8-year-old female visited...

An 18-year-old female visited the hospital with a complaint of painful decayed teeth in her mouth for the past month and underwent medication. The patient had an H/o seizure ten years back. 

The patient is poorly oriented, short stature, and mentally challenged on general examination. An extraoral investigation revealed a flat face with ocular hypertelorism and midface deformity with underdeveloped nasal bone. The physical inspection of the patient revealed broad fingers, palms and toes, as shown in the figure. On intraoral examination, multiple teeth were decayed, including root stumps and a few missing. 

The tongue appeared to be fissured & is more significant than average (macroglossia), which protrudes on mastication. Radiographic findings revealed multiple decayed teeth with evident periapical abscesses and a few missing, as shown in the figure. The lateral skull view revealed a hypoplastic maxilla which makes a prognathic mandible.