COM February 2005

This is a 5-year-old male who was referred to Children’s Hospital and Regional Medical Center Oral and Maxillofacial Surgery Department by Dr. GB Givler of Helena, Montana. The patient’s family reported a history of incidental finding of a mandibular lesion at a dental visit on March 4, 2004. He had multiple premature resorption and exfoliation of the deciduous teeth. A panoramic radiograph revealed bilateral mandibular well-defined radiolucencies extending into the ramus. The patient went through an incisional bone biopsy and extraction of multiple deciduous teeth.

Figure 1. Panoramic view at first presentation demonstrating symmetrical and bilateral multilocular radiolucency involving the first and second mandibular molars and extending posteriorly into the ramus.

The past medical history is unremarkable. There is no family history of related disease. Siblings were tested for similar condition and were negative.

Fullness in the posterior jaws was evident clinically and more prominently in the right side of the mandible. This was confirmed radiographically where bilateral multilocular radiolucencies (Fig 1) with focal areas of complete compartment formation were evident. The symmetrical bilateral radiolucencies involved the unerupted first and second molar teeth. The radiolucencies are well-demarcated to corticated and involve the angle of the mandible extending posteriorly into the ramus, typical of this condition. The features of the panoramic radiograph were confirmed by the CT scan image (Fig 2).

Figure 1. Panoramic view at first presentation demonstrating symmetrical and bilateral multilocular radiolucency involving the first and second mandibular molars and extending posteriorly into the ramus.

Figure 2. CT scan showing swelling and buccal and lingual expansion of the bilateral mandible involving the ramus.

Histologic specimens showed small pieces of loose and vascular granulation tissue with clusters of multinucleated giant cells (Fig 3-4). Figure 4 shows two small blood vessels with thick (hyalinized) walls frequently seen in this condition. The histologic diagnosis was rendered by Dr. Kathy Patterson at the Seattle Children’s Hospital, Department of Pathology.

Figure 3. Low power (x100) histology shows granulation tissue background with many giant cells and clusters of extravasated erythrocytes.

Figure 4. Low power (x100) histology shows granulation tissue with occasional giant cells and hyalinized small blood vessels.