Clinical  and Radiographic Findings

Physical examination revealed an expansile lesion in the anterior mandible between teeth #s 22 and 28 (Fig 1). Panoramic radiographs showed a large, expansile, well demarcated to corticated unilocular radiolucency (Fig 1). This lesion recurred in 1992 after thorough curettage of the area. The first recurrence (Fig 2) was small and well demarcated between teeth #s 28 and 29, but less well defined in area of missing teeth #s 26-27. This lesion was also thoroughly curetted and several teeth were extracted (teeth #s 22-24 and 28-30). The second recurrence (Fig 3) took place in 2005, 13 years after the first recurrence. It was mostly in the anterior mandible and was a well demarcated to corticated unilocular radiolucency. It was also slightly expansile.

Figure 1.
Verruciform xanthoma of the lateral posterior surface of tongue at the primary clinical presentation.  Note the yellowish-orangey color with warty surface appearance.  These are characteristic features of this lesion.

Figure 2.
Lichen planus of the mandibular vestibule extending to the alveolar ridge.  Note the white interlacing striae of Wickham typical of lichen planus.

Fig 3.

Lichen planus of the buccal mucosa (bilateral).  Note the white interlacing striae of Wickham typical of lichen planus.