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Year : 2008  |  Volume : 20  |  Issue : 3  |  Page : 100-103 Table of Contents   

Florid cemento-osseous dysplasia: Report of four cases

1 Department of Oral Medicine and Radiology, Government Dental College, Trivandrum, South India, India
2 Department of Oral Medicine and Radiology, Academy of Medical Sciences, Pariyaram, South India, India

Date of Web Publication16-Jun-2009

Correspondence Address:
Anita Balan
Department of Oral Medicine and Radiology, Government Dental College, Trivandrum, South India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0972-1363.52775

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Florid cemento-osseous dysplasia (FCOD) is one among the uncommon bone dysplasias affecting the maxillofacial region. Reports from India are extremely rare with only five cases in literature. We report four Indian patients with FCOD, reported to our department during a period of seven years. The radiological features of the four lesions represent different stages, supporting the theory of progression of the lesion from a completely radiolucent stage to a mixed and finally to a completely radiopaque stage. Features are discussed and compared with that from other populations.

Keywords: Florid cemento-osseous dysplasia

How to cite this article:
Haris P S, Balan A, Ramachandran S. Florid cemento-osseous dysplasia: Report of four cases. J Indian Acad Oral Med Radiol 2008;20:100-3

How to cite this URL:
Haris P S, Balan A, Ramachandran S. Florid cemento-osseous dysplasia: Report of four cases. J Indian Acad Oral Med Radiol [serial online] 2008 [cited 2022 Dec 4];20:100-3. Available from: http://www.jiaomr.in/text.asp?2008/20/3/100/52775

   Introduction Top

"The term fibro-osseous lesion is a generic term for a group of jaw disorders", [1] characterized by the replacement of bone by a benign connective tissue matrix, containing foci of mineralization in the form of woven bone or cementum-like structures. The fibro-osseous lesions include cemento- osseous dysplasia, fibrous dysplasia and cemento-ossifying fibroma and their subtypes.

Florid cemento-osseous dysplasia (FCOD) or florid osseous dysplasia is one among the four 'cemento-osseous dysplasias', [2] characterized by multiple irregular radiolucent to radiopaque lesions involving two or more quadrants of the jaws and predominantly affecting middle aged black women. It is rare in other populations with a reported incidence of 0.01 cases per 100,000 in Oriental population. [3] Reports from Indian population is even rarer, with only five cases in literature. [3],4],[5] Considering the rarity, four Indian patients with FCOD are reported.

Report of cases

All the patients were females, within the age range of 29 to 60 years. Two patients presented with swelling of gums [Figure 1] and [Figure 2] and one patient presented with features of osteomyelitis [Figure 3]. One case was detected incidentally [Figure 4]. The details of the cases are given in [Table 1].

All the lesions involving mandible were above the mandibular canal except the first case [Figure 5], which showed partial involvement of the area inferior to mandibular canal on left side. None of the patients had abnormalities of other bones of skull, other than jaw bones.

   Discussion Top

Florid cemento-osseous dysplasia is one among the fibro-osseous lesions, and is found predominantly in middle to old aged black women. Many names have been suggested to describe this rare lesion, but the name 'florid cemento-osseous dysplasia' is the widely accepted terminology. Though the term FCOD is a histopathological term rather than clinical or radiological, most often diagnosis is achieved by radiological observation, indicating the importance of maxillofacial radiologist in diagnosing such lesions.

FCOD has been defined by the WHO's 'International histological classification of odontogenic tumors' as "lobulated masses of dense, highly mineralized, almost acellular cemento-osseous tissue typically occurring in several parts of the jaws". [2] Although radiolucent, mixed and predominantly radiopaque stages have been described for FCOD, [6] WHO definition refers only to the end stage of this disease. The accepted criterion for the diagnosis and differentiation from other osseous dysplasias is the involvement of more than one sextant by the radiolucent, mixed or radiopaque lesions.

Radiologically, the cases presented were of different stages, supporting the theory of progression of the lesion from a completely radiolucent stage to a completely radiopaque stage. Most of the area in the first lesion was completely radiolucent except the anterior region where it showed a mixed pattern [Figure 5]. All the other lesions were completely radiopaque, but showed significant difference among them. The second case showed multiple discrete globular radiopaque masses [Figure 6] whereas the third case showed multiple confluent globular radiopaque masses [Figure 7] and fourth case showed diffuse patchy radiopacities involving the entire upper and lower jaws [Figure 8]. The areas of involvement also showed a gradual progression. First case showed the involvement of three sextants of mandible only, second case showed involvement of four sextants whereas third and fourth cases showed involvement of all the sextants [Table 1]. The diagnosis was confirmed by histopathological examination [Figure 9].

