Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
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Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


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Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Dentistry
Year : 2012 | Month : May | Volume : 6 | Issue : 3 | Page : 539 - 541 Full Version

Central Ossifying Fibroma of the Mandible: An Unusual Case Report


Published: May 1, 2012 | DOI: https://doi.org/10.7860/JCDR/2012/.2088
Bal Reddy P., Sridhar Reddy B., Prasad N., Kiran G., Karthik Patlolla

1. Professor & HOD, Dept. of Oral and Maxillofacial Pathology. GDCH, Hyderabad. A.P., India. 2. Asst. Professor, Dept.of Oral & Maxillofacial Surgery, GDCH, Hyderabad. A.P., India. 3. Asst. Professor, Dept.of Oral & Maxillofacial Surgery. GDCH, Hyderabad. A.P., India. 4. Asst. Professor, Dept.of Oral & Maxillofacial Pathology. GDCH, Hyderabad. A.P., India. 5. Dental Surgeon. Karthik Dental Center, Hyderabad. A.P., India.

Correspondence Address :
Asst. Professor, Dept. of Oral and Maxillofacial Pathology.
Govt.Dental College & Hospital, Afzalgunj,
Hyderabad, A.P., India - 500012.
Phone: 09885920145
E-mail: Kiran.dentist@gmail.com

Abstract

Cemento-ossifying fibroma is a fibro-osseous lesion which belongs to the same category as fibrous dysplasia and cementossifying dysplasia. In a recent WHO classification (2005), the term ‘cemento-ossifying fibroma’ was replaced with ‘ossifying fibroma’. These are slow growing, painless lesions which are seen more commonly in women between the third and fourth decades of life. We are reporting an unusual case report of a central ossifying fibroma of the left mandible in an 18 year old male patient who presented with a painful swelling on the left side of the face. The lesion was treated with surgical resection and reconstruction.

Keywords

Ossifying fibroma, Fibro-osseous lesions, Cemento-ossifying fibroma

INTRODUCTION
Central Ossifying Fibroma (COF) is a benign osseous neoplasm which consists of highly cellular, fibrous tissue with varying amounts of calcified tissue, which resembles the bone, the cementum or both (1). COF very closely resembles lesions such as fibrous dysplasia, cemetifying periapical dysplasia or cemento-osseous florid dysplasia. COF is believed to originate from the periodontal membrane (2). It is usually seen in the third to fourth decades of life and it generally shows a female predominance (3). Most of the cases are located in the mandible, as a painless swelling (4). Radiographically, COF presents as a well-defined, unilocular lesion which contains varying amounts of radiopaque material (5). Once it is completely excised, COF does not usually recur (6). Here, we are reporting an unusual case of COF in the left side of the mandible.

Case Report

An 18-year old male patient reported to our institute with the chief complaint of swelling on the left side of the face since five years and pain since one week. His history revealed that the swelling was small in size primarily, which was initially at the left side of the mandible, which had gradually increased recently and attained the present size. The pain was intermittent in nature, which subsided on taking analgesics. Since the patient had not had any pain, discomfort or facial deformity earlier, he did not visit any hospital. His extra-oral examination showed a swelling of about 6 x 7 centimetre in size. The swelling was hard in consistency. On palpation, mild tenderness was noted. His intra-oral examination showed a swelling on the left side of the lower jaw, at the molar region. Expansion of the buccal and the lingual cortical plates was seen over that region. All the molars at that site were absent. Pus discharge was also observed in that region. An orthopantamograph revealed a radiopaque lesion which was distal to the lower left second premolar, which extended from the alveolar crest to the inferior borders of the mandible. Surrounding the lesion, radiolucency was observed. Computerized tomography showed the presence of a well defined, lobulated, hyperdense lesion which measured about 3.5 x 3.2 cm of HU 1600, with thin perilesional lucency, in the body of the mandible on the left side. Magnetic Resonance Imaging of the mandible revealeda large, lobulated, well defined, expansile, altered signal intensity which measured 3.3 x 2.5 cm, which was hypotense, which was noted in the body of the mandible, on the left side. A biopsy was done and histopathologically, the lesion showed dense connective tissue stroma, which contained areas of immature bone formation and cementum like tissue and a diagnosis of COF was given.

After obtaining consent from both the patient and the physician, resection of the tumour and reconstruction was planned under general anaesthesia. An intraoral incision was made from the lower left incisor region to the distal part of the lower left third molarregion. A vertical releasing incision was made at the incisor region. The mucoperiosteal flap was raised and after preserving the mental nerve, the lesion was exposed upto the inferior border. Vertical slop cuts and a horizontal cut were made, with bur holes. The lesion was removed in toto. The reconstruction angle plate was fixed withscrews over the site and a thorough irrigation with antiseptic fluids was done. This case was followed up for one year at three monthly intervals and the healing was uneventful.

Discussion

Fibro-osseous lesions (FOL) are a group of conditions which are characterized by the replacement of normal bone by fibrous tissue, which contains a newly formed, mineralized product (7). They include, fibrous dysplasia (FD), cemento-ossifying dysplasia (COD), COF and their subtypes (8). Various classifications were proposed to classify these lesions (7),(9). Branon and Fowler were the first to use the term ‘ossifying fibroma’ (OF) in place of COF and the recent WHO (2005) edition of the classification of odontogenic neoplasms has replaced the term COF with OF (6),(10). The origin of COF is not clearly understood. Few authors have considered that these lesions arose from the periodontal membrane which contains multi-potential cells, that under certain pathologic conditions, are capable of producing tumours which are composed of either cementum, lamellar bone or fibrous tissue (2). Based on their pathogenesis, Waldron (1985) subclassified COFs as medullary or periodontal ligamentous in origin (7). A more aggressive form of COF which occurs in younger individuals has been designated as Juvenile COF (11).

