Juvenile ossifying fibroma is a rare, benign but locally aggressive bone tumor that is most common in males under the age of 15, usually occurring in the paranasal sinuses and orbits. It appears on radiographs and CT scans as a well-defined radio-opaque lesion that causes expansion of the affected area. On MRI it has intermediate to low signal on T1-weighted imaging and low signal on T2-weighted imaging, with some areas of higher signal representing fatty marrow in ossified regions. While small lesions can be treated with curettage or enucleation, larger tumors requiring radical resection due to infiltration of surrounding sinuses. Recurrence rates after treatment are moderate, between 30-58

1. Adnan Rashid, MD
Department of Diagnostic Radiology,
SIMS/SHL
Radiology of
Juvenile ossifying fibroma

2. Juvenile ossifying fibroma
Rare Benign locally aggressive tumor
Most common below age of 15yrs
Most common in males

3.  Most common site Paranasal sinuses & orbits
 Slowly evolving and asymptomatic tumors
 No genetic association

4. Common radiologic modalities:
Radiograph:
Panoramic
PNS
CT
Plain
Contrast enhanced (CECT)
MRI
T1WI,T2WI.
Contrast (Gad-enhanced)

5. Panoramic radiograph (initially Radio-lucent)
Extensive radio-opaque lesion with well-defined corticated
border.
Journal of International Oral Health 2014; 6(5):108-110

6. Paranasal view
Ill-defined
radioopacity
occupying the
floor of the
maxillary sinus
Contemp Clin Dent. 2012 Apr;
3(Suppl1): S45–S50.

7. CT Head & Neck
Plain: Large expansile,
soft tissue lesion with
peripheral areas of
calcification/ sclerosis,
involving right maxillary
sinus, causing balooning of
the walls of sinus and out-
pouching through the
alveolar bone.
On CECT: The soft tissue
component usually
enhances 1.

8. MRI
T1WI
 intermediate to low signal
 focal regions of higher signal( fatty marrow in ossified
components)
 T2WI: low signal
 T1 WI+ Contrast (Gd): soft-tissue component
may demonstrate some enhancement

9. MR Scan (T2)
-intermediate to low
signal
-focal regions of higher
signal( fatty marrow in
ossified components)
A Rare Case of Psammomatoid (Juvenile) Ossifying Fibroma of the Maxillary Sinus

10. Histologically two types:
 Trabecular
 Psammomatoid

11.  Small lesions can be conservatively treated
by curretage and enucleation
 Large and irregular shaped tumors with
infiltrating sinuses can be treated by radical
resection
 Adjuvant interferon therapy for 1year for
psammomatoid variant.

12.  Recurrence rate is 30-58%

13. Follow up
 Follow up of the patient will be done for three
years
 CT scan …….. Six monthly basis during first
year.

14. THANK YOU!