Psammomatoid type juvenile ossifying fibroma of mandible
A 7-year-old boy reported to our unit with the complaint of swelling of the face at right posterior region of the mandible and asymmetry of face since 1 year. Patient's parents presented history of extra-oral swelling since 3 years; initially, swelling appeared small in size and reached to present size with asymptomatic. Extra-oral examination revealed a 3 × 3 cm swelling on the right posterior of the mandible, extending from posterior to the corner of the mouth over the ramus and angle of the mandible []. The swelling appeared bony hard in consistency on palpation and no discharge of pus, paresthesia of the lip or restricted mouth opening. Intraorally, mucosa over swelling appearing in normal color, hard in consistency with expanded cortical plate and also noticed altered vestibular region. Anterioposteriorly, the swelling was extending from permanent first molar to retromolar area and involving the part of ramus region as well. Superioinferiorly, the swelling was extending from retromolar region towards the angle and inferior border of mandible []. Routine radiographs like panoramic, AP and lateral views of skull showed large radioluceny and well-defined sclerotic border along with radiopacity observed in the center of the lesion (mixed lesion) with inferior border intact. The lesion extending from distal to first molar and 1 cm away from the posterior border of ramus of mandible anterioposteriorly. Superioinferiorly, the lesion extending from sigmoid notch towards the inferior border short about 0.5 cm. The panoramic view showed erupted first molar and the second molar, displaced inferiorly and anteriorly, lying below the apex of first molar []. Computed tomography revealed mixed radioluceny and radiodensity and well-defined osteolytic mass involving the right posterior region of the mandible []. Routine blood investigation revealed normal study. Aspiration and biopsy was performed to rule out arteriovenous malformations, cystic lesions, and the fibro-osseous lesions. On aspiration, nothing was revealed and biopsy was done. Histopathology report confirmed psammomatoid type of juvenile ossifying fibroma. Considering the factors like intact inferior border, no involvement of adjacent structures, no paresthesia of lip, and age of the patient, this case was planned primarily for excision and curettage without resection [Figure and ]. Postoperative regular follow-up for 3 years has been done; facial and intra-oral photographs showed normal study [Figure and ]. Panoramic and computed tomography showed osseous regeneration and normal bone pattern [Figure and ]. Regular follow-up has been done since then and there is no evidence of recurrence so far.