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Traumatic Bone Cyst of the Jaw: A Case Report and Review of Previous Studies
... It rarely occurs in the jaw and accounts to 1% of all jaw cyst. 6 TBC is usually found in the mandible body from canine to third molar area. A few cases have been recorded in the condyle, ramus and symphysis region of the mandible. ...
... Though the occurrence is found in both gender there is male predilection. 6 In most cases the cyst is asymptomatic and is identified during routine radiographic examination. Radiographically it manifests as a single unilocular radiolucent lesion with a well-defined border. ...
... TBC cavity was found empty in 60.2% of cases on exploration and only in 9.2% cases material was obtained which could be evaluated. 6 The curettage of the bony cavity induces bleeding which provides favourable environment for bone formation. In the present case, surgical exploration and curettage allowed bone formation. ...
The Traumatic bone cyst (TBC) is an unusual jaw lesion. It is classified under pseudocyst as it lacks of an epithelial lining. The lesion is asymptomatic intraosseous, slow growing benign non expansile, empty or fluid filled cavity having a tenuous lining of connective tissue without epithelium, occurs most frequently in young adults during the second decade of life. The lesion is often diagnosed accidently during routine radiographic examination. It presents as unilocular radiolucency. The most common location being the posterior mandible. This paper presents a case of TBC in the posterior mandible in a young patient. The simple surgical exploration of the lesion led to regeneration of bone. KEY WORDS-traumatic bone cyst, pseudocyst, mandible.
... [1] SBC has different synonyms such as traumatic bone cyst, simple bone cyst, idiopathic bone cyst, hemorrhagic bone cyst, progressive bone cavity, or unicameral bone cyst suggesting its different etiopathogenesis. [1,2] While the term "traumatic bone cyst" is more widely used in the literature, the International Histological Classification adopted by the World Health Organization for odontogenic tumors uses the term "solitary bone cyst." [3] SBCs are generally asymptomatic and found incidentally on radiographic examination. ...
... The lesion has a male predilection with a male-to-female ratio of 1.6:1. [2,4] However, some researchers suggested equal sex distribution, while others have suggested male predominance. [2,3] Howe's analysis found that the lesion was more common in Asian and black females. ...
... [2,4] However, some researchers suggested equal sex distribution, while others have suggested male predominance. [2,3] Howe's analysis found that the lesion was more common in Asian and black females. [4] It occurs more commonly in the mandible and seldom in the maxilla. ...
Solitary bone cyst (SBC) is an uncommon, nonneoplastic osseous lesion that mainly affects metaphysis of long bones and rarely presents in jaws. Due to the lack of true epithelial lining, it is considered as a pseudocyst. It is generally asymptomatic and often discovered incidentally during routine radiographic examination as well-defined unilocular or multilocular radiolucent lesion in the posterior mandible mainly in the first two decades of life. Here, we report a very rare case of a 15-year-old female patient having a lesion in the posterior maxilla with clinical, radiological, and histopathological presentations of SBC.
... in 1946, comprising of a single bony cavity without epithelial lining, encompassed by bony walls, lacking contents or containing liquid and/ or connective tissue. (6) Afterwards, Hansen added another criterion i.e. upon surgery, the lesion is essentially empty and occasionally the cavity may contain some fluid and/or small amount of tissues. (7) WHO classified traumatic cyst as a non-neoplastic osseous lesion due to absence of epithelial lining, which demarcates it from other true cysts. ...
... (31) Radiographic features of TBCs are non-pathognomonic. (6) However, on radiologic evaluation, the lesion exhibits unilocular or multilocular radiolucency with well-defined or ill-defined margins. When multiple teeth are affected the radiolucencies involving the roots shows a dome like projections that scallops between the roots (32) and often scallops between the roots of the teeth, almost always diagnostic. ...
The traumatic bone (TBC) cyst is an uncommon benign empty or fluid containing cavitywithin bone that is not lined by epithelium. The etiopathogenesis of TBC is still unknown. TBCis frequently encountered in young patients during the second and third decades of life. Sexpredilection is equal but some studies in literature suggest clear female predominance. Body of themandible between the canine and the third molar is the most common site (75%) in head and neckregion followed by mandibular symphysis. The cysts are usually asymptomatic. Associated teethare usually vital with no resorption or displacement. It expands the cortices and, seldom, intraoral orextra oral swelling may be seen. Most of the TBCs are diagnosed incidentally in orthopantomogram(OPG). On radiographic examination, a unilocular irregular but well defined lytic lesion is seencharacteristically extending between the roots of the teeth. TBC is representing approximately1% of all jaw cysts. A final diagnosis of a TBC is almost invariably made at the time of surgery,where in identification of an empty air-filled cavity serves as a valuable diagnostic tool. Surgicalexploration was proved not only essential in making the right diagnosis but also curative from atreatment plan perspective. Recurrence of TBC is assumed to be extremely rare. However, a distinctproportion of recurrences may occur.
(2) (PDF) TRAUMATIC BONE CYST OF THE MANDIBLE; DIAGNOSTIC CHALLENGE AND MANAGEMENT A CASE REPORT. Available from: https://www.researchgate.net/publication/339931270_TRAUMATIC_BONE_CYST_OF_THE_MANDIBLE_DIAGNOSTIC_CHALLENGE_AND_MANAGEMENT_A_CASE_REPORT [accessed Oct 26 2022].
... Surgical exploration is the most recommended curative therapy, as well as the best way to close the diagnosis of traumatic bone cyst. Therefore, thus ruling out other cystic lesions with more aggressive behavior in its differential diagnosis [8]. ...
The traumatic bone cyst is an uncommon nonneoplastic lesion of the jaws that is considered as a “pseudocyst” because of the lack of an epithelial lining. This lesion is particularly asymptomatic and, therefore, is diagnosed by routine dental radiographic examination as a unilocular radiolucency with scalloped borders, mainly in the posterior mandibular region. The exact etiopathogenesis of the lesion remains uncertain, though it is often associated with trauma. The objective of this paper is to report one case of atypical traumatic bone cyst involving impacted lower third molar, addressing its clinical and radiographic characteristics, differential diagnosis, treatment through surgical exploration and case follow-up.
Indexing terms
Bone cysts; Differential diagnosis; Oral surgical procedures; Tooth, impacted
... [6] Traumatic bone cyst (TBC) commonly found in the metaphysis of long bones, while relatively rare in the jaws, representing approximately 1% of all jaw cysts, lesions are mainly situated in the body and ramus of the mandible, and rarely in the maxilla, teeth exhibit no mobility or displacement and remain vital. [7] Dentigerous cysts are always associated with an impacted tooth. [8] Lateral periodontal cyst is an unusual cyst of odontogenic origin, most frequently encountered in the mandible between the roots of canines and premolars; histology demonstrates a cystic cavity supported by fibrous connective tissue and is lined by a thin nonproliferative layer of epithelium showing areas of focal thickening which may be interspersed with glycogen-containing clear cells. ...
A radicular cyst (RC) is one of the types of inflammatory cyst of odontogenic origin. It is usually associated with nonvital teeth and is mostly observed in males. It is routinely treated by nonsurgical endodontic therapy; however, if the cystic lesion does not respond to endodontic therapy, then surgical intervention with or without regeneration is the treatment of choice, depending upon the size, location of lesion, the bone integrity of the cystic lesion wall, proximity to vital structures and residual bone defect elicit after enucleation, etc., We hereby present successful interdisciplinary management of rare true lateral RC in the interproximal site with respect to teeth number 21 and 22 as well as associated mucosal fenestration that was occurred postoperatively other than its apparent etiology and diagnosis.
... Moreover, the incidence of history of trauma in patients with TBC is not greater than that in the general population and is wide-ranging, from 17% to 70% on the basis of reported case series [11,28]. Additionally, men display a higher incidence of trauma, and the anterior mandibular region is predominantly traumatized, whereas TBC is equally dispersed between sexes and occurs in posterior regions of the mandible [29]. Hence, the relevance of trauma to development of TBC is open to question. ...
Background:
A traumatic bone cyst is an uncommon nonneoplastic lesion of the jaws that is considered as a "pseudocyst" because of the lack of an epithelial lining. This lesion is particularly asymptomatic and therefore is diagnosed by routine dental radiographic examination as a unilocular radiolucency with scalloped borders, mainly in the posterior mandibular region. The exact etiopathogenesis of the lesion remains uncertain, though it is often associated with trauma.
Case presentation:
We report three Persian cases of traumatic bone cyst with different clinical and radiographic features, and we present a review of the literature to further discuss diagnostic and treatment challenges. Only one of the three patients reported a history of trauma, and despite the usual signs and symptoms of the lesion, extension of the defect to the ramus, swelling of the lingual cortex, and their unusual presence in the anterior mandible were noted in these patients.
