Peripheral Ossifying Fibroma of the Hard Palate: A Rare Paediatric Phenomenon

ABSTRACT Background Peripheral ossifying fibroma (POF) is a benign reactive lesion that is proliferative in nature; it is composed of cellular fibroblastic spindle cell proliferation containing mineralised tissue such as bone and cementum‐like structures. It is commonly located in the anterior maxilla and appears as a gingival growth on the interdental papilla. The pathogenesis is unclear, but the aetiology involves chronic minor injury by irritants such as orthodontic appliances and plaque. Despite similarity in nomenclature, POF is a completely distinct entity from a cemento‐osseous fibroma. This case report explores the rare occurrence of a POF on the hard palate of a child. Although the term POF is commonly used in the United States, oral and maxillofacial pathologists in the United Kingdom often refer to it as fibrous hyperplasia with metaplastic bone or ossifying fibrous epulis. Case Presentation A 10‐year‐old female presented to the Oral and Maxillofacial clinic with an unusual 8 mm circular lesion on the hard palate that appeared coral pink with a pustulated yellow centre. The histology from the excisional biopsy reported a peripheral ossifying fibroma. Blood test results showed elevated parathyroid hormone and serum phosphate levels. Subsequent referral to the paediatric endocrinology consultant and a further hand X‐ray illustrated findings consistent with pseudohypoparathyroidism. There was no recurrence at the 6‐month follow‐up. Conclusions POF should be considered in the list of differentials for lesions on the hard palate. It can pose a challenge to confidently diagnose based on clinical findings alone due to it rarely presenting on the hard palate; hence, histology can be invaluable. This case also describes the co‐existence of endocrinological abnormalities and the presence of a POF; there is currently no evidence of a causal link between them.