Reconstruction of maxillary cemento-ossifying fibroma defect with buccal pad of fat
A 35-year, 10 month-old male patient presented to department of oral surgery with a chief complaint of swelling in the left side of the face with visual disturbances []. Further, he complaints of a huge mass in the upper left dental arch region for past 1 year, which gradually increasing in size with difficulty in mastication and bleeding on touch without any difficulty in pain and swallowing. Past medical history reveals he was affecting nasal obstruction for past 6 months. Visual evaluation shows he was suffering from diplopia. Extra oral examination showed along with swelling in the left region off the face an altered infra orbital bony contour and proptosis. On intra oral examination, a large circumscribed mass involving the left posterior region of hard palate from midline and extended bilaterally displacing the left upper molars and premolars []. Swelling was firm and well-demarcated margin. 2nd and 3rd molar teeth was having grade 3 mobility, displaced, extruded severely below the occlusal plane, bleeding on probing without pain and tenderness.\nOrthopantomogram and contrast enhanced computed tomography scan showed expansible lytic lesion with osseous fragments involving the posterior 1/3 of the hard palate and alveolar ridge corresponding to premolar and molar regions [Figures and ]. Further, it invades the left maxillary sinus involving the floor of the orbit and part of ethmoid. Anteriorly, it involves the right nasal passage abutting the inferior turbinate and blocking the airway. Histopathology report confirmed as COF.\nWeber-Fergusson approach was carried out with en-bloc resection of the tumor [Figures and ]. Following resection closure of palatal defect was carried out using ipsilateral buccal pad of fat by careful, gentle dissection and reconstruction []. Remaining portion was packed with Bismuth Iodoform Paraffin Paste pack and secured with an acrylic stent. Post-operative period was uneventful and healing was favorable and good [].