J Korean Assoc Oral Maxillofac Surg.  2017 Apr;43(2):94-99. 10.5125/jkaoms.2017.43.2.94.

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

• You MS
• Kim DY
• Ahn KM

• KMID: 2377012
• DOI: http://doi.org/10.5125/jkaoms.2017.43.2.94

Abstract

OBJECTIVES
Idiopathic 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 METHODS
A 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.
RESULTS
Female 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.
CONCLUSION
Differential 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.

Keyword

Cysts; Jaw; Bone and bones; Allografts

MeSH Terms

Allografts
Bone and Bones
Collagen
Curettage
Diagnosis, Differential
Female
Follow-Up Studies
Humans
Incisor
Jaw
Male
Mandible
Necrosis
Pectinidae
Radicular Cyst
Recurrence
Retrospective Studies
Tooth
Transplants
Collagen

Figure

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  Fig. 1 Age distribution of 27 patients of idiopathic bone cavities.

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  Fig. 2 Distribution of 30 idiopathic bone cavities in 27 patients.

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  Fig. 3 Bilateral idiopathic bone cavities in the posterior mandible (arrows).

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  Fig. 4 A. Bilateral idiopathic bone cavities in the posterior mandible (arrows). B. Recurrence of the lesion in the right posterior mandible two years after first operation (arrows).

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  Fig. 5 Idiopathic bone cavity in the left maxilla.

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  Fig. 6 A. Preoperative panoramic radiograph of the patient with idiopathic bone cavity in the anterior mandible. B. Cone-beam computed tomography showing bone cavity with cortical bone resorption. C. Surgical exposure of the anterior mandible with crevicular and vertical incision. Erosion of the cortical bone is observed. D. Creation of bone window for removal of fluid and curettage. E. Allogenic bone graft in the bone cavity. F. Bony window reposