cherubism is a rare , hereditary , autosomal dominant , benign , fibro - osseous bone disease of childhood that causes a progressive but generally self - limiting , diffuse , bilateral and multiocular expansion of the mandible and/or maxilla and has a characteristic radiographic and histopathologic appearance . the disease progresses or becomes increasingly evident at the time of puberty and then shows gradual regression thereafter . the signs and symptoms of disease depend on the severity of the condition , and range from clinically and radiologically undetectable features to severe deformity of the jaws , upright palate , respiratory distress , impairment of vision and hearing . a 6-year - old male child of non - consanguineous parents presented with a history of painless progressive swelling of bilateral cheeks of 2 years duration . there was no history of similar disease in any of the siblings or in the parents of the affected child . on clinical examination , the child had mild swelling of bilateral cheeks , more prominent on the right side , which was seen to involve angle of the mandible . panoramic radiograph revealed variably expansile , multiloculated osteolytic lesions involving angle and bilateral rami of the mandible with sparing of condyles [ figure 2 ] . computed tomography ( ct ) with thin axial and coronal section was performed and multiplanar images were reconstructed and three - dimensional images were obtained . ct confirmed the presence of multiloculated cystic lesions affecting the angle and rami of mandible . the lesions caused marked expansion of the bones , with a multifocal cortical breakthrough [ figures 3 and 4 ] . computed tomographic image of left side of the jaw . due to lack of family history of similar disease , an incisional biopsy was performed intraorally under general anesthesia and the specimen was obtained from the right side of the mandible and sent for histopathologic examination . gross examination : multiple thick fragments of grayish brown firm tissue , microscopic examination : multiple sections stained with hematoxylin and eosin ( hande ) were examined . lesion was made up of highly vascular fibrous stroma containing spindle fibroblasts at places arranged compactly . vascular spaces were dilated , but thick - walled blood vessels surrounded by collagenous tissue were not identified . diagnosis of giant cell lesion compatible with cherubism was considered [ figures 5 and 6 ] . multinucleate giant cells contain variable number of nuclei and are sparse as compared to giant cell granuloma or giant cell tumor . therefore , a diagnosis of cherubism was made based on the characteristic radiological findings , along with compatible histopathologic features . due to expected tendency of these lesions to regress spontaneously , no surgical intervention was undertaken and the patient was kept on follow - up . gross examination : multiple thick fragments of grayish brown firm tissue , together measuring 2  2  1.5 cm , were received . microscopic examination : multiple sections stained with hematoxylin and eosin ( hande ) were examined . lesion was made up of highly vascular fibrous stroma containing spindle fibroblasts at places arranged compactly . vascular spaces were dilated , but thick - walled blood vessels surrounded by collagenous tissue were not identified . diagnosis of giant cell lesion compatible with cherubism was considered [ figures 5 and 6 ] . multinucleate giant cells contain variable number of nuclei and are sparse as compared to giant cell granuloma or giant cell tumor . therefore , a diagnosis of cherubism was made based on the characteristic radiological findings , along with compatible histopathologic features . due to expected tendency of these lesions to regress spontaneously , no surgical intervention was undertaken and the patient was kept on follow - up . cherubism is a fibrous osseous condition characterized by firm , painless swelling of the jaws that are said to give the patient a  cherubic appearance  . familial multiocular cystic disease involving mandible and maxilla  , but the term  cherubism  was later coined to describe the classical characteristics of full round cheeks , which resembled those of the cherubs immortalized by renaissance art . it is inherited as an autosomal dominant trait which appears to have 100% penetrance in males and 5070% penetrance in females . there was no history of a similar disease in any of the family members of our patient , thus adding to the list of non - familial cases that have been reported in literature . the affected child is normal at birth and develops the disease in the second or third year of life . clinically , cherubism is characterized by progressive swelling of the face , with marked increase in the fullness of cheeks and jaws , resulting in a round face , sometimes retrusion of the lower eyelid that produces a visible sclera beneath the iris causing  eye raised at heaven  look . usually , the mandible is affected more than the maxilla . abnormalities in the configuration of the dental arch or dental eruption , premature exfoliation of deciduous or permanent teeth , resorption of roots , and malformation are frequently observed in cases of cherubism . the radiographic appearance of cherubism is unique because of its diffuse , bilateral , multiocular nature which begins at the angle of the mandible and extends into the ramus and body . these multiocular areas of diminished densities are later replaced by irregular patchy sclerosis with progressive calcifications . the presence of numerous unerupted teeth and the destruction of the alveolar bone may displace the teeth , producing an appearance referred to as  floating tooth syndrome  . there is a classical but not specific  ground glass appearance  as a result of tightly compressed trabecular pattern . in our case ct scan provides a clear delineation of the extent of the disease which is difficult on radiographs due to an overlapping of the facial bones . ct investigation is the best method for demonstrating expansile lesions and soft tissue components in these lesions . histologically , the lesion contains numerous multinucleated giant cells scattered throughout a fibrous connective tissue . since the lesion undergoes spontaneous regression , the surgical intervention is usually delayed until after puberty . however , in patients with functional or cosmetic problems or emotional disturbances , surgical intervention can be considered .
cherubism is a rare , self - limiting , non - neoplastic fibro - osseous disorder of the jaws , usually seen in pediatric population . 
 it is characterized by painless bilateral swelling of the jaws that gives the patient a typical cherubic appearance . here 
 , we describe the clinical , radiographic , histologic and computed tomographic features of cherubism in a 6-year - old boy .