To the Editor: The term ``®bromatoses'' refers to a group of ®brous tumours or tumourlike lesions of soft tissue. These lesions of unknown cause take their origin from fascia, musculoaponeuroses, or periosteum and are locally aggressive in behaviour with a tendency for recurrence. The treatment is primarily surgical. When the lesion is found near the mandible in an advanced state, a radical excision of the jaw might be necessary. Severe functional, aesthetic and psychological problems in the child are to be anticipated. These can be avoided by careful planning and reconstruction, as our experience with a 12-year-old boy indicates. He suffered from Little disease 1 since early childhood and presented to us with a 4 Â 4 cm ®xed submandibular mass on the left side. Oral examination revealed ®xed and in®ltrating lesions in the left submandibular and paralingual area. CT and MRI (Fig. 1) con®rmed a mass in®ltrating the mandible. Biopsy revealed ®bromatosis. Dissection of the submandibular region was performed with resection of the body and angle of the mandible and the paralingual region of the ¯oor of the mouth. At ®rst, metal plates were used for reconstruction and 3 months later the segmented mandibular defect was substituted by a freely transplanted rib (Fig. 2). The rib was not absorbed and the occlusion remained stable in accordance with other reports [3,6]. The child did not experience any problem with talking or swallowing. The aesthetic result was very good and he showed no psychological problems that could be related to the operation. Continuous follow-up revealed no signs of recurrence for 28 months.
Fibromatosis is a very rare disease in the paraoral region. Most of the lesions occur in the soft tissues adjacent to the mandible, including lesions in the submandibular or submental region. Next in frequency is the parotid region, tongue, maxillary gingiva, palate, and lip. Characteristically, the lesion is poorly circumscribed and in®ltrates the surrounding tissue, usually the striated musculature. Over one-third of the lesions exhibit secondary erosions or invasion of bone. The most common presenting condition is a painless mass. Other signs and symptoms reported are: trismus, ulceration and bleeding, dysphagia, loose teeth, otalgia, or speech impediment depending on the speci®c location. For the surgical pathologists, the major challenge is to avoid an over-