Surgical resection of a giant peripheral ossifying fibroma i
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A 41 year old-man presented with the complaint of a slowly growing exophytic mass in the mandible to the mouth floor. A pedunculated, smooth, rubbery, gingival tissue like mass was seen extending from the mouth floor to the lower labial alveolar ridge (Figure 1A,B). The mass was 48 × 35 × 30 mm. Indentation due to an upper lateral incisor and canine was seen in the surface of the mass. The upper lateral incisor and canine were flared out by the mass. Panoramic x-rays indicated displacement of a lower lateral incisor and alveolar bone resorption (Figure 1C). Traditional computed tomography (CT) imaging revealed a small amount of calcified tissue in the mass (Figure 1D). Contrast enhanced CT images displayed a homogeneously enhanced margin of the mass (Figure 1E).

A biopsy and histological examination were performed; malignant disorder was denied. He does not have any medical history. We planned resection of the mass with the patient under general anesthesia. The large mass located at the mouth floor complicated the insertion of a laryngoscope blade. The Mallampati score is used to predict the ease of intubation, and our patient's Mallampati score was IV. Therefore, performed nasotracheal intubation using a McGrath™ video laryngoscope and fiberscope. With the patient under general anesthesia, the mass was excised completely along with adjacent mucosa and periosteum (Figure 2A). Floating lower lateral incisor was extracted. The bone surface was covered with a collagen sheet and a tie over. The cut section of a resected specimen showed marked pseudo epitheliomatous hyperplasia of stratified squamous epithelium with a calcified area in the subepithelial connective tissue (Figure 2B,C). The lesion included fibrous tissue with calcification, and it was surrounded by a cellular mass of proliferating fibroblastic cells (Figure 2D). There was no finding of inflammation or recurrence 1 year after surgery.