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| IMC Wiki | Pseudocysts of the Jaw

Pseudocysts of the Jaw

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Introduction

Pseudocysts of the jaw are bone cavities without an epithelial lining. They are classified as cysts based on their clinical and radiological features, and they belong at the same time to the group of non-neoplastic bone lesions.

Three types of intraosseous jaw cysts are distinguished:
Solitary bone cyst
Aneurysmal bone cyst
Latent pseudocyst.
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Solitary bone cyst

These lesions appear as unilocular, air- or liquid-filled cavities that lack an epithelial lining and are located predominantly in the mandibular ramus
Solitary bone cysts of the jaw are extremely rare.

Aetiology

The aetiology is unclear. The following hypotheses have been proposed:
  • Complication of traumatic intramedullary haemorrhage with impaired haematoma resorption.
  • Chronic impairment of bone circulation leading to ischaemic necrosis.
  • Local growth disorder.
  • Healing stage of benign giant cell tumours.

Clinical and radiological symptoms

  • Solitary bone cysts are frequently discovered as an incidental clinical finding, and they occur chiefly in adolescents and children.
  • They infrequently present with swelling, pain and tooth hypersensitivity.
  • Sensory deficits can occasionally be detected in the mental nerve territory; the inferior alveolar nerve may also freely cross the bone cavity.
  • Very slow growth; spontaneous healing has been reported.
  • Vital teeth are affected.
Radiological features: The solitary bone cyst generally appears as a well-circumscribed, unilocular cavity which frequently includes a portion of the root apices.

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Differential diagnoses

  • Aneurysmal bone cyst
  • Keratocystic odontogenic tumour
  • Ameloblastoma

Treatment and prognosis

  • Depends on the size and location of the cavity.
  • Careful curettage of tissue possibly present and filling with collagen, if necessary, or autologous bone.
  • Benign pseudotumour; no recurrence.

Aneurysmal bone cyst

Aneurysmal bone cysts are benign lesions that occur predominantly in the metaphyses of tubular long bones; their occurrence in the jaw region is very rare.
Although aneurysmal bone cysts are principally benign lesions, they can cause extensive bone destruction when diagnosed at a late stage.

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Aetiology

The aetiology is unclear. The following hypotheses have been proposed:
  • Local circulatory disturbances leading to increased venous pressure and dilatation of the vascular space.
  • Maldevelopment of blood vessels (arteriovenous aneurysm) with subsequent bone destruction.
  • Bone trauma in association with resorptive granuloma.
  • Excessive repair process.
  • Haemangiomatous transformation of an ossifying bone fibroma.
  • Special variant of giant cell tumour.

Clinical and radiological symptoms

  • Mainly located in the mandibular molar region.
  • Extremely variable growth dynamics: As these cysts can remain asymptomatic for a long time, their growth frequently goes undetected. However, some cause considerable symptoms and produce rapidly progressive swelling and pain.
  • Recurrence rate: up to 40 percent.
Radiological features: Uncharacteristic.
Usually well-defined, unilocular or multilocular cystic lesion that frequently resembles a soap bubble. If there is rapid growth, the bony margin may be absent; the lesion may give the impression of a malignant tumour.

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Differential diagnoses

  • Odontogenic cyst
  • Haemangioma
  • Giant cell granuloma
  • Eosinophilic granuloma
  • Myxoma
  • Ameloblastoma
  • Metastasis

Treatment and prognosis

Excochleation
Intensive recall over a period of several years is essential due to the possibility of recurrence.

Latent bone cavity of the mandible

Synonyms: Stafne bone cyst; static bone cavity of the mandible

A Stafne bone cyst is a lingual depression in the mandibular cortex adjacent to the angle of mandible.
These lesions, which were first described by Stafne, are not included in the WHO classification system.

Aetiology

Their aetiology is unclear. The following hypotheses have been proposed:
  • Pressure atrophy of the bone surface occurring due to pressure on the mandible from a dorsal flap of the submandibular gland.
  • The depression may also be caused by functionally related transformation processes in the bone.

Clinical and radiological symptoms

  • These lesions generally do not cause clinical symptoms (incidental finding).
  • Radiologically, the lesion appears as a well-defined, round to oval radiolucency (diameter: 1 to 3 cm) at the inferior border of the body of the mandible.
  • The typical location is the area proximal to the angle of mandible, below the mandibular canal.
  • Lack of growth tendency.
  • Their occurrence is almost always unilateral.
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Differential diagnoses

  • Central tumours of the jaws (e.g. eosinophilic granuloma)
  • Salivary gland adenoma

Treatment

Radiological follow-up at 2 months, 6 months, and one year to assess for potential radiographic changes. If the lesion remains unchanged, no treatment is required.
Revision surgery may be indicated in individual cases based on differential diagnostic considerations.


sources

  • Bánkfalvi A, Piffkó J, Joos U, (2006), Klinische Oralpathologie, VVerlag MIB Gmbh, Münster