The images in this case demonstrate the orthopantomogram of a young child. The orientation of the teeth is a mess! This is even more so than would be expected by the numerous unerupted and extra teeth present. The unerupted teeth of course indicate that the patient is a child, however, in addition to the haphazard arrangement in both the maxilla and mandible the teeth are also associated with numerous cysts. Unerupted teeth are usually associated with a small cystic covering but this is more than would be expected as the cysts are quite large in cases. The cystic lesions are well-defined peripherally with no obvious erosion. Notably, most cysts appear related to the crown of unerupted teeth. The findings are highly suggestive of dentigerous cysts. The presence of multiple mandibular or maxillary cysts, in particular dentigerous cysts is highly suggestive of the Gorlin's syndrome.
These findings are sometimes misinterpreted as ameloblastoma. Ameloblastoma is usually a solitary multiloculated soap bubble type lesion that typically is located at the angle of the mandible. The lesion is frequently associated with resorption of adjacent roots as it is a locally aggressive lesion. Similarly, eosinophilic granuloma may cause tooth root resorption and the classically described “floating teeth” appearance. The possibility of cleidocranial dysostosis is a significant consideration in view of extranumerary teeth. However, the presence of multiple cysts is atypical. Additionally, other features that might be present such as midline failure of fusion of the mandible or maxilla are not demonstrated in this case. Remember, of course that orthopantomograms are often “fuzzy” in the midline. This is a difficult but characteristic (Aunt Minnie) type of diagnosis. Hopefully, once seen this is not forgotten. Recall that there are associations in Gorlin's syndrome that might include basal cell naevi and intracranial calcifications.
These findings are sometimes misinterpreted as ameloblastoma. Ameloblastoma is usually a solitary multiloculated soap bubble type lesion that typically is located at the angle of the mandible. The lesion is frequently associated with resorption of adjacent roots as it is a locally aggressive lesion. Similarly, eosinophilic granuloma may cause tooth root resorption and the classically described “floating teeth” appearance. The possibility of cleidocranial dysostosis is a significant consideration in view of extranumerary teeth. However, the presence of multiple cysts is atypical. Additionally, other features that might be present such as midline failure of fusion of the mandible or maxilla are not demonstrated in this case. Remember, of course that orthopantomograms are often “fuzzy” in the midline. This is a difficult but characteristic (Aunt Minnie) type of diagnosis. Hopefully, once seen this is not forgotten. Recall that there are associations in Gorlin's syndrome that might include basal cell naevi and intracranial calcifications.
RSS Feed
