2. CONTENTS
Introduction
Classification
Etiology
Clinical Features
Monostotic Form
Polyostotic Form
Craniofacial form
Radiographic Features
Histologic Features
Treatment &Prognosis
Conclusion
3. Fibro-Osseous
Lesion
• “Replacement of normal bone by tissue composed of
collagen fibers and fibroblasts, containing varying
amount of mineralized substance” – Waldron 1985.
• “A collection of non – neoplastic intraosseous lesions
that replace bone and consists of a cellular fibrous
connective tissue within which non- functional osseous
structures form” Eversole
INTRODUCTION
4. WHO CLASSIFICATION 1992
1. Osteogenic Neoplasms
a. A.Cemento-Ossifying Fibroma (Cementifying Fibroma, Ossifying
Fibroma)
2. Non-Neoplastic Bone Lesions
a. Fibrous Dysplasia Of Jaws
b. Cemento-Osseous Dysplasia
I. Periapical Cemental Dysplasia (Periapical Fiberous Dysplasia),
II. Florid Cemento-Osseous Dysplasia (Gigantiform Cementoma, Familial
Multiple Cementomas)
III. Other Cemento-Osseous Dysplasia
c. Cherubism (Familial Multilocular Cystic Disease Of The Jaws)
d. Central Giant Cell Granuloma
e. Aneurismal Bone Cyst
f. Solitary Bone Cyst (Traumatic, Simple, Hemorrhagic Bone Cyst)
5.
WALDRON MODIFIED CLASSIFICATION
OF FIBRO-
Osseous Lesions Of Jaws (1993)
1. Fibrous Dysplasia
2. Cement-Osseous Dysplasia
a. Periapical Cement-Osseous Dysplasia
b. Focal Cement-Osseous Dysplasia
c. Florid Cement-Osseous Dysplasia
3. Fibro-Osseous Neoplasm
a. Cementifying Fibroma, Ossifying Fibroma, Cement-Ossifying
Fibroma
6. WHO CLASSIFICATION 2005
1) Ossifying Fibroma (OF)
2) Fibrous Dysplasia
3) Osseous Dysplasia
a. Periapical Osseous Dysplasia
b. Focal Osseous Dysplasia
c. Florid Osseous Dysplasia
d. Familial Gigantiform Cementoma
4)Central Giant Cell Granuloma
5)Cherubism
6)Aneurismal Bone Cyst
7)Solitary Bone Cyst
7.
EVERSOLE 2008 CLASSIFICATION
1.Bone dysplasias
a. Fibrous dysplasia
i. Monostotic
ii. Polyostotic
iii. Polyostotic with endocrinopathy (McCune-Albright)
iv. Osteofibrous dysplasia
b. Osteitis deformans
c. Pagetoid heritable bone dysplasias of childhood
d. Segmental odontomaxillary dysplasia
2. Cemento-osseous dysplasias
a. Focal cemento-osseous dysplasia
b. Florid cemento-osseous dysplasia
3.Inflammatory/reactive processes
a. Focal sclerosing osteomyelitis
b. Diffuse sclerosing osteomyelitis
c. Proliferative periostitis
4. Metabolic Disease: hyperparathyroidism
8.
5. Neoplastic lesions (Ossifying fibromas)
a. Ossifying fibroma
b. Hyperparathyroidism jaw lesion syndrome
c. Juvenile ossifying fibroma
i. Trabecular type
ii. Psammomatoid type
d. Gigantiform cementomas
9. TERMINOLO
GY
• Skeletal developmental anomaly of the bone - defect in osteoblastic
differentiation and maturation
• 2.5% of all bony tumours & 7% of all non-malignant tumours of bone
• Von recklinghausen 1891- osteitis fibrosa cystica.
• Fibrous dysplasia of bone.
Lichentenstein
1938
10. DEFINITION
A benign lesion, presumably developmental in nature, characterized by
the presence of fibrous connective tissue with a characteristic whorled
pattern and containing trabeculae of immature non lamellar bone.
Waldron 1985.
Reeds definition : fibrous dysplasia is an arrest of bone maturation in
woven bone with ossification resulting from metaplasia of a non specific
fibro-osseous type.
FIBROUS DYSPLASIA
16.
