PMC6178905_01
Photographs of (
a) the palms of the hands showing normal skin and (
b) the soles of the feet showing very slight hyperkeratosis.
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Examination of the palms of the hand revealed normal skin, while the soles of the feet revealed very slight hyperkeratosis ( Figure 1a,b).
Intraoral photographs showing (
a) severe gingival recession and inflammation, especially in anterior region, and aggressive periodontitis; (
b) swelling related to the maxillary right missed canine region extending toward occlusal surface.
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The size of the swelling was 4x4 mm, and upon palpation it was not tender but slightly hemorrhagic ( Figure 2a,b).
Panoramic radiograph showing severe destruction and loss of alveolar bone in both maxillary and mandibular arch, especially in the anterior region and anterior teeth appear as if floating in air without surrounding alveolar bone.
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Radiographic examination showed severe destruction and loss of alveolar bone ( Figure 3).
Photograph showing (
a) removal of the swelling and (
b) excisional biopsy of the swelling.
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Thorough curettage of the adjacent periodontal ligament and periosteum was carried out to prevent recurrence ( Figure 4 a,b).
Histopathological image showing evidence of calcifications in the hypercellular fibroblastic stroma confirming the lesion as peripheral ossifying fibroma.
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Histopathological examination revealed the lesion as peripheral ossifying fibroma ( Figure 5).
Follow-up photograph after 2 years showing loss of more teeth with no recurrence of the lesion.
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The patient was followed up for 2 years during which loss of maxillary left central incisor occurred and extraction of loose upper left canine was done with no recurrence of the lesion ( Figure 6).
Follow-up photographs after 2 years showing (
a) absence of change in the palms of the feet and (
b) slight increase in keratosis in the soles of the feet.
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The palms of the hands revealed no change, while examination of the soles of the feet showed slight increase in keratosis ( Figure 7 a,b).