Conclusions:
Because features of this cyst can be varied, careful history taking and radiographic evaluation alongside the clinical signs and symptoms have a very significant role in definitive diagnosis, appropriate treatment, and accurate assessment of prognosis.
The traumatic bone cyst is characterized by the presence of an asymptomatic sinus devoid of epithelial lining, which is rarely found in the jaws.
To describe the clinical, surgical and radiographic findings of traumatic bone cysts.
A retrospective study was made of patients diagnosed with traumatic bone cysts at an oral pathology department from 1992 to 2007. Data on the clinical, radiographic and surgical complications were gathered.
Twenty-six cases of traumatic bone cyst were diagnosed in 15 years; 17 were male and 09 were female. Most patients were within first two decades of life and had no pain or history of trauma in the affected area. The multilocular pattern was observed in only seven cases, its radiographic appearance suggests a tumor. Air was found inside the lesion in about 70% of cases; serous fluid with blood and blood only were uncommon within the lesions.
A higher prevalence in young patients, absence of a history of trauma, and a small number of lesions containing serous fluid with blood reflects the need to discuss the true pathogenesis of traumatic bone cysts.
The simple bone cyst (SBC) is a pseudocyst that can occur as a solitary entity in the jaws or may occur in association with cemento-osseous dysplasia (COD).
The purpose of this study was to review the clinical and radiographic features of solitary and COD-associated SBCs.
Archived imaging reports from the Special Procedures Clinic in Oral and Maxillofacial Radiology at the Faculty of Dentistry at the University of Toronto between 1 January 1989 and 31 December 2009 revealed 23 COD-associated SBCs and 68 solitary SBCs.
Almost all solitary and COD-associated SBCs were found in the mandible. Furthermore, 87.0% of COD-associated SBCs were found in females in their fifth decade of life (P < 0.001) while solitary SBCs were found in equal numbers in both sexes in their second decade of life (P < 0.005). COD-associated SBCs were also more likely to cause thinning of the endosteal cortex, bone expansion and scalloping of the superior border between teeth (all P < 0.001) than solitary SBCs that are classically described as having these characteristics. Finally, COD-associated SBC demonstrated a loss of lamina dura more often (P < 0.05) than solitary SBCs.
Knowledge of the sporadic association between COD and SBC and their potential radiographic appearances should prevent inappropriate treatment and management of these patients.
To describe the clinical and radiological characteristics, and surgical findings of traumatic bone cysts.
A retrospective observational study was made of 21 traumatic bone cysts. The diagnosis was based on the anamnesis, clinical exploration, and complementary tests. Panoramic and periapical X-rays were obtained in all cases, together with computed tomography as decided by the surgeon. A descriptive statistical analysis was made of the study variables using the SPSS v12.0 for Windows.
There was a clear female predominance (14:7). The mean age was 26.5 years (range 8-45 years). The cysts in all cases constituted casual findings during routine radiological exploration. In those cases where computed tomographic images were available, preservation of the vestibular and lingual cortical layers was observed. Five of the 21 patients (23.8%) reported a clear antecedent of traumatism in the affected zone. All the lesions were subjected to surgery, and the cavities were found to be vacant in 90.5% of the cases. In only two patients were vascular contents seen within the cavity. Two of the patients presented postoperative paresthesia of the inferior dental nerve that subsided within two weeks. The 19 patients in whom adequate postoperative follow-up proved possible all showed complete bone healing.
Traumatic bone cysts were a casual finding. During the surgery, most cases showed to be vacant cavity without an ephitelial lining. Careful curettage of the lesion favors progressive bone regeneration, offering a good prognosis and an almost negligible relapse rate. Other treatment options only would be justified in cases of relapse.
Objectives
This study contributes three well-documented cases of multiple simple bone cysts (SBCs) of the jaws and reviews previously published cases.
Study Design.
A comprehensive literature search of multiple SBCs was conducted using PubMed database. Synonyms of SBC were used as search key words in combination with “mandible or jaw”, “bilateral, multiple, multifocal, atypical, and unusual”.
Results
A total of 34 cases of multiple SBCs (including 2 asynchronous cases) were identified, including the three new cases reported here. Multiple SBCs primarily occurred in the second decade (52.9 %) and bilaterally in the posterior mandible. Lesions showed female predominance (1.8:1) and were frequently accompanied by bony expansion (44.1 %) and a multilocular radiolucent appearance (20.6 %). Recurrence was reported in 3 patients (mean age: 39.3 years old).
