Gardner syndrome

A 58-year-old male patient was referred for a panoramic radiograph after having presented with a hard swelling of the right mandible. Panoramic radiographic examination (Fig. 1) demonstrated multiples dental anomalies and variable bone densities in both jaws prompting clinicians to “dig” further. Teeth 17, 12, 11, 26 and 27 were missing. Teeth 13, 23, 24, 25, 38, 34, 33 and 43 were unerupted. An unerupted supernumerary left mandibular molar appeared in the region of the mandibular coronoid process. Multiple, small, well-defined radiopacities of density comparable to odontogenic material were evident in the anterior maxilla and mandible. These opacities often demonstrated radiolucent borders consistent with the finding of multiple odontomas. Both jaws demonstrated variable bone density. Cottonwool like opacities partially blending into adjacent trabeculae were evident in the mandible and maxilla posteriorly. The contour of the inferior border of the mandible bilaterally in proximity to the angle was irregular with multiple, well-defined, smooth, lobulated homogenous radiopacities suggestive of osteomas. The radiographic features of multiple osteomas, odontomas, variable bone density, supernumerary and unerupted teeth warranted the referral of the patient for gastroenterological investigation to exclude Gardner Syndrome