North American Burkitt's lymphoma presenting with intraoral symptoms

A case is presented in which posterior tooth mobility and pain, bilateral intraoral swelling of the mandible, and anterior open bite following an incident of facial trauma were the presenting symptoms of a 4-year-old, white American male with Burkitt-type malignant lymphoma. Radiographic examination revealed multiple osteolytic lesions in the body of the mandible, with loss of osseous trabecular architecture, and generalized loss of lamina dura in both maxillary and mandibular arches. The patient also had bone marrow involvement at the time of diagnosis. Following the initial course of chemotherapy, the patient experienced a significant resolution of the bilateral mandibular swelling, anterior open bite, tooth mobility, and dental pain. Relapse occurred shortly after remission was achieved, with tumor metastasis to the central nervous system and testes. The tumor remained resistant to further chemotherapeutic treatments and radiation strategems. Because of renal and metabolic complications, Burkitt's lymphoma constitutes an oncologic emergency. If untreated, this rapidly growing tumor is fatal. Early interception and referral of these cases by the examining dentist is crucial.