Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Psammomatoid variant of juvenile ossifying fibroma involving mandible: A rare case report

Psammomatoid variant of juvenile ossifying fibroma involving mandible: A rare case report The term juvenile ossifying fibroma (JOF) is used in literature in naming two microscopically distinct fibro‑osseous lesions of the craniofacial skeleton. One is characterized by small uniform spherical ossicles resembling psammoma bodies (psammomatoid JOF [PsJOF]). The other is distinguished by trabeculae of fibrillary osteoid and woven bone (trabecular JOF). Psammomatoid ossifying fibromas represent a unique subset of fibro‑osseous lesions of the craniofacial region. PsJOF has been distinguished because of its location, clinical behavior, and age of occurrence. They have distinctive histomorphologic features and a tendency toward locally aggressive behavior, including invasion and destruction of adjacent anatomic structures. It is generally seen in the younger age group, and the most common site is paranasal sinuses, orbits, and frontoethmoidal complex. We report a case of JPOF involving mandible which is rarely been described in literature. An insight into the radiographic progression of this rare entity along with the clinical feature and surgical management is discussed. Keywords: Fibro‑osseous lesion, juvenile ossifying fibroma, psammomatoid variant aggressive behavior than does the conventional ossifying Introduction fibroma. Microscopically, it has a characteristic feature of irregularly mineralized cellular osteoid strands lined by Ossifying fibromas are the well‑defined type of a benign plump osteoblasts. fibro‑osseous lesion of jaws. It has two types conventional and juvenile ossif ying fibroma (JOF). The JOF is a controversial [4] Most JOFs arise in the vicinity of the paranasal sinuses. With lesion that has been distinguished from the larger group of regard to the incidence of JOF in the jaws, there are conflicting ossifying fibroma on the basis of the age of the patients, [4,5] reports of maxillary and mandibular predilections. A recent the most common sites of involvement, and clinical study by El‑Mofty identified two histopathological variants, behavior. JOF is an uncommon, benign, osteogenic, trabecular JOF (TrJOF) and psammomatoid JOF (PsJOF). One and nonodontogenic tumor. It is considered a separate clinical feature that helps differentiate TrJOF from PsJOF is entity from ossifying fibroma due to its locally aggressive [1,2] the site of involvement, with PsJOF occurring in the paranasal behavior and propensity to occur at an adolescent age. sinuses and TrJOF occurring in the maxilla. This makes our The most distinguishing feature of ossifying fibroma is the case report unique and rare, which reports a psammomatoid well‑circumscribed appearance of the lesion radiographically, [6] variant in mandibular region. clinically, and the ease with which it is separated from the [3] normal bone surgically. The juvenile variety is usually present in children and adolescent. The lesion has a more Case Report A 20‑year‑old male patient reported to our unit with a Department of Dental and Oral Surgery Unit-1, Christian Medical complaint of swelling in the right lower jaw since 1 year. He College Hospital, Vellore, Tamil Nadu, India also complained of loose mobile teeth in the same region. Correspondence: Dr. Saurabh Kumar , He has been evaluated at various places in his hometown, Department of Dental and Oral Surgery Unit‑1, OPD Block, and previous biopsies reported were inconclusive. Extraoral Christian Medical College Hospital, Ida Scudder Road, examination revealed a diffuse swelling present over the Thottapalayam, Vellore ‑ 632 004, Tamil Nadu, India. right lower third of the face which was hard and nontender E‑mail: dr.s.kumar.bds@gmail.com on palpation with no localized rise in temperature; there Access this article online This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows Quick Response Code: others to remix, tweak, and build upon the work non-commercially, as long as the Website: author is credited and the new creations are licensed under the identical terms. www.contempclindent.org For reprints contact: reprints@medknow.com DOI: How to cite this article: Kumar S, Paul A, Ghosh A, Raut R. 10.4103/0976-237X.169839 Psammomatoid variant of juvenile ossifying fibroma involving mandible: A rare case report. Contemp Clin Dent 2015;6:581‑3. 