|Year : 2008 | Volume
| Issue : 2 | Page : 71-73
Rare odontogenic tumor of the mandible
V Vaishnavee, Karthikshree V Prashad, SV Srinivasan, M Jonathan Daniel
Department of Oral Medicine and Radiology, Mahatma Gandhi Postgraduate Institute of Dental Sciences, Puducherry, India
Postgraduate Student, Dept. of Oral Medicine and Radiology, Mahatma Gandhi Postgraduate Institute of Dental Sciences, Indira Nagar, Puducherry- 605006
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Central odontogenic fibroma is an extremely rare benign tumor accounting for less than 0.1% of all odontogenic tumors. This case report describes a case of central odontogenic fibroma arising in relation to the left lower second premolar and first molar in a 21 year old male. The tumor was a well-circumscribed intraosseous lesion occurring inter-radicularly, which gave a radiographic picture of the lateral periodontal cyst. Histopathologically, the lesion was reported to have characteristic features of central odontogenic fibroma.
Keywords: Benign, central, fibroma and odontogenic tumor
|How to cite this article:|
Vaishnavee V, Prashad KV, Srinivasan S V, Daniel M J. Rare odontogenic tumor of the mandible. J Indian Acad Oral Med Radiol 2008;20:71-3
|How to cite this URL:|
Vaishnavee V, Prashad KV, Srinivasan S V, Daniel M J. Rare odontogenic tumor of the mandible. J Indian Acad Oral Med Radiol [serial online] 2008 [cited 2020 Sep 20];20:71-3. Available from: http://www.jiaomr.in/text.asp?2008/20/2/71/44369
| Introduction|| |
The central odontogenic fibroma is a rare benign central mesodermal neoplasm of odontogenic origin  accounting for less than 0.1% of all odontogenic tumors. It occurs exclusively in the mandible and maxilla and is considered to be derived from the mesenchymal tissues of dental origin: periodontal ligament, dental papilla or dental follicle.  Although the growth may arise from the periodontal membrane, it usually does not interfere with odontogenesis. 
The great variability in radiologic appearance of central odontogenic fibroma emphasizes that despite its rarity, central odontogenic fibroma should be considered in the differential diagnosis of all abnormal radiolucencies of the jaws. 
| Case Report|| |
A 21 year old male presented to the Department of Oral Medicine and Radiology, Mahatma Gandhi Postgraduate Institute of Dental Sciences, Puducherry in May 2007 with pain in relation to the left lower posterior teeth of one week duration.
His medical history was non-contributory. On general physical examination, left submandibular lymphadenopathy was noted.
On intra-oral examination, the teeth in the region of concern were sound with no evidence of carious involvement. No periodontal pockets or mobility of teeth were present. The teeth were non-tender on percussion.
On palpation, the buccal cortical plate in relation to 35, 36 region showed mild expansion [Figure 1].
Pulp vitality was done and it was elicited that there was a delayed response in 34 and no response in 35 and 36.
Based on above findings, a provisional diagnosis of a benign odontogenic tumor or cyst was considered.
Panoramic radiograph showed a well defined unilocular septate radiolucency of 0.5 cm diameter with partially sclerotic borders present inter-radicularly between 35 and 36 [Figure 2].
Mandibular occlusal view revealed mild buccal cortical plate expansion in relation to 35 and 36 [Figure 3].
Correlating clinical and radiographic findings, a working diagnosis of odontogenic tumor such as unilocular ameloblastoma or odontogenic fibroma was made. The lesion was surgically removed and sent for histopathologic examination.
The lesion consisted of fibrous connective tissue with delicate fibers in certain areas and hyalinized tissue in other areas. Throughout, there were plump and spindle shaped fibroblasts in fibrous background. No evidence of odontogenic epithelium seen. Occasional areas of foci of calcification noticed [Figure 4]. Based on clinical feature of centrally located lesion and histological predominance of fibrous connective tissue, the pathology was suggestive of central odontogenic fibroma of the simple type.
| Discussion|| |
The central odontogenic fibroma is perhaps the most ill-defined and least understood of the neoplasms of odontogenic origin. This is due, in part to its rare occurrence. 
The central odontogenic fibroma, like the odontogenic myxoma, is unique to the bones of the jaws and is reported more commonly in the mandible (55%). , In the maxilla, it has a tendency to involve the anterior area, whereas in the mandible, the molar and premolar areas are the most prevalent sites.  In the present case, mandible was affected in the posterior region.
