Treatment for Nonossifying Fibroma (NOF)
For most nonossifying fibromas (NOFs), a conservative "watch and wait" approach is recommended as the first-line treatment since these benign lesions typically regress spontaneously without intervention.
Initial Management Approach
Assessment and Monitoring
- NOFs are benign bone tumors commonly found in children and adolescents, typically in the metaphysis of long bones
- Most NOFs are asymptomatic and discovered incidentally on radiographs
- Initial evaluation should include:
- Plain radiographs (characteristic appearance: cortical osteolytic lesions with sclerotic margins)
- MRI for better characterization if symptoms are present
Conservative Management
- For asymptomatic NOFs: observation only with periodic radiographic follow-up
- Monitoring schedule:
- First evaluation within 8-12 weeks
- Every 3 months during the first year
- Every 6 months up to the fifth year
- Yearly thereafter 1
Indications for Intervention
Surgical intervention should be considered in the following scenarios:
- Symptomatic lesions causing persistent pain that interferes with daily activities 2
- Large lesions involving >50% of bone diameter (high risk of pathological fracture) 3
- Pathological fracture has occurred
- Aggressive behavior with rapid growth on serial imaging 2
Surgical Treatment Options
When intervention is necessary, the standard surgical approach includes:
- Curettage of the lesion - thorough removal of the fibrous tissue 3, 2
- Bone grafting of the resulting defect using:
- External fixation may be required in cases with significant bone weakening 2
- Free vascularized fibular graft for challenging locations such as femoral neck 3
Post-Treatment Management
- Regular radiographic follow-up to monitor healing and incorporation of graft material
- Gradual return to activities as healing progresses
- Full return to sports and daily activities typically possible after complete healing 4
Special Considerations
- In skeletally immature patients, calcium sulfate pellets have shown excellent results with full incorporation and no growth disturbances 4
- Chemical cauterization of bone walls during surgery does not interfere with calcium sulfate pellet integration 4
- Multiple NOFs may be associated with Jaffe-Campanacci syndrome, which requires more comprehensive evaluation for associated conditions 6
Prognosis
The prognosis for NOFs is excellent, with most lesions resolving spontaneously over time. Even surgically treated symptomatic lesions typically have good outcomes with appropriate intervention 5, 4.