Painless unilateral maxillary swelling in an adolescent
14-year-old female
§Chief complaint
Gradual enlargement of the left cheek over 3 years
§Medical & dental history
- 01No cafe-au-lait macules, no endocrine abnormality
- 02Menarche normal
- 03No trauma or infection at the site
§Clinical examination
- 01Diffuse, bony hard, non-tender enlargement of the left maxilla with facial asymmetry
- 02Buccal expansion obliterating the sulcus; teeth displaced but vital
- 03Overlying mucosa normal; no paraesthesia
- 04No proptosis or visual disturbance
§ figuresFigures (5)
Fig. 1Medium power shot with the classic 'Chinese character' bone spicules.
“Bone FibrousDysplasia LP CTR” · Sarahkayb · CC BY-SA 4.0 · Wikimedia Commons
Fig. 2Immature bony trabeculae in a fibrous stroma.
“Bone FibrousDysplasia Jaw MP3 PA” · Sarahkayb · CC BY-SA 4.0 · Wikimedia Commons
Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Fibrous Dysplasia figures pending faculty review.
§Differential diagnosis
§Final diagnosis
Monostotic fibrous dysplasia of the left maxilla
The imaging signature is a ground-glass matrix with margins that blend imperceptibly into normal bone — the opposite of the sharply demarcated ossifying fibroma. Absence of cafe-au-lait macules and endocrinopathy excludes McCune-Albright syndrome.
§Investigations
- 01CT — ground-glass matrix, expansion, cortical thinning, indistinct borders
- 02Serum alkaline phosphatase mildly raised; calcium and phosphate normal
- 03Incisional biopsy where the diagnosis is not radiologically certain
- 04Endocrine screen and skeletal survey to exclude polyostotic disease
§Treatment plan
- 01Observation until skeletal maturity where function and appearance permit
- 02Conservative surgical recontouring for aesthetic or functional problems
- 03Avoid radiotherapy — risk of sarcomatous transformation
- 04Long-term clinical and radiographic review
§Surgical procedure
- 01Recontouring osteoplasty via an intraoral vestibular approach after growth stabilised
§Histopathology report
Irregular, curvilinear trabeculae of woven bone (Chinese-letter pattern) without osteoblastic rimming, lying in a cellular fibrous stroma that merges with surrounding bone. Fibrous dysplasia.
§Follow-up & outcome
- 01Facial symmetry improved after recontouring
- 02Stable at 3 years with no regrowth
- 03Advised on the small risk of malignant change
§Clinical pearls / learning points
- 01Fibrous dysplasia tends to stabilise after skeletal maturity — timing surgery matters.
- 02Never irradiate fibrous dysplasia.
- 03The absence of osteoblastic rimming histologically helps separate it from ossifying fibroma.
§ evidenceReferences & Evidence
Current Classification
WHO Classification of Head and Neck Tumours
5th Edition — Volume 9
WHO Classification of Tumours Editorial Board · 2022
The authoritative international classification of head and neck, odontogenic and salivary gland tumours. Current terminology on this site follows this edition.
Evidence summary
Highest level of evidence linked to this page: WHO / Official Classification.
- L1 · Classification — 2
- L2 · Guideline — 1
- L6 · Textbook — 3
1 linked source was published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.
Content last reviewed
September 2026
Evidence last reviewed
September 2026
Next scheduled review
September 2027
Review status
EVIDENCE REVIEWED
Search latest PubMed evidence
Last literature search: 7 September 2026
Current Classification
WHO Classification of Tumours Editorial Board. IARC / World Health Organization · 2022
The authoritative international classification of head and neck, odontogenic and salivary gland tumours. Current terminology on this site follows this edition.
IARC / WHO. IARC · 2022
Continuously updated online edition of the WHO head and neck tumour classification.
Clinical Guidelines
Javaid MK, Boyce A, Appelman-Dijkstra N et al.. Orphanet journal of rare diseases · 2019 · 14(1):267
International consensus best-practice guidelines for fibrous dysplasia / McCune-Albright syndrome.
Histopathology References
Barnes L. CRC Press · 2008
Detailed histopathological reference for head and neck diagnostic criteria.
Textbook References
Neville BW, Damm DD, Allen CM et al.. Elsevier · 2024
Standard reference textbook of oral and maxillofacial pathology used throughout this atlas.
Rajendran R, Sivapathasundharam B. Elsevier · 2020
Undergraduate and postgraduate oral pathology textbook widely used in BDS and FCPS curricula.
Additional sources cited on this page
- WHO Classification of Head and Neck Tumours, 5th ed. (2022).
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