History of the present illness

This is a 14-year-old white male who was referred to South Sound Oral Surgery by his general dentist for extraction of a painful, carious mandibular left first molar. A panoramic radiograph taken by the dentist revealed four large cystic lesions (Figure 1). The first was associated with impacted tooth #4; the second with impacted tooth #11; the third with impacted tooth #17, displacing tooth #18; and the fourth with impacted tooth #32. Teeth #s 17 and 32 were displaced vertically into the superior ramus. There was a hint of scalloping associated with the radiolucencies in the areas of teeth #s 17 & 32, especially with tooth #17. The latter area also showed evidence of buccolingual expansion but no other area exhibited expansion. The patient's past medical history is positive for a ventriculoperiotoneal shunt which had been in place and functioning well for many years. He was hospitalized for pneumonia December 1999, at which time the chest x-ray revealed bifid right third and fourth ribs and broadening of the lateral aspect of the third rib with partial fusion of the fifth and sixth ribs.

Figure 1 Panoramic view at first presentation demonstrating a total of four cysts, area of teeth #s 4, 11, 17 and 32. The cyst associated with tooth #17 is the largest radiolucency which is has a scalloped border.