Surgical management of idiopathic bone cavity: case series of consecutive 27 patients

Abstract

ObjectivesIdiopathic bone cavity (IBC) is an uncommon intra-osseous cavity of unknown etiology. Clinical features of IBC are not well known and treatment modalities of IBC are controversial. The purpose of this study was to investigate the clinical characteristics of 27 IBC patients who underwent surgical exploration.Materials and MethodsA total of 27 consecutive patients who underwent surgery due to a jaw bone cavity from April 2006 to February 2016 were included in this study. Nine male and 18 female patients were enrolled. Patients were examined retrospectively regarding primary site, history of trauma, graft material, radiographic size of the lesion, presence of interdental scalloping, erosion of the inferior border of the mandible, complications, results of bone graft, and recurrence.ResultsFemale dominance was found. Maxillary lesion was found in one patient, and bilateral posterior mandibular lesions were found in two patients. The other patients showed a single mandibular lesion. The posterior mandible (24 cases) was the most common site of IBC, followed by the anterior mandible (5 cases). Two patients with anterior mandibular lesion reported history of trauma due to car accident, while the others denied any trauma history. Radiographic cystic cavity length over 30 mm was found in 10 patients. Seven patients showed erosion of the mandibular inferior border. The operations performed were surgical exploration, curettage, and bone or collagen graft. One bilateral IBC patient showed recurrence of the lesion during follow-up. Grafted bone was integrated into the native mandibular bone without infection. One patient reported necrosis of the mandibular incisor pulp after operation.ConclusionDifferential diagnosis of IBC is difficult, and IBC is often confused with periapical cyst. Surgical exploration and bone graft are recommended for treating IBC. Endodontic treatment of involved teeth should be evaluated before operation. Bone graft is recommended to reduce the healing period.

Assessment of spontaneous resolution of idiopathic bone cavity

“…The surgical approach is still considered a safe procedure for the diagnosis and treatment of IBC 18 , 24 . Surgery must be performed for symptomatic cases whenever boundary changes, or size and cortical expansion occurs.…”

Idiopatic bone cavity mimicking odontogenic tumor - case report

“…The classic radiographic aspect of IBC is that of a well-defined, unilocular, lucent image whose edges reach in between the roots in a wavy pattern 1,3,4 . However, in this case report, the image was lucent, multilocular, circumscribed, well-defined with cortical expansion.…”

“…Thus, it is necessary to connect clinical history, physical examination, and imaging tests, besides surgical exploration for a clearer sight. In some cases, these radio-and tomographic aspects may lead to diagnostic hypothesis of odontogenic tumor, more aggressive diseases with high probability of recurrence 2,4 .…”

“…Odontogenic tumors such as ameloblastoma are traditionally treated by means of resection 2 . These groups of pathologies, as well as the idiopathic bone cavity, can share the same imaging presentation 4 . Thus, the absence of incisional biopsy can lead to over-indicated and often mutilating treatments with severe aesthetic and functional repercussions caused by negligence of a well-established preoperative diagnosis.…”

Traumatic Bone Cyst of the Mandible; Diagnostic Challenge and Management a Case Report

“…Recurrence of TBC is assumed to be extremely rare, (26) a recent study has reported the recurrence rate of TBC in facial bone to be about 20%. (56) On recurrence, a marked increase in the size with multilocular appearance. (57) If present, recurrence usually occur within three months after surgery.…”