Case Report
A 19 year old female presented with history of rapidly-growing, non-resolving swelling over right lower face region since 2 months. Clinically this tumorous growth was sessile, bright pink in colour resembling fibromatosis gingivae but rapid growth rate had caused almost complete coverage of posterior teeth.(Figure 1) Extraoral facial swelling near right body of mandible was bony hard and slow growing.(Figure 2) Despite of striking differences both were painless which was contrary to previous reports from literature4,5,6.
Panoramic radiograph showed a diffuse radiolucent lesion overlying right body of mandible and empty alveolus of first molar (Figure 3). A subsequent computed tomography scan (Figure 4) revealed a hyper-attenuated diffuse exophytic lesion extending from external oblique ridge till alveolus of first mandibular right first molar. The bony mass was more towards lingual aspect of mandible.
Bright pink, tough, fibrous tissue was obtained from incisional biopsy, microscopy of which revealed ossifying fibroma(Figure 5), but due to sheer rate of growth and radiographic findings biopsy report was found to be inconsistent with clinical findings. Hence repeat biopsy was performed which revealed fibrous hyperplasia(Figure 6). With both biopsies pointing towards a benign pathology excisional biopsy was planned under general anaesthesia. Pre-anaesthetic workup showed low haemoglobin levels with normal bleeding & clotting times, ESR, serum electrolytes and liver function tests.
Under all aseptic precautions, intraoperatively complete excision of intraoral soft tissue lesion was performed and buccal and lingual mucoperiosteal flaps were raised to expose the bony lesion. By preserving mental nerve complete excision of exophytic bony mass was done(Figure 7) and closure was done with 3-0 vicryl. Soft and hard tissue specimens were sent separately for histopathological analysis.