|Year : 2008 | Volume
| Issue : 3 | Page : 100-103
Florid cemento-osseous dysplasia: Report of four cases
PS Haris1, Anita Balan1, Sunu Ramachandran2
1 Department of Oral Medicine and Radiology, Government Dental College, Trivandrum, South India, India
2 Department of Oral Medicine and Radiology, Academy of Medical Sciences, Pariyaram, South India, India
|Date of Web Publication||16-Jun-2009|
Department of Oral Medicine and Radiology, Government Dental College, Trivandrum, South India
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Florid cemento-osseous dysplasia (FCOD) is one among the uncommon bone dysplasias affecting the maxillofacial region. Reports from India are extremely rare with only five cases in literature. We report four Indian patients with FCOD, reported to our department during a period of seven years. The radiological features of the four lesions represent different stages, supporting the theory of progression of the lesion from a completely radiolucent stage to a mixed and finally to a completely radiopaque stage. Features are discussed and compared with that from other populations.
Keywords: Florid cemento-osseous dysplasia
|How to cite this article:|
Haris P S, Balan A, Ramachandran S. Florid cemento-osseous dysplasia: Report of four cases. J Indian Acad Oral Med Radiol 2008;20:100-3
|How to cite this URL:|
Haris P S, Balan A, Ramachandran S. Florid cemento-osseous dysplasia: Report of four cases. J Indian Acad Oral Med Radiol [serial online] 2008 [cited 2021 Jan 17];20:100-3. Available from: https://www.jiaomr.in/text.asp?2008/20/3/100/52775
| Introduction|| |
"The term fibro-osseous lesion is a generic term for a group of jaw disorders",  characterized by the replacement of bone by a benign connective tissue matrix, containing foci of mineralization in the form of woven bone or cementum-like structures. The fibro-osseous lesions include cemento- osseous dysplasia, fibrous dysplasia and cemento-ossifying fibroma and their subtypes.
Florid cemento-osseous dysplasia (FCOD) or florid osseous dysplasia is one among the four 'cemento-osseous dysplasias',  characterized by multiple irregular radiolucent to radiopaque lesions involving two or more quadrants of the jaws and predominantly affecting middle aged black women. It is rare in other populations with a reported incidence of 0.01 cases per 100,000 in Oriental population.  Reports from Indian population is even rarer, with only five cases in literature. ,4], Considering the rarity, four Indian patients with FCOD are reported.
Report of cases
All the patients were females, within the age range of 29 to 60 years. Two patients presented with swelling of gums [Figure 1] and [Figure 2] and one patient presented with features of osteomyelitis [Figure 3]. One case was detected incidentally [Figure 4]. The details of the cases are given in [Table 1].
All the lesions involving mandible were above the mandibular canal except the first case [Figure 5], which showed partial involvement of the area inferior to mandibular canal on left side. None of the patients had abnormalities of other bones of skull, other than jaw bones.
| Discussion|| |
Florid cemento-osseous dysplasia is one among the fibro-osseous lesions, and is found predominantly in middle to old aged black women. Many names have been suggested to describe this rare lesion, but the name 'florid cemento-osseous dysplasia' is the widely accepted terminology. Though the term FCOD is a histopathological term rather than clinical or radiological, most often diagnosis is achieved by radiological observation, indicating the importance of maxillofacial radiologist in diagnosing such lesions.
FCOD has been defined by the WHO's 'International histological classification of odontogenic tumors' as "lobulated masses of dense, highly mineralized, almost acellular cemento-osseous tissue typically occurring in several parts of the jaws".  Although radiolucent, mixed and predominantly radiopaque stages have been described for FCOD,  WHO definition refers only to the end stage of this disease. The accepted criterion for the diagnosis and differentiation from other osseous dysplasias is the involvement of more than one sextant by the radiolucent, mixed or radiopaque lesions.
Radiologically, the cases presented were of different stages, supporting the theory of progression of the lesion from a completely radiolucent stage to a completely radiopaque stage. Most of the area in the first lesion was completely radiolucent except the anterior region where it showed a mixed pattern [Figure 5]. All the other lesions were completely radiopaque, but showed significant difference among them. The second case showed multiple discrete globular radiopaque masses [Figure 6] whereas the third case showed multiple confluent globular radiopaque masses [Figure 7] and fourth case showed diffuse patchy radiopacities involving the entire upper and lower jaws [Figure 8]. The areas of involvement also showed a gradual progression. First case showed the involvement of three sextants of mandible only, second case showed involvement of four sextants whereas third and fourth cases showed involvement of all the sextants [Table 1]. The diagnosis was confirmed by histopathological examination [Figure 9].
The exact origin of FCOD is still debated. Waldron et al .  suggested a periodontal ligament origin, by observing the confinement of lesions to alveolus and similarity of histopathological appearance of FCOD to normal periodontal ligament. Though this was not widely accepted, the odontogenic origin is accepted by most authors.  Kawai et al .  described two major types of lesions, those that were clearly in contact with the root and those that were separated from it by a radiolucent line that appeared to be continuous with the periodontal ligament space. They suggested that, the latter could have been partly or wholly derived from the medullary bone rather than from the periodontal ligament. Among four cases reported here, the first case belongs to the first type and second and third cases belong to the second group according to the Kawai's classification.
A systematic review of 158 cases reported by various authors was given by MacDonald Jankowski.  The features described in the systematic review were very similar to what we have observed in these cases [Table 2] except for the following differences. Seventy five percent of our patients had symptoms, in contrast to 50% in review. A higher frequency of involvement of anterior region was also noted in our cases in comparison to the systematic review.
The patient presented with osteomyelitis was an edentulous patient. The susceptibility of edentulous jaws with FCOD to infection and subsequent symptoms has been reported by various others. , All the presented cases showed symmetry of involvement. However, in the edentulous case, upper left maxilla was surgically resected 10 years back. Symmetry of areas of involvement is universally accepted as a characteristic feature of FCOD.
In conclusion, we report four cases of florid cemento-osseous dysplasia (FCOD), which represented different stages radiologically. This difference in radiological presentation shows the progression of FCOD lesions from a relatively radiolucent stage to a mixed stage to a completely radiopaque stage. The extreme difference in the age between the two patients of the advanced radiopaque stage of FCOD may indicate the difference in rate of progression of the disease.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]
[Table 1], [Table 2]