Int. J. Oral Maxillofac. Surg. 1994; 23:298-299 Printed in Denmark.

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Atypical simple bone cyst of the mandible

A case report
H. Shigematsu, K. Fujita, K. Watanabe: Atypical simple bone cyst o f the mandible. A case report. Int. J. Oral Maxillofac. Surg. 1994; 23: 298-299. Munksgaard,
1994

Hisao S h i g e m a t s u , K u n i y a Fujita, Kiyoshi W a t a n a b e Second Department of Oral and Maxillofacial Surgery, Meikai University School of Dentistry, Sakado, Saitama, Japan

Abstract. A n atypical case of simple bone cyst involving the ramus and condyle
of the mandible in a 7-year-old boy is presented. The literature is briefly reviewed.

Key words: simple bone cyst; mandibular condyle. Accepted for publication 8 February 1994

In 1879, VmcI~ow published the first report of simple bone cyst (SBC) in the humerus. The proximal ends of the femur and humerus 5 are the c o m m o n sites of this lesion. In the jaws, SBC was first reported by LUCAS7 in 1929. Since this report, numerous cases have been reported, In most cases, SBCs are located in the mandibular body. The following is an account of an atypical case o f SBC involving the ramus and condyle of the mandible.

Case report A 7-year-old boy was referred to our department by an orthopedic surgeon for diagnosis and treatment of a nonsymptomatic lesion located in the right ascending ramus, which had been discovered on radiographs after mandibular trauma. He had no specific complaints, except for slight tenderness of the right temporomaudibular joint. There was no visible swelling, but palpation revealed a slight bony expansion. Family and medical histories were not contributory. The patient

was healthy and had a normal mixed dentition. Routine laboratory values were within normal range. A panoramic radiograph showed a welldefined radiolucent area in the ramus that extended into the condylar process (Fig. 1). A computed tomography (CT) scan showed swelling of the buccal and lingual cortex of the ramus, and a cyst-like erosion with a lowdensity area (Fig. 2). The CT value of content was 47 Hounsfield units. A tentative diagnosis of cystic lesion or tumor was made. Surgical treatment was done under general

Fig. 1. Panoramic radiograph taken in February 1993 showing radiolucent lesion in right ramus and condyle of mandible.

Fig. 2. Axial CT scan showing expansion of ramus caused by lesion.

Atypical simple bone cyst Table 1. Atypical cases of simple bone cyst
Age (years) HOSSEINI (1978) 3 GILMAN & DINGMAN (1982) t
PERSSON8 (1985)

299

Sex F F F M M M M

Location Ramus-condyle Ramus-condyle Condyle Condyle Condyle Ramas-condyle Ramus-condyle

Contents Empty .Serous Serous Empty Empty Serous Serous fluid fluid

History of tramna + + -

Recurrence + + -

RUBIN & MURPHY (1989) 9 KUTTENBERGERet al. 1 (1992) Our case (1993)

11 14 11 25 12 10 7

fluid fluid

anesthesia. An intraoral incision was made on the anterior border of the ramns, and the external oblique ridge was exposed. A subperiosteal dissection was done to expose the whole ascending ramus. The expanded buccal surface of the ramus, having a parchment-like crepitation, was clearly observed. Aspiration was done with an 18-G needle, and a small quantity of clear, yellow liquid was obtained. The lesion was fenestrated and curetted carefully. The cavity was lined by thin and friable membrane. The postoperative course was uneventful. The histologic sections showed multiple fragments of thin lining of granulation tissue with occasional multinucleate giant cells and foci of hemorrhage. The histopathologic findings were consistent with those of SBC. Discussion SBCs have a predilection for the body or symphysis of the mandible. HOSSEINI3 stated that "occasionally these lesions m a y extend into the ramus; however, few cases have been reported in a location which is entirely beyond the angle." Only six atypical lesions localized in the mandibular condyle, ramus, or both have been reported (Table 1) 1'3'6'8'9. The differential diagnosis o f a soli-

tary radiolucent lesion involving the mandibular condyle, ramus, or both should include chondroma, osteoblastoma, eosinophilic granuloma, central giant cell granuloma, aneurysmal bone cyst, and simple bone cyst. The differential diagnosis has great practical importance; however, it is difficult to establish the diagnosis without a biopsy. In the case presented, the biopsy was obtained under general anesthesia because of the young age of the patient. The operative findings were highly suggestive for the diagnosis o f SBC; therefore, no further treatment was done apart from curettage. It is generally accepted that complete healing of the defect occurs after opening o f the cyst, and recurrences are supposed to be extremely rare 2,4. References 1. GILMAN RH, DINt3MAN RO. A solitary bone cyst of the mandibular condyle. Plastic Reconstr Surg 1982: 70: 610-14. 2. HEUBNER GR, TURLINGTON EG. Socalled traumatic (hemorrhagic) bone cysts of the jaws. Oral Surg 1971: 31: 354-6.

3. HOSSEINIM. Two atypical solitary bone cysts, Br J Oral Surg 1978: 16: 262-9. 4. KAMIVAY, IWASEH, SIROZUT, et al. A recurrent case of simple bone cyst of the mandible. Jpn J Oral Maxillofac Surg 1990: 36: 1653-8.
5. gALLEY HC, KAY LW, SEWARD GR. Benign cystic lesions of the jaws, their diag-

nosis and treatment. 3rd ed. Edinburgh: Churchill Livingstone, 1977: 119-35. 6. KUTTENBERGER JJ, FARMAND M, STOESS H. Recurrence of a solitary bone cyst of the mandibular condyle in a bone graft. Oral Surg 1992: 74: 550-6. 7. LUCAS CD. Quoted in BLUM T. Do all cysts of the jaws originate from the dental system? J Am Dent Assoc 1929: 16: 647-61. 8. PERSSON G. An atypical solitary bone cyst. J Oral Maxillofac Surg 1985: 43: 905-7. 9. RUBIN MM, MURPHY FJ. Simple bone cyst of the mandibular condyle. J Oral Maxillofac Surg 1989: 47: 1096-8. Address:

Dr Hisao Shigematsu Second Department of Oral and Maxillofacial Surgery Meikai University School of Dentistry Keyakidai 1-1, Sakado, Saitama, 350-02 Japan