The classification of fibro-osseous lesions was first introduced by Kramer and Waldron. These lesions were related to the jaws and mandible. The evolution of bone-related lesions has been studied and researched for the past few decades. As a result, fibrous dysplasia and ossifying fibroma are the two major types of these lesions.
The osteogenic neoplasm, also known as cemento ossifying fibroma is a lesion that is categorized as non-neoplastic. Cemento ossifying fibroma is described as neoplasms that are non-encapsulated. The mineralized material is present in the tissue, which varies in amount. The fibrous tissue resembles the bone due to its structure.
These fibro-osseous lesions are benign and can arise from the skull or skeleton of the face. The majority of the cases, around 70%, are seen to arise from the regions of the head and neck. This particularly includes the jaws. The recurrence of cemento ossifying fibroma is rare.
Cemento Ossifying Fibroma Symptoms
The fibroma is an intra-bony mass that has slow growth. The location of the cemento ossifying fibroma is mandibular premolars and sometimes molars as well. The patients usually present with no symptoms. This means it is asymptomatic. Furthermore, patients who experience symptoms of cemento ossifying fibroma might experience one of the following symptoms:
- Pain and swelling in the jaw or affected areas
- Loose teeth
- Swelling expands to the entire jaw, which is often painless
- Opening and closing of mouth becomes difficult
- Difficulty in swallowing
- Sores and ulcers in the mouth can be painful and discomforting
- Bad odor of mouth
- Bleeding from the mouth can be recurrent
- A patch in the mouth can be an early sign of these fibromas
- Dentures do not fit properly
- Lower teeth, lip, and chin area can be felt numb all the time
- Speech difficulties
- A lump in the neck can also be seen
Cemento Ossifying Fibroma Causes
The primary culprits of the cemento fibroma can be excessive tobacco use and smoking. Alcohol can also be one of the reasons behind this fibroma. Chemicals in tobacco can cause irritation of the mouth and throat leading to harmful consequences.
Human papillomavirus(HPV) can be a leading factor if the fibroma originates from the throat. These collective 200 viruses can easily spread through sex. Areca nut and betel leaf are common in southeast Asian countries. Chewing them excessively can result in cemento ossifying fibroma.
Moreover, oral hygiene should not be poor. Sometimes, if the teeth are missing, that can lead to inflammation or breeding ground for bacterial infections. But as explained earlier, most of the cases of cemento ossifying fibroma are benign, so the causes are usually unknown. Genetic syndrome and benign growths can be a factor in this case.
Cemento Ossifying Fibroma Diagnosis
The diagnosis of cemento ossifying fibroma can be crucial. Physical examination is vital and is the first step to diagnose fibroma. Your doctor will physically examine your head and neck. Imaging tests are recommended by the doctor to confirm the diagnosis.
CT scan will help to find out the extent of the spread of the tumor and most importantly it helps to find out the exact location. The radio waves of MRI can be helpful and will reveal the size of the fibroma. It can also disclose other tumors present nearby. Moreover, a panorex X-ray can be used to get a 2D image of the entire jaw.
Incisional biopsy is often recommended when the test results from all the imaging techniques are clear. A piece of the fibroma or tumor is removed and clinically examined for the type and the cause. The patient is under general anesthesia during the procedure.
Cemento Ossifying Fibroma Treatment
The first step or treatment option in the case of cemento ossifying fibroma is always complete surgical resection. This will remove all the tumors and have fewer chances of recurrence. Mandibulectomy is a procedure in which the part of the mandible is removed as it is affected.
Maxillary bone and the upper jaw can be removed in a procedure called maxillectomy. The location of the fibroma, in this case, is important. Glossectomy and neck dissection are other procedures that can help if the tumor has spread to other parts of the body.
Benign fibroma cases don’t usually require a continuous follow-up. But in some cases, radiation and chemotherapy are prescribed to get rid of cemento ossifying fibroma completely. In other cases, annual check-ups and imaging tests are vital to ensure that the fibroma is not growing back.