Australian Dental Journal 1998;43:(6):390-4
Fibrous dysplasia of the jaw bone: A review of 15 new
cases and two cases of recurrence in Jamaica together
with a case report
C. Ogunsalu, BDS(Ib), MSc(Lond), FRACDS*
N. J. D. Smith, BDS, MSc, MPhil, DDRRCR
A. Lewis, BchD, FDS, RCS(Eng&Edin), LDS, MBA
Abstract
The authors reviewed 15 new cases of fibrous
dysplasia of the jaw bone and two cases of
recurrence seen in Jamaica between 1980 and
1995. Only cases which had a histological
confirmation of fibrous dysplasia were included.
The clinical behaviour and radiological findings of
these cases were studied from the case files, either
at the Cornwall Regional Hospital or the Kingston
Public Hospital in Jamaica.
Key words: Fibrous dysplasia, atypical clinical
presentations, case report.
(Received for publication November 1996. Accepted
December 1996.)
Introduction
Fibrous dysplasia is a fairly common localized
misdifferentiation of the bone-forming mesenchyme
affecting a single or many bones in the skeletal
system. Skeletal aberration represents the cardinal
feature but certain endocrinopathies, abnormal
pigmentation of the skin and mucous membrane,
and occasionally other abnormalities form part of
the entire disease process. When the finding of
fibrous dysplasia coincides with the finding of
abnormal pigmentation of the skin, the condition is
called McCune-Albright syndrome.
Monostotic fibrous dysplasia, though less serious
than polyostotic fibrous dysplasia, is of greater
concern to the dentist because of the frequency in
which the jaws are affected. In a series of 67 cases of
monostotic fibrous dysplasia, Schlumberger1 found
*Oral and Maxillofacial Surgeon, Cornwall Dental Centre, Montego
Bay, Jamaica.
Head of Department of Dental Radiology, Dental Institute, Kings
College Medical and Dental School, United Kingdom.
Consultant and Head of Department of Oral and Maxillofacial
Surgery, Kingston Public Hospital, Jamaica.
390
seven cases involving the maxilla and two cases
involving the mandible. In the present series of 15
new cases in Jamaica, ten cases involved the maxilla
and five involved the mandible.
The diagnosis of fibrous dysplasia is often made in
infancy and childhood. The maxilla or mandible
may be involved but a predominance of the maxilla
has been documented.2 Males are less often affected
than females. The deformity of the jaw results from
a progressively slow-growing painless swelling, but
growth often slows or become arrested at a time
coinciding with the onset of puberty.2
Materials and methods
All cases histologically confirmed to be fibrous
dysplasia were studied for findings such as age of the
patient, sex, radiographic appearance and clinical
behaviour of the tumour (fibrous dysplasia). This
study was conducted by using the information
documented for each patient in the case files at both
the Cornwall Regional Hospital and Kingston
Public Hospital in Jamaica. Based on the existing
legislation3 on the retention of medical records in
Jamaica, records were only readily available from
1980 to April 1995, a period of 15 years. No records
pertaining to a patient were recorded twice, and
cases of recurrence were recorded separately. A total
of 15 new cases of fibrous dysplasia and two cases of
recurrence were found.
Results
The present series of 15 new cases and two cases
of recurrent fibrous dysplasia of the jaw bones is the
first to be documented in Jamaica. Between 1980
and April 1995, 15 new cases of monostotic fibrous
dysplasia and two cases of recurrent fibrous
dysplasia of the jaw bone were recorded. The cases
Australian Dental Journal 1998;43:6.
Table 1. Summary of cases of fibro-osseous
lesions
Fibro-osseous lesions No of cases %
Monostotic fibrous dysplasia 15 47.0
Ossifying fibroma 10 31.2
Gigantiform cementoma 3 9.4
Recurrent fibrous dysplasia 2 6.2
Cementoma (cementoblastoma) 1 3.1
Cemental dysplasia 1 3.1
Cementifying fibroma 0
Total number of fibro-osseous lesions 32 100

