Florid cemento-osseous dysplasia complicated by chronic diffuse osteomyelitis in the maxilla

Florid cemento-osseous dysplasia (FCOD) is a benign fibro-osseous lesion that primarily affects the jaws of middle-aged women of African ancestry. This lesion may be completely asymptomatic and in such cases the lesion is detected incidentally in radiographs. Clinical symptoms may occur due to secondary infection of exposed masses or may be due to mucosal irritation under prostheses. Radiographic features of these lesions pass from initially radiolucent (osteolytic stage), then develop into mixed radiolucent/radiopaque lesions (intermediate or cementoblastic stage) before becoming radiopaque masses (osteosclerotic or inactive phase) usually located in multiple quadrants of the jaws. Occurrence of FCOD with chronic suppurative osteomyelitis is rare. In this article a case of FCOD is reported which had evidence of infection as the first presentation. A 52-year-old Indian female patient was initially diagnosed as having chronic suppurative osteomyelitis based on clinical findings but later diagnosed with FCOD after radiological examination of a digital orthopantomogram. Histopathological findings revealed formation of calcified dense sclerotic masses of cementum suggestive of the diagnosis of FCOD. The patient was managed by periodical debridement of the area which had undergone osteomyelitic changes and with oral clindamycin 300 mg. This case emphasizes that the diagnosis of FCOD can be done on radiographic features alone. Early radiological investigations should be carried out to prevent complications in FCOD patients.