Conclusion
Knowledge of the clinical and radiographic features of multiple SBCs is important in the diagnosis and management of this entity.
This report is of a patient with unusual multiple simple bone cysts. A 17-year-old Japanese man presented with 3 cystic lesions, 2 in the mandible and 1 in the left maxillary sinus. Biopsies from the mandible revealed fibrous tissue, bone, and red blood cells, which did not suggest any specific lesion. A diagnosis of multiple simple bone cysts was made. After treatment of surgical exploration, curettage, and packing, computed tomography scan showed bone regeneration. However, the lesions repeatedly recurred in the mandible. It is generally thought that the prognosis of this lesion is good. Therefore the cause of this recurrence is examined.
Simple bone cysts are well-defined intraosseous radiolucencies that often extend between the roots and appear clinically like empty cavities. This article aims to provide more information about this lesion with limited prominence in academic literature, to illustrate atypical cases, and to provide a review of the current literature. A series of six atypical cases of simple bone cysts is presented and their clinical, radiographic and microscopic characteristics, differential diagnosis, treatment and follow-up are discussed. Correct diagnosis of this entity is of key importance, since it presents with clinical & radiographic similarities to other bone lesions, some exhibiting more aggressive behaviour.
Solitary bone cyst is a radiolucent lesion classified as a pseudocyst with a variety of reported shapes including round, oval, and irregular. In the long bones, a truncated cone shape has been described, and the fallen trabecula sign is seen in association with pathologic fracture. The purpose of this study was to classify and document the various shapes, to describe the width versus height dimensions of jaw SBCs, to determine the identifying signs of trauma, and to evaluate other reported radiographic features. Radiographs of 44 SBCs in 43 patients were studied. Sixty-four percent demonstrated the cone shape, and four subtypes of this shape were identified. Other shapes included oval (16%), irregular (16%), and round (4%). Radiographic signs of trauma were observed in 28% of the cases. No evidence of the "fallen trabecula sign" was found in this series.
Idiopathic bone cavity (IBC), also named simple or traumatic bone cyst, is a common lesion of unknown cause. The mandible is a very common location, although it may occur in any bone of the body. The authors performed a retrospective analysis of 44 cases in order to assess the causation of this entity.
Each case was analysed by two of the authors (IV and SM) for medical and dental history, history of mandibular/maxillary trauma, clinical presentation, radiographic appearance, surgical findings and histopathology.
This retrospective study suggested a possible relationship between IBCs and orthodontic treatment. This association was noted in 10/44 cases (22.73%). All of these cases were located in the mandible and were well-circumscribed radiolucencies. Evaluation of these cases disclosed that 6/44 (13.64%) demonstrated scalloping, and 3/44 (6.82%) revealed bony expansion. The age range of the patients evaluated was 9-74 years. None of these cases had a history of trauma or extractions in the area.
The findings of this retrospective study suggest an association between orthodontic treatment and the development of this IBC. This occurrence may be multifactorial; further research in the dental science is required.
Solitary bone cysts (SBCs) of the jaws are often polymorphic, show scalloped borders when located between the teeth roots, are devoid of an epithelial lining, and are usually empty or contain blood or a straw-colored fluid. The numerous synonyms referring to these lesions reflect their uncertain nature (eg, traumatic bone cyst, simple bone cyst). SBC, also found in other skeletal locations, is often suspected after epidemiologic and radiologic test results and confirmed at surgery. Histology usually shows fibrous connective tissue or only bone. The various etiologic elements responsible for SBC include tumor degeneration, trauma, or abnormalities during bone growth. The pathogenesis of the SBC is unknown, but it is widely accepted that it could be the result of a vascular dysfunction leading to a local posthemorrhagic ischemia, inducing an osseous aseptic necrosis. This article reviews likely but still-debated etiopathogenic hypotheses of lesions of the jaws and other, more frequent bony locations, such as the humeral and femoral metaphysis.
Fifteen cases of extravasation lesions of the mandible have been treated. In six cases, the lesions were entered surgically, explored, and directly curetted following preliminary diagnosis by needle aspiration. Healing was uneventful in all cases, and bone regeneration occurred rapidly. Hemorrhage was easily controlled, and the surgery was considered a minor procedure. Nine cases were treated by a combined diagnostic-curettement technique. The entire procedure was quickly performed under local anesthesia. There was little chance of injury to surrounding structures, and there were few postoperative sequelae. The resolution of the lesion and bone regeneration occurred in a time span similar to that of the surgical treatment of lesions.
Thirty-four patients with florid osseous dysplasia were studied. The majority were asymptomatic Negro women: Seventeen biopsy-proven simple bone cysts were found in affected quadrants of fourteen patients. Radiographs displayed a spectrum of sclerotic and ground-glass opacities limited to alveolar processes but not to root apices. Biopsy material was studied in all cases, and biochemical analyses of serum and cyst fluid were performed on some patients. Test results and skeletal radiographs indicate that the disease is limited to the jaws. Patients have remained asymptomatic with little alteration of radiographic patterns. Three cysts failed to heal following treatment, others filled with radiographically abnormal tissue. Chronic osteomyelitis may infrequently complicate the disease. These cases appear to represent the most exuberant manifestation of this reactive fibro-osseous jaw disease.
A clinicopathologic study was made on 30 cases of the traumatic bone cyst of the jaws, and these observations were recorded. --The lesion is one of skeletal-wide distribution, but in the jaws it occurs most frequently in the posterior portions of the mandible. --The majority of cases are not associated with trauma, and the lesion is most commonly detected in routine radiographs. --The median age of this series of patients was 20 years, and the majority of patients in this series white men. --Histologically extravasated red blood cells, degenerating fibromyxomatous tissue both inside and outside of bone, hemorrhagic membranes, and other changes consistent with degenerative processes were observed. --The origin of the traumatic bone cyst was not determined in this study, but histologic evidence pointed toward a degenerative process that also could not be adequately explained; therefore, the more general term solitary bone cyst is suggested for use. --Treatment of the solitary bone cyst consists essentially of exposing the lesion and mild curetting to produce a clot formation that will subsequently organize and fill in with new bone.
Nineteen simple bone cysts found in 15 patients were studied by classifying them into younger and older age groups. The clinical, radiographic, and histopathologic features of 11 cysts in the younger group of 10 patients were consistent with those of previous reports. Among patients in the older age group, female predominance (80% vs 30%), involvement of the maxilla (25% vs 0%), multiple occurrence (60% vs 10%), simultaneous presence of radiopaque fibro-osseous lesions or hypercementosis (63% vs 0%), and loss of lamina dura of related teeth (83% vs 14%) resulting in exposure of their roots on surgical intervention were the characteristic features.
The etiology and pathogenesis of traumatic bone cyst are still far from being conclusively established with multiple theories, names, and forms of management being proposed and used. The rarity of these lesions in the older age groups suggests that self-healing can occur. This article presents two well-documented cases of what clinically and radiographically were consistent with so-called "traumatic bone cyst" of the mandible, which have appeared to heal without surgical intervention, thus providing additional information to our understanding of the biologic nature of this entity. Case 1 involved a 14-year-old boy with a lesion of the anterior left mandible that was monitored for 7 years and 5 months. Case 2 involved a 19-year-old female patient with a lesion of the right mandible that was monitored for 2 years and 9 months. In both cases, intraosseous biopsy or other surgical procedures were not undertaken. By the time both patients approached age 22, their lesions had resolved and the trabecular bone pattern radiographically approached normal.
A retrospective study of 23 simple bone cysts including analysis of clinical, radiographical, histopathological features and follow-up information was made. The age of the patients varied from 8 to 59 years (mean 21.4 years). All lesions were found in the mandible, and 2 of them were radiologically multilocular. A loose connective tissue lining was found histologically in 8 out of 17 cysts with the biopsy specimens available. At follow-up, 2 failures of the primary surgical treatment were noted. The results emphasize that a proper follow-up is required after the treatment of simple bone cyst.
A total of 161 cases of traumatic bone cyst, 94 from a review of the literature and 67 previously unreported ones, were analyzed for clinical and histologic features. No gender predilection was noted, and the history of prior trauma was equivalent to that described in the general population. The possibility of an association with florid osseous dysplasia is strengthened by the finding of a higher incidence of traumatic bone cyst in black females among the patients over the age of 30.
The findings in a clinicopathologic study of sixty-six previously unreported cases of traumatic bone cysts are presented and compared with the findings in more than 150 previously reported cases. Most of the patients were between 11 and 20 years of age, and there was no difference in the incidence of the lesion between the sexes. Most patients were asymptomatic, although a significant number of them had symptoms and/or bony expansion. Vitality of teeth was not related to etiology or pathogenesis. In some cases the radiographic findings suggested a traumatic bone cyst, but surgical exploration was essential for definitive diagnosis. The lesion occurs in the maxilla more often than previously reported, although the mandible is still the most common location. The etiology and pathogenesis of the traumatic bone cyst remain unknown. Although the possibility that trauma plays a role in some cases cannot be excluded, present evidence is far from convincing.
A case of traumatic bone cyst of the body of the mandible in a 24-year-old woman is presented. This lesion had been treated surgically on three prior occasions and had not resolved. The two mandibular premolars and the first molar were found to be involved in the cystlike cavity and were endodontically treated during the second and third surgical procedures. The treatment reported here consisted of the removal of four nonvital teeth involved in the lesion, placement of a homograft of freeze-dried cancellous bone chips, and primary closure of the surgical site. Clinical and roentgenographic examinations 6 months following this procedure showed satisfactory healing of the traumatic bone cyst.
Summary Six further cases in which the mandible was the site of an haemorrhagic bone cyst are reported. The records of these patients, together with those of 54 previously reported cases, have been subjected to a detailed analysis in an attempt to clarify the clinical features which characterize the lesion. Unicameral bone cysts, latent bone cysts and aneurysmal cysts have been described and their possible relationship to extravasation bone cysts examined. The difficulties involved in diagnosis, terminology and pathogenesis have been detailed and discussed.
Two cases of traumatic bone cyst of the mandible are reported exhibiting a considerable variation in their presentation and pathogenesis. This spectrum of behaviour is discussed and comparison made with the solitary unicameral bone cyst.
The trabecular bone cyst (TBC) is the jaws' equivalent of the unicameral cyst of the long bones. A series of 20 TBCs were surgically treated in the jaws (19 in the mandible and one in the maxilla) of 14 Chinese patients (five males and nine females), who could broadly be divided into two age-sex groups; a young group of both sexes and an older, exclusively female group. Three patients in the older group had more than one TBC and the one with initially five separate TBCs (including one in the maxilla) exhibited six episodes of recurrence of the mandibular lesions which finally coalesced to affect the whole body of the mandible bilaterally.
The purpose of this study is to examine the correlation between histopathologic and radiographic findings and to discuss the cause of the simple bone cyst.
Histopathologically, we classified 53 simple bone cysts into two types. Type A has a connective tissue membrane and type B has a partially thickened wall with dysplastic bone formation. Radiographically, we evaluated the following: margin, radiolucency, or radiopacity, relationship with tooth apices, bucco-lingual bone expansion, and displacement of the mandibular canal.
Bone expansion and radiopacity were closely related to histopathologic findings although there was no correlation between the histopathologic findings and radiographic margin, relationship with tooth apices, and displacement of mandibular canal. Local recurrence was more likely to be observed in patients diagnosed as having type B than type A lesions.
Type A and type B bone cysts may have different causes. Cysts determined radiographically to be radiopaque, those diagnosed as type B histopathologically, and cysts that have been treated surgically should all be followed by radiographic examinations.
A patient presented with a large, multilocular, refractory traumatic bone cyst. The radiolucency had increased in dimension since her last recall. Over 11 years, therapy had included needle aspiration biopsies followed by simple curettage and closure, the most common therapy for traumatic bone cysts. However, all treatment had proved unsuccessful for this patient. It was decided to treat the patient with a slightly unique method. After curettage of the lesion, the traumatic bone cyst was packed with a mixture of autogenous blood, harvested autogenous bone chips, and hydroxyapatite.
The solitary bone cyst (SBC) has not yet revealed all its secrets. The pathogeny of the SBC is thus considered and also its evolutivity. Conservative treatment has been used in attempts to heal this tumor-like bone. In the case of surgery, an original technique is described. The SBC still remains mysterious in many of its aspects. At the time of this writing, nobody can predict the occurrence modalities of this benign bone tumor. In a similar way, the reality of this tumor-like lesion cannot be precisely described. This emphasizes the first controversial point about this lesion. Indeed, must we consider differently the bone cysts that remain close to the growth plate and those which located in the diaphysis? Must we regard the true unicameral bone cysts (UBCs) differently and those that are multilocular? Moreover, are the cysts located in the long bones identical to the those of the short cancellous bones? Alas, SBC was supposed to be a lesion in children that disappeared after growth ended. Is it still true since some cases have been reported more recently in adults? This study represents a long follow-up. It includes the different aspects of the SBC and emphasizes an original technique in case surgery becomes indicated.
The nature and etiology of so-called simple bone cyst (SBC) are still a subject of debate. Our comprehensive review of the literature suggests that SBC, which appears histologically to be a single entity, has different natures and etiologies, resulting in divergent clinical features. In addition, an interesting case of mandibular SBC in an 11-year-old girl is presented with details of radiographic changes over a 7-year period. Fully documented patient records revealed that this lesion originated in the apical area of the first molar and took about 4 years to develop into a clinically evident bony expansion.
the mechanism probably not dissimilar to fistulas that can develop elsewhere in the gastrointestinal tract in Crohn’s disease. The mainstay of medical management of Crohn’s disease is the use of anti-inflammatory and immunosuppressive drugs. Acute attacks usually require oral corticosteroids and aminosalicylates to suppress the disease activity, the dosage of which is gradually reduced as the patient improves. Parenteral nutrition and, more recently, the use of monoclonal antibodies for refractory disease may also be necessary. In this case, the patient reported an improvement in his oral symptoms and cutaneous salivary fistula while on steroids for flare-ups of his gastrointestinal Crohn’s disease. Antibiotics such as metronidazole may be useful in severe perianal Crohn’s disease and repeated courses of antibiotics, including co-amoxiclav (clavulanic acid and amoxycillin) in this case, also helped to improve the oral symptoms, presumably by controlling the episodes of secondary infection in the buccal tissues. It is assumed that with the underlying infection and inflammatory process under control, the deep ulceration and fissuring are minimized, thus allowing the buccal tissues time to heal and close the fistula.
Cemento-osseous dysplasia (COD) is a nonneoplastic process usually confined to the tooth-bearing areas of the jaws or edentulous alveolar bone.(1-4) Several clinicopathologic forms of this disease are recognized, including solitary, multiple, florid, and periapical subtypes.(1-5) These lesions all share the same histologic spectrum consisting of admixtures of bone and cementum-like material in a fibrous stroma, but differ primarily in their extent of jaw involvement. In addition, a rare familial form of this disease has been described.(2,6) An unusual association of COD with simple bone cysts (SBCs) has infrequently been reported.(3,7-10) The aim of this article is to report 7 additional cases of COD which were associated with SBCs, because of the highly unusual radiographic presentations that can mimic other jaw lesions.
To estimate the prognosis of simple bone cyst of the jaws.
We reviewed 132 of our own and published cases that received postoperative follow-up until healing or recurrence. The recurrence rate was obtained from treatment outcomes. The time to healing or recurrence was estimated from the distributions of the times of examinations that confirmed healing or recurrence.
Simple bone cyst lesions healed in 98 cases and recurred in 34 cases. The overall recurrence rate was 26%. The recurrence rate was 71% and 75% for cases with multiple cysts and cemento-osseous dysplasia, respectively. In most cases, healing or recurrence was confirmed within 3 years, 5 months of surgery. The maximum number of cases with healing and recurrence was observed 12 to 17 months and 2 to 2.5 years after surgery, respectively.
The recurrence rate was higher than rates reported previously. We recommend that postoperative examination be continued until complete healing is confirmed radiographically, particularly in cases with multiple lesions or cemento-osseous dysplasia. Healing or recurrence should be confirmed within 3 years of treatment.
To improve the interpretation of simple bone cyst (SBC) lesions of the jaw.
A comparative study of SBC lesions of the jaw and extracranial bones was performed through a literature survey.
In extracranial SBC, the cavities were always filled with fluid, and a high recurrence rate was shown through extensive research. Aneurysmal bone cyst (ABC) was included in the differential diagnosis owing to some clinicopathologic similarities. Fluid, gas and blood were found in the cavity in jawbone SBC, and recurrence was believed to be rare. Differential diagnosis was rarely discussed in the literature.
Based on reports, the cavity did not normally contain gas because no air-fluid level was observed on panoramic radiographs and no density/intensity area indicating gas was seen on CT or MRI. A blood-filled cavity should be examined carefully, and the possibility of an ABC should be considered. The recurrence rate needs to be re-estimated because an extensive survey has not been performed to clarify the treatment outcomes of jawbone SBC.
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