Benign Fibro-Osseous Lesions of the Jawbones (BFOLJ): A Clinicopathologic Analysis of 518 Cases from a Single Institution

Abstract

Introduction

BFOLJ represent a heterogeneous group of conditions with overlapping clinico-radiographic and histopathologic features despite diverse etiopathogenesis and biologic behavior. Overall, BFOLJ are subclassified into cemento-osseous dysplasia (COD), (cemento-)ossifying fibroma (OF) and fibrous dysplasia (FD). Herein, we present our institutional experience regarding the epidemiologic and clinicopathologic characteristics of BFOLJ.

Material and methods

Archived BFOLJ cases diagnosed over a 22-year period (2000-2022) were retrieved from the electronic laboratory databases of Oral Pathology Consultants at The OSU. Available information regarding patient age and gender, anatomic location, lesion focality, radiographic appearance, and histopathologic diagnosis was recorded and used for analysis.

Results

A total of 518 BFOLJ cases were identified with 440 (85%) affecting women and 78 (15%) men (F:M=5.6:1; age range=4-92y, mean=40.5y). The mandible was involved in 86% and the maxilla in 14% of the cases with the posterior mandible being the most common site (304, 57%). Among 123 BFOLJ with available clinico-radiographic information, 101 (82%) appeared unifocal and 22 (18%) showed multifocality with 63% of the cases presenting as well-defined, mixed radiopacity/radiolucency, 23% as unilocular radiolucency and 14% as radiopacity. Most BFOLJ were diagnosed as COD (449, 86.7%; F:M=7.8:1; age range=11-92y, mean=43y) further subcategorized as focal (292, 65%), florid (46, 10.25%), periapical (19, 4.25%), and COD NOS (92, 20.5%). Other diagnoses included OF (33, 6.4%; F:M=1:1; age range=4-47y, mean=26y), FD (28, 5.4%; F:M 3:1, age range=8-66y, mean=31y), juvenile OF (7, 1.3%) and renal osteodystrophy (1, 0.2%). Thirty (5.8%) BFOLJ were associated with secondary lesions, chiefly traumatic bone cyst (18, 60%), followed by central giant cell lesion (4, 13.3%) and xanthoma of bone (3, 10%).

Conclusions

BFOLJ are relatively uncommon and largely represent forms of COD with a strong predilection for the posterior mandible of middle-aged women. Histopathologic examination and clinico-radiographic correlation are required for accurate diagnosis and proper management.