Introduction

Cemento-ossifying fibroma is a benign (non-cancerous) lesion originating from bone tissue. It is found in the region of the head and neck, predominantly on the jaw. The cause of this condition has not yet been established. However, these fibromas are associated with past trauma to the region from which they arise. This lesion grows progressively and can reach enormous sizes. Though cemento-ossifying fibromas are rare, they most commonly occur in those assigned females at birth aged between 20 and 40 years. The condition can be diagnosed through

1. A patient’s medical history
2. A physical examination
3. A biopsy
4. By employing imaging techniques

Surgical removal of a cemento-ossifying fibroma is the mainstay treatment for the condition. There is a risk, however, that the condition recurs after treatment.^1,2,3

Causes of cemento-ossifying fibromas

The cause of cemento-ossifying fibromas is not completely understood. However, it is thought that there are certain factors associated with an increased risk of the condition occurring:^1,2,3

• Being assigned female at birth
• Ages 20 to 40 years
• Previous trauma to the jaw

Signs and symptoms of cemento-ossifying fibromas

A cemento-ossifying fibroma typically presents as a slow-growing lesion on the jaw. Typically, no signs and symptoms accompany this lesion.¹

Diagnosis of cemento-ossifying fibromas

A medical history, physical examination, a biopsy, and imaging techniques can all serve as important tools. They aid in ruling out conditions that are similar to cemento-ossifying fibromas and confirming a diagnosis of the condition.^1,2,3,4

Differential diagnosis of cemento-ossifying fibromas

Several conditions can present similarly to cemento-ossifying fibromas and may need to be ruled out to confirm a diagnosis. These include:⁴

• Ameloblastoma: This is a benign tumour of the jaw that grows slowly and can become cancerous. If left untreated, the tumour can damage the jaw and mouth
• Fibrous dysplasia: In fibrous dysplasia, fibrous tissue grows instead of bone tissue. This leads to the deformation of the bone and makes it more fragile, increasing the likelihood of fractures
• Florid cemento-osseous dysplasia: Lesions arise symmetrically on the jaw bone where bone tissue is replaced with abnormal tissue. Signs and symptoms are uncommon. The condition is typically found incidentally during routine imaging at dental appointments 

Medical history

During a consultation with your doctor, you may be asked questions about your medical history. You can be asked:

1. Do you have any medical conditions?
2. Which procedures you have undergone in the past?
3. Which medications do you take?
4. Family history
5. Signs and symptoms you may currently be experiencing

This also is an opportunity for you to share your ideas, concerns, and expectations, as well as ask any questions you may have.⁵

Physical examination

A physical examination allows a physician to inspect a lesion that may be a cemento-ossifying fibroma. By doing this, the physician can determine whether a cemento-ossifying fibroma may be present or what other conditions it could be. This will also allow the physician to determine if further tests should be done.⁶

Biopsy

A biopsy involves taking a sample of a lesion to understand its composition. This way, it can be established what is causing it. For the biopsy, the area from which a sample is taken is sanitised. Furthermore, a local anaesthetic is applied to numb the area. A small sharp blade will then be inserted into the lesion to retrieve a sample of tissue. This tissue sample will then be analysed under a microscope. Generally, biopsies are considered safe procedures. However, there is a risk of bleeding and infection.⁷

Imaging techniques

Computed tomography (CT) is a scan that can be used to diagnose cemento-ossifying fibromas. Computed tomography takes images of the inside of the body. During this scan, you will lie on a flat bed that is surrounded by a scanner. The scanner will move as it takes images and you will have to lie still. You may be asked to breathe in or out or hold your breath during some parts of the scan. Typically, the scan will take 10 to 20 minutes. A radiologist will then analyse the images generated.⁴

A type of X-ray, known as an orthopantomogram, may also be used to aid in diagnosing cemento-ossifying fibromas. Similar to computed tomography, X-rays take images of the inside of the body. X-rays pass through the body and are absorbed to varying extents in different regions of the body. These different levels of absorption are then picked up by a detector which creates an image. X-rays are quick and painless and typically take a couple of minutes to complete.

Treatment of cemento-ossifying fibromas

The mainstay treatment for cemento-ossifying fibromas is surgery to remove the lesion. Depending on the location and size of the tumour, the type of surgery can vary. If cemento-ossifying fibromas are found in the head and neck, a specialist called an oral and maxillofacial surgeon may perform the procedure. Often, a tumour can be removed whilst preserving the surrounding structures. However, sometimes surrounding structures, such as teeth and parts of the jaw, may need to be removed. In those cases, reconstructive surgery can take place to help restore said structures. Consulting with your physician can help you establish what procedure may be most suitable for you.^8,9

The prognosis for cemento-ossifying fibromas

The prognosis for cemento-ossifying can vary from person to person. Surgical removal of the tumour can resolve the condition. However, in some patients, the tumour may recur. There are cases of patients who have left a cemento-ossifying fibroma untreated for over 30 years without any consequences to their health.⁸

FAQs

Are cemento-ossifying fibromas benign or malignant tumours?

Cemento-ossifying fibromas are benign tumours, meaning they are non-cancerous.

What are the risk factors for developing cemento-ossifying fibromas?

Several risk factors are associated with the development of cemento-ossifying fibromas. These are being assigned female at birth, ages 20 to 40 years, and previous trauma to the jaw.

Can cemento-ossifying fibromas recur after treatment?

Though not common, cemento-ossifying fibromas can recur after treatment. This recurrence has been linked to lesions not completely removed during surgery.

What are the complications of untreated cemento-ossifying fibromas?

Complications of untreated cemento-ossifying fibromas are not common. Untreated cemento-ossifying fibromas have been found in several patients to cause no complications even after 30 years. However, this can vary from patient to patient.

Are there any lifestyle changes that can reduce the risk of cemento-ossifying fibromas?

As the cause of cemento-ossifying fibromas is not completely understood, it has not been established how to reduce the risk of occurrence. However, cemento-ossifying fibromas are associated with trauma to the jaw. Therefore, taking steps to avoid this may help reduce the risk of the condition occurring.

Summary

Cemento-ossifying fibromas are benign (non-cancerous) lesions. These lesions can arise from any part of the bone forming the face. However, they are mostly found in the region of the jaw and they grow gradually. A cemento-ossifying fibroma may grow to a very large size if left untreated. They are a rare occurrence but most commonly impact those assigned females at birth aged between 20 and 40 years. Additionally, cemento-ossifying fibromas are associated with past trauma to the jaw. Ruling out other conditions that can present similarly to cemento-ossifying fibromas and confirming a diagnosis can involve several steps. These include taking a medical history, conducting a physical examination, performing a biopsy, and employing imaging techniques. Surgery serves as the typical treatment for cemento-ossifying fibromas, though there is a risk of recurrence.