Sculpting Solutions: A Case Report of Resection and Reconstruction in an Aggressive Mandibular Juvenile Ossifying Fibroma and Review of Literature.

Juvenile ossifying fibroma (JOF) is a rare, benign, yet locally aggressive fibro-osseous lesion that primarily affects children and adolescents. This case report describes a 10-year-old female patient presenting with a three-month history of progressive swelling on the right lower third of her face, accompanied by trismus. Clinical examination revealed a firm, non-tender swelling extending from the right corner of the mouth to the angle of the mandible, with buccal cortical expansion and vestibular tenderness near the mandibular right second molar. Radiographic imaging demonstrated ill-defined mixed radiolucent lesions extending to the condylar region of the right mandible, prompting a provisional diagnosis of a fibro-osseous lesion, specifically ossifying fibroma. The histopathological evaluation confirmed the psammomatoid variant of JOF, a rare and aggressive subtype that typically occurs in the sinonasal region, making its mandibular presentation unusual. Given the aggressive nature of this variant, surgical resection was performed to minimize recurrence risk. The defect was reconstructed using a costochondral graft, a preferred method due to its adaptability, biocompatibility, and growth potential, particularly in pediatric patients. Costochondral grafts have been historically favored in maxillofacial reconstruction for their ability to mimic native bone structure and support functional restoration. Costochondral grafts have success in treating mandibular defects, especially in growing individuals, as they allow for continued growth and integration with surrounding tissues. This case highlights the importance of early diagnosis, aggressive surgical management, and effective reconstruction in managing rare and aggressive variants of JOF, ensuring both functional and aesthetic outcomes.