History of the present illness
This is a 15-year-old white female who presented with a history of increasing swelling without pain in the left mandible.  Her mother noted the swelling and took her to the family dentist for a clinical evaluation where a periapical radiograph was taken.  The dentist then referred this patient to Dr. Grace who took a panoramic radiograph (Fig 1).  This radiograph revealed a large scalloped radiolucency in the left posterior mandible extending into the ramus.  There is a hit of multilocular appearance of the radiograph.  Also identified were multiple missing teeth.  There was no impacted third molar in the site.  She had no soft tissue swelling or pain at the site and no parasthesia.   

 

Figure 1. Panoramic view at first presentation demonstrating large radiolucency with scalloped border and a hint of multilocular appearance extending high into the ramus.  Notice the missing teeth and the absence of teeth # 17 and 18.