We report the case of a 7-year-old boy with no relevant medical history who was referred to the Maxillofacial Surgery outpatient clinic of the Marqués University Hospital in November 2004 for an indolent evolution of the floor in November.
The examination showed mixed dentition and a tumor at the level of mandibular symphysis, with respected oral mucosa and bulging of lingual and vestibular cortical, and stable deciduous teeth at that level.
The patient did not present significant neurological alterations.
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Orthopantomography (OPG) reveals a radiolucent image of poorly defined margins in mandibular symphysis -73 to 83-, with destructured basilar at this level.
Three permanent teeth included in the lesion and some degree of rhizolysis and dental displacement are also observed.
Computed tomography (CT) was requested, which confirmed the presence of an osteolytic, non-constant cyst and multilocular solid cyst of 3×1.8cm, with expanded and thinned cortical bones, but no solid tissue density was described.
Needle aspiration biopsy (FNAB) is inconclusive.
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Under general anesthesia, a vestibular approach is performed, which allows the visualization of the expanded and thinned cortical bone, but without loss of continuity, with the typical aspect of «egg hood».
Once the lesion is exposed, an intraoperative biopsy is taken to rule out malignant bone pathology.
With the firm suspicion of solid OAC, curettage and extraction of the three definitive teeth included in the lesion were performed.
Bone defect does not require reconstruction, but in order to promote guided bone voiding, a demineralized bone plate is used at the level of the external mandibular cortical bone.
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Upon discharge, he was referred to the orthodontist for lower arch ferulization, with the objective of ensuring its stability, given the significant loss of bone support at the crestal level of mandibular symphysis.
This fixation is maintained for 6 months.
The definitive histological study confirms the diagnosis of solid type aneurysmal bone cyst.
Macroscopically, several irregular fragments of hemosiderin-brown color and occasional elastic and firm consistency are identified; while microscopically, small vascular spaces lined by fibrous cell foci macrophages, giant cells are observed.
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The patient has a good postoperative evolution, with good aesthetic and functional appearance.
Currently, after 6 years of follow-up, the patient does not present clinical signs or local recurrence and has started orthodontic treatment for correction of dental malposition.
