Bilateral Radiolucencies of the Posterior Mandible :
A Clinicopathologic Review
In the case above , TN was considered given its proximity to the IANC . Due to asymptomatic nature , the separation of the lesion from the IANC , and lack of any surgical or traumatic history , TN was considered unlikely in the differential diagnoses . Furthermore , bilateral intraosseous traumatic neuromas have been reported , but are extraordinarily rare . 7
C . Idiopathic bone cavity ( IBC ) ( also known as traumatic bone cyst or simple bone cyst ) is a bone lesion with an unknown etiology , although there is a question of trauma playing a role in the development . However , cases of IBC have arisen without a history of trauma . 1 It usually presents surgically as an empty cavity , but occasionally can be a fluid-filled cavity . IBCs can present in any bone , with the long bones as the most common location . While they may be seen anywhere , when present in the mandible , the favored location of the lesion is the molar-premolar area or at the symphyseal area . 1 No gender predilection is reported in jaw lesions , and they are commonly seen in the second or third decade of life . IBCs are usually asymptomatic , and 20 percent of them can present with swelling . 1 Consequently , they are usually incidental findings on routine radiologic studies . Commonly , they present as single lesions , but occasionally multiple lesions can be present . 8 They are most likely to present as a well-circumscribed , unilocular radiolucencies radiographically , but some cases of ill-defined multilocular radiolucencies have been reported . Rarely , multiple IBCs have been reported in a patient . 9 The borders can range from well-corticated to diffuse . They can vary in size from a few millimeters to up to 10cm . The borders often scallop around the roots of teeth , with the teeth in the area remaining vital . A panoramic radiograph of an anterior IBC is included for comparison ( Figure 3 ). It depicts a well-defined , unilocular radiolucency in the left mandibular premolar and canine area . It has the classic scalloping of the border around the roots of the teeth . IBC often mimic other bone lesions , such as periapical lesions or in our case , SDs . Histologically , the lesions contain fragments of thin , vascular , fibro-collagenous soft tissue with a lack of epithelial cystic lining . Red blood cells and osteoid-like material may be seen along with osteoclastic , multinucleated giant cells and calcifications . The lesion lacks an epithelial cystic lining , and therefore is not a true cyst . Hence , traumatic bone cyst and simple bone cyst are misnomers , and IBC is the preferred terminology .
Treatment involves surgical exploration and curettage . Exposure with or without curettage is enough to induce bone regeneration . Although minimal tissue is usually obtained from curettage , it is advisable to submit the tissue for histopathologic review to confirm the diagnosis .
Figure 2 : A computed tomography scan with bilateral , well-circumscribed , unilocular radiolucencies in the posterior mandible which are in communication with the inferior alveolar nerve . Histologically , these lesions are compatible with bilateral intraosseous traumatic neuromas .
Figure 3 : A panoramic radiograph with a well-circumscribed , unilocular radiolucency present in the anterior left mandible . Its borders scallop around the roots of the canine and premolar .
JANUARY / FEBRUARY 2017 | PENNSYLVANIA DENTAL JOURNAL 31