3194 https://www.journal-imab-bg.org J of IMAB. 2020 Apr-Jun;26(2)

Case report

TRAUMATIC BONE CYST OF THE MANDIBLE:CASE REPORT

Elitsa DeliverskaDepartment of Dental, Oral and Maxillofacial surgery, Faculty of Dental Medi-cine, Medical University - Sofia.

Journal of IMAB - Annual Proceeding (Scientific Papers). 2020 Apr-Jun;26(2)Journal of IMABISSN: 1312-773Xhttps://www.journal-imab-bg.org

ABSTRACTBackground: Idiopathic bone cavities (IBCs) are os-

seous pseudocysts with unclear etiology. Their clinicalcourse and response to treatment are poorly understood.

Purpose: The aim of this study is to present a caseof a patient with IBC with long-term follow-up.

Patients and Methods: A retrospective case of 16-years old male patient with IBC of the jaw is implemented.Medical records of the patient were reviewed for data onpresentation and imaging. The patient underwent surgicalexploration to confirm the diagnosis. Follow-up radio-graphs were evaluated for resolution or persistence after theprocedure.

Results: The lesion was asymptomatic and discov-ered as incidental findings. Common radiographic featuresincluded scalloping without root resorption or displace-ment and cortical thinning in lingual aspect expansion.Intraoperative findings showed an empty bone cavity of-ten filled with blood-tinged serous fluid or blood. The his-topathology of scrapings from the bony wall showed be-nign mixed fibrous tissue and no epithelial lining. Radio-graphic follow-up was 3 years after surgery. After explora-tion and curettage, the patient had a complete bone fill.

Conclusion: IBC is a rare condition, and several dif-ferential diagnosås should be considered. A single proce-dure to confirm the diagnosis and curettage is sufficientfor management.

Keywords: bone cyst, pseudocyst, mandible,

INTRODUCTIONTraumatic bone cysts may be characterized by the

presence of an asymptomatic cavity in bone with no epi-thelial lining. Traumatic bone cysts were described in1929; they are commonly found in the metaphysis of longbones but are rare in the jaws. [1, 2, 3]

Traumatic bone cysts may be classified as unicam-eral, simple, solitary, hemorrhagic, or idiopathic.[1, 4, 5, 6,7, 8] They are usually asymptomatic and appear on rou-tine radiographies. Because of a lack of unique clinical andradiographic features, it is important to establish the dif-ferential diagnosis between traumatic bone cysts and otherbone lesions of the jaws, especially translucent lesions. [1]

CASE REPORTThis is a case report of a 16-year-old patient who

presented with a large lesion in the posterior region ofthe mandible, asymptomatic, and with no previous his-tory of trauma.

A 16 years boy was referred to our department. Ona routine, OPG (fig. 1) was detected a solitary radiolucentlesion and CBCT scan was performed. Radiographically,the lesion presented as well demarcated, unilocular radi-olucency that scallop adjacent teeth roots, which were vi-tal without evidence of resorption or displacement butwith cortical expansion in lingual aspect. (fig. 2, 3) Afterendodontic treatment of 45 and 46, the surgery wasplanned under local anesthesia. The serosanguineous fluidwas aspirated, and surgical exploration was performed andrevealed an empty bone cavity with smooth walls.

A thin fibrous lining was removed by curettage. Itremains unclear whether placing grafts into the defect as-sists healing, and no bone grafting was used.

Histologically, no signs of the epithelium wasfound, and the final diagnosis was made as IBC.

The patient was placed on a frequent recall sched-ule and also began seeing the general practice residencyfor frequent prophylaxis.

Over the next 3 years, healing was tracked with se-rial OPG radiographs with no signs of recurrence. (fig. 4,5)

Fig. 1. Preoperative OPG with initial presentation ofthe lesion

https://doi.org/10.5272/jimab.2020262.3194

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Fig. 2. CT csan of the lesion

Fig. 3. CT scan of the lesion

3196 https://www.journal-imab-bg.org J of IMAB. 2020 Apr-Jun;26(2)

Fig. 4. Postoperative OPG 8 month after surgery mon, as seen in our sample. This opens the possibility thatmicrotrauma of teeth and the alveolar ridge are involvedin the pathogenesis of traumatic bone cysts [11].