70%-80% of fibrous dysplasia.
Occurs in rib, femur , tibia, craniofacial
bones and humerus
Pain or pathologic fracture
Bone deformity less severe
Painless swelling of the jaw
Swelling involves labial or buccal plate
Protuberance - inferior border of mandible
MONOSTOTIC FORM
24.
CAFE-AU-LAIT
SPOTS
MAZABRAUDS
SYNDROME
MALIGNANCIES
• Increased
melanin in basal
cells of epidermis
• Cutaneous
pigmentation
seen ipsilateral to
side of bone
lesion.
• Fibrous dysplasia
and
intramuscular
myxoma, risk of
sarcomatous
malformation
• Osteosarco Mc-
Cune albright
syndrome
• Chondrosarco
Mc-Cune albright
syndrome
• Fibrosarco Mc-
Cune albright
syndrome
• LiposarcoMc-
Cune albright
syndrome
25.
In 10-25% of pt. with monostotic form.
In 50% of pt. with polyostotic form.
Also in isolated craniofacial form.
No extracranial lesions present.
Sites: frontal, sphenoid, maxillary, ethmoid
bones.
Extreme prominence of zygomatic process,
facial deformity
Vestibular dysfunction, tinnitus, hearing loss,
Hypertelorism, cranial asymmetry, facial deformity,
visual impairment, exophthalmos, blindness .
CRANIOFACIAL FIBROUS
DYSPLASIA
26. Network of fine bone trabec
ulae
Increased trabeculation – lesion more opaque & mottled
appearance
Cortical bone becomes thinned
Roots of teeth moved out of normal position
RADIOGRAPHIC FEATURES
28.
HISTOLOGIC FEATURES
Proliferating fibroblasts in a compact stroma of interlacing
collagen fibres.
Irregular bony trabeculae scattered throughout lesion.
Chinese character shaped.
Trabeculae usually coarse woven bone
Lesions rich in spindle shaped fibroblasts with a swirled
appearance within the marrow space
Lesional bone fuses directly with normal bone at the periphery
30. WOVEN BONE
Lamellar bone
Monotonous pattern-calcification-FD differs from haphazard mixture of woven,
lamellar bone & spheroid particles-ossifying fibroma & cemento-osseous dysplasia.
31.
FIBROUS
DYSPLASIA
1st & 2nd decades
Usually-Maxilla
Self limited
One or more bones
Diffuse opacity
Vascular matrix
Woven bone trabeculae
Chinese letter pattern
Peri-trabecular clefting is
present
Ossifying fibroma
3rd & 4th decades
Usually-mandible
Continuous
One bone
Circumscribed
Cellular fibrous matrix
Bony islands & trabeculae
”bizarre” character shape
Absent
32. No significant change in se
rum
calcium/phosphorus
Elevated Alkaline phosphatase
Moderate increase in Basal Metabolic Rate
LAB FINDING
37. CONCLUSION
• FIBROUS DYSPLASIA IS A LESION OF BONE COMMONLY
AFFECTING THE YOUNGER
• AGE GROUP. IT SHOWS SIMILARITIES WITH
OTHER FIBRO OSSEOUS LESIONS CLINICALLY,
RADIOLOGICAL & HISTOPATHOLOGICALLY.
• HENCE THROUGH KNOWLEDGE ABOUT THESE LESIONS IS
NECESSARY FOR PROPER DIAGNOSIS & TREATMENT PLAN.
38.
Shafer’s textbook of oral pathology 7th Edition
Burkitt’s oral medicine,11th edition.
Neville, Damm, Allen, Bouquot. Oral & maxillofacial
pathology ,1st south asia edition
Lucas Pathology Of Tumours Of The Oral Tissues
Fibrous Dysplasia. Pathophysiology, Evaluation, and
Treatment www.jbjs.org
REFERENCES
39.
polyostotic Fibrous Dysplasia-
clinical dentistry jul-sep-2010/vol
Craniofacial
contemporary
1/issue 3.
Fibrous Dysplasia In the Maxillomandibular region–
Journal of IMAB - Annual Proceeding (Scientific
Papers) vol. 16, book 4, 2010
Regezi- Textbook of oral pathology- 5th edition.