(1244) Juvenile Psammomatoid Ossifying Fibroma: Patterns of Presentation and Surgical Management

Introduction: Juvenile psammomatoid ossifying fibroma (JPOF) is a rare, benign, and locally aggressive fibro-osseous tumor of the craniofacial skeleton with variable presentation and limited consensus on optimal management. This systematic review summarizes clinical presentation, surgical management, and outcomes, including recurrence.

Methods: A PRISMA-guided systematic review was conducted of histopathologically confirmed craniofacial JPOF. PubMed, Embase, Scopus, and Web of Science were searched for studies published between 2000 and 2025. Case reports, case series, and cohort studies were included. Extracted variables included demographics, lesion location and size, surgical approach, recurrence, and follow-up, with descriptive analyses performed.

Results: A total of 127 studies comprising 142 patients were included. Median age at presentation was 15 years (range, 3 months-68 years), with slight male predominance (54.1%). Symptom duration varied widely from 3 days to 20 years; most common presenting symptoms were facial swelling (92 patients, 64.8%), proptosis (67, 47.2%), and nasal obstruction (49, 34.5%). Lesions most frequently involved the maxilla (52, 36.6%) and mandible (36, 25.4%), with a median largest dimension of 4.7 cm (1.0–20.0 cm). A left-sided predominance was observed (72, 50.7%), followed by right-sided (48, 33.8%) and midline or bilateral involvement (22, 15.5%). Open or combined approaches were used in 62.0% of cases, while 26.1% underwent endoscopic resection. Adjunctive procedures were required in 17 patients (12.0%), including orbital decompression or craniofacial reconstruction. Median follow-up was 12 months Recurrence occurred in 14.8% of patients, most often within the first postoperative year and typically requiring revision surgery.

Conclusions: JPOF commonly arose from the maxilla, mandible, or ethmoid sinus with frequent extension into surrounding craniofacial structures. Surgical excision remained the mainstay of treatment, and recurrence patterns highlight the need for durable follow-up.