Gingival mass with massive soft-tissue necrosis

Abstract

On February 20, 1989, a 47-year-old white man was referred by his general dentist for evaluation of a localized soft-tissue mass in the left maxilla. The patient sought treatment from his dentist because he had had a left maxillary canine removed approximately 1 month before and desired prosthetic replacement as well as the removal of multiple carious teeth in the anterior maxilla. The medical history included a motor vehicle accident in 1987 during which the patient had traumatically avulsed multiple teeth. In 1983, he sustained a renal contusion and rib fracture in another motor vehicle accident. The review of systems was significant for a recent unexplained weight loss and chronic maxillary sinusitis. He had a 30 packlyr history of cigarette usage, denied use of alcohol, and used salicylates for occasional pain. Examination revealed an extremely apprehensive, thin, talkative man in no acute distress. The head and neck examination was unremarkable. However, the oral examination revealed multiple carious teeth, gross generalized periodontitis, and a nonhealing maxillary left canine extraction site. A purplish-red soft-tissue mass with a granular surface measuring 2.5 x 2.0 cm was noted in the area of the left maxillary extraction site (Fig 1). Extensive tissue necrosis was present in the left maxillary vestibule extending from the maxillary tuberosity to the anterior midline and superiorly into the canine fossa, the infraorbital region, and the left maxillary sinus. In the right anterior maxillary vestibule, an erythematous punctate l-cm mucosal lesion was noted in the area of the canine eminence. A Water’s view radiograph showed left maxillary sinus mucosal thickening (Fig 2). A panoramic radiograph showed extensive osseous destruction in the area of the