Fibro-Osseous Lesions in Craniofacial Anatomy

Fibro-osseous lesions of the craniofacial skeleton represent a heterogeneous group of disorders in which normal bone is progressively replaced by fibrocellular stroma and irregular calcified matrix. These lesions encompass developmental anomalies such as fibrous dysplasia, reactive conditions like cemento-osseous dysplasia, and true neoplasms including ossifying fibromas. Although benign, they often present as slowly enlarging maxillofacial swellings causing functional impairment, deformity or dental displacement. Radiographically they evolve from purely radiolucent to mixed-density and ultimately radiopaque phases, mirroring the degree of mineralisation. Histopathological assessment is complicated by overlapping patterns of fibrous and osseous elements, challenging differentiation between subtypes. Recent advances have focused on integrating molecular diagnostics, high-resolution imaging modalities and stereological analysis to enhance diagnostic precision, inform management decisions and explore targeted therapeutics. Recognition of distinct genetic and signalling pathways within these lesions underscores their diverse pathogenesis and highlights the importance of multidisciplinary evaluation for optimal clinical outcomes.

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Fibro-Osseous Lesions in Craniofacial Anatomy publication trend

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Technical terms

Fibro-osseous lesion: A pathological condition in which normal bone is replaced by fibrous connective tissue and irregular mineralised matrix.

Ossifying fibroma: A benign neoplasm characterised by well-circumscribed fibrous tissue producing bone or cementum-like material, typically affecting the jaws.

Fibrous dysplasia: A developmental anomaly featuring replacement of normal bone with fibrocellular stroma and irregular woven bone, often stabilising after skeletal maturity.

Cemento-osseous dysplasia: A reactive fibro-osseous process in tooth-bearing jaw regions, distinguished by evolving radiographic stages from lucent to sclerotic.

Psammomatoid ossifying fibroma: A subtype of juvenile ossifying fibroma marked by laminated calcific spherules (‘psammoma-like bodies’) within a fibrous stroma.

RAS-MAPK pathway: A cell-signalling cascade regulating proliferation and differentiation, frequently implicated in oncogenic transformation.

References

1. Psammomatoid Ossifying Fibroma Is Defined by SATB2 Rearrangement. Modern Pathology (2023).
2. A Clinical, Radiological and Histopathological Review of 74 Ossifying Fibromas. Head and Neck Pathology (2023).
3. Cemento-osseous dysplasia is caused by RAS-MAPK activation. Pathology (2022).