According to several authors, most cases of trau-matic bone cysts present in young patients, although theymay be detected at any age [12, 13, 14]; our case was simi-lar – the patient was 16 years of old.

Most cases of maxillofacial traumatic bone cysts de-scribed in the literature are asymptomatic and do not causeexpansion of the cortical area – these cysts are diagnosedas accidental findings in routine radiographs as in our case.[11, 13]

Traumatic bone cysts generally show up as unilocu-lar radiolucent areas in the posterior portion of the mandi-ble; its margins are scalloped among dental roots [10, 11,12] Therefore, traumatic bone cysts should be part of thedifferential diagnosis of maxillary radiolucent lesions – to-gether with dentigerous cysts, keratocystic odontogenic tu-mours, ameloblastomas, odontogenic myxomas,aneurismatic bone cysts, focal osteoporotic bone marrowdefect, intraosseous vascular malformations, central giantcell lesions, among others. [1]

A few authors have reported the occurrence of mul-tiple traumatic bone cysts, and their association with fi-brous/bony lesions – such as the florid cemento-osseousdysplasia – especially in older patients [15, 16, 17] Pro-viders should be prepared for long-term follow-up in pa-tients treated for multiple IBCs because of the high prob-ability of recurrence.

The histology of traumatic bone cysts reveals onlya connective tissue membrane lining the pathologic cav-ity, characteristic of pseudocysts. Cholesterol crystals,hemorrhagic foci, and osteoclasts may be found [1, 11, 18].A final diagnosis of a traumatic bone cyst is almost invari-ably made at the time of surgery; the material available forhistology is usually sparse because of the difficulty in re-moving the thin connective tissue membrane. Surgeonsusually encounter an empty cavity, although there may beblood, serum, or both. [1, 19]

The treatment of choice for traumatic bone cysts issurgery for curettage of the bone walls, which generally re-sults in short-term healing [1, 11]. Recurrences are rare andusually occur within three months of surgery. Cases of mul-tiple cysts or those associated with florid cemento-osseousdysplasia have high recurrence rates – respectively, about71% and 75% [1, 20].

CONCLUSIONThe prognosis is usually excellent, although in some

cases, IBCs are difficult to treat and require annual follow-up until radiographic healing has been completely verified.

Fig. 5. Postoperative OPG one and a half year aftersurgery

DISCUSSIONTraumatic bone cysts are rare lesions of the jaws.

They are classified by the World Health Organization aspart of a group of bone lesions that include the ossifyingfibroma, fibrous dysplasia of bone, central giant cell le-sions, aneurysmatic bone cysts, and cherubism. [1] Althoughtraumatic bone cysts were described at the beginning of the20th century, the pathogenesis remains unclear and specu-lative. [9] The most accepted version at present is the trau-matic-hemorrhagic theory, which suggests that lesions de-velop if intramedullary clots due to trauma do not undergolysis or resolution. [10] This theory explains why traumaticbone cysts occur more often in young individuals (an ageat which trauma occurs more often) and also explain thepresence of blood within the cavity at the time of surgicalexploration. Reports of trauma at the site of lesions andthe presence of blood in the cavities, however, are uncom-

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2. Surej Kumar LK, Kurien N, ThahaKA. Traumatic Bone Cyst of Mandible.J Maxillofac Oral Surg. 2015 Jun;14(2):466-9. [PubMed] [Crossref]

3. Saito Y, Hoshina Y, Nagamine T,Nakajima T, Suzuki M, Hayashi T.Simple bone cyst. A clinical and his-topathologic study of fifteen cases.Oral Surg Oral Med Oral Pathol. 1992Oct;74(4):487-91. [PubMed] [Crossref]

