History of the present illness

This is a 44-year-old white male who presented to Dr. Snyder as a new patient. His main complaint was that he had an under bite and that his “lower front teeth seem to be drifting and moving anteriorly” (Figure 1). He had had a mountain bike accident the year before. His brother is a physician who lives in a different city had recently commented to his brother that his face “seems different.” On examination, he had a bilateral class III bite with cross bite on the left side and edge to edge on the right side. His tongue was very large and his lips (especially the lower lip) were full and had frontal bossing (Figure 2). The panoramic radiograph was not large enough to show his entire mandible A-P and left to right. His lower teeth were spaced and all of his teeth were internally dark purple in color. On further questioning, the patient also stated that his hands and feet were growing and that his gloves “keep getting too small.”

Figure 1 This photograph was taken at the patient’s first clinical presentation to the dentist. Note the spacing of the mandibular teeth. The brown-gray color of the teeth is not related to this condition.

Figure 2 This photograph was taken at the patient’s first clinical presentation to the dentist. It demonstrates frontal bossing and full lips.