Macrostomia (Tessier's 7 cleft, transverse facial cleft or lateral facial cleft) is a rare facial anomaly with an incidence of 1/80,000 to 1/300,000 live births. It can occur unilaterally or bilaterally, in isolation or as part of a syndrome, with the isolated unilateral form being particularly uncommon. Surgical repair must balance functional and aesthetic outcomes. This study presents a new case of isolated unilateral macrostomia and details its management using an anatomic approximation commissuroplasty with straight-line cutaneous closure. The key steps involved anatomical marking based on the normal side, multi-layer closure (mucosa, orbicularis oris muscle, subcutaneous tissue, skin), and excision of an associated preauricular tag. At one-year follow-up, the result was satisfactory with good oral competence and commissural symmetry. Early diagnosis and timely, anatomically sound reconstruction are important for optimal physical and psychological rehabilitation. This report contributes a rare case to the literature and highlights a reliable surgical technique for this anomaly. • Extreme Rarity: This report details an exceedingly rare case of isolated, unilateral macrostomia. • Multilayer Reconstruction: The surgical outcome was achieved through meticulous multi-layer closure (mucosa, orbicularis oris muscle, subcutaneous tissue, skin), which is critical for functional and aesthetic restoration. • Contributing to Evidence: This report adds a well-documented case and technical detail to the sparse literature on this rare condition, providing a reference for surgical management.

Ossifying fibroma is a benign fibro-osseous neoplasm that rarely arises in the maxillary alveolus and is uncommon in elderly patients, making diagnosis particularly challenging. We report the case of a 70-year-old male who presented with a gradual enlarging pedunculated intraoral swelling measuring approximately 3.5 × 2.5 cm on the left maxillary alveolus. Contrast-enhanced computed tomography revealed internal bony deposits that suggested a chondroid benign tumor, while fine-needle aspiration cytology showed extensive hemorrhage with dense lymphocytic infiltrate but uneventful and no recurrence was observed at six months. This case illustrates that ossifying fibroma should be considered in the differential diagnosis of maxillary swellings in elderly patients, and emphasizes that definitive diagnosis relies on histopathology while surgical excision remains the treatment of choice. • Rare case of maxillary alveolar ossifying fibroma in a 70-year-old male. • Clinical and radiological features mimicked a chondroid benign tumor. • Fine-needle aspiration cytology was inconclusive for diagnosis. • Definitive diagnosis confirmed by histopathological examination. • Complete surgical excision ensured uneventful recovery with no recurrence.

The intermixed mandibular lesion of cemento-ossifying fibroma (COF) and aneurysmal bone cyst (ABC) is a rare occurrence with dramatic ramifications if left untreated. COF is a benign fibro-osseous neoplasm that predominantly affects the tooth bearing regions of the jaws. It is most commonly observed in women during their third and fourth decades of life. ABC, alternatively, is a vascular lesion characterized by blood-filled spaces within the bone. The coexistence of these two distinct pathologies in the mandible presents diagnostic challenges due to their overlapping radiographic features. Once a diagnosis is obtained, smaller lesions can be enucleated and curettaged, although for larger and mixed lesions, en bloc resection is advised to reduce risk of recurrence. We present a case of a 17-year-old female with an intermixed lesion of the left mandible, undiagnosed for over 1 year, which led to severe facial asymmetry and mass effect on surrounding tissues. Treatment was completed with a left hemimandibulectomy and reconstruction with a custom plate, condylar head and free fibular flap transfer.

• Atypical presentation of apocrine intraductal carcinoma not associated with salivary gland. • Isolated low-grade malignancy associated with the mandibular condyle. • Histochemical diagnosis allows for a decreased need for further treatment. • Incorrect diagnosis could lead to extensive surgical procedures, chemotherapy, or radiation.