A 6-year-old girl presented with a painless, bilateral symmetrical swelling of both mandible and maxilla. Her parents had noticed her round face, full of cheeks, which later became more pronounced.
Examination
Intraoral examination showed malocclusion with the displacement of teeth and swelling of the alveolar bone. The patient had oral caries on her upper anterior teeth, and her oral hygiene was poor. Some deciduous teeth were missing, and wide edentulous interdental spaces were detected on intraoral examination. Physical and mental developments were normal. Physical examination showed a heart rate of 84 beats/min, blood pressure of 115/70 mmHg, a respiratory rate of 16 breaths/min, and oxygen saturation of 94% on room air. The abdominal examination was significant for mild abdominal distension and diffuse peritonitis. Laboratory tests showed a white blood cell count of 8.7×109/L with 7% immature cell forms and a hemoglobin level of 11.6 gm/dL. A plain erect chest and abdominal X-ray showed free gas under the right hemidiaphragm and nonspecific gaseous distension of the small bowel.
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