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.