An Atypical Presentation of Aggressive Oral Pyogenic Granuloma With Oroantral Communication and Bone Erosion

Oral pyogenic granuloma is a benign, reactive vascular lesion that commonly affects the oral mucosa and is often triggered by trauma or irritation, presenting as a friable, bleeding mass. A 30-year-old man presented with a recurrent, rapidly growing oral mass in the right maxillary posterior region, causing difficulty in chewing and spontaneous bleeding for one year. Two years subsequent to the extraction of the right maxillary second premolar, a lesion manifested and was subsequently excised through surgical means. One year ago, the lesion re-emerged and progressively expanded to encompass both the alveolar ridge and the buccal vestibule. Clinical examination revealed a 10×12×15 mm erythematous, pedunculated, exophytic growth, which was soft and bleeding on palpation. Cone-beam computed tomography revealed alveolar bone erosion near the maxillary sinus floor. Electrosurgical excision was performed under local anesthesia with the extraction of an adjacent tooth due to lesion infiltration. Intraoperative oroantral communication was identified and closed using a hemostatic agent and sutures. Histopathology confirmed oral pyogenic granuloma, characterized by vascular proliferation and inflammatory infiltrates. Postoperative care included antibiotics, nasal decongestants, and strict oral hygiene, which resulted in uneventful healing by day 10 and no recurrence at nine months. This rare case of aggressive oral pyogenic granuloma with bone destruction and sinus involvement highlights the importance of early diagnosis, thorough excision, and removal of etiological factors, such as trauma, to prevent recurrence. This emphasizes the need for clinicians to consider such atypical presentations in differentials for vascular oral lesions and ensure multidisciplinary management to optimize outcomes.