Elsevier

Clinical Radiology

Volume 59, Issue 1, January 2004, Pages 11-25
Clinical Radiology

Review
Fibro-osseous lesions of the face and jaws

https://doi.org/10.1016/j.crad.2003.07.003Get rights and content

Abstract

Maxillofacial fibro-osseous lesions (FOL) consists of lesions that differ, with the exception of fibrous dysplasia, to those found in the rest of the skeleton. FOLs of the face and jaws are cemento-ossifying dysplasia, fibrous dysplasia and cemento-ossifying fibroma. Radiology is central to their diagnosis because the pathology for all FOLs is similar, although they range widely in behaviour, from dysplasia, hamartoma to benign neoplasia with occasional recurrence. Furthermore, once diagnosed the management of each is different. For cemento-ossifying dysplasia, this may mean doing nothing, simply because no treatment is generally appropriate. Almost all cemento-ossifying fibromas should be treated surgically, whereas cases of fibrous dysplasia are treated according to their clinical presentation, ranging from review and follow-up to surgery necessary to save the patient's sight or reduce deformity. The most important and frequent features of the FOLs differential diagnosis is discussed with assistance of a flow-chart.

Introduction

“The term fibro-osseous lesion (FOL) is a generic designation of a group of jaw disorders”1 characterized by the replacement of bone by a benign connective tissue matrix. This matrix displays varying degrees of mineralization in the form of woven bone or of cementum-like round acellular intensely basophilic structures. The last are indistinguishable from “cementicles”.2

The maxillofacial FOL considers lesions that are different (with the exception of fibrous dysplasia) to those found in the rest of the skeleton (see O'Hara3 and Unni4). The term FOL in the maxillofacial region is applied to cemento-ossifying dysplasia (COD), fibrous dysplasia (FD) and cemento-ossifying fibroma (COF)5 and their subtypes.

Section snippets

The importance of radiology to the diagnosis of FOL

Maxillofacial FOLs are of particular interest to the radiologist because they emphasize the central role of the radiologist in the diagnostic process. This role arises because the pathology for all FOLs is identical, although they range widely in behaviour, from dysplasia, hamatoma to benign neoplasia with occasional recurrence. The late Charles Waldron wrote “In absence of good clinical and radiologic information a pathologist can only state that a given biopsy is consistent with a FOL. With

The classification and nomenclature of FOLs

FOLs of the jaws have been subject to frequent renaming and reclassification; the development of this nomenclature and classification is summarized in Fig. 1.5., 10., 11., 12., 13., 14., 15., 16., 17., 18., 19., 20., 21., 22., 23. Fig. 1 includes only those terms that appear to be still in use, and therefore, still clinically relevant. Nevertheless, this simplified figure is still able to display the “lumping” and “splitting” that appear to attend frequently the development of most

Fibrous dysplasia (FD)

FD is an important lesion affecting the maxillofacial region because it can cause severe deformity and asymmetry, and most devastating of all, blindness. Although according to various authorities, including Waldron,5 the majority of cases “burn out” in early adulthood when skeletal maturity has been reached, according to Eisenberg and Eisenbud6 there are no studies of FD cases followed up over a long period to substantiate that view. Their contention is supported by later recurrence or

Differential diagnosis of FOLs

The majority of lesions that appear prominently in the differential diagnosis of FODs are radiopacities occurring in the jaw bones; these are idiopathic osteosclerosis (IOS),62 condensing osteitis (CO; secondary to dental inflammation),62 and odontomas.63 Once the film-development artefacts, and soft-tissue and metallic (iatrogenic) radiopacities have been excluded then four important aspects of the radiopacities can be considered sequentially as shown on the flow-chart (Fig. 12). These are:-

  • 1.

Acknowledgements

Most of the figures and my publications contributing to this review were based on the patients treated by the Department of Oral and Maxillofacial Surgery of the University of Hong Kong (Chair: Prof. H Tideman). I am also grateful to Dr T. Li, Head of Oral Radiology and his Chief Radiographers, Mr D. Mills and Mr W. Cheung, for their administrative and photographic assistance, and the TC White Fund of the Royal College of Physicians and Surgeons of Glasgow and, Prof. F. Smales, Dean, Faculty of

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