History of the present illness

This is a 15-year-old male who was referred for third molar removal to accommodate arch length deficiency. All four third molars were extracted uneventfully. However, one week post-surgery, the patient presented with pain in the area of tooth #1. He was diagnosed with an infection and treated with antibiotics. The pain persisted, however. In the second week post-surgery, the patient presented with an ulcerated soft tissue swelling in the right retromolar pad region associated with trismus. The soft tissue swelling was surgically excised with a non-specific histology. It recurred after two more weeks, once again ulcerated and associated with trismus, and did not resolve. The second specimen was also excised and this time was noted to extend medially to the mandible.

Figure 1 Photograph is taken at second recurrence in October demonstrating a large, ulcerated and necrotic lesion in the right retromolar pad area and extending into the tuberosity area and anteriorly into the posterior buccal mucosa.