This report documents the dramatic destruction of the patient's facial skeleton, particularly the mandible, and the challenges associated with making a diagnosis. It aims to raise the awareness of clinicians regarding the clinical presentation of tumefactive fibroinflammatory lesions, and to facilitate diagnosis and treatment planning of similar cases in the future. I N TRODUC TIONA tumefactive fibroinflammatory lesion (TFIL) is a rare idiopathic tumour, usually occurring in the head and neck region. Though it is benign, clinically and radiographically it appears malignant because of its aggressive clinical course. 1 TFILs are locally invasive and may cause pronounced bony destruction, but do not metastasize. [2][3][4] It is suspected to be part of a wider spectrum of entities called inflammatory pseudotumours. 3 The aetiology is unknown and little evidence base exists regarding the most appropriate management of TFILs. This report documents the case of a now 72-year-old male and the challenges involved in reaching this diagnosis. CASE R EPORTA 63-year-old male was referred by his General Medical Practitioner in 2011 to the Oral and Maxillofacial Surgery department. He complained of intermittent left facial swelling with discomfort and restricted mouth opening.Medically the patient had Korsakoff's syndrome, diverticulosis, angina and cardiac arrhythmia. He had been admitted to hospital multiple times following episodes of collapse. Previous interventions included insertion of a pacemaker and excision of an undifferentiated sarcoma from the left groin. He was a heavy pipe smoker of 48 years and had a history of excessive alcohol consumption. He previously had input from homelessness services and is now aided by