Florid Cemento Osseous Dysplasia

Findings

Figure 1, Figure 2, Figure 3, and Figure 4: Mandibular and maxillary cystic lesions with central calcification, bony expansion and selective involvement of the periapical regions are noted.


Diagnosis: Florid Cemento Osseous Dysplasia


Florid cemento-osseous dysplasia is a slow growing benign lesion which is extremely aggressive and infiltrative. It involves the periapical regions of both the maxilla and mandible with a diffuse distribution of mixed lucent-opaque osseous changes. The lesions are benign fibro-osseous lesions, which histologically, represent normal bone replaced by highly cellular fibrous connective tissue and cementum. Cemento-osseous dysplasia predominantly affects females greater than males (10-14:1) with a predilection for African American patients. Treatment of these lesions should be further radiographic follow-up without surgery unless the lesions become symptomatic, necrotic, or super-infected. Odontoma would also be in the differential as it is a hamartomatous malformation composed of odontogenic tissues. These lesions are usually discovered in the 2nd decade of life and can cause impaction, malpositioning or resorption of adjacent teeth. Ameloblastoma is the most common odontogenic tumor arising from follicular epithelium, dental lamina or enamel. It is a benign lesion but extremely aggressive and infiltrative. It most commonly occurs as an expansile lesion in the posterior mandible in the region of the third molar within the 3rd to 5th decades of life. The unicystic variant occurs in adolescents and has a soap bubble like appearance and involves the ramus and posterior body of the mandible. Large tumors may erode the bony cortex and infiltrate adjacent soft tissues. More malignant processes such as osteosarcoma exhibit a more pronounced periosteal reaction, bone destruction and the presence of a soft tissue mass. Multifocal osteosarcoma is rare. Also, chronic diffuse osteomyelitis is less likely, as it is usually unilateral, associated with pain and fever, exhibits poorly defined borders and would not be exclusively confined to tooth bearing areas.