Simple bone cyst: A Case Series, Review of the Literature, and Support for the Use of the Term, “Idiopathic Bone Cavity.”
Suganya Appugounder, DMD, MS,* Michael P Johnson, DMD †
Simple bone cyst, also called traumatic bone cyst, hemorrhagic bone cyst, solitary bone cyst, or idiopathic bone cavity, is a benign intrabony cavitation that most commonly occurs in the body of the mandible in patients between 10 and 20 years of age. No true epithelial lining exists, so idiopathic bone cavity (IBC) is the more appropriate term.
IBCs are usually incidental radiographic findings. IBC’s can be large, multilocular, and exhibit impressive expansion but do not demonstrate radiographic features of local anatomic destruction such as displacement of teeth, resorption of tooth roots, creation of periodontal pathology, cortical bony erosion, or displacement of the inferior alveolar nerve.
IBCs should be strongly considered in a differential diagnosis of a lesion that is radiolucent, well-defined, unilocular or multilocular, expansile, large or small, and lacks features of anatomic destruction. Other pathologic entities to consider would include keratocystic odontogenic tumor, ameloblastoma, inflammatory cyst, central giant cell granuloma, myxoma, aneurysmal bone cyst, benign fibro-osseous lesion, and intrabony vascular malformation. These lesions vary significantly in their definitive surgical management, so surgical exploration and biopsy is mandatory.
Histology may reveal a thin, vascular connective tissue membrane adjacent to the bone. No true epithelial lining is present. Presence of Howship’s lacunae represents bone resorption. Owing to difficulty obtaining any tissue during biopsy, diagnosis is often based on clinical and radiographic features.
Treatment of this lesion occurs at the same time as diagnosis. Treatment is surgical exploration and curettage which induces bleeding into the intrabony cavity which eventually fills up with new bone. Periodic radiographic follow up is necessary until complete healing occurs.
Four unique cases that varied significantly from the classic presentation will be reviewed, including clinical presentation, imaging, treatment and follow-up.
Due to the varied presentation of IBCs, a thorough understanding is essential to ensure appropriate surgical management and to avoid radical treatment.
- Resident, Department of Oral and maxillofacial surgery, Yale New Haven Hospital, New Haven, CT
- Attending, Department of Oral and maxillofacial surgery, Yale New Haven Hospital, New Haven, CT
References:
- Solitary bone cyst of the jaws: A review of the Etiopathogenic hypotheses
Clavert et al J Oral Maxillofac Surg 66:2345-2348, 2008
- Multilocular Lesion in the Bony of the Mandible
Laskin et al J Oral Maxillofac Surg 60:1045-1048, 2002