AGGRESSIVE ORAL PYOGENIC GRANULOMA WITH MAXILLARY SINUS INVASION

o present a rare case of aggressive pyogenic granuloma with maxillary sinus invasion and emphasize the critical role of advanced radiologic assessment in the diagnosis and management of atypical presentations of this typically benign lesion.Materials and methods.A female patient in her 60s with a two-month history of a slowgrowing, bleeding lesion in the left upper posterior region underwent clinical examination, panoramic radiography, and cone beam computed tomography (CBCT).Histopathological examination was performed to confirm the diagnosis.Results.Clinical examination revealed a pedunculated erythematous growth extending from the distal aspect of tooth 27 to the maxillary tuberosity.Panoramic radiography identified a root stump in relation to tooth 26, pathologic migration of tooth 27 and widespread bone loss.CBCT demonstrated destruction of alveolar bone, discontinuity in the maxillary sinus floor and a welldefined radioopaque mass within the left maxillary sinus.Histopathological examination confirmed oral pyogenic granuloma.Discussion.This case illustrates that pyogenic granuloma, despite typically following a benign course, can occasionally manifest as an aggressive lesion with invasion of deeper structures, including the maxillary sinus.Advanced imaging techniques, particularly CBCT, are essential for comprehensive evaluation of lesion extent, especially when involving vital anatomical structures.The radiographic findings of alveolar bone destruction and sinus invasion represent exceptionally rare features that significantly impact treatment planning and necessitate a multidisciplinary approach. Conclusion.Early recognition, accurate diagnosis through appropriate imaging, and multidisciplinary management are crucial for optimal outcomes in cases of aggressive pyogenic granuloma.Clinicians should maintain vigilance for aggressive variants, particularly when accompanied by unusual clinical features or radiographic evidence suggesting local invasion.This case highlights the importance of not underestimating seemingly benign oral lesions and employing advanced diagnostic modalities when atypical presentations occur.