581 © 2015 Contemporary Clinical Dentistry | Published by Wolters Kluwer - Medknow Kumar, et al.: Psammomatoid juvenile ossifying fibroma was no associated clinical lymphadenopathy. Intraorally Discussion bony expansion of alveolus was present with obliteration of gingivobuccal sulcus [Figure 1]. Orthopantomogram (OPG) Juvenile aggressive ossifying fibroma (JAOF) is a relatively rare done 3 months prior to the presentation [Figure 2] showed a fibro‑osseous lesion of the jaw characterized by the early age well‑defined sharply demarcated border involving the roots of onset, the location of the tumor, radiological appearance, of right side lower canine extending up to the first molar. and high recurrent potentials. JAOF may present as one of However, OPG at the time of presentation showed increase two histologic variants: Juvenile psammomatoid ossifying [7] in radio‑opacity as well as size of the lesion [Figure 3]. All fibroma (JPOF) and juvenile trabecular ossifying fibroma. the radiographs showed root resorption of the associated The psammomatoid type of JOF is reported more commonly roots of the teeth. An incisional bone biopsy was done than the trabecular variety and is more aggressive with a which showed lamellar bone along with islands of round strong tendency to recur. JPOF occurs in young patients with to spindle‑shaped cells displaying bland chromatin and peaks occurring in those who are above 15 years of age and is eosinophilic cytoplasm, arranged in sheets. Spherical usually characterized by rapid growth and a high tendency for [8,9] basophilic structures resembling cementum were evident recurrence. The age of the patients ranges from 3 months to [4,10,11] within these islands. There was no evidence of malignancy. 72 years, with mean age of occurrence 17.7 years. It is most Based on the biopsy report and clinical presentation, a commonly seen in the first and second decade of life. It shows provisional diagnosis of benign fibro‑osseous lesion was slight male predominance with the male:female ratio of 1.2:1. made. Due to the aggressiveness of the lesion, complete The age and gender of the present case are in confinement of excision of the tumor was done, and the surgical defect was the data from literature. Most cases affect sinonasal area and reconstructed with titanium reconstruction plate [Figure 4]. jaws (90%), out of which 10% cases involve mandible. In the jaw, The surgical specimen on histopathology was reported as painless swelling with expansion of cortical plates is present. consistent with PsJOF. Mandibular ramus is more common site than the body of the [11] mandible. The present case shows one such rare presentation involving the body of the mandible. The clinical and radiographic presentations of our patient were consistent with the features of JOF with respect to the age, rapidly progressive nature, and the well‑delineated radiographic picture. Figure 1: Intraoral examination showed bony hard swelling Figure 2: Orthopantomogram done 3 months prior to with vestibular obliteration presentation showing well‑circumscribed mixed radio‑opaque and radiolucent lesion involving the roots of premolar and first molar Figure 3: Orthopantomogram at the time of presentation showed increase in the size of the lesion involving the canine Figure 4: Postoperative orthopantomogram showing resection and the second molar, highlighting the aggressiveness of the defect with adequate margin and reconstruction with titanium lesion reconstruction plate Contemporary Clinical Dentistry | Oct-Dec 2015 | Vol 6 | Issue 4 582 Kumar, et al.: Psammomatoid juvenile ossifying fibroma The imaging study of the present case showed a multilocular osteolytic nature. The diagnosis of psammomatoid variant expansile lesion with a narrow transitional zone with the of JOF, especially when it affects structures other than the adjacent normal bone. These lesions usually presents with paranasal sinuses can be quite challenging as was seen in internal structure that can be radiolucent, mixed or radiopaque this case where the mandible was involved. JOAF is treated depending on the degree of calcification and presence of cystic by surgical excision and may recur if local resection is not areas. Root displacement usually is common and resorption, complete. Long‑term follow‑up is necessary owing to its though rare, can occur. The present case demonstrated a locally aggressive nature and high recurrent potentials. mixed