|Year : 2007 | Volume
| Issue : 2 | Page : 73-75
Central odontogenic fibroma
SP Khandekar, Alka Dive
Department of Oral Pathology and Microbiology, V.S.P.M..s D.C.R.C., Hingna Road, Nagpur, Maharashtra, India
S P Khandekar
Department of Oral Pathology and Microbiology, V.S.P.M..s D.C.R.C., Digdoh Hills, Hingna Road, Nagpur, Maharashtra - 440 019
Source of Support: None, Conflict of Interest: None
| Abstract|| |
The central odontogenic fibroma (COF) is a rare and incompletely understood odontogenic tumour. It occurs more commonly in the mandible, but new cases illustrate occurrences in maxilla and postsurgical recurrence. The need for follow-up of patients with a confirmed diagnosis of COF is reinforced.
Keywords: Central odontogenic fibroma, dental follicle, odontogenic neoplasm
|How to cite this article:|
Khandekar S P, Dive A. Central odontogenic fibroma. J Oral Maxillofac Pathol 2007;11:73-5
| Introduction|| |
The central odontogenic fibroma (COF), as the name implies, is a benign odontogenic neoplasm occurring within the jaws. Based on its anatomic distribution and histological appearance, this neoplasm is considered to be a tumour of the mesenchymal components of the odontogenic apparatus - the periodontal ligament, dental papilla or dental follicle. ,,
The COF is a poorly defined tumour of the jaw bones, which has only been infrequently reported in the literature. , Wesley and his colleagues in 1975 found that COF occurs predominantly in the mandible in young individuals (mean age 27 years with a range of 11-67 years) and has equal sex distribution. These authors also stated that COF showed no evidence of recurrence for up to two years. 
Shafer, Hine and Levy feel that COF is a rare entity, which is distinct from the central odontogenic myxoma and parafollicular fibrosis found in dentigerous cyst and follicles; but this is disputed by Bhaskar, who claims that odontogenic fibroma is one of the most common odontogenic tumours. ,
We use the following criteria for the case reported: Clinically, the lesion is central in bone and has persistent progressive growth. Radiographically the lesions appear as a loculated radiolucent area that may be associated with unerupted or displaced teeth. Histopathologically the lesion shows primarily mature collagen interspersed with fibroblast. The collagenous tissue is 'moderately dense' to dense in most areas, and inactive odontogenic epithelium in strands and nests may be present. 
Since its inclusion in the 1971 WHO classification of odontogenic tumours, there has been controversy as to the concept and definition of this lesion because the term COF has been applied to various types of lesion. In 1980, Gardner published an attempt at classification of this entity, in which he reported COF in two types designated as simple and WHO variant. Since then, most authors have used this classification; but the concept of COF is still a matter of debate, and only 39 cases with typical histologic features of the neoplasm have been reported. ,
The purpose of the report is to present an additional case of COF, as well as to compare its clinical, radiological and histological features with the cases previously reported.
| Case Report|| |
A 12-year-old female patient reported with swelling in the lower right posterior region of the jaw since two months, gradually increasing in size. She also complained of pain with the swelling, which used to get aggravated on touching.
Clinical examination revealed the swelling was present in lower right posterior region of jaw, 3 × 3 cm in size, ovoid in shape. Intraorally the lesion was extending from permanent right mandibular canine to the permanent right mandibular first molar.
No lymphadenopathies were evident. Panoramic radiography revealed a well-defined radiolucency with sclerotic border extending from permanent right mandibular canine to the distal root of permanent right mandibular first molar. The mandibular right second premolar was impacted and displaced in the radiolucent lesion [Figure - 1]. A provisional diagnosis of dentigerous cyst involving mandibular right second premolar.
At surgery, a well-defined but not encapsulated lesion that produced buccal expansion and thinning of vestibular cortex was evident. The lesion was surgically excised.
The biopsy specimen consisted of a single soft tissue of about 1 × 1 cm in size, whitish in color and firm in consistency. Microscopic examination showed lesional tissue consisting of fibrocellular connective tissue stroma with odontogenic epithelial islands in the form of long strands and small islands. Based on these histopathological features a diagnosis of central odontogenic fibroma of simple type was made [Figure - 2],[Figure - 3],[Figure - 4]. The patient has been observed for one and half years without clinical and radiological evidence of recurrence.
| Discussion|| |
While analyzing the 15 acceptable cases of COF, including the present case, we found that 10 occurred in female and six in male patients. The age range was 11-80 with a mean of 29 years. The predominant clinical symptom was a painless swelling of the jaw. Twelve of the 15 tumours occurred in the mandible. The lesion appeared as loculated radiolucent areas, some containing radiopaque foci. ,
Gardner described two histologically distinct types of odontogenic fibroma, the simple type and the WHO type. The WHO type differs from the simple type by having greater amount of calcified material and odontogenic epithelial islands. The present case corresponds to the histologic appearance of the simple type of odontogenic fibroma, which is primarily composed of a delicate fibrous connective tissue stroma, containing small number of odontogenic epithelial islands. 
The present case is consistent with the stated clinical and morphological characteristics of COF and emphasizes the benign nature of the neoplasm. The tumour was associated with an impacted and displaced mandibular second premolar.
Wesley and others found that COF has been reported as only occurring in the mandible. Two previously reported cases in maxilla by Silverman and Knight are thought to be more consistent with hyperplastic dental follicles, and one case reported by Hamner and others appears to be a dental follicle. 
Though the present case was seen in very young age, the lesion is not confined exclusively to young people; since 27% of the reported cases - 4 out of 15 - occurred in patients over the age of 40 years.  The reported rate of recurrence is 13% (2 of 15). However, one case recurred nine years after initial treatment. This fact points to the need for long-term follow-up of the patient with a diagnosis of COF. ,
| References|| |
|1.||Central odontogenic fibroma: Review of literature and report of cases. Dahl EC, Wolfson SH, Hangen JC, editors. Iowa City. |
|2.||Bhaskar SN. Synopsis of oral pathology, 5 th ed. The C.V. Mosby Company: St. Louis; 1977. p. 259. |
|3.||Shafer, Hine MK, Levy BM. A textbook of oral pathology, 5 th ed. W.B. Saunders Company: Philadelphia; 1974. p. 263-4. |
|4.||A clinical review of central odontogenic fibroma with addition of three new cases. Svirsky JA, Abbey LM, Kaugars GE, editors. |
|5.||Lucas RB. Pathology of tumour of the oral tissues, 3 rd ed. Churchill Lining Store: New York; 1976. p. 171-2. |
|6.||Combined central odontogenic fibroma and giant cell granuloma like lesion of the mandible: Report of a case and review of a literature. Taylor AM, dez Flores VB, Diaz Franco MA, editors. |
|7.||Pindborg JJ, Kramer IR, Torloni H. Histological typing of odontogenic tumours, Jaw cyst and allied lesions, International Histological Classification of Tumours No.5, WHO: Geneva; 1971. |
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]