A 17-year-old white female patient came to the Department of Oral and Maxillofacial Surgery and Traumatology at the Hospital de Buenos Aires with a facial manifestation of ten days of evolution.
Clinical examination revealed a volume increase at the level of the body of the lower jaw on the left side that erased the bottom of the vestibular groove.
The lining mucosa of the area was normal.
The patient complained of severe pain in the pulp cavity and the vital pulp test was negative for teeth 3.6 and 3.
The imaging study revealed an osteolytic, radiolucent, unilocular and distally partitioned lesion of the second left pre-molar that compromised the body and ascending branch of the lower jaw.
It was also observed the presence of a third molar retained in relation to the cavity and the loss of definition of the canal of the inferior dental nerve.
1.
Cut-offs allowed assessing the actual extent of the lesion.
The lesion measured 8 x 3 x 2 cm and expanded the buccal bone plate.
Under local anesthesia, a surgical biopsy was performed to obtain a blade tissue fragment whose remarkable characteristic was its great thickness.
Microscopically, fibrogranulomatous tissue with myxoid areas was observed, due to the presence of cholesterol crystals and old and recent hemorrhagic areas with cellular gigantic reaction with accumulation of macrophages with pigmented red blood cells.
Peripherally reactional osteogenesis was visualized with formation of osteoid trabeculae, and in some sectors eosinophilic material masses of fibrinoid aspect with foci of calcification were found.
The diagnosis was a simple bone cyst with characteristics similar to those observed in the simple bone cyst of long bones.
Previous endodontic treatment of devitalized teeth and in a second surgical procedure carried out under general anesthesia, the lesion was again approached performing the cystic cavity and the third molar bltening.
During the surgical procedure there was profuse bleeding that was controlled with local hemostasis maneuvers.
The surgical bed showed the neurovascular bundle that was free by reabsorption of the bone canal.
The control at three, six and twelve months showed a satisfactory evolution of the process with tissue repair.
