A 72-year-old female patient reported to the Department of Oral and Maxillofacial Surgery, with a chief complaint of growth over the upper left back tooth region since one month. She noticed the growth as a small mass that progressively enlarged in size and it was associated with pain from the past one week. The pain was intermittent, moderate in intensity and relieved by analgesics. On examination, there was no obvious facial swelling. Intraoral examination revealed a swelling of 4x3 cm in diameter soft in consistency with irregular edges around maxillary left second and third molars covering up to the middle thirds of crown of these teeth. The growth showed red and white areas and was tender on percussion. The patient was advised for routine blood investigation and Computed Tomography (CT) scan. CT report showed a lesion with greatest dimension of 7x5 cm involving the left posterior maxilla and maxillary sinus with ill-defined granular bone periphery. Internally the lesion showed evidence of large hypodense and hyperdense areas with thin trabecular pattern and thin separations within the lesion. Roots of second molars showed areas of resorption. The medial, superior and posterior lateral walls of the left maxillary sinus were intact. An incisional biopsy was taken from the first molar region and was sent for histopathological examination. The microscopic examination showed parakeratinized stratified squamous epithelium which appeared hyperplastic and underlying connective tissue showed dense chronic inflammatory cell infiltrate, chiefly lymphocytes. The deeper connective tissue showed dis persed multinuclear giant cells in association with vesiculated mononuclear cells with moderate vascularity. The histopathological report confirmed the mass as central giant cell granuloma. A subtotal maxillectomy was planned for the patient. Written informed consent was obtained from the patient. Patient was prepared and draped under orotracheal intubation. Weber Ferguson incision was made through the skin and subcutaneous tissue. Upper lip was divided through its full thickness upto gingival labial sulcus and incision was extended sublabially along the mucobuccal fold upto the tuberosity. The subciliary component was extended preseptally. A subperiosteal cheek flap was then elevated from the maxilla. The maxilla was fully exposed and a subtotal maxillectomy was performed removing the tumour in toto [Table/ Fig-1]. As the primary closure of the defect couldn't be made during the surgery, a preoperatively fabricated obturator was placed and stabilized to the cheek flap using 3-0 ethilon suture. Postoperative period of the patient was uneventful. Patient was kept under observation for one year.One year follow up showed a reduction in the size of defect to about 2x3 cm, then a posteriorly based tongue flap was planned to close the oroantral fistula. Written informed consent was taken from the patient. Patient was prepared and draped under nasotracheal intubation. De-epithelization was done around the oroantral fistula. A poster...

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