A Unique Case of Removing a Large Facial Tumor in the Oral and Maxillofacial Surgery Unit at Al-Assad University Hospital

Psammomatoid ossifying fibroma is a rare subtype of this tumor, characterized by small uniform spherical ossicles known as psammoma bodies. This type occurs most often in the maxilla and in males. The medical literature has recorded less than three hundred cases, including two documented cases of ossifying fibroma in the mandible in two women, with the disease lasting for a decade.

This pattern tends to be of fragmentary lobular growth, giving the clinical impression of independent tumors that actually belong to a single tumor. It requires special care due to its rare nature, and what makes it more complicated is the possibility that it is highly perfused in a few lobes and not others, which complicates the surgical procedure. The only positive thing about this rare tumor is that no case of malignant transformation has been recorded.

A 59-year-old woman visited the Oral and Maxillofacial Surgery Unit at Al-Assad University Hospital complaining of a large facial tumor that began to appear about 12 years ago and increased in size until it reached a huge size that began to cause great pressure on the digestive and respiratory tract and difficulty in swallowing for the patient.

The tumor extended from the right zygomatic region and included the entire right part of the lower jaw, passing through the right cheek and reaching the right cervical area and the submandibular space and extending to the medial side of the lower jaw, the side of the pharynx and the floor of the mouth.

The medical team decided to surgically remove the tumor. The biopsy before surgery and the pathological examination after surgery revealed the type of tumor and described it histologically as: (Psammomatoid ossifying fibroma).

In the specific surgical procedure, the multi-mass tumor was reached through an inlet under the lower jaw, extending to the side of the neck and the midline. Three tumor masses were initially removed, each measuring 4 x 4 x 4 cm, two below the lower jaw and the third along the right internal jugular vein. The main tumor mass was then reached through a biopsy of the lower lip, dissecting the tumor from the overlying healthy soft tissues and completely removing the right half of the lower jaw with the mass measuring 11 x 7 x 5. Then the last tumor mass was removed, extending to the medial side of the lower jaw and the side of the pharynx, measuring 10 x 5 x 5 cm.

The excised portion was then replaced with a mandibular reconstruction plate, and the flap and soft tissues were closed and sutured.