History of Present Illness

This is a 12-year-old African American girl who presented to the Seattle’s Children’s Hospital with a history of “jaw bumps” that have been present for an unknown period of time. They have increased in size over the last year and are now of concern esthetically. Lack of past medical attention makes her medical and family histories difficult to assess; the patient is one of six sisters raised by their grandmother. The patient otherwise appears healthy. The clinical examination revealed a 4 cm bony hard lesion on the left angle of the mandible (Fig 1). A similar but smaller lesion is on the right angle of the mandible (Fig 1) and a third is present in the right maxilla. In addition, three soft tissue nodules were identified outside the oral cavity; the largest is 5 cm in size and is on the right parietal scalp region, the second is on the right posterior neck and the third is on the right lateral ankle. The latter two are 2 cm each. The patient was referred to a gastroenterologist and geneticist to confirm the provisional clinical diagnosis.

Fig 1. Panoramic film demonstrating a combination of multiple radiopaque lesions (exophytic and flat), odontoma, retained deciduous teeth and impacted permanent teeth.