A 14-year-old female patient attended our clinic for evaluation prior to orthognathic surgery.
The main concerns of the patient were facial aesthetics and occlusal correction.
Facial examination revealed an occlusal alteration, an oral breathing and a dentofacial class II dentoskeletal anomaly.
In the physical examination it was observed a difficulty to the maximum opening and with a mandibular dynamics of normal range and asymptomatic.
She reported bilateral masticatory pain, which could be attributed to a classic picture of tension bruxism or chewing gum.
She reported no history of trauma in the maxillofacial area.
Routine evaluation with a panoramic radiograph revealed radiologic features in the area of the mandibular ramus and left condyle.
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Cone-beam CT scan detected a multilocular radiolucent lesion affecting the upper third of the mandibular ramus up to the middle third of the left condyle.
Well-defined limits and cortical bone expansion were observed.
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It was decided to biopsy the lesion under general anesthesia with an extraoral approach prior to orthognathic surgery.
A modified preauricular approach was used to access the condyle and branch of the affected side.
Upon reaching the bone plane, it was observed that the cortical bone of the lateral side of the condyle was perforated.
An osteotomy was performed with a peripheral burr at the perforation. An empty cavity was observed without filling the walls of the lesion.
Exhaustive curettage and irrigation with saline solution were performed.
Bone curettage was sent for biopsy.
The bone defect was fixed with 6 cc of lyophilized bone Puros® mixed with platelet-rich plasma and covered with a resorbable collagen membrane.
There were no complications during surgery or in the immediate postoperative period.
The patient remained in weekly clinical controls for one month after surgery and monthly controls for 4 months after surgery without aesthetic or functional complications.
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Histopathological examination revealed fragments of bone tissue and loose connective tissue with signs of hemosiderin and without membrane recovery.
These findings were compatible with condyle simple bone cyst (SBC) and upper portion of the left mandibular ramus.
