Benign fibro-osseous lesion and odontoma of the mandible: A report of a rare, hybrid lesion and review of literature

This report documents a case of a 12-year-old male with a combined benign fibro-osseous lesion (BFOL) and odontoma. Radiographic imaging revealed an extensive, well-defined, multilocular, radiolucent lesion with small radiopaque entities in the left mandible. Microscopic examination revealed a central BFOL with associated odontomas. To the best of the authors’ knowledge, this is the third report of a combined BFOL and odontoma and an extensive review of the English language literature on combined BFOL and odontoma cases is included. This case is important because it demonstrates the importance of diagnosing bone lesions with an accompanying radiograph. The initial biopsy was signed out as a BFOL with a comment that there was tooth-like material as well and a possibility that it represented an odontoma. The patient was operated on in our teaching hospital and the lesion completely excised with a diagnosis of dentigerous cyst. The hard tissue was grossed only as it appeared tooth-like. Seeing the final diagnosis, we requested decalcification of the hard tissue. Based on clinical, radiographic and histologic findings, the final diagnosis of BFOL and odontoma was made. Another reason for reporting this case is that the paucity of published cases of these combined lesions makes treatment decisions a challenge. Further future reporting of BFOL arising in association with odontomas with long-term follow-up information is paramount to better understand these entities vis-à-vis their nature and behavior.