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Year : 2000  |  Volume : 10  |  Issue : 2  |  Page : 103-104
Images: Cementoossifying fibroma of the maxilla

1 Dept of Radiology, Pt. B.D. Sharma PGIMS, Rohtak, India
2 Dept of ENT, Pt. B.D. Sharma PGIMS, Rohtak, India

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Keywords: Maxilla, Cementoossifying Fibroma, Fibro-osseous Tumor

How to cite this article:
Magu S, Airon RK, Mishra DS, Yadav RK, Kakkar V. Images: Cementoossifying fibroma of the maxilla. Indian J Radiol Imaging 2000;10:103-4

How to cite this URL:
Magu S, Airon RK, Mishra DS, Yadav RK, Kakkar V. Images: Cementoossifying fibroma of the maxilla. Indian J Radiol Imaging [serial online] 2000 [cited 2021 Feb 26];10:103-4. Available from:
Cementoossifying fibroma of the maxilla is an uncommon tumor. Lesions with fibrous and osseous components include fibrous dysplasia (FD), ossifying fibroma (OF), cementoossifying fibroma (COF) and cementifying fibroma (CF) [1]. Fibro-osseous lesions other than FD seem to arise from the periodontal membrane [2]. The periodontal membrane is a layer of fibrous connective tissue surrounding the roots. It contains multipotential cells capable of forming cementum, lamellar bone and fibrous tissue. Under pathological conditions neoplasms containing any or all of the components may be produced [3]. More aggressive lesions usually involve the maxillary antrum where extensive growth is unimpeded by anatomic obstacles. Because all cementum containing lesions are theoretically of periodontal membrane origin, maxillary sinus spread after origin from an upper premolar or molar tooth is a distinct possibility [4]. Although central COFs of the mandible are common, central COFs of the maxillary sinus are unusual tumors; twenty have been reported in literature [2].

   Case Report Top

A sixteen-year old boy presented with nasal obstruction and proptosis of the right eye, gradually increasing over three years. On clinical examination, a bony hard mass was seen in the right nostril. There was fullness on the right side of the face. Radiograph of the paranasal sinuses revealed a soft tissue shadow occupying the right maxillary sinus and nasal cavity with expansion of the lateral wall of the right maxillary sinus [Figure - 1]. [Figure - 2] and [Figure - 3] are axial and coronal CT sections of the same, showing a mixed density mass with diffuse scattered calcification involving the maxillary alveolar ridge, occupying and expanding the right maxillary sinus and involving the ipsilateral hard palate, projecting into the right nasal cavity. Biopsy confirmed it to be a COF.

   Discussion Top

In the maxilla, the clinical and radiological differential diagnosis includes fibrous dysplasia, osteosarcoma or chondrosarcoma, squamous cell carcinoma of the maxillary sinus, calcifying epithelial odontogenic tumor (Pindborg tumor) and calcifying odontogenic cyst (Gorlin cyst) [4].

In FD, an intimate continuity between the lesion and normal bone is generally found. The tumor expands throughout its length and the margins are diffuse and radiographically poorly defined. Its radiological structure is more homogeneous than OF or COF, both of which are filled with radio-opaque foci. OF and COF are well circumscribed tumors growing expansively with clearly defined margins. Lesions are oval, spherical or multilobular and clearly separated from the surrounding bone by osteolytic borders. Furthermore, these tumors are monostotic and circumscribed, with an eggshell like bony capsule [2]. Central COFs are typically well-defined solitary radiolucencies with scattered radio-opaque foci. They maintain a spherical shape, expand cortical bone without causing perforation and may cause tooth divergence. Large tumors may involve the nasal septum orbital floor and infra-orbital foramen [4].

Typically, CT reveals a well-defined mixed density tumor with diffuse scattered calcification. It protrudes into the sinus, maintaining a thin bony shell that is a remnant of the alveolar process [Figure - 2]. The lesion can involve the sinus walls, the hard palate [Figure - 3] and the nasal septum. MR shows a mass with diffuse low signal, consistent with calcification.

CF, a slow-growing lesion is composed of cellular fibroblastic tissue containing basophilic masses of cementum-like tissues. In some patients, varying amounts of bony trabeculae are interspersed within the lesion, reflecting the name cementoossifying fibroma. Those lesions in which the calcification appear as trabeculae of woven bone are called ossifying fibroma [5].

   References Top

1.Huebner GR, Brenneise CV, Ballenger J. Central Ossifying Fibroma of the anterior maxilla: Report of case. J Am Dent Assoc 1988; 116: 507-10.   Back to cited text no. 1  [PUBMED]  
2.Bertrand S, Eloy Ph, Cornelis J Ph, Gosseye S, Clotuche J, Gilliard Cl. Juvenile aggressive ossifying fibroma: case report and review of the literature. Laryngoscope 1993; 103: 1385-90.   Back to cited text no. 2    
3.Krausen AS, Gulmen S, Zografakis G. Cementomas II Aggressive cemento ossifyng fibroma of the ethmoid region. Arch Otolaryngol 1977; 103: 371-3   Back to cited text no. 3  [PUBMED]  
4.Kuta AJ, Worley MacDonald, Kaugars GE. Central cemento ossifying fibroma of the maxillary sinus: A review of six cases. AJNR 1995; 16: 1282-6.   Back to cited text no. 4    
5.Homner JE, Scofield HH, Cornyn J. Benign fibroosseous jaw lesions of periodontal membrane Origin. An analysis of 249 cases. Cancer 1968; 22: 861-78   Back to cited text no. 5    

Correspondence Address:
Sarita Magu
Residence Superintendent, Boys Hostel, PGIMS, Rohtak 124 001, Haryana
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Source of Support: None, Conflict of Interest: None

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[Figure - 1], [Figure - 2], [Figure - 3]

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