Society
than a true difference in tumor biology. 3,6,7 JOF are character- ized by fibrocellular stroma of spindle- or stellate-shaped cells with bony trabeculae, with or without osteoblastic rimming, and lacking cementicles or a formal capsule. Bony trabeculae vary in size and often are a combination of woven and lamellar components. The twomain histologic subtypes of JOF are trabecular (WHO type) and psammomatoid. 2,3,7,8 Ossifying fibromas contain similar fibrocellular stroma and are characterized by osteoblastic rimming due to rapid growth. By contrast, fibrous dysplasia is characterised by fibrous stroma with loose myxomatous areas, a good blood supply, feathery irregular-shaped trabeculae of immature “woven” bone (“Chinese character” shapes), and a poorly- defined periphery. 2,5,8 Radiographically, OF lesions are monostotic and well circumscribed. 4 They appear osteolytic and progess to a mixoid appearance. Lesions that contain greater amounts of cementum may contain additional irregular radiopaque or radiolucent areas. As is the case with our presentation, these lesions may exhibit cortical expansion and bony thinning. 2,9,10 However, these imaging characteristics are relatively nonspecific in appearance andmake preoperative diagnosis based on imaging alone difficult. Due to potential involvement of crucial adjacent struc- tures and high recurrence rate, management of OFs in the paranasal sinuses and turbinates is surgical. These lesions do not tend to metastasize. 4 However, radiotherapy can in- duce malignant transformation (0.4%-44% increased risk). 1,4 Several approaches have been described, including simple curettage, functional endoscopic sinus surgery, a sublabial Caldwell-Luc type approach, and even radical maxillec- tomy. 3,6,7,10 Themain goals of surgery are to achieve complete resection while preserving cosmesis and function of the eye. In conclusion, juvenile ossifying fibroma is a locally destructive neoplasm of the pediatric population. Early recognition of this entity and complete surgical excision of these lesions can achieve promising results. REFERENCES 1. Gondivkar SM, Gadbail AR, Chole R, Parikh RV, Balsaraf S. Ossifying fibroma of the jaws: Report of two cases and literature review. Oral Oncol . 2011 Sep;47(9):804-9. 2. Hamner JE, Scofield HH, Cornyn J. Benign fibro-osseous jaw lesions of periodontal membrane origin: An analysis of 249 cases. Cancer . 22;1968(22):861–878. 3. Hakeem AH, Hakeem IH. Intraoral Sublabial Approachfor Anterior Skull Base Juvenile Ossifying Fibroma. J Craniofac Surg . 2011 Sep;22(5):1976-7. 4. Caylakli F, Buyuklu F, Cakmak O, Ozdemir H, Ozluoglu L. Ossifying fibroma of the middle turbinate: a case report. Am J Otolaryngol . 2004 Sep-Oct;25(5):377-8. 5. Galvan O, Gassner EM, Neher A, Gunkel AR. Fibro-osseous lesion of the middle turbinate: ossifying fibroma or fibrous dysplasia? J Laryngol Otol . 2007 Dec;121(12):1201-3. 6. Bowyer JD, Majid MA, Ah-Fat F, Kaye SB, Kokai GK, May PL, McCormick M. Giant cemento-ossifying fibroma of the maxilla causing proptosis in a young patient. J Pediatr Ophthalmol Strabismus . 2001 Nov-Dec;38(6):359-62.
7. Slootweg PJ, Panders AK, Koopmans R, Nikkels PG. Juvenile ossifying fibroma. An analysis of 33 cases with emphasis on histopathological aspects. J Oral Pathol Med . 1994 Oct;23(9):385-8. 8. Williams HK, Mangham C, Speight PM. Juvenile ossifying fibroma. An analysis of eight cases and a comparison with other fibro-osseous lesions. J Oral Pathol Med . 2000 Jan;29(1):13-18. 9. White SC, Pharoah MJ. Oral radiology principles and interpretation . 5th ed. St. Louis, MO: Mosby; 2004: 498–501. 10. Yang HY, Zheng LW, Luo J, Yin WH, Yang HJ, Zwahlen RA. Psammomatoid juvenile cemento-ossifying fibroma of themaxilla. J Craniofac Surg . 2009 Jul;20(4):1190-2. Dr. Carter is with the Tulane University Department of Otolaryngology - Head and Neck Surgery in New Orleans. Dr. Winters is with the Department of Otolaryngology and Communication Sciences, State University of New York – Upstate Medical University in Syracuse, New York. Dr. Yang with the Department of Pediatric Otolaryngology Head & Neck Surgery, Cincinnati Children’s Hospital Medical Center in Cincinnati, Ohio. Dr. St. Hilaire is with the Louisiana State University Division of Plastic and Reconstructive Surgery in New Orleans. Dr. Rodriguez is the with the Ochnser Health System Department of Otolaryngology - Head and Neck Surgery in New Orleans.
102 J La State Med Soc VOL 166 May/June 2014
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