History of the present illness

This is a 13-year old white male who presented with a rapidly growing swelling of the left posterior mandible (Figures 1), area of teeth #s 19-21 of one month’s duration with significant displacement of teeth and completely covering tooth # 20. There was no history of trauma, purulence or bleeding. The lesion was asymptomatic including no sensory disturbances. The panoramic view revealed a large and well circumscribed radiolucency centered over tooth #20 and displacing teeth #s19-21 (Figure 2).


Figure 1 Occlusal view.  Photograph taken at first clinical presentation to Children’s Hospital.  Note the pink/red, sessile swelling expanding the mandible both buccal and lingual displacing teeth #s 19 and 21.  Lingual expansion is more prominent.  Tooth # 20 is completely covered by the neoplasm


Figure 2 Panoramic radiograph demonstrating bone resorption, left mandible in the area of teeth # 19-21.  This radiograph reveals a well-demarcated destructive soft tissue lesion.  The bone in the area is almost all resorbed giving the impression of teeth floating in space