10
2

Fig. 2. Extra-oral appearance of a patient (Case 14, Table 2) with

fibrous dysplasia.
15

K Monostotic fibrous dysplasia; K Ossifying fibroma;

K Gigantiform cementoma; K Recurrent fibrous dysplasia D;
K Cementoblastoma; K Cemental dysplasia.
Fig. 1. Pie chart showing the distribution of fibro-osseous lesions in
Jamaica (1990 to 1995).

of new monostotic fibrous dysplasia and recurrent

fibrous dysplasia accounted for 5.2 per cent and
0.68 per cent respectively of jaw bone tumours in
Jamaica. Fibrous dysplasia (excluding recurrent
fibrous dysplasia) accounted for 47 per cent of all
cases of fibro-osseous lesions (WHO classification)
seen in Jamaica during this period (Table 1, Fig. 1).
Recurrent fibrous dysplasia accounted for 6.2 per
Fig. 3. Intra-oral appearance of the patient shown in Fig. 2.
cent of all cases of fibro-osseous lesions during this
period.
years (Table 2) with a mean age of 25.7 years. Of
Clinical features these, five (33.3 per cent) were 20 years old and
The presenting symptom in all cases was an below, and 12 (80 per cent) were 30 years old and
increasing swelling of the jaw bone that either below. Two cases were patients aged 47 years at the
interfered with function or was disfiguring (Fig. 2, time of presentation, which has been previously
3). Case 14 (Table 2) presented with a painful, recorded as the average age at presentation. Figure 4
suppurative swelling with ulceration, which is very shows the age distribution of fibrous dysplasia in
atypical of fibrous dysplasia (Fig. 3). Jamaica. The male:female ratio of the patients was
For the new cases of monostotic fibrous dysplasia, 2:3. Five lesions were located in the mandible and
the patients were between the ages of 10 and 47 ten in the maxilla, thus giving a site ratio of 1:2 for
Australian Dental Journal 1998;43:6. 391
Table 2. Summary of cases of fibrous dysplasia in Jamaica
Case Sex Age (years) Site Radiographic appearance
1 F 16 Ant maxilla (R) Not located
2 F 27 Ant maxilla (R) Orange peel
3 F 23 Ant maxilla Orange peel
4 F 29 Ant and post mandible (R) Radiolucent lesion between 48 and 44
5 F 47 Ant and post mandible (R) Evidence of excessive bone production*
6 M 25 Ramus (post) mandible (L) Varying degree of opacification
7 M 10 Post mandible (R) Orange peel
8 F 31 Ant maxilla (R) Not located
9 M 16 Post maxilla (L) Ground glass appearance
10 F 47 Post mandible (R) Radiolucent lesion
11 F 11 Post mandible (R) Ground glass appearance
12 M 23 Ant and post maxilla (R) Large opacification of maxilla
13 F 28 Ant and post maxilla (R) Opacification of lower part of R antrum
14 M 34 Post maxilla (R) Radiopacity of R antrum
15 M 20 Post maxilla (L) Radiopacity of the L antrum
*Particularly involving the alveolar process.

8- 4. Varying degree of opacification (not ground

K Female glass and not orange peel).
K Male Figures 5 and 6 show the radiographic appearance
6- of two cases of fibrous dysplasia.
Surprisingly, Cases 4 and 10, female patients aged
29 and 47 respectively, presented as radiolucent
4- lesions of the mandible, thus signifying early lesions
of fibrous dysplasia in patients over the age of 25
years.
2-
Recurrent fibrous dysplasia
Two separate cases of recurrent fibrous dysplasia
were also documented during this period (Table 3).
0-
Because so few attempts at total removal of the
10-19 20-29 30-39 40-49
lesion have been reported (for obvious reasons), any
Age band (years)
discussion of recurrence rate of fibrous dysplasia
Fig. 4. Age and sex distribution of 15 cases of fibrous dysplasia in
Jamaica (1990-1995). may not be practicable.

mandible and maxilla respectively. Table 2 shows the Case repor t

exact location of the tumours as recorded in the
patients case files. All cases for the mandible were
located in the posterior mandible while, interestingly,
Case 6 involved the ascending ramus of the left
mandible. Four cases were located in the anterior
maxilla, three cases in the posterior maxilla, while
three cases involved both the posterior and anterior
maxilla.
Radiologic appearance
The radiographic appearance of fibrous dysplasia
in Jamaica is shown in the appropriate column in
Table 2. The radiographs or radiographic report for
Cases 1 and 8 could not be located, hence only 13
radiographic reports were available. For simplicity, it
was decided to categorize the radiographic
appearance as follows:
1. Orange peel/ground glass appearance.
2. Opacification of the antrum.
3. Radiolucent lesion of the mandible.
392
A 34 year old male, otherwise healthy looking,
presented at the Maxillofacial Clinic of the Cornwall
Regional Hospital in Jamaica with a rapidly growing,
painful swelling of the right maxilla of two months
duration. Epiphoria, nasal discharge and anaesthesia
in the distribution of the infra-orbital nerve on the
right side of the jaw were associated findings of
clinical significance.
Extra-oral examination revealed a bony, hard
swelling of the right maxilla, extending from the
right infra-orbital region above, to the area just
above the right angle of the mouth below, and
extending to the zygomatic region. The nasolabial
fold on this side had been obliterated (Fig. 2).
Intra-oral examination revealed an extensive,
ulcerated lesion extending from the distal aspect of
13 to the region of 18. The lesion measured 50 mm
at its largest diameter. Ulceration and suppuration
of this swelling were the confusing clinical findings
(Fig. 3).
Australian Dental Journal 1998;43:6.
Fig. 5. Occipitomental view radiograph of a patient (Case 14, Table
2) with fibrous dysplasia. Note complete opacification of the right
maxillary antrum.
The gross intra-oral appearance was disfiguring
and masticatory activity and phonation were
impaired. The clinical impression was that of a
malignant neoplasm such as a fibrosarcoma or
carcinoma of the maxillary antrum.
An occipitomental radiograph revealed complete
opacification of the right maxillary antrum (Fig. 5),
suggestive of a space-occupying lesion in the right
maxillary sinus.
Histologically, the gross appearance of the
submitted specimen consisted of five irregular
portions of firm, tan tissue, some of which were
partially covered by mucosa. On sectioning, each
revealed a firm, cream cut surface.
Sections showed a portion of a lesion consisting of
irregularly shaped spicules of woven bone dispersed
in a background of compact, collagenous fibrous
tissue (Fig. 7a, b). Osteoblastic rimming of the bony
spicules was not evident. Some sections were
partially covered by stratified squamous, non-
keratinizing epithelium, which was focally ulcerated
and associated with areas of haemorrhage and a
heavy chronic inflammatory cell infiltrate within the
subjacent fibrous stroma. The overall histologic
features were those of fibrous dysplasia with
ulceration and infection.
Table 3. Summary of cases of recurrent fibrous dysplasia in Jamaica
Case Sex Age (years) Site
1 M 35 Post maxilla (R)
2 F 13 Post mandible (R)
Australian Dental Journal 1998;43:6.
Fig. 6. Occlusal radiograph of the maxilla of a 31 year old black
Jamaican female showing what may be called ground glass appearance
of the palate on the left side.
The excision of this lesion was followed by
recurrence to the original size in less than six months
(Case 1, Table 3). For a 34 year old patient with
fibrous dysplasia, recurrence following excision of
the lesion is not expected, as has always been
previously reported.
Discussion
Because of the similarity between fibrous
dysplasia and ossifying fibroma at a histological
level, the diagnosis of each of these fibro-osseous
lesions continues to be a problem. For this reason
one can correctly say that the X-ray studies are
indispensable for the interpretation of fibro-osseous
lesions of the jaw, and more particularly in the
differentiation between fibrous dysplasia and ossifying
fibroma, which is virtually impossible on the basis of
histopathology alone.
Monostotic fibrous dysplasia is characterized by a
swelling resulting from a poorly circumscribed area
of fibro-osseous proliferation. Prior to 1970, fibrous
dysplasia was used as an all-inclusive term that
encompassed both monostotic and polyostotic
forms of fibrous dysplasia and a variety of other
fibro-osseous lesions, notably ossifying fibroma,
fibrous osteoma and osteoblastoma.4 Recently, the
Radiographic appearance
Radiopacity of the R antrum
Ground glass appearance of the mandible in the molar region
393
 a b
Fig. 7. a, b, Photomicrographs (380 and 3500 respectively) showing irregularly shaped spicules of woven bone dispersed on a background of
compact, collagenous fibrous tissues.
term fibro-osseous lesion has been frequently used
for disorders ranging from fibrous dysplasia to the
circumscribed lesions of ossifying or cementifying
fibroma and cemental dysplasia. More recently, the
WHO classification of fibro-osseous lesion has
recognized these conditions as distinct entities.
Monostotic fibrous dysplasia starts in childhood
but typically undergoes increasing ossification and
subsequent arrest in adulthood. It is clinically seen
mainly in young persons, usually in their 20s, as a
painless, smoothly rounded swelling, usually in the
maxilla. In this study of 15 new cases in Jamaica,
this was found not to be so, as the majority (10
cases) presented initially after the age of 20 years
and, more surprisingly, two cases presented at the
age of 47 years. The authors are very certain that
pain from a rapidly growing swelling which was not
previously present (confirmed by the referring
dentist) was the presenting complaint of Case 14
who was seen in late 1994. Because of the atypical
clinical behaviour of fibrous dysplasia in Jamaica, as
documented by findings from this series of 15 new
cases, further study on the clinicopathologic aspect
of the disease is necessary.
The mean age of occurrence in the 69 patients
reported by Zimmerman and his associates5 was 27
years, while in the 53 patients with craniofacial
fibrous dysplasia reported by Gardner and Halpert,
the mean age was 34 years,6 both of which are higher
than the mean age of 25.7 years for 15 patients
reported in the present study.
The aetiology of monostotic fibrous dysplasia is
unknown. Although a variety of possible factors has
been suggested, none has found general acceptance.
The word new has been used for the 15 cases of fibrous dysplasia to
distinguish them from the two cases of recurrent fibrous dysplasia also
recorded.
394
There is clinical evidence which indicates that local
infection or trauma may eventuate in the disease
under yet unrecognized conditions,1 and this may be
the cause in Case 14. Despite the similarity in
nomenclature and histologic appearance, the mono-
stotic fibrous dysplasia is not necessarily related to
the polyostatic form and the former does not
necessarily progress into the latter.
Conclusion
The clinicopathological aspect of the 15 new cases
of fibrous dysplasia in this series differs from what
has been previously documented. It is also very
surprising to find recurrence at the age of 34 years.
For these reasons, there is a need for further study of
new cases in Jamaica.
References
1. Schlumberger HG. Fibrous dysplasia (ossifying fibroma) of the
maxilla and mandible. Am J Orthodont Oral Surg 1946;32:579-87.
2. Neville BW, Damn DD, Allen CM, Bunquot JE. Oral and
maxillofacial pathology. 1st edn. Philadelphia: WB Saunders,
1995:460-9.
3. Ogunsalu CO. A study of tumours of the jaw bones in Jamaica with
special emphasis on radiology. London: University of London,
1995. MSc thesis.
4. Lynch MA, Brightman VJ, Greenberg MS, eds. Burkets oral
medicine: diagnosis and treatment. 8th edn. Philadelphia:
Lippincott, 1984:327-9.
5. Zimmerman DC, Dahlin DC, Stafne EC. Fibrous dysplasia of the
mandible and maxilla. Oral Surg Oral Med Oral Pathol
1958;11:55-68.
6. Gardner AF, Halpert L. Fibrous dysplasia of the skull with special
reference to the oral regions. D Practitioner D Record
1963;13:337-40.
Address for correspondence/reprints:
Mr Christopher Ogunsalu,
Cornwall Dental Centre,
42 Market Street,
Montego Bay, Jamaica.
Australian Dental Journal 1998;43:6.