Search Results (33)

Background/Objectives: Fibrous dysplasia (FD) is a benign fibro-osseous disorder characterized by the replacement of normal bone with fibrous tissue and immature woven bone, most commonly involving the craniofacial skeleton. It typically presents as an intraosseous lesion in children and young adults. Fibrous dysplasia may rarely present with predominant gingival involvement and minimal radiographic evidence of intraosseous disease. We report an unusual case of craniofacial fibrous dysplasia that clinically mimicked an exophytic gingival mass in the anterior maxilla of a middle-aged patient. Methods: A middle-aged patient presented with a slowly enlarging gingival mass extending from the right canine to the left central incisor region. After being lost to follow-up for approximately 4.5 years, the patient returned with increased swelling, pain, spacing of the anterior teeth, and functional impairment affecting mastication and speech. Clinical, radiographic, surgical, and histopathologic findings were evaluated. Surgical management included excision of the lesion, extraction of non-restorable teeth, and bone grafting under general anesthesia. Results: Radiographic examination demonstrated minimal osseous involvement without a clearly defined intraosseous expansile lesion. Histopathologic analysis revealed irregular curvilinear trabeculae of woven bone within a fibrous stroma containing bland spindle cell proliferation, consistent with FD. At the six-month follow-up, the patient remained asymptomatic without complications and was undergoing prosthetic rehabilitation with plans for future implant placement. Conclusions: FD may rarely present as a predominantly gingival lesion with minimal radiographic evidence of bone involvement, posing a diagnostic challenge. Recognition of this atypical presentation is important to avoid misdiagnosis and to facilitate appropriate management through comprehensive clinicoradiologic and histopathologic correlation. Full article

The term “periapical lesion” refers to a pathological change in the tissues surrounding the apex of a tooth root, defined by its anatomical location rather than a distinct disease entity. Periapical lesions may be of endodontic origin, most commonly resulting from microbial infection of the root canal system following pulp necrosis due to caries, trauma, or other insults, or of non-endodontic origin, such as developmental cysts, benign and malignant odontogenic and non-odontogenic tumors, and fibro-osseous lesions. Accurate diagnosis requires a systematic approach combining patient history, clinical examination, pulp vitality testing, and radiographic assessment; histopathological evaluation is indicated when clinical and radiographic findings are inconsistent or suspicious. The pathophysiology of these lesions involves dynamic interactions between root canal microorganisms and the host immune-inflammatory response. The primary management for endodontic periapical lesions is root canal treatment, which aims to reduce or eliminate root canal microorganisms through mechanical debridement and chemical disinfection. Persistent or extensive endodontic lesions and non-endodontic lesions may require surgical intervention. Molecular and inflammatory biomarkers have been investigated as adjunctive tools for assessing disease activity and prognosis; however, these remain largely investigational and are not yet part of routine clinical practice. Future developments in artificial intelligence, advanced imaging, molecular diagnostics, and personalized therapies may enhance the diagnosis and management of periapical lesions, although further clinical validation is required. Full article

Extremity vascular malformations in children and adolescents are congenital vascular developmental abnormalities that often present to pediatric orthopedic surgeons with pain, swelling, restricted motion, contracture, gait disturbance, limb asymmetry, and growth-related deformity rather than with an obvious vascular phenotype. The orthopedic importance of these lesions lies less in surface appearance than in their potential to affect muscle balance, joint integrity, osseous development, and peri-procedural safety. This review translates contemporary vascular anomaly classification and multidisciplinary management pathways into a practical orthopedic framework for diagnosis, referral, and longitudinal limb management. The most useful first step is to distinguish low-flow from high-flow lesions and then define lesion depth, periarticular or osseous involvement, coagulopathy risk, and syndromic overgrowth phenotype. Ultrasound is usually the first-line imaging modality for flow characterization, whereas magnetic resonance imaging is the cornerstone for defining extent and planning treatment. Plain radiographs remain highly relevant for identifying phleboliths, osseous remodeling, arthropathy, contracture-related deformity, and limb-length discrepancy. Venous malformations generally warrant pathway-based coagulation assessment, especially D-dimer and fibrinogen, because localized intravascular coagulopathy has direct implications for intervention and surgery. Arteriovenous malformations are best managed within specialist multidisciplinary teams. Fibro-adipose vascular anomaly and syndromic overgrowth phenotypes warrant particular attention because they frequently drive pain, contracture, and progressive limb imbalance. Outcome assessment in this field should extend beyond lesion size and incorporate pain, function, quality of life, and growth-related consequences. For pediatric orthopedic surgeons, management should move from late deformity correction toward early classification, early referral, longitudinal surveillance of joint and growth-related complications, and careful integration of local, surgical, and systemic therapies. Full article

