Juvenile Aggressive Ossifying Fibroma of the Maxilla: A Case Report and Review of the Literature
A 7-year old female child presented to the pediatric unit of our institution with a 9-month history of right maxillary tumor. A clinical assessment of Burkitt's lymphoma was made, and the child was subjected to several courses of chemotherapy without adequate histologic confirmation. The child was later referred to the maxillofacial unit after about 2 months of unsuccessful management by the pediatricians.\nOn presentation, there was an expansile lesion, measuring about 12 cm by 8 cm in its greatest diameter, involving the right maxilla with proptosis of the right eye and moderate hypertelorism. Vision was, however, intact in the associated right eye. The right nostril was completely obstructed by an exophytic growth, and thus patient had to breathe via the left side []. Intra-orally, the lesion had involved the whole of the right hemipalatal region with a little extension to the contralateral side. The associated teeth had little or no displacement but with grade 1 mobility. On general examination, there was mild palor and weight loss, but there was no difficulty in swallowing.\nComputerized tomographic findings showed a well-delineated osteolytic lesion, which had destroyed the right maxilla and with extension into the maxillary antrum []. Incisional biopsy was done, and the histopathologic analysis confirmed a diagnosis of juvenile aggressive ossifying fibroma of the trabecular variety [].\nA hemi-maxillectomy was planned. A Weber-Feguson incision was used to expose the lesion, which was excised. The lesion was well-defined, and some areas of cystic degeneration were encountered. The lesion was excised along the line of cleavage. Gross examination of the specimen showed multiple gray-white, soft to firm fragments measuring 5.5 × 4.0 × 3.0 cm in largest dimension. The whole specimen was sent for histopathologic diagnosis. Slides from the initial biopsy were reviewed and compared. The initial histologic diagnosis of trabeculae juvenile ossifying fibroma was confirmed. The nasal lesion was found to be in isolation from the maxillary lesion and was excised, labeled separately, and sent for histopathologic diagnosis. The result came out as nasal polyp.\nThe patient was rehabilitated by fabrication of an obturator to cover the surgical defect. Post-operative recovery was uneventful, and patient was discharged after 1 week following surgery.