radio‑opaque and lucent structure with resorption of A careful assessment of its clinical, radiographic, and the roots of the second molar. The lesion can cause expansion histopathologic features is necessary to overcome the as well as perforation. The radiographic features can resemble diagnostic and therapeutic challenges associated with this that of fibrous dysplasia and cemento‑ossifying fibroma. lesion. JPOF is not capsulated but is separated from the surrounding bone by radiopaque borders, and this finding is helpful Financial support and sponsorship in differentiating it from fibrous dysplasia. It usually has a Nil. centrifugal growth pattern, which can lead to an erroneous clinical diagnosis of cemento‑ossifying fibroma. Other major Conflicts of interest conditions in the differential diagnosis include aneurismal bone There are no conflicts of interest. cyst, osteoblastoma, osteosarcoma, and cemento‑osseous dysplasia. Burkitt lymphoma should also be considered in References the differential diagnosis of JAOF because of the similarity 1. Mohsenifar Z, Nouhi S, Abbas FM, Farhadi S, Abedin B. Ossifying in the age and site of presentation, rapidity of growth, and fibroma of the ethmoid sinus: Report of a rare case and review of radiolucent radiographic appearance. The characteristic literature. J Res Med Sci 2011;16:841‑7. histologic feature is the presence of numerous small, round 2. Yadav N, Gupta P, Naik SR, Aggarwal A. Juvenile psammomatoid ossicles, or “psammomatoid” bodies embedded in a cellular ossifying fibroma: An unusual case report. Contemp Clin Dent [11] 2013;4:566‑8. fibrous stroma. The aggressive nature of this entity with 3. Pindborg JJ, Kraner IR. Histologic Typing of Odontogenic Tumors. high rates of recurrence (30–56%) suggests that JPOF should Jaw Cysts and Allied Lesions. Geneva: WHO; 1971. be treated with surgical resection, rather than conservative 4. Johnson LC, Yousefi M, Vinh TN, Heffner DK, Hyams VJ, curettage. Recurrence may be attributed to difficulty in Hartman KS. Juvenile active ossifying fibroma. Its nature, dynamics and origin. Acta Otolaryngol Suppl 1991;488:1‑40. proper resection caused by the location of the lesion and the 5. Waldron CA. Fibro-osseous lesions of the jaws. J Oral Maxillofac infiltrative nature of the tumor borders. Complete resection Surg 1985;43:249‑62. [12] results in no recurrence for 6 months to 7 years or more. 6. El-Mofty S. Psammomatoid and trabecular juvenile ossifying fibroma of the craniofacial skeleton: Two distinct clinicopathologic entities. Oral Surg Oral Med Oral Pathol Oral Radiol Endod Because of high recurrence rate, immediate reconstruction is not 2002;93:296‑304. advised. Secondary reconstruction may be undertaken sooner 7. Mehta D, Clifton N, McClelland L, Jones NS. Paediatric for slow‑growing lesions and be delayed for fast‑growing lesions. fibro‑osseous lesions of the nose and paranasal sinuses. Int J Although there are no cases of malignant transformation, Pediatr Otorhinolaryngol 2006;70:193‑9. 8. Kramer IR, Pindborg JJ, Shear M. The WHO Histological typing rapidly growing lesions should raise suspicion and add a reason of odontogenic tumours. A commentary on the second edition. for delaying reconstruction. The prognosis is good because Cancer 1992;70:2988‑94. [11,12] malignant changes and metastases have not been reported. 9. Breheret R, Jeufroy C, Cassagnau E, Malard O. Juvenile ossifying Radiotherapy is contraindicated because of the risk of malignant fibroma of the maxilla. Eur Ann Otorhinolaryngol Head Neck Dis 2011;128:317‑20. transformation and potential harmful late effects in children. 10. Margo CE, Ragsdale BD, Perman KI, Zimmerman LE, Sweet DE. Thus, appropriate recommended treatment is aggressive surgical Psammomatoid (juvenile) ossifying fibroma of the orbit. approach followed by clinical and radiological follow‑up. Opthalmology 1985;92:150‑9. 11. Sarode SC, Sarode GS, Waknis P, Patil A, Jashika M. Juvenile psammomatoid ossifying fibroma: A review. Oral Oncol Conclusion 2011;47:1110‑6. 12. Makek MS. Clinical pathology of fibro‑osteo‑cemental lesions JAOF is a rare, clinical entity often misdiagnosed and of the craniofacial skeleton and jaw bones. Basel (Switzerland): mismanaged because of its rapidly progressive and Karger; 1983. p. 1. 583 Contemporary Clinical Dentistry | Oct-Dec 2015 | Vol 6 | Issue 4 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Contemporary Clinical Dentistry Pubmed Central