The range of possible inflammatory changes in the oral cavity and in the maxillary and mandibular bones may present with diverse patterns and characteristics in both clinical and radiological evaluation. In most cases, a standard radiological examination, such as dental panoramic radiograph (DPR), has significant limitations in assessing early or complex bone changes associated with chronic bone inflammation. Advanced imaging with multidetector computed tomography or cone-beam computed tomography (MDCT or CBCT) can improve lesion characterization and surgical planning when a detailed evaluation of tooth-bearing structures, tooth apices, cortical plates, and cancellous bone is required. Such imaging allows more detailed assessment of alterations in medullary bone morphology and architecture, as well as identification of possible periosteal reactions adjacent to chronic bone inflammation. Osteomyelitis of the jaws comprises a heterogeneous group of inflammatory bone disorders characterized by variable clinical presentations and a broad spectrum of radiological appearances. Depending on disease chronicity, host factors, and microbial burden, mandibular osteomyelitis may mimic odontogenic tumors, fibro-osseous lesions, or malignant bone pathologies. Quite often, dental treatment affects bone status and condition, leading to unwanted events such as bone inflammation. Imaging plays a central role in diagnosis; however, radiographic findings are often nonspecific, particularly in early or chronic stages. Each case of osteomyelitis underscores the importance of correlating imaging findings with clinical history and highlights the role of repeated imaging in distinguishing inflammatory bone disease from aggressive jaw lesions. This study aims to characterize diverse patterns of chronic mandibular osteomyelitis associated with various prior treatment modalities using CBCT. By presenting a series of illustrative cases from heterogeneous clinical settings, the authors highlight the nonspecific radiographic features and diagnostic challenges inherent in chronic bone inflammation. The focus remains on the interpretation of complex imaging findings rather than a comparative analysis of technical protocols. Full article

Cherubism is a rare fibro-osseous disorder of the jaws that typically presents in early childhood and is recognised as genetically heterogeneous. While the condition is well described in non-African populations, African data and molecular confirmation remain limited. Background/Objectives: This structured narrative review aimed to synthesize published African cases of cherubism by describing patterns of presentation, diagnosis, management, and genetic investigation. Methods: A structured narrative literature review was conducted using PubMed, Scopus, Google Scholar, and African Journals Online. Peer-reviewed case reports and case series describing cherubism in African patients were included. Data extraction followed predefined criteria, capturing demographic features, age at onset and presentation, clinical, radiological and histological findings, management strategies, and the use of molecular genetic testing. Findings were synthesised descriptively. Results: Fourteen studies reporting 20 individual cases from eight African countries were identified, with the majority originating from North Africa. Although symptom onset most commonly occurred in early childhood, the median age at presentation for management was 13.75 years, suggesting delayed access to care. Molecular genetic testing was reported in only two cases, while most diagnoses relied on clinical, radiological, and histopathological features. Surgical intervention was commonly described, with fewer cases managed conservatively. Conclusions: Within the limitations of a structured narrative review based predominantly on published case reports and case series, and constrained by the scarcity of molecularly confirmed cases, the available African literature on cherubism remains limited in scope, geographically skewed, and characterised by incomplete genetic reporting. Recurring features include delayed presentation, reliance on clinical diagnosis, and limited use of molecular testing. These observations reflect gaps in reporting and genetic characterisation rather than population-level patterns, underscoring the need for improved molecular diagnostics, multidisciplinary care, and African registries. Full article

