Main complaint and medical history:

An otherwise healthy 23 year old female presented to the Oral Medicine Clinic at Groote Schuur hospital, complaining of a growth on the right side of her upper jaw. The lesion appeared approximately one year ago and was initially asymptomatic. The patient had thought it was a dental abscess and assumed it would stop growing or burst.

In the past two months the patient began experiencing pain which she described as being mild, intermittent and increasing in its intensity while eating. She consulted a private dental practitioner who subsequently referred her to the Oral Medicine Clinic.

The patient reported smoking cigarettes – approximately 6 per day for the past 5 years. She was taking no chronic medication for an underlying illness.

Clinical examination:

The extra oral examination revealed right submandibular lymphadenopathy and facial asymmetry due to bulging of the cheek on the right hand side.

The intra-oral examination revealed the patient was partially edentulous, practiced fair oral hygiene, with the presence of root remnants and carious teeth.

In the first quadrant, a large exophytic mass was present which protruded over the 15. The 15 appeared to be enveloped within the lesion.

The mass extended from the distal of 14 root remnant to mesial of 18. The mass was tissue coloured, firm and did not blanch. Upon palpation it was smooth in surface

texture with localised areas with minor surface ulcerations. The lesion was broad based, with no definitive margin between the lesion and the surrounding tissues. The mass extended towards the mandibular ridge and the patient was occluding on its surface.


  •   Presence of a radiolucency in the first quadrant from the 15 to 18 region, with obliteration of the sinus floor.
  •   Root of tooth 15 was mesially displaced and appeared to be “floating” up against the root remnant of tooth 14.
  •   Teeth 18, 37, 38 and 48 were carious.Figure 1: Extra -oral view of swelling of right cheek

Figure 2: Intra-oral view of the lesion

Differential diagnosis:

Based on the clinical findings the following were considered possible differential diagnosis:

  • –  Pyogenic granuloma
  • –  Peripheral giant cell granuloma
  • –  Peripheral ossifying fibroma
  • –  Salivary gland neoplasmManagement:An incisional biopsy was performed under local anaesthetic (Xylotox E80-A) of the area immediately distal to the 15. The specimen was sent for histopathological examination.Numerous pathologists consulted on the case and a diagnosis of hyalinising clear cell carcinoma was reached.

CT scans:

The patient was referred to Head and Neck Oncology Unit at Groote Schuur Hospital for further management. Surgical intervention performed included a partial maxillectomy with submandibular and cervical node neck dissection and tracheostomy. Regional lymph node biopsies revealed no metastasis. Postoperative radiotherapy was initiated after postoperative healing and stabilisation.