Psammomatoid variant of juvenile ossifying fibroma involving mandible: A rare case report

Contemporary Clinical Dentistry , Volume 6 (4) – Nov 1, 168

Loading next page...
 
/lp/pubmed-central/psammomatoid-variant-of-juvenile-ossifying-fibroma-involving-mandible-mcO0Xb0Kbe

References (16)

Publisher
Pubmed Central
Copyright
Copyright: © Contemporary Clinical Dentistry
ISSN
0976-237X
eISSN
0976-2361
DOI
10.4103/0976-237X.169839
Publisher site
See Article on Publisher Site

Abstract

The term juvenile ossifying fibroma (JOF) is used in literature in naming two microscopically distinct fibro‑osseous lesions of the craniofacial skeleton. One is characterized by small uniform spherical ossicles resembling psammoma bodies (psammomatoid JOF [PsJOF]). The other is distinguished by trabeculae of fibrillary osteoid and woven bone (trabecular JOF). Psammomatoid ossifying fibromas represent a unique subset of fibro‑osseous lesions of the craniofacial region. PsJOF has been distinguished because of its location, clinical behavior, and age of occurrence. They have distinctive histomorphologic features and a tendency toward locally aggressive behavior, including invasion and destruction of adjacent anatomic structures. It is generally seen in the younger age group, and the most common site is paranasal sinuses, orbits, and frontoethmoidal complex. We report a case of JPOF involving mandible which is rarely been described in literature. An insight into the radiographic progression of this rare entity along with the clinical feature and surgical management is discussed. Keywords: Fibro‑osseous lesion, juvenile ossifying fibroma, psammomatoid variant aggressive behavior than does the conventional ossifying Introduction fibroma. Microscopically, it has a characteristic feature of irregularly mineralized cellular osteoid strands lined by Ossifying fibromas are the well‑defined type of a benign plump osteoblasts. fibro‑osseous lesion of jaws. It has two types conventional and juvenile ossif ying fibroma (JOF). The JOF is a controversial [4] Most JOFs arise in the vicinity of the paranasal sinuses. With lesion that has been distinguished from the larger group of regard to the incidence of JOF in the jaws, there are conflicting ossifying fibroma on the basis of the age of the patients, [4,5] reports of maxillary and mandibular predilections. A recent the most common sites of involvement, and clinical study by El‑Mofty identified two histopathological variants, behavior. JOF is an uncommon, benign, osteogenic, trabecular JOF (TrJOF) and psammomatoid JOF (PsJOF). One and nonodontogenic tumor. It is considered a separate clinical feature that helps differentiate TrJOF from PsJOF is entity from ossifying fibroma due to its locally aggressive [1,2] the site of involvement, with PsJOF occurring in the paranasal behavior and propensity to occur at an adolescent age. sinuses and TrJOF occurring in the maxilla. This makes our The most distinguishing feature of ossifying fibroma is the case report unique and rare, which reports a psammomatoid well‑circumscribed appearance of the lesion radiographically, [6] variant in mandibular region. clinically, and the ease with which it is separated from the [3] normal bone surgically. The juvenile variety is usually present in children and adolescent. The lesion has a more Case Report A 20‑year‑old male patient reported to our unit with a Department of Dental and Oral Surgery Unit-1, Christian Medical complaint of swelling in the right lower jaw since 1 year. He College Hospital, Vellore, Tamil Nadu, India also complained of loose mobile teeth in the same region. Correspondence: Dr. Saurabh Kumar , He has been evaluated at various places in his hometown, Department of Dental and Oral Surgery Unit‑1, OPD Block, and previous biopsies reported were inconclusive. Extraoral Christian Medical College Hospital, Ida Scudder Road, examination revealed a diffuse swelling present over the Thottapalayam, Vellore ‑ 632 004, Tamil Nadu, India. right lower third of the face which was hard and nontender E‑mail: dr.s.kumar.bds@gmail.com on palpation with no localized rise in temperature; there Access this article online This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows Quick Response Code: others to remix, tweak, and build upon the work non-commercially, as long as the Website: author is credited and the new creations are licensed under the identical terms. www.contempclindent.org For reprints contact: reprints@medknow.com DOI: How to cite this article: Kumar S, Paul A, Ghosh A, Raut R. 10.4103/0976-237X.169839 Psammomatoid variant of juvenile ossifying fibroma involving mandible: A rare case report. Contemp Clin Dent 2015;6:581‑3. 