Fibrous dysplasia is an uncommon, intramedullary fibro-osseous lesion representing approximately 5% to 7% of benign fibro-osseous lesions. The incidence of malignant transformation of fibrous dysplasia is considered very rare. The aim of this case report is to present a rare case of a chondro-sarcomatous transformation of a case previously diagnosed with mandibular fibrous dysplasia, a patient who was initially referred for a gingival tumoral extirpation in the third quadrant. A 57-year-old female patient presented for a consultation and, after a biopsy, was diagnosed with fibrous dysplasia of the mandibular bone. After two interventions of surgical removal of the lesion, the malignant transformation of chondrosarcoma occurred, which was identified by radiologic and histopathologic investigations, with the overall AJCC staging being pT1N0M0, G3. Radical resection of the mandibular bone with free margins of tumor was performed. Malignant transformation of mandibular fibrous dysplasia is a very rare and challenging complication of this disease. Early recognition and proper surgical treatment must be the key actions from doctors and clinicians. Full article

Mandible cemento-osseous dysplasia (COD) can be found mostly associated with dental roots and tooth-bearing anatomical structures. A variety of odontogenic cysts and tumors might have similar appearances. A lesion in the jaw bone not associated with dental roots with a cyst-like appearance might suggest a non-odontogenic lesion, an empty bone cavity, an osseous, fibrous, or fibro-osseous lesion, or a traumatic bone cyst (TBC). A radiolucent irregular bone cavity without clear borders always requires improved diagnostics in cone-beam computed tomography (CBCT) as well as a revision and a biopsy in some cases. When there is some bone swelling and asymmetry on radiological evaluation, followed by extra-cortical spread, and the lesion has irregular borders with thickening or atypical calcifications, a biopsy should be performed. COD and TBCs can be found mostly associated with dental roots, but sometimes they are not associated with tooth-bearing jaw structures and might cause some diagnostic problems, especially if they resemble an empty radiolucent cystic-like lesion in an atypical location. Regardless of the type of lesion, a bone revision and a biopsy are important. When a sufficient amount of a sample is removed and evaluated, this can greatly improve the final diagnosis. The authors present an interesting case of a lesion accidentally found in a routine panoramic radiograph used for screening before scheduled orthodontic treatment. Full article

Background and Clinical Significance: Juvenile ossifying fibroma (JOF) is a rare, benign, but locally aggressive fibro-osseous neoplasm that primarily affects the craniofacial skeleton of children and adolescents. Early surgical intervention is often required due to the lesion’s rapid growth and potential for significant facial deformity. Long-term functional and esthetic rehabilitation following maxillary resection in early childhood remains a clinical challenge. Case Presentation: This case reports a unique long-term follow-up of a 22-year-old female patient who underwent partial maxillary resection at the age of five due to JOF. Initial reconstructive efforts failed, necessitating a removable prosthesis to restore function and appearance. The patient experienced persistent self-consciousness and social withdrawal during adolescence, attributed to altered facial esthetics and repeated surgical disappointment. Nevertheless, prosthetic rehabilitation significantly improved mastication, phonetics, facial symmetry, and psychological well-being. Conclusions: The enduring psychosocial and functional impact of early maxillary resection for JOF and the pivotal role of prosthodontic management in long term rehabilitation are highlighted. A multidisciplinary approach that includes psychological support is suggested. This case report is among the few reports documenting long-term prosthetic outcomes for pediatric JOF patients extending into adulthood. Full article

Background and Clinical Significance: Chronic nonbacterial osteomyelitis (CNO) of the jaw is a rare autoinflammatory bone disorder that primarily affects children and adolescents. Diagnosing CNO of the mandible can be challenging due to its rarity, and the clinical and radiographic findings overlap with those of other bone disorders. Case Presentation: This case series retrospectively presents four female pediatric patients (9–12 years old) diagnosed with mandibular CNO. The patients were treated at King Abdulaziz University Dental Hospital, Jeddah, Saudi Arabia, between 2018 and 2024. Clinical features and radiographic and histopathological findings were evaluated. All cases had mandibular swelling and pain. Radiographic features consistently revealed mixed sclerotic and radiolucent lesions with bone expansion and periosteal reactions. Histopathological findings revealed viable bone interspersed with varying degrees of fibrous tissue. No evidence of bacterial colonies or inflammation was observed. This case series highlights the radiographic and histopathological features of CNO in the mandible of pediatric patients. The mixed radiographic features and variability of histopathological findings combined with the refractory nature of the lesions contribute to diagnostic complexity. Diagnostic challenges include differentiating CNO from other inflammatory and fibro-osseous conditions. The presence of recurrent episodes of pain, the formation of subperiosteal bone, periostitis, lysis of the cortical layer, expansion of the mandibular canal, and sterile bone biopsies with nonspecific inflammatory changes were related mainly to CNO. Conclusions: These findings underscore the need for increased awareness and a multidisciplinary approach for accurate diagnosis and management of CNO. Conservative management, particularly in dental cases, avoids prolonged unnecessary use of antibiotics, and the prescription of nonsteroidal anti-inflammatory drugs should be followed. Full article

