Dx: Central Odontogenic Fibroma

KEY FACTS

Terminology Synonyms: Simple odontogenic fibroma; odontogenic fibroma (WHO) type; myxofibroma Definition: Tumor of odontogenic ectomesenchymal origin that may contain mature fibrous tissue (simple type) or is more cellular with possible calcifications (WHO type) Imaging Mandible: Premolar-molar region Maxilla: Anterior to 1st molar tooth Small lesions: Well-defined, unilocular radiolucency Large lesions: Multilocular radiolucency; septations can be fine and straight (differentiate from myxoma) or granular (differentiate from central giant cell granuloma) 12% have fine, unorganized radiopaque flecks CBCT and bone CT findings Expansion of bone cortices Preservation of thin cortical boundary Will detect any facial/lingual root resorption Root divergence may be seen May grow along length of bone with minimal expansion Top Differential Diagnoses
Periapical rarefying osteitis

Lateral periodontal cyst

Keratocystic odontogenic tumor

Odontogenic myxoma Central giant cell granuloma

Central desmoplastic fibroma

Clinical Issues Bony expansion; loosening of teeth Often depression on palate adjacent to lesion
TERMINOLOGY

Abbreviations Central odontogenic fibroma (COF) Synonyms Simple odontogenic fibroma; odontogenic fibroma (WHO) type; myxofibroma Definitions Tumor of odontogenic ectomesenchymal origin that may contain mature fibrous tissue (simple type) or is more cellular with possible calcifications (WHO type)
IMAGING

General Features Location Maxilla: Anterior to 1st molar tooth

Mandible: Premolar-molar region

Radiographic Findings Radiography

Small lesions

Well defined Unilocular Completely radiolucent

Large lesions

Multilocular radiolucency Septations can be fine and straight (differentiate from myxoma) or granular (differentiate from central giant cell granuloma) 12% have fine, unorganized radiopaque flecks (WHO type) CT Findings CBCT Expansion of cortices
Preservation of thin cortical boundary Root resorption on facial or lingual surfaces of teeth can be detected

Root divergence may occur May grow along length of bone with minimal expansion
DIFFERENTIAL DIAGNOSIS

Periapical Rarefying Osteitis

Apical radiolucency associated with pulpal pathology Tooth is nonvital Root resorption rare Lateral Periodontal Cyst Unilocular inter-radicular radiolucency Mandibular premolar areas most commonly Root resorption usually not seen
Keratocystic Odontogenic Tumor

Loculations, if present, are usually large Tends to grow along length of bone, especially in mandible Root resorption rare
Odontogenic Myxoma (Myxofibroma)

Fine, thin septations may be present in both myxomas and COFs Septa tend to be straight or form geometric patterns Mandible > maxilla: Posterior > anterior
Central Giant Cell Granuloma (CGCG)

Granular septations may be present in both Histopath of COF may show CGCG-like component
Central Desmoplastic Fibroma More aggressive

May destroy cortices of bone May invade soft tissues Thick, straight, and angular septations

PATHOLOGY

General Features 2 types

Simple

Stellate fibroblasts arranged in whorled patterns Collagen fibrils and substantial ground substance
WHO type

Cellular fibrous connective tissue with collagen fibers arranged in interlacing bundles Odontogenic epithelium in long strands or nests is present and may make up bulk of lesion Calcifications (dentinoid or cementoid material) may be present Examples of COF with giant cell granuloma-like components have been reported
CLINICAL ISSUES

Presentation Most common signs/symptoms Bony expansion Loosening of teeth May see depression on palate adjacent to lesion Occasional destruction of lingual cortex and exposure of tooth root Demographics Age: Reported between 4 and 80 years with mean age of 40 years Gender: F:M = 2:1 Treatment Enucleation
Vigorous curettage