The exact origin of FCOD is still debated. Waldron et al . [7] suggested a periodontal ligament origin, by observing the confinement of lesions to alveolus and similarity of histopathological appearance of FCOD to normal periodontal ligament. Though this was not widely accepted, the odontogenic origin is accepted by most authors. [8] Kawai et al . [9] described two major types of lesions, those that were clearly in contact with the root and those that were separated from it by a radiolucent line that appeared to be continuous with the periodontal ligament space. They suggested that, the latter could have been partly or wholly derived from the medullary bone rather than from the periodontal ligament. Among four cases reported here, the first case belongs to the first type and second and third cases belong to the second group according to the Kawai's classification.

A systematic review of 158 cases reported by various authors was given by MacDonald Jankowski. [10] The features described in the systematic review were very similar to what we have observed in these cases [Table 2] except for the following differences. Seventy five percent of our patients had symptoms, in contrast to 50% in review. A higher frequency of involvement of anterior region was also noted in our cases in comparison to the systematic review.

The patient presented with osteomyelitis was an edentulous patient. The susceptibility of edentulous jaws with FCOD to infection and subsequent symptoms has been reported by various others. [7],[11] All the presented cases showed symmetry of involvement. However, in the edentulous case, upper left maxilla was surgically resected 10 years back. Symmetry of areas of involvement is universally accepted as a characteristic feature of FCOD.

In conclusion, we report four cases of florid cemento-osseous dysplasia (FCOD), which represented different stages radiologically. This difference in radiological presentation shows the progression of FCOD lesions from a relatively radiolucent stage to a mixed stage to a completely radiopaque stage. The extreme difference in the age between the two patients of the advanced radiopaque stage of FCOD may indicate the difference in rate of progression of the disease.

   References Top

1.Koury ME, Regezi JA, Perrott DH, Kaban LB. "Atypical" fibroosseous lesions: Diagnostic challenges and treatment concepts. Int J Oral Maxillfac Surg 1995;24:162-9.  Back to cited text no. 1    
2.Kramer IR, Pindborg JJ, Shear M. Histological typing of odontogenic tumours. World Health Organization, International hisological classification of tumours. 2 nd ed. Berlin, Germany: Springer-Verlag; 1992.  Back to cited text no. 2    
3.Loh FC, Yeo JF. Florid osseous dysplasia in Orientals. Oral Surg Oral Med Oral Pathol 1989;68:748-53.  Back to cited text no. 3  [PUBMED]  
4.Swaroop VD, Borges AM, Agarwal KB. Fibro osseous lesions of craniofacial bones. Indian J Cancer 1990;27:158-64.  Back to cited text no. 4  [PUBMED]  
5.Mangala M, Ramesh DN, Surekha PS, Santosh P. Florid cemento-osseous dysplasia: Review and report of two cases. Indian J Dent Res 2006;17:131-4.  Back to cited text no. 5  [PUBMED]  Medknow Journal
6.Neville BW, Damm DD, Allen CM, Bouquot JE. Oral and maxillofacial pathology. 2 nd ed. Philadelphia, PA: Saunders; 2002.  Back to cited text no. 6    
7.Waldron CA, Giansanti JS, Browand BC. Sclerotic cemental masses of the jaws (so-called chronic sclerosing osteomyelitis, sclerosing osteitis, multiple enostosis and gigantiform cementoma). Oral Surg Oral Med Oral Pathol 1975;39:590-604.  Back to cited text no. 7    
8.Melrose RJ. The clinico-pathologic spectrum of cementoosseous dysplasia. Oral Maxillofac Clin North Am 1997;9:643-53.  Back to cited text no. 8    
9.Kawai T, Hiranuma H, Kishino M, Jikko A, Sakuda M. Cemento-osseous dysplasia of the jaws in 54 Japanese patients: A radiographic study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:107-14.  Back to cited text no. 9    
10.MacDonald-Jankowski DS. Florid cemento-osseous dysplasia: A systematic review. Dentomaxillofac Radiol 2003;32:141-9.  Back to cited text no. 10    
11.MacDonald-Jankowski DS. Florid osseous dysplasia in Hong Kong Chinese. Dentomaxillofac Radiol 1996;25:39-41.  Back to cited text no. 11    


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]

  [Table 1], [Table 2]


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