Rare Mandibular Occurrence of Psammomatoid Juvenile Ossifying Fibroma: A Case Report

Abstract

Psammomatoid juvenile ossifying fibroma (PsJOF) is an uncommon benign fibro-osseous lesion known for its locally aggressive behaviour and characteristic involvement of the paranasal sinuses and orbital region. Occurrence within the mandible is rare and represents a departure from its usual sinonasal distribution. A 16-year-old male patient with an uncommon case of mandibular PsJOF is described in this study. The patient's clinical presentation included a steadily growing mandibular enlargement, cerebral expansion, and facial asymmetry. Cone beam computed CT showed a well-defined expansile lesion with internal septations, cortical thinning with localized perforation, mixed radiolucent–radiopaque density, and inferior alveolar canal displacement. Histopathological evaluation showed a highly cellular fibrous connective tissue stroma containing numerous psammoma body–like ossicles, establishing the diagnosis of PsJOF. Surgical management consisted of complete lesion excision with thorough curettage while preserving adjacent vital structures, followed by meticulous postoperative surveillance. This case highlights the diagnostic challenge posed by atypical mandibular involvement and emphasizes the need for comprehensive clinico-radiographic and histopathologic correlation, along with long-term follow-up, owing to the lesion’s aggressive nature and risk of recurrence.