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Various Radiographic Appearances of Fibrous Dysplasia in the Mandible - A Case Report

Johannes Angermair, Tobias Fretwurst, Wiebke Semper-Hogg, Gian Kayser, Katja Nelson, Rainer Schmelzeisen

Introduction: Fibrous dysplasia appears in a clinically and radiologically variable way. Radiographic diagnostic is an important factor for final diagnosis especially as this rare lesion is often observed accidently in dental radiographic examinations. Therefore, the present case report demonstrates deviating clinical and radiological manifestations of monostotic and polyostotic forms of fibrous dysplasia (FD) in the facial area and its impact on dental and surgical therapy.

Presentation of case: In the first patient, showing a monostotic form a hard, non-compressive swelling in the lower incisor area was detectable and radiographic investigation showed a “ground glass”-like radiopacity in the lower mandible. A surgical reduction of the process and a biopsy were indicated due to progression of the lesion and the development of aesthetic impairment at a young age. In the second patient, with a polyostotic manifestation, radiographic investigation revealed mixed heterogeneous sclerotic areas in the left mandibular angle and a “ground glass”-like pattern and osteolyses spreading out from the sphenoid sinus. A biopsy was obtained to confirm the radiological diagnosis without complete removal of the diseased bone.

Conclusion: The two cases demonstrate the strongly varying clinical and radiological appearances of craniofacial FD and underline why it poses a challenge to the medical and dental practitioner. Furthermore, the present case report is discussing different diagnostic and therapy concepts according to different forms of FD and the consequences for dental therapy. Therapy strategies should always be determined by the progression and dimension of the disease and requires close interdisciplinary cooperation.