Simple Bone Cyst of The Mandible: A Case Report and Literature Review

ISSN: 2320-5407 Int. J. Adv. Res.
9(10), 830-833
Journal Homepage: - www.journalijar.com
Article DOI: 10.21474/IJAR01/13615

DOI URL: http://dx.doi.org/10.21474/IJAR01/13615
RESEARCH ARTICLE
SIMPLE BONE CYST OF THE MANDIBLE: A CASE REPORT AND LITERATURE REVIEW
Varun Muthuraman, Aravind Christo, V. Usha, K. Prabhu Sankar and G. Rajabackiyam

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Manuscript Info Abstract
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Manuscript History Simple bone cyst is a benign pseudo cystic cavity in the bone that is
Received: 29 August 2021 less commonly associated in the maxillofacial region. The other
Final Accepted: 30 September 2021 synonyms are traumatic bone cyst or idiopathic bone cyst. These cysts
Published: October 2021 are devoid of an epithelial lining and usually contain straw-colored
fluid or is empty. Simple bone cyst is mainly seen in young individuals,
Key words:-
Simple Bone Cyst, Traumatic Bone frequently during the first and second decade of life. Here we report a
Cyst, Anterior Mandible case of simple bone cyst of a mandibular anterior region in a 21-year-
old patient.
Copy Right, IJAR, 2021,. All rights reserved.
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Introduction:-
Simple or solitary bone cyst (SBC) is a less common pseudocyst of jaws, representing approximately 1% of all jaw
cysts1. Lucas and Blum in 1929 for the first time described SBC as a separate disease entity2. According to WHO
this cyst is defined as an unusual, benign, asymptomatic, slow growing, nonexpansile, intra-osseous, empty or fluid
filled cavity having a tenuous lining of connective tissue with no epithelium3.Rushton4 adopted the following criteria
for establishing diagnosis: i) a single lesion; ii) no epithelial lining; iii) no infection; iv) no perforation of the bony
walls and no contents or fluid or connective tissue in the lesion. Afterwards, Hansen5 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.
SBC is mainly seen in young individuals, frequently during the first and second decade of life, and equally affecting
both genders with a slight predominance to males1. The majority of SBCs are seen in long bones (90%) and far less
frequently in jaw bones (10%). However body of the mandible between the canine and the third molar is the most
common site (75%) in head and neck region followed by mandibular symphysis.1 Very few cases are reported in the
maxilla5,6. Definite diagnosis of SBC is inevitably reached during surgery when a cavity lacing epithelial lining is
either empty or with content or filled with serous or sanguineous fluids 7.
The world health organization's (WHO) International tumor histological classification accepted the term simple
bone cyst in 1971, and the term solitary bone cyst in 1992 so as to differentiate this lesion from other cystic lesions
of the jaws. In the 1997 WHO classification, solitary bone cyst is included in the group of bone related non
neoplastic diseases along with aneurismatic cysts, ossifying fibroma, fibrous dysplasia, bone dysplasia, giant cell
central granuloma and cherubism. This article presents a case of simple bone cyst presenting the anterior mandible.
Case report
A 21 year old, female patient reported with a chief complaint of dull pain in the front lower region of jaw since 3
months. The patient’s medical history did not reveal any trauma to the jaw. Clinical examination showed no facial
swelling and asymmetry. Intraoral examination minimal localized gingival recession seen in relation to 41, 42 & 43
region.
Corresponding Author:- Varun Muthuraman 830