581 © 2015 Contemporary Clinical Dentistry | Published by Wolters Kluwer - Medknow Kumar, et al.: Psammomatoid juvenile ossifying fibroma was no associated clinical lymphadenopathy. Intraorally Discussion bony expansion of alveolus was present with obliteration of gingivobuccal sulcus [Figure 1]. Orthopantomogram (OPG) Juvenile aggressive ossifying fibroma (JAOF) is a relatively rare done 3 months prior to the presentation [Figure 2] showed a fibro‑osseous lesion of the jaw characterized by the early age well‑defined sharply demarcated border involving the roots of onset, the location of the tumor, radiological appearance, of right side lower canine extending up to the first molar. and high recurrent potentials. JAOF may present as one of However, OPG at the time of presentation showed increase two histologic variants: Juvenile psammomatoid ossifying [7] in radio‑opacity as well as size of the lesion [Figure 3]. All fibroma (JPOF) and juvenile trabecular ossifying fibroma. the radiographs showed root resorption of the associated The psammomatoid type of JOF is reported more commonly roots of the teeth. An incisional bone biopsy was done than the trabecular variety and is more aggressive with a which showed lamellar bone along with islands of round strong tendency to recur. JPOF occurs in young patients with to spindle‑shaped cells displaying bland chromatin and peaks occurring in those who are above 15 years of age and is eosinophilic cytoplasm, arranged in sheets. Spherical usually characterized by rapid growth and a high tendency for [8,9] basophilic structures resembling cementum were evident recurrence. The age of the patients ranges from 3 months to [4,10,11] within these islands. There was no evidence of malignancy. 72 years, with mean age of occurrence 17.7 years. It is most Based on the biopsy report and clinical presentation, a commonly seen in the first and second decade of life. It shows provisional diagnosis of benign fibro‑osseous lesion was slight male predominance with the male:female ratio of 1.2:1. made. Due to the aggressiveness of the lesion, complete The age and gender of the present case are in confinement of excision of the tumor was done, and the surgical defect was the data from literature. Most cases affect sinonasal area and reconstructed with titanium reconstruction plate [Figure 4]. jaws (90%), out of which 10% cases involve mandible. In the jaw, The surgical specimen on histopathology was reported as painless swelling with expansion of cortical plates is present. consistent with PsJOF. Mandibular ramus is more common site than the body of the [11] mandible. The present case shows one such rare presentation involving the body of the mandible. The clinical and radiographic presentations of our patient were consistent with the features of JOF with respect to the age, rapidly progressive nature, and the well‑delineated radiographic picture. Figure 1: Intraoral examination showed bony hard swelling Figure 2: Orthopantomogram done 3 months prior to with vestibular obliteration presentation showing well‑circumscribed mixed radio‑opaque and radiolucent lesion involving the roots of premolar and first molar Figure 3: Orthopantomogram at the time of presentation showed increase in the size of the lesion involving the canine Figure 4: Postoperative orthopantomogram showing resection and the second molar, highlighting the aggressiveness of the defect with adequate margin and reconstruction with titanium lesion reconstruction plate Contemporary Clinical Dentistry | Oct-Dec 2015 | Vol 6 | Issue 4 582 Kumar, et al.: Psammomatoid juvenile ossifying fibroma The imaging study of the present case showed a multilocular osteolytic nature. The diagnosis of psammomatoid variant expansile lesion with a narrow transitional zone with the of JOF, especially when it affects structures other than the adjacent normal bone. These lesions usually presents with paranasal sinuses can be quite challenging as was seen in internal structure that can be radiolucent, mixed or radiopaque this case where the mandible was involved. JOAF is treated depending on the degree of calcification and presence of cystic by surgical excision and may recur if local resection is not areas. Root displacement usually is common and resorption, complete. Long‑term follow‑up is necessary owing to its though rare, can occur. The present case demonstrated