Maxillofacial Cemento-Ossifying Fibroma: A Rare Case Report

Cemento-ossifying fibroma is a relatively rare lesion affecting the jaws, especially the anterior mandible. The most common clinical presentation is swelling. Diagnosis based on clinical observation only is challenging. Radiological images and histological findings can be misleading due to similitudes with other osteo-fibrous lesions. We report a rare case of a 22-year-old female patient who presented with a painless mass in the upper right maxillary region that has been developing for 10 years. On examination, this tumor was bulky, ulcerated, disfiguring, hard to the touch, and occupying the whole of nasal, malar and maxillary regions. CT scan showed a well-circumscribed mass spanning from the right palatal and maxillary bones with mixed density content of soft tissue and diffuse calcified foci. The mass harbored dense bundles of fibrocollagenous connective tissue in a cellular stroma on histopathological examination. After a provisional diagnosis of osteoblastoma based on clinical and computed tomography features, the final diagnosis was based upon correlation of histopathological characteristics with both clinical and radiographic findings. A one-time surgical resection was performed to enucleate the tumor. This was followed by curettage. The lateral maxillary location of this tumor makes it unusual. Henceforth, a proper conclusive diagnosis of cemento-ossifying fibroma should be obtained from a histopathological study, in conjunction with clinical and radiological findings, and particular traits that the patient may present.