ISSN: 2320-5407 Int. J. Adv. Res. 9(10), 830-833
Patient was advised to undergo panoramic radiography in order to assess the periodontal status and to look for any
pathology. OPG revealed a unilocular radiolucency, roughly ovoid in shape, seen the 33 to 44 region (fig.1). It was
located in between the right and left mental foramen in the apical region, with well – defined margins measuring
approximately 5*2 cm in dimension. Slight tenderness was elicited by the patient on palpation on the labial side in
the mandibular anterior region, and the pathology could not be palpated by bi-digital palpation.
Fig 1:- Orthopantomagram of simple bone cyst.
It was then planned for aspiration under local anesthesia. A straw color cystic fluid aspirated (fig.2).
Fig 2:- Straw color cystic fluid.
An intra oral incision, full thickness enveloped flap was placed in relation to 33 to 44 region. The bony thinning was
identified in the bilateral parasymphysis region.
Fig 3:- Debridement of bony cavity.
During exploration, macroscopically, a very thin friable epithelial lining could be identified.After debridement of
bony cavity (fig.3), the wound was closed in layers. Healing was uneventful (fig.4).
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ISSN: 2320-5407 Int. J. Adv. Res. 9(10), 830-833
Fig 4:- Wound closure
Histologically, the biopsy material showed spicules of bone with an adjacent cyst wall composed of proliferating
fibroblasts, chronic inflammatory cells composed of lymphocytes and plasma cell. Hence a final diagnosis of simple
bone cyst was made(fig.5).
Fig 5:- Histopathology (Simple bone cyst).
Discussion:-
A simple(traumatic) bone cyst is not a true cyst because it lacks an epithelial lining. The cause of simple bone cyst is
unknown, although some believe that it developes in response to trauma. These lesions are usually discovered in the
second decade of life. Their most common site of occurrence is the mandible. Simple bone cysts are usually
asymptomatic and are incidental radiographic findings. The lesions are typically unilocular, lucent defects that often
have a characteristics scalloped superior margin extending between the roots of teeth. There may be attendant
thinning of the mandibular cortex with osseous expansion. Multiple lesions occur in some usual cases. The
differential diagnosis includes vascular lesions, central giant cell granuloma, and ossifying fibroma.
When taking into consideration many of the presented theories, and regardless of location, three theories prevail: 1.
Bone growth anomaly 2. Process of tumor degeneration and 3. A particular triggering factor for hemorrhagic
trauma.
The main characteristic of SBCs is scalloping when they extend towards the dental roots; this scalloping is also
described in edentulous areas8,9,10. Another radiographic feature of SBCs is the broad extension of the lesion without
causing bone expansion; the cortical bone tends to be thinned due to intraosseous erosion. This characteristic can be
observed in the CT images.
The etiology and pathogenesis of these bone cavities are not well established. Trauma can be an important factor in
their development, although its mode, intensity, frequency, and pathogenesis must be determined before any firm
conclusions can be reached8. In the case presented here, the patient did not recall any major trauma.
Since the material available for histological study is often scarce, it may be difficult to obtain sufficient evidence for
a definitive diagnosis11. Peñarrocha-Diago et al.12 agreed that teeth with apexes involved in the lesion should not
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ISSN: 2320-5407 Int. J. Adv. Res. 9(10), 830-833
undergo endodontic treatment, since prognosis is favorable and normal healing occurs without any further
complications.
The present case fulfilled these criteria at the time of surgical intervention leading to a diagnosis of SBC which was
later confirmed by histopathology. Various treatment modalities are suggested for SBC: 13,14 i) Keeping the case
under observation and waiting for spontaneous regression, if it is asymptomatic; ii) Aspiration of the contents; iii)
Surgical exploration and curettage to stimulate bleeding, healing, and initially to confirm the diagnosis; iv) Packing
with gel foam saturated with thrombin and penicillin; v) Endodontic intervention alone; vi) Injection of methyl