a locally aggressive nature and high recurrent potentials. mixed radio‑opaque and lucent structure with resorption of A careful assessment of its clinical, radiographic, and the roots of the second molar. The lesion can cause expansion histopathologic features is necessary to overcome the as well as perforation. The radiographic features can resemble diagnostic and therapeutic challenges associated with this that of fibrous dysplasia and cemento‑ossifying fibroma. lesion. JPOF is not capsulated but is separated from the surrounding bone by radiopaque borders, and this finding is helpful Financial support and sponsorship in differentiating it from fibrous dysplasia. It usually has a Nil. centrifugal growth pattern, which can lead to an erroneous clinical diagnosis of cemento‑ossifying fibroma. Other major Conflicts of interest conditions in the differential diagnosis include aneurismal bone There are no conflicts of interest. cyst, osteoblastoma, osteosarcoma, and cemento‑osseous dysplasia. Burkitt lymphoma should also be considered in References the differential diagnosis of JAOF because of the similarity 1. Mohsenifar Z, Nouhi S, Abbas FM, Farhadi S, Abedin B. Ossifying in the age and site of presentation, rapidity of growth, and fibroma of the ethmoid sinus: Report of a rare case and review of radiolucent radiographic appearance. The characteristic literature. J Res Med Sci 2011;16:841‑7. histologic feature is the presence of numerous small, round 2. Yadav N, Gupta P, Naik SR, Aggarwal A. Juvenile psammomatoid ossicles, or “psammomatoid” bodies embedded in a cellular ossifying fibroma: An unusual case report. Contemp Clin Dent [11] 2013;4:566‑8. fibrous stroma. The aggressive nature of this entity with 3. Pindborg JJ, Kraner IR. Histologic Typing of Odontogenic Tumors. high rates of recurrence (30–56%) suggests that JPOF should Jaw Cysts and Allied Lesions. Geneva: WHO; 1971. be treated with surgical resection, rather than conservative 4. Johnson LC, Yousefi M, Vinh TN, Heffner DK, Hyams VJ, curettage. Recurrence may be attributed to difficulty in Hartman KS. Juvenile active ossifying fibroma. Its nature, dynamics and origin. Acta Otolaryngol Suppl 1991;488:1‑40. proper resection caused by the location of the lesion and the 5. Waldron CA. Fibro-osseous lesions of the jaws. J Oral Maxillofac infiltrative nature of the tumor borders. Complete resection Surg 1985;43:249‑62. [12] results in no recurrence for 6 months to 7 years or more. 6. El-Mofty S. Psammomatoid and trabecular juvenile ossifying fibroma of the craniofacial skeleton: Two distinct clinicopathologic entities. Oral Surg Oral Med Oral Pathol Oral Radiol Endod Because of high recurrence rate, immediate reconstruction is not 2002;93:296‑304. advised. Secondary reconstruction may be undertaken sooner 7. Mehta D, Clifton N, McClelland L, Jones NS. Paediatric for slow‑growing lesions and be delayed for fast‑growing lesions. fibro‑osseous lesions of the nose and paranasal sinuses. Int J Although there are no cases of malignant transformation, Pediatr Otorhinolaryngol 2006;70:193‑9. 8. Kramer IR, Pindborg JJ, Shear M. The WHO Histological typing rapidly growing lesions should raise suspicion and add a reason of odontogenic tumours. A commentary on the second edition. for delaying reconstruction. The prognosis is good because Cancer 1992;70:2988‑94. [11,12] malignant changes and metastases have not been reported. 9. Breheret R, Jeufroy C, Cassagnau E, Malard O. Juvenile ossifying Radiotherapy is contraindicated because of the risk of malignant fibroma of the maxilla. Eur Ann Otorhinolaryngol Head Neck Dis 2011;128:317‑20. transformation and potential harmful late effects in children. 10. Margo CE, Ragsdale BD, Perman KI, Zimmerman LE, Sweet DE. Thus, appropriate recommended treatment is aggressive surgical Psammomatoid (juvenile) ossifying fibroma of the orbit. approach followed by clinical and radiological follow‑up. Opthalmology 1985;92:150‑9. 11. Sarode SC, Sarode GS, Waknis P, Patil A, Jashika M. Juvenile psammomatoid ossifying fibroma: A review. Oral Oncol Conclusion 2011;47:1110‑6. 12. Makek MS. Clinical pathology of fibro‑osteo‑cemental lesions JAOF is a rare, clinical entity often misdiagnosed and of the craniofacial skeleton and jaw bones. Basel (Switzerland): mismanaged because of its rapidly progressive and Karger; 1983. p. 1. 583 Contemporary Clinical Dentistry | Oct-Dec 2015 | Vol 6 | Issue 4

Journal

Contemporary Clinical DentistryPubmed Central

Published: Nov 1, 168

There are no references for this article.