The occurrence of osseous, fibrous, and fibro-osseous lesions in the jaw bones might pose challenges for accurate diagnosis and the selection of the best therapeutic approach. Certain radiolucent, radiopaque, or mixed-origin lesions can look very similar to other bone lesions, because of the stages of their growth, calcification, maturation, and possible local factors affecting the lesion. Ossifying fibroma (OsF, OF) is a type of fibro-osseous lesion, whose radiological characteristics might sometimes be uncertain. It may appear on classic radiographs and cone beam computed tomography as a radiolucent/radiopaque lesion with calcification bodies or a shape with a cloud-like appearance. The appearance is mostly related to the lesion’s maturation level, calcification stage, and number of fibrous elements. Diagnosis might be challenging. Its histopathological evaluation reveals a combination of mineralized and fibrous connective tissues in the mass. From a radiological point of view, because of the tumor’s various stages of bone remodeling, formation, and resorption, diagnosis might be troublesome. Different diagnoses should include cemento-osseous dysplasia, fibrous dysplasia, or cementoblastoma. A biopsy could provide an accurate histopathological examination, improving diagnosis and influencing later surgical approaches. Regardless of the final specimen evaluation, surgery is the treatment of choice. The authors would like to present the correlation between radiological and histopathological data in tumor treatment outcomes. Full article

Introduction: Liposclerosing myxofibrous tumors (LSMFTs) have been described as an infrequent and peculiar fibrous dysplasia variant with a predilection for the intertrochanteric femoral region and are not globally considered a distinct tumor. Given their features, they may be confused with a variety of entities. Our aim is to analyze the clinical, radiological, histopathological and molecular features of LSMFTs. Material and Methods: We report 15 new LSMFT cases managed in our tertiary referral hospital and compare our findings with those of the 241 previous LSMFT cases published in the English medical literature. Results: In plain radiography and computerized tomography, LSMFTs are well-defined intraosseous lytic masses with peripheral sclerotic rims and variable amounts of internal calcifications. Histopathologically, LSFMTs consist of variable amounts of spindle cells, bone matrix, adipose tissue, and cystic spaces embedded in a predominantly fibromyxoid stroma. Molecular tests reveal GNAS and TP53 mutations. Conclusions: Knowledge of LSMFT and its typical radiological appearance with heterogeneous histopathological findings—especially in small biopsies—are key to preventing the misdiagnosis and overtreatment of affected patients. Full article

Background: Fibrous dysplasia (FD) is often difficult for skull base surgeons to address. FD arises due to the abnormal proliferation of fibroblasts, ultimately resulting in immature osseous tissue replacing normal cancellous bone. When the skull base is involved, it can result in cranial nerve compression. FD affecting the optic canal and optic nerve is the most concerning as new onset of vision loss is considered a surgical emergency. The prevalence of FD is approximately 3.6 per 1,000,000. The most severe implications of this disease are neurological deficits due to cranial nerve compression, cosmetic appearance, and high recurrence rates even in the setting of surgical and medical therapy interventions. Methods: A PubMed search of “pediatric fibrous dysplasia management” using MESH Terms was conducted. Articles were excluded for non-English languages, inaccessibility, and events/erratum/letters to the editor. Included articles were in English, as well as encompassed pediatric FD case reports or comprehensive reviews of FD that discussed pediatric presentations. Results: A total of 109 articles were reviewed, and 44 were included in the final review. Most articles were case reports. There is a clear need for guidelines regarding surgical intervention, especially in the pediatric population, where hormonal fluctuation can influence rates of recurrence and bony deformity. Overall, most surgeons recommend close observation with biomarkers and radiographic imaging for asymptomatic patients until at least the age of 16 years old. Conservative methods, such as RANK-L inhibitors, can be utilized to decrease growth with some success, especially in older adolescents. Conclusion: This review is an update on this disease and its presentations, imaging findings, and treatment options. The current literature lacks clear guidance on management, especially in regard to surgical intervention or recurrence monitoring algorithms. Full article

