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 [ figure 1 ] . 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 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 [ figure 2 ] . swelling was firm and well - demarcated margin . 2 and 3 molar teeth was having grade 3 mobility , displaced , extruded severely below the occlusal plane , bleeding on probing without pain and tenderness . extra oral photograph- frontal view intraoral photograph showing displaced teeth orthopantomogram 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 3 and 4 ] . 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 . orthopantomogram showing the lesion computed tomography image showing the extension of the lesion weber - fergusson approach was carried out with en - bloc resection of the tumor [ figures 5 and 6 ] . following resection closure of palatal defect was carried out using ipsilateral buccal pad of fat by careful , gentle dissection and reconstruction [ figure 7 ] . 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 [ figure 8 ] . intraoperative view after excision of mass specimen of the lesion intra operative buccal fat of pad harvesting post - operative surgical site after 6 months of healing weber - fergusson approach was carried out with en - bloc resection of the tumor [ figures 5 and 6 ] . following resection closure of palatal defect was carried out using ipsilateral buccal pad of fat by careful , gentle dissection and reconstruction [ figure 7 ] . 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 [ figure 8 ] . intraoperative view after excision of mass specimen of the lesion intra operative buccal fat of pad harvesting post - operative surgical site after 6 months of healing cof was a well - circumscribed expansible lesion with calcified matrices involving both maxilla and mandible and it was considered as an aggressive lesion when it involves the maxillary antrum . however , surgical resection was done when lesion was very wide with involvement of adjacent structures . recurrence following complete excision is generally considered to be uncommon . in case of bone erosion reconstruction of the defect also is simple with primary closure , split thickness skin grafting , regional flap , skin graft , tongue flap and buccal pad of fat . studies suggested that the buccal fat of pad with its high vascularity and easy harvesting technique has a very high success rate in the reconstruction of oral defects . cof a rare kind of lesion in maxilla even in aggressive extensive form can be managed surgically with least recurrence . reconstruction of the defect with buccal fat pad helps the surgeon to reduce the size of the defect with favorable prognosis thereby avoiding the need to opt for extensive flaps or other reconstructive options .
a cemento - ossifying fibroma ( cof ) is a rare benign neoplasm of maxilla when compared with mandible ( world health organization , 1992 ) . 
 cof of maxilla may be quite large and locally very aggressive lesion . 
 these tumor mass was peeled out by en - bloc excision using gentle blunt dissection . 
 this paper presents 35-year - old male patient who had a gradually expanding lobular mass in the left maxillary posterior region for past 1 year . 
 he has been treated successfully by surgical en - bloc resection . 
 various techniques were used to reconstruction the defect . 
 buccal pad of fat is a simple technique having advantages like good vascularity , adaptability , good closure of the defect with favorable prognosis .