Kaffe et al . reported that majority of central odontogenic fibroma are unilocular radiolucent lesions with well defined borders, but they may also appear as multilocular lesions and in rare instances may exhibit a mixed radiolucent/radiopaque appearance with poorly defined or diffused borders. 
Meta analysis of literature revealed that 29% of the lesions were located in the inter-radicular bone or occupied mainly the basal bone. They displace adjacent teeth in 55% of the cases or cause root resorption in 29% of cases.  In the present case, the lesion was inter-radicularly located and displaced the adjacent teeth.
Although the lesion has been diagnosed in individuals ranging from 5 to 80 years of age, it is more frequent in the 3 rd and 4 th decades of life. A clear predilection for the female sex has been observed.  In the present case, the patient was a male in the 2 nd decade of life.
An odontogenic fibroma can exhibit a varied histomorphology making it not feasible to define unique histologic aspects of that lesion. In view of the diversity of tumors that can arise from the odontogenic epithelium, it is not surprising that the odontogenic mesenchyme may also give origin to tumors with varying histopathologic features, the simple odontogenic fibroma and the odontogenic fibroma (WHO type) having been recognized as different lesions. 
The simple type is composed of fibrous connective tissue which is delicate and considerable amount of ground substance. Small rests of odontogenic epithelium may or may not be scattered throughout the lesion.  The WHO type differs from the simple type in exhibiting features such as dysplastic dentin, cementum-like calcified tissues and marked epithelial proliferation. 
Two unusual cases of central odontogenic fibroma were described by Jones et al .; one with a cystic lesion and the other with abundant areas of osseous metaplasia in addition to typical histological appearance of odontogenic fibroma. 
Dunlap et al . postulated an ectomesenchymal-epithelial interaction in the histogenesis of this unusual tumor. 
Enucleation with vigorous curettage is the preferred mode of treatment. Although the tendency towards recurrence is very low,  Heimdal et al . reported a case of recurrence 9 years after enucleation.  Post-operative patient follow-up for 5 years after surgery is advisable. 
| References|| |
|1.||Hamner JE 3rd, Gamble JW, Gallegos GJ. Odontogenic fibroma: Report of two cases. Oral Surg Oral Med Oral Pathol 1966;21:113-9. [PUBMED] |
|2.||Wesley RK, Wysocki GP, Mintz SM. The central odontogenic fibroma: Clinical and morphologic studies. Oral Surg Oral Med Oral Pathol 1975;40:235-45. [PUBMED] |
|3.||Mallow RD, Spatz SS, Zubrow HJ, Kline SN. Odontogenic fibroma with calcification: Report of a case with a review of the literature. Oral Surg Oral Med Oral Pathol 1966;22:564-8. [PUBMED] |
|4.||Kaffe I, Buchner A. Radiologic features of central odotogenic fibroma. Oral Surg Oral Med Oral Pathol 1994;78:811-8. [PUBMED] |
|5.||Cercadillo-Ibarguren I, Berini-Aytιs L, Marco-Molina V, Gay-Escoda C. Locally aggressive central odontogenic fibroma associated to an inflammatory cyst: A clinical, histological and immunohistochemical study. J Oral Pathol Med 2006;35:513-6. |
|6.||Slootweg PJ, Muller H. Central fibroma of the jaw, odontogenic or desmoplastic. Oral Surg Oral Med Oral Pathol 1983;56:61-70. |
|7.||Gardner DG. The Central Odontogenic fibroma: An attempt at clarification. Oral Surg Oral Med Oral Pathol 1980;50:425-32. [PUBMED] |
|8.||Jones GM, Eveson JW, Shepherd JP. Central odontogenic fibroma: A report of two controversial cases illustrating diagnostic dilemmas. Br J Oral Maxillofac Surg 1989;27:406-11. [PUBMED] |
|9.||Dunlap CL, Barker BF. Central odontogenic fibroma of the WHO type. Oral Surg Oral Med Oral Pathol 1984;57:390-4. [PUBMED] |
|10.||Heimdal A, Isacsson G, Nilsson L. Recurrent central odontogenic fibroma. Oral Surg Oral Med Oral Pathol 1980;50:140-5. [PUBMED] |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]