Background: Cemento-osseous dysplasias (CODs) are rare lesions of the jawbone. Their occurrence, localization, type, size, and shape can vary between cases. This fibro-osseous lesion is typically found in the jaw near tooth-bearing areas and is often asymptomatic, discovered incidentally, and may be associated with the periapical region of the teeth. In rare cases, COD can lead to secondary bone osteomyelitis. Currently, there is limited information in the literature on the occurrence and characteristics of COD. This paper’s main aim was to focus on the authors’ COD experience in the lower Silesian area. Methods: A retrospective evaluation of radiographies (RTG-Panx, cone-beam computed tomography (CBCT)) was conducted on patients treated, diagnosed, or consulted by the authors. A statistical correlation analysis was made to establish any relationship within the gathered data. Results: COD is predominantly an incidental finding in the mandibular bone near tooth apices. It is most commonly diagnosed in females. Both CBCT and panoramic radiographies are generally sufficient for diagnosing the lesion. COD rarely requires treatment. Conclusions: COD lesions are mostly discovered incidentally during routine radiographies or cone-beam computed tomography (CBCT) scans. In most cases, clinical and radiological monitoring is sufficient, along with evaluating the teeth’s response to cold stimuli and assessing the surrounding bone structures. Biopsies or tooth extractions are seldom necessary. When oral hygiene is well-maintained and no periapical inflammation is present, COD lesions typically remain asymptomatic. Full article

Fibrous dysplasia (FD) is a mosaic skeletal disorder involving the development of benign, expansile fibro-osseous lesions during childhood that cause deformity, fractures, pain, and disability. There are no well-established treatments for FD. Fibroblast activation protein (FAPα) is a serine protease expressed in pathological fibrotic tissues that has promising clinical applications as a biomarker and local pro-drug activator in several pathological conditions. In this study, we explored the expression of FAP in FD tissue and cells through published genetic expression datasets and measured circulating FAPα in plasma samples from patients with FD and healthy donors. We found that FAP genetic expression was increased in FD tissue and cells, and present at higher concentrations in plasma from patients with FD compared to healthy donors. Moreover, FAPα levels were correlated with skeletal disease burden in patients with FD. These findings support further investigation of FAPα as a potential imaging and/or biomarker of FD, as well as a pro-drug activator specific to FD tissue. Full article

Introduction: Ectopic foreign bodies in the maxillary sinus occur rarely. Ectopic tooth eruption rarely occurs in the orbit, nasal cavity, maxillary sinus, and elsewhere. Ectopic eruption of teeth in the maxillary sinus is most commonly associated with wisdom teeth and is rarely associated with supernumerary teeth. This rare phenomenon may be accompanied by chronic recurrent sinusitis with headaches and facial pain. However, fibro-osseous lesions in the paranasal sinuses are discovered incidentally on X-ray images and are often asymptomatic. Osteoma is the most common fibro-osseous lesion that develops in the paranasal and nasal sinuses. Osteomas rarely cause serious symptoms such as orbital lesions and intracranial invasion. Case Presentation: We report a rare case of exostosis containing supernumerary teeth within the maxillary sinus. A characteristic pedicled bone lesion with a clear border on computed tomography was the undefined orthopantomogram radiopacity in the maxillary sinus, and the lesion contained supernumerary teeth. As the patient had chronic nasal congestion, the tumor was surgically removed. Pathologically, the surgical specimen revealed an osteoma. The patient’s symptoms of chronic sinusitis disappeared. Because the patient had no history of midface trauma or surgery, the supernumerary teeth were speculated to have migrated during a reactive osteogenic process caused by chronic sinusitis. Conclusions: A foreign body in the maxillary sinus can be easily diagnosed by computed tomography. Surgical removal is recommended if the foreign body is symptomatic or occupies more than half of the maxillary sinus. This can help resolve chronic sinusitis symptoms and prevent serious complications in the future. Full article