Florid cemento-osseous dysplasia: a case series analyzing clinical variability, radiographic features, and surgical outcomes with a focus on secondary osteomyelitis

This series of cases is a study of clinical variation, radiographic features, and surgical outcomes of florid cemento-osseous dysplasia (FCOD), highlighting especially its relationship with secondary osteomyelitis and post-surgical patterns of healing. Four cases of FCOD were examined in detail for their clinical presentation, radiographic appearances, and surgical treatments. Particular notice was taken of variability of lesion shape, pain presentation, and secondary infection due to Actinomyces-related osteomyelitis. The patterns of healing post-surgery were also systematically compared. Radiographic appearance of FCOD varied tremendously among the cases, ranging from radiopaque well-defined lesions to radiolucent-radiopaque combined patterns. Secondary osteomyelitis in two patients, in whom a patient showed an infection of Actinomyces in the absence of prior exposition of the dysplastic tissue to the oral cavity, was diagnosed. The treatment plan included “en bloc” surgical resection, curettage, and antibiotics. The factors on which healing depended included infection, surgical procedure, and size of the lesion. The cases which were primarily closed showed faster mucosal healing, whereas infection cases showed a longer time for healing. FCOD diagnosis and treatment pose great challenges, all the more so when complicated by secondary infection. This case serves to illustrate the imperative for thorough radiographic surveillance, conservative treatment modalities, and judicious surgical strategies for maximizing patient outcomes while minimizing risk of complications.