prednisolone acetate solution for treatment of long bone cases; vii) Injection of autogenous blood with bone graft or
hydroxyapatite to stimulate the osteogenic activity; and viii) Bone grafting. Widely accepted and recommended
treatment option for this cyst is surgical exploration and curettage of bony walls15,16. Careful curettage of the lesion
helps progressive bone regeneration, offering a good prognosis and reduces relapse. Recurrence of the lesion is not
commonly encountered.
The most frequently recommended treatment for SBCs is surgical exploration followed by curettage of the bony
walls. Surgical exploration is a diagnostic maneuver which can also be considered as therapeutic since it causes the
walls of the cavity to bleed. In fact, the induction of bleeding in the cavity allows the formation of a clot which is
eventually replaced by bone. Some authors have also reported cases of spontaneous resolution8,17.
Reference:-
1. Harnet JC, Lombardi T, Klewansky P, et al. Solitary bone cyst of the jaws: a review of the etiopathogenic
hypotheses. J Oral MaxillofacSurg 2008;66:2345-8.
2. Lucas C, Blum T. Do all cysts of the jaws originate from the dental system. J Am Dent Assoc 1929;16:659-61.
3. Barnes L, Eveson JW, Reichart P, Sidransky D. Editors. World Health Organization classification of tumours.
Pathology and genetics of Head and Neck Tumours. Lyon: IARC Press; 2005.
4. Rushton MA. Solitary bone cysts in the mandible. Br Dent J 1946;81:37-49
5. Oral B, Oral F, Piskin B, Ozkan BT. Traumatic bone cyst of the anterior maxilla. Int J Dent Case Reports
2011;1:41-6.
6. Ahmed KA, Al-Ashgar F. Maxillary solitary cyst: review of literature and case report. Saudi Dent J 1991;3:109-
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7. Diago MP, Bielsa JMS, Marco JB, Sanz JMM (2001) Surgical treatment and follow-up of solitary bone cyst of
the mandible: a report of seven cases. Br J Oral MaxillofacSurg 39(3): 221-223.
8. A. A. Xanthinaki, K. I. Choupis, K. Tosios, V. A. Pagkalos, and S. I. Papanikolaou, “Traumatic bone cyst of the
mandible of possible iatrogenic origin: a case report and brief review of the literature,” Head & Face Medicine, vol.
2, no. 1, p. 40, 2006.
9. M. A. Copete, A. Kawamata, and R. P. Langlais, “Solitary bone cyst of the jaws: Radiographic review of 44
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10. J. R. Sabino-Bezerra, A. R. Santos-Silva, J. Jorge Jr, A. F. Gouvêa, and M. A. Lopes, “Atypical presentations of
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11. D. S. MacDonald-Jankowski, “Traumatic bone cysts in the jaws of a Hong Kong Chinese population,” Clinical
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12. M. Peñarrocha-Diago, J. M. Sanchís-Bielsa, J. Bonet-Marco, and J. M. Mínguez-Sanz, “Surgical treatment and
follow-up of solitary bone cyst of the mandible:a report of seven cases,” British Journal of Oral and Maxillofacial
Surgery, vol. 39, no. 3, pp. 221–223, 2001.
13.Hansen LS, Sapone J, Sproat RC. Traumatic bone cysts of jaws: report of sixty-six cases. Oral Sur Oral Med Oral
Pathol 1974;37:899-910.
14.Ahmed KA, Al-Ashgar F. Maxillary solitary cyst: review of literature and case report. Saudi Dent J 1991;3:109-
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15. Xanthinaki AA, Choupis KI, Tosios K, et al. Traumatic bone cyst of the mandible of possible iatrogenic origin: a
case report and brief review of the literature. Head Face Med 2006;12:40-4.
16. Cortell-Ballester I, Figueiredo R, BeriniAytes L, Gay-Escoda C. Traumatic bone cyst: A retrospective study of
21 cases. Med Oral Pathol Oral Cir Bucal 2009;14:e239- 43.
17. J. J. Kuttenberger, M. Farmand, and H. Sto¨ss,“Recurrence of a solitary bone cyst of the mandibular condyle in a
bone graft,” Oral Surgery, Oral Medicine, Oral Pathology, vol. 74, no. 5, pp. 550–556, 1992.
833

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ISSN: 2320-5407 Int. J. Adv. Res.

Journal Homepage: - www.journalijar.com

Article DOI: 10.21474/IJAR01/13615

Varun Muthuraman, Aravind Christo, V. Usha, K. Prabhu Sankar and G. Rajabackiyam

Corresponding Author:- Varun Muthuraman 830

Fig 1:- Orthopantomagram of simple bone cyst.

Fig 2:- Straw color cystic fluid.

Fig 3:- Debridement of bony cavity.

Fig 4:- Wound closure

Fig 5:- Histopathology (Simple bone cyst).

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