Some may confuse this appearance with 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 extranumarry 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. Please remember that there are associations in Gorlin's syndrome that might include basal cell naevi and intracranial calcifications.