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Deeply imacted tooth with dilacerated and hypercementosed roots In cases of severe trismus Third Molar Classification (TMC) III like in our case. Conclusion Prior to the removal of lower third molars which are placed under TMC III, it is mandatory to educate the patient regarding the extraoral approach under general anaesthesia for better completion of the procedure. A meticulous handling of inferior dental nerve (IDN) and extra oral soft tissues and skin will invariably recover absolutely without any morbidity. Notes Financial or Other Competing Interests None.A 28-year-old systemically healthy, male patient reported to the Department of Periodontology, SRM Dental College, Chennai, India, with the chief complaint of painless, non-bleeding, gradually increasing growth in relation check details to his lower front teeth for the past one year. The patient gave a history of a similar growth in the same region four years back, which was diagnosed histopathologically as a fibro-epithelial polyp and managed by surgical excision. On intra oral clinical examination, a single painless oval shaped well circumscribed growth, measuring about 9 mm by 12 mm in the inter dental region of 32 and 33 involving the buccal attached gingiva and interdental papilla was noticed. The overlying mucosa was pale CAPNS1 pink in color with a smooth surface. The growth was soft to firm in consistency, immobile, sessile and non-tender on palpation with spacing between 32 and 33 as shown in [Table/Fig-1]. Based on the patient��s history and clinical findings the lesion was provisionally diagnosed as a fibroma. A treatment plan comprising of complete phase I therapy and surgical excisional biopsy of the growth was proposed. Additionally, we planned for a connective tissue graft to manage the anticipated esthetic compromise. Informed consent was obtained from the patient. [Table/Fig-1]: Baseline picture of Tyrphostin AG-1478 datasheet fibrolipoma in relation to 32 and 33 region Under aseptic conditions, after achieving adequate local anaesthesia an incision was given extending 2mm beyond the growth on the facial side and continued as interdental incisions between 32 and 33 and completed with a paracrestal incision on the lingual side. A complete excision of the growth was achieved along with the periosteum which was immediately transferred to a container with 10% buffered formalin for routine histopathological evaluation. The surgical excision led to a soft tissue defect in the interdental area as shown in [Table/Fig-2]. To overcome this, a full thickness flap was elevated from the mid-buccal region of tooth number 31 to 34 extending upto and beyond the mucogingival junction. On the lingual side the incisions were limited to the adjacent teeth and were not extended.