Review of the literature has revealed that COFs are usually seen in the third and fourth decades of life. However, our patient was much younger, 18-years old (3). Most of the studies showed a female predominance, whereas in our case, the patient was a male (3). Although few cases have been reported in the maxilla, the most common location is the mandible, which was the same in our case also (5),(12). Classically, the patients present with a painless swelling, though with time, the lesion may become large enough to cause facial deformation, whereas in our case, the patient presented with a painful swelling which was associated with pus discharge (13). MacDonald-Jankowski described three stages of COF, based on the radiographic features; an initial radiolucent stage, then a mixed stage and eventually, a sclerotic appearing stage (4). COF usually presents as a mixed lesion with well defined borders. Our case presented as a radiopaque mass with surrounding radiolucency (6).

Histopathologically, COF shows a well vascularized fibrocellular connective tissue with immature bony trabeculae and cementoid, but these findings are not specific to COF alone and they can also be seen in FD. Our case also showed similar findings of areas of immature bone and cementum like tissue in the connective tissue. Because of the overlapping histologic features, the diagnosis of the individual lesions in the FOL group poses a difficulty (14),(15). The differential diagnosis of COF includes fibrous dysplasia (FD), a calcifying odontogenic cyst (COC), cementoblastoma, chondrosarcoma and osteosarcoma. FD has a characteristic ‘ground glass’ appearance. COC and cementoblastomas are associated with the roots of vital permanent teeth. COF is differentiated from sarcomas by presence of well defined margins (5). Surgical curettage or enucleation with a long term follow-up is the initial treatment of choice for small COFs, whereas surgical resection is indicated for the large lesions (5),(15). Eversole et al reported a recurrence rate of 28 % following curettage (4). Hence, a long term follow-up of the patients is recommended. In our case, we carried out surgical resection and reconstruction and the followup revealed normal healing.

Conclusion

We reported a case of COF in an 18-year old male patient who came with a radiopaque swelling and pus discharge on the left side of the mandible. We suggest that a proper correlation of the clinical, radiological and the histological features is necessary for establishing a definitive diagnosis, as well as for categorizing the FOL lesions. Since chances of recurrence of COF are reported in the literature, surgical resection and follow-up of the patients is warranted.

References

1.
Liu Y, You M, Wang H, Yang Z, Miao J, Shimizutani K, Koseki T. Ossifying fibromas of the jaw bone: a study of 20 cases. Dentomaxillofacial Radiology. 2010; 39: 57-63.
2.
Sarwar HG, Jindal MK, Ahmad SS. Cemento-ossifying fibroma-a rare case. J Indian Soc Pedod Prev Dent. 2008; 26: 128-131.
3.
Eversole LR, Leider AS, Nelson K. Ossifying fibroma: a clinicopathologic study of sixty-four cases. Oral Surg Oral Med Oral Pathol 1985; 60: 505–11.
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MacDonald-Jankowski DS. Cemento-ossifying fibromas in the jaws of the Hong Kong Chinese. Dentomaxillofac Radiol 1998; 27: 298–304.
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Cemento-ossifying fibroma of the mandible: Presentation of a case and review of the literature. J Clin Exp Dent. 2011; 3(1): e66-69.
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MacDonald-Jankowski DS. Ossifying fibroma: a systematic review. Dentomaxillofac Radiol 2009; 38: 495-513.
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Waldron CA. Fibro-osseous lesions of the jaws. J Oral MaxillofacSurg 1985; 43: 249–62.
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MacDonald-Jankowski. Fibro-osseous lesions of the face and the jaws. Clinical Radiology. 2004; 59: 11-25.
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Waldron CA. Fibro-osseous lesions of the jaws. J Oral MaxillofacSurg 1993; 51: 828-35.
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Reichart PA, Philipsen HP, Sciubba JJ. The new classification of head and neck tumours (WHO) – any changes? Oral Oncol 2006; 42: 757-58.
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Slootweg PJ, Panders AK, Koopmans R, Nikkels PG. Juvenile ossifying fibroma. An analysis of 33 cases with an emphasis on the histological aspects. J Oral Pathol Med 1994; 23: 385-88.
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Tamiolakis D, Thomaidis V, Tsamis I. Cemento-ossifying fibroma of the maxilla: a case report. Acta Stomatal Croat. 2005; 39: 319-21.
13.
Summerlin DJ, Tomich CE. Focal cemento-osseous dysplasia: a clinicopathologic study of 221 cases. Oral Surg Oral Med Oral Pathol 1994; 78: 611–20.
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Ogunsalu CO, Lewis A, Doonquah L. Benign fibro-osseous lesions of the jaw bones in Jamaica: analysis of 32 cases. Oral Dis 2001; 7: 155–62.
15.
Koury ME, Regezi JA, Perrott DH, Kaban LB. Atypical fibro-osseous lesions: diagnostic challenges and treatment concepts. Int J Oral Maxillofac Surg 1995; 24:162-69.

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