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Ossifying fibroma is the most concerning of the fibro-osseus lesions. Differentiation from fibrous dysplasia is paramount as their management may differ. Radiographically, ossifying fibroma appears as a well-circumscribed lesion with an eggshell rim and central lucency, while fibrous dysplasia takes on its characteristic ‘ground glass’ appearance. Ossifying fibroma presents as an expansile lesion with a definite demarcation from surrounding bone; these tumors can be locally erosive and very destructive. While these lesions are most commonly found in the mandible, they are even more aggressive when located in other locations, such as the paranasal sinuses.

Due to the destructive nature of these lesions, early complete resection is recommended.  While most lesions have been resected via external open approaches in the past, endoscopic surgery offers a viable alternative in selected cases. The well-defined borders may allow for a complete endoscopic resection with tumor-free margins.