English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

The traumatic bone (TBC) cyst is an uncommon benign empty or fluid containing cavity within bone that is not lined by epithelium. The etiopathogenesis of TBC is still unknown. TBC is frequently encountered in young patients during the second and third decades of life. Sex predilection is equal but some studies in literature suggest clear female predominance. Body of the mandible between the canine and the third molar is the most common site (75%) in head and neck region followed by mandibular symphysis. The cysts are usually asymptomatic. Associated teeth are usually vital with no resorption or displacement. It expands the cortices and, seldom, intraoral or extra oral swelling may be seen. Most of the TBCs are diagnosed incidentally in orthopantomogram (OPG). On radiographic examination, a unilocular irregular but well defined lytic lesion is seen characteristically extending between the roots of the teeth. TBC is representing approximately 1% of all jaw cysts. A final diagnosis of a TBC is almost invariably made at the time of surgery, where in identification of an empty air-filled cavity serves as a valuable diagnostic tool. Surgical exploration was proved not only essential in making the right diagnosis but also curative from a treatment plan perspective. Recurrence of TBC is assumed to be extremely rare. However, a distinct proportion of recurrences may occur. (3028) Abeer Hussen Elsagali, et al. E.D.J. Vol. 63, No. 4 in 1946, comprising of a single bony cavity without epithelial lining, encompassed by bony walls, lacking contents or containing liquid and/ or connective tissue.(6) Afterwards, Hansen added another criterion i.e. upon surgery, the lesion is essentially empty and occasionally the cavity may contain some fluid and/or small amount of tissues.(7) WHO classified traumatic cyst as a non-neoplastic osseous lesion due to absence of epithelial lining, which demarcates it from other true cysts.(8) TBCs are included in the group of bone-related lesions, together with the aneurysmal bone cyst, ossifying fibroma, fibrous dysplasia, osseous dysplasia, central giant cell granuloma and cherubism.(9) For explaining this lesion various theories have been put forth by many authors,(10) none of them explains all the clinical and pathological characteristics of the lesion.(11) Regarding the presence of a history of trauma in most reported cases,(12) the traumatic–hemorrhagic theory seems to be the most accepted.(13) The explanation underlying the hypothesis of trauma(14) according to this theory TBC arises from a focus of intramedullary hemorrhage that causes a hematoma after trauma. (15) This hematoma subsequently liquefies and fails to organize and be replaced with tissue.(16) The other theories assert failure of growth and development of osseous tissue, biochemical and mesenchymal differentiation, degeneration of benign neoplasms and low-grade infection.(17) According to Wakasa et al. Florid cemento-osseous dysplasia is the initiative factor for TBC to develop due to lymphatic drainage obstruction.(18) The TBC is an uncommon,(2) The lesion is mostly diagnosed in patients below 30 years of age with an approximate mean age of 20 years.(19) Reduced prevalence of TBCs in older age group has led to the speculation that this lesion may be selfrepairing.(20) Sex predilection is equal.(21) Although some studies state they are more frequently in men.(22) But some studies in literature suggest clear female predominance (14:7).(23) The majority of cases are seen in long bones (90%).(1) TBCs are rare lesions, accounting for 1% of all jaw cysts.(24) Most commonly, the TBC involves the body or symphysis of the mandible,(25) with only a few cases reported in the condyle.(26) Maxillary lesions tend to be uncommon, although the reasons for this are unclear.(27) Most of times this lesion is asymptomatic and discovered on routine radiographic examination only.(28) However, dull pain is associated in 10–30% of the patients,(7-15) swelling, tooth sensitivity, and less commonly with fistula, root resorption, paresthesia, displacement of inferior alveolar canal,(29) delayed eruption of permanent teeth. Cortical plate expansion is seen in some cases, which occurs commonly on buccal side and pathological fracture of the mandible.(30) The adjacent to the lesion teeth are usually vital and there is no mobility.(31) Radiographic features of TBCs are non-pathognomonic.(6) However, on radiologic evaluation, the lesion exhibits unilocular or multilocular radiolucency with well-defined or ill-defined margins. When multiple teeth are affected the radiolucencies involving the roots shows a dome like projections that scallops between the roots(32) and often scallops between the roots of the teeth, almost always diagnostic.(33) The scalloped outline, however, is often found in edentulous areas also.(7) Furthermore, scalloped margin is a sign of possible recurrence, although this should not be confused with the interdental scalloping associated with an intact lamina dura.(34)However, This radiographic pattern may vary, which includes multilocular presentation, association with impacted teeth, and multiple occurrences in the same patient.(20) The histopathological evaluation reveals a vascular connective tissue or a thick myxofibromatous proliferation intermixed with normal bone,(35) with a scant yellowish, even blood colored liquid,(36) devoid of epithelial lining in the edges of lesion.(37) Numerous fibroblasts and giant cell like osteoclasts are sometimes visible, with some newly TRAUMATIC BONE CYST OF THE MANDIBLE; DIAGNOSTIC CHALLENGE (3029) formed trabecular bone surrounded by numerous osteoblasts. Numerous congested capillaries and cholesterol crystals related to the osseous necrosis also may be present. (38) A final diagnosis of a TBC is almost invariably made at the time of surgery, when identification of an empty air-filled cavity serves as a valuable diagnostic tool.(24) Diagnosis established with aspiration of lesion and opening of bone window and accumulation of bleeding and fibrin inside the cavity is usually efficient for resolution of bone.(7) Because of a lack of unique clinical and radiographic features, it is important to establish the differential diagnosis between TBCs and other radiolucent lesions of the jaws.(4) Differential diagnosis included central giant cell granuloma, aneurysmal bone cysts, haemangioma,(39) dentigerous cysts, keratocystic odontogenic tumors, ameloblastomas, odontogenic myxomas, calcifying epithelial odontogenic tumor, adenomatoid odontogenic tumor, focal osteoporotic bone marrow defect, intraosseous vascular malformations, early stage of cementoma (periapical cemental dysplasia), fibrous dysplasia and cherubism.(21) Several treatment modalities have been reported, including resection, curettage, bone grafting, corticosteroid injection and more recently, injection of autologous medullary bone.(40) The widely recommended treatment for TBCs is surgical exploration followed by curettage of the bony walls.(23) It serves as both a diagnostic maneuver and a definitive therapy by producing bleeding in the cavity. Haemorrhage in the cavity forms a clot which is eventually replaced by bone,(25) offering a good prognosis.(23) It is believed that in some cases there may be a spontaneous resolution,(41) that might allow more aggressive lesions keep growing, leading to additional complications such as pathological fracture, involvement of adjacent teeth and need for wider surgical margins.(18) Recurrence of TBC is assumed to be extremely rare.(30) If there are multiple cysts recurrence rates would be high(42) or those associated with florid cemento-osseous dysplasia.(23)

TRAUMATIC BONE CYST OF THE MANDIBLE; DIAGNOSTIC CHALLENGE AND MANAGEMENT A CASE REPORT