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case_images: (a) Orthopantomography in the phase of mixed dentition. A normal rate of tooth eruption, without any radiolucent lesion, is seen in the area of the third quadrant. (b) Follow-up orthopantomography of the third molars after orthodontic treatment. The radiolucent lesion affecting the areas of 35, 36, and 37 is diagnosed.
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case_images: By chance, during a routine postorthodontic visit, an orthopantomography of the third molars identified a radiolucent image encompassing the periapical area of teeth 35 and 36 (Figures 1(a) and 1(b)).
case_images: Cone beam computerized tomography. A welldefined unilocular radiolucent lesion of 12.0 x 17.8 mm is observed, with preservation of both the root apex and the cortical bone. However, a marked thinning of the lingual cortical mandibular plate is seen.
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case_images: However, the lingual cortical plate was observed to be extremely thin, due to the compressive effect of the pseudocyst itself (Figure 2).
case_images: (a) Clinical image of the mucoperiosteal flap for accessing the buccal cortical plate and for performing trepanation to allow drainage of an amber-colored serohematic fluid. (b) Cannulation of the lesion via a microperforated Nelaton catheter.
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case_images: Finally, the bone cavity was cannulated through the end (3.5 cm) of a Nelaton-type catheter leaving a 1 cm section exposed which was fixed with silk 3/0 (Figures 3(a) and 3(b)).
case_images: Cone beam computerized tomography 2 months after surgery. A slight reduction in lesion size (11.1 x 15.9 mm) is seen. Note the incipient recovery of the cancellous bones in the radiolucent image. The drainage catheter placed in the area of the lesion can also be seen.
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case_images: After two months, a new CBCT was requested to inspect the area of the lesion, which indicated the incipient recovery of cancellous bone in the radiolucent image (Figure 4).
case_images: Control orthopantomography 5 months after surgery, showing a significant improvement in bone density at the level of the cavity.
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case_images: Five months after treatment, a control orthopantomography indicated improved bone density at the site of the lesion (Figure 5).
case_images: (a) Clinical image: excellent scarring of the area where the drainage catheter was placed. (b) Control orthopantomography 9 months after surgery. Significant reductions are seen in the size of the lesion and in the presence of cancellous bone.
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case_images: At nine months, a new orthopantomography showed a significant reduction in the size of the lesion and a significant increase in the cancellous bone inside (Figures 6(a) and 6(b)).
case_images: Cone beam computerized tomography within 18 months of canalization. Complete replacement of the radiolucent image is observed, with a density compatible with normal bone tissue in the process of calcification. The lingual cortical plate adjacent to the lesion in the area of teeth 35-37 presents normal thickness.
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case_images: Surprisingly, at 18 and 24 months after the surgical cannulation, the pathological image presented a bone density compatible with normal bone tissue in the process of calcification, and indeed, it was difficult to define the original lesion (Figures 7 and 8). In addition, the thickness of the lingual cortical plate adjacent to the lesion in the area of teeth 35-37 was normal (Figure 7).
case_images: Control orthopantomography 24 months after surgery. Note the complete recovery of the lesion.
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case_images: fig8
case_images: Surprisingly, at 18 and 24 months after the surgical cannulation, the pathological image presented a bone density compatible with normal bone tissue in the process of calcification, and indeed, it was difficult to define the original lesion (Figures 7 and 8).