4. Jafee HL, Lichtenstein L. Soli-tary unicameral bone cyst: With Em-phasis on the Roentgen Picture, thePathologic Appearance and the Patho-genesis. Arch Surg. 1942 Jun;44(6):1004-25. [Crossref]

5. Kuroi M. Simple bone cyst ofthe jaw: Review of the literature andreport case. J Oral Sur. 1980 Jun;38(6):456-9. [PubMed]

6. Rushton MA. Solitary bone cystsin the mandible. Br Dent J. 1946Jul;81(2):37-49. [PubMed]

7. Jones AC, Baughman RA. Mul-tiple Idiopathic Mandibular BoneCysts in a Patient With Osteogenesis

Imperfecta. Oral Surg Oral Med OralPathol. 1993 Mar;75(3):333-7.[PubMed] [Crossref]

9. IARC. Pathology and Genetics ofHead and Neck Tumours [OP] (Medi-cine). Barnes L, Eveson JW, ReichartP, Sidransky D. Editors. WHO. 1st Edi-tion. March 1, 2005. [Internet]

10. Howe GL. ‘Haemorrhagic cysts’of the mandible. I. Br J Oral Surg. 1965Jul;3(1):55-76. [PubMed] [Crossref]

11. Harnet JC, Lombardi T,Klewansky P, Rieger J, Tempe MH,Clavert JM. Solitary Bone Cyst of theJaws: A Review of the EtiopathogenicHypotheses. J Oral Maxillofac Surg.2008 Nov;66(11):2345-8. [PubMed][Crossref]

12. Forssell K, Forssell H,Happonen RP, Neva M. Simple bonecyst: review of the literature and analy-sis of 23 cases. Int J Oral MaxillofacSurg. 1988 Feb;17(1):21-4. [PubMed][Crossref]

13. MacDonald-Jankowski DS.Traumatic bone cysts in the jaws of aHong Kong Chinese population. ClinRadiol. 1995; 50(11):787-91. [Crossref]

14. Perdigao PF, Silva EC, SakuraiE, Soares de Araujo N, Gomez RS. Idi-opathic Bone Cavity: A Clinical, Ra-diographic, and Histological Study. BrJ Oral Maxillofac Surg. 2003 Dec;

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Address for correspondence:Elitsa Georgieva DeliverskaDepartment of Dental, Oral and Maxillofacial surgery, Faculty of Dental medi-cine, Medical University- Sofia.1, Georgi Sofiiski Blvd., Sofia 1431, Bulgaria.E-mail: elitsadeliverska@yahoo.com,

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Multifocal Traumatic Bone Cysts: CaseReport and Current Thoughts onEtiology. J Oral Maxillofac Surg. 2010Jan;68(1):208-12. [PubMed] [Crossref]

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17. Surej Kumar LK, Kurien N,Thaha KA. Traumatic Bone Cyst ofMandible. J. Maxillofac. Oral Surg.2015 Apr;14(2):466-9. [PubMed][Crossref]

18. Patil SP, Sodhi SJ, Mishra SS,Farha SS. Solitary Bone Cyst of Poste-rior Maxilla: A Rare Presentation.Contemp Clin Dent. 2019; 10(1):166-9. [PubMed] [Crossref]

19. Satish K, Padmashree S, RemaJ. Traumatic bone cyst of idiopathicorigin? A report of two cases. Ethiop JHealth Sci. 2014 Apr;24(2):183-7.[PubMed] [Crossref]

20. da Costa ED, Roque-Torres GD,Peyneau PD, Godolfim LR, Haiter NetoF, Almeida SM. Simple bone cyst: rareincidental finding in the mandibularcondyle by cone beam computed to-mography. Gen Dent. 2018 Jan-Feb;66(1):54-56. [PubMed]

Please cite this article as: Deliverska E. Traumatic Bone Cyst of the Mandible: Case Report. J of IMAB. 2020 Apr-Jun;26(2):3194-3197. DOI: https://doi.org/10.5272/jimab.2020262.3194

Received: 02/07/2019; Published online: 11/06/2020