case_images: PMC11232798_01
case_images: Immediate preoperative view: Showing solitary sessile swelling involving the marginal, attached gingiva, and alveolar mucosa of teeth #35, #36, and #37
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case_images: The swelling was mildly compressible with a weak pulsation felt at the inferior border [Figure 1].
case_images: Intraoral periapical radiographic view: Showing no abnormal findings. An enlarged trabecular space anticipated apical to #35 (yellow circle)
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case_images: An enlarged trabecular space was anticipated apical to tooth #35 [Figure 2].
case_images: Intraoperative view: Showing high-power diode LASER incisions with 2mm wide margins for the excision of the swelling. mm - millimeter
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case_images: Amplification by Stimulated Emission of Radiation) (Ga-Al-As, operating at 900 nm wavelength and 5 W power), including 2 mm of healthy margins from the posterior, inferior, and anterior borders of the swelling [Figures 3 and 4].
case_images: Intraoperative view: Showing excised lesion (20mmx15mm). mm - millimeter
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case_images: Amplification by Stimulated Emission of Radiation) (Ga-Al-As, operating at 900 nm wavelength and 5 W power), including 2 mm of healthy margins from the posterior, inferior, and anterior borders of the swelling [Figures 3 and 4].
case_images: Immediate postoperative view: Showing single point of profuse bleeding (cauterized with repeated application of high-power diode LASER) on the buccal cortical plate between teeth #35 and #36 (Yellow arrowhead)
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case_images: After excision, an unusual and massive pooling of blood was encountered from a single well-demarcated opening in the buccal cortical plate between #35 and #36, which was controlled with the repeated application of diode LASER [Figure 5]. After achieving hemostasis and curettage of remnant tissues, the vestibule was sutured (4-0 MERSILK, Ethicon), and the area was covered with periodontal dressing (Coe-Pack, GC America Inc.) [Figure 6].
case_images: Postoperative view: Showing periodontal pack placed at the surgical site after giving sutures
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case_images: After excision, an unusual and massive pooling of blood was encountered from a single well-demarcated opening in the buccal cortical plate between #35 and #36, which was controlled with the repeated application of diode LASER [Figure 5]. After achieving hemostasis and curettage of remnant tissues, the vestibule was sutured (4-0 MERSILK, Ethicon), and the area was covered with periodontal dressing (Coe-Pack, GC America Inc.) [Figure 6].
case_images: Photomicrograph of the lesion (x40) showing stratified squamous epithelium (black arrowhead) overlying lobular budding capillaries (white-black arrowheads) and hemorrhagic areas (yellow arrowheads) in fibrocollagenous inflammatory connective tissue stroma (red arrowheads)
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case_images: PG) [Figure 7].
case_images: Cone-beam computed tomographic view of left mandible showing mental foramen (black arrowhead), accessory buccal foramen in the crestal region between #35, #36 (red circle), and areas of bone resorption (yellow ellipsoid)
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case_images: A serpentine course of radiolucency was seen arising from the mandibular canal at the premolar region to the above-mentioned accessory buccal foramen [Figures 8 and 9].
case_images: Cone-beam computed tomography analysis: Thin tortuous osseous channel seen between #35, #36 (yellow arrowhead, [a and b]), traced image of mandibular canal and aberrant branch osseous channel (c), coronal sections showing the tortuous course of the osseous channel (yellow arrowhead, [d and e]), traced outline shows no communication with the mental foramen (f)
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case_images: A serpentine course of radiolucency was seen arising from the mandibular canal at the premolar region to the above-mentioned accessory buccal foramen [Figures 8 and 9].
case_images: Contrast-enhanced magnetic resonance imaging showing the thin tortuous aberrant branch of the inferior alveolar artery (yellow arrowhead) emerging from the mandibular canal (red arrowhead)
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case_images: This aberrant branch arteriole was considered to be the feeder vessel of the PG, explaining the unusual hemorrhage encountered during the biopsy procedure [Figures 10 and 11].
case_images: Contrast computed tomography angiogram (sagittal section) showing inferior alveolar artery (red arrowhead), aberrant branch of inferior alveolar artery (yellow arrowhead)
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case_images: This aberrant branch arteriole was considered to be the feeder vessel of the PG, explaining the unusual hemorrhage encountered during the biopsy procedure [Figures 10 and 11].
case_images: Postoperative (2 years) views: Showing (a) Involution of the lesion (b) Aberrant branch artery showing an indentation of the accessory foramen in the gingiva (yellow arrowhead, right)
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case_images: The patient was recalled every 3 weeks for evaluation and needful treatment but had not reported any recurrence after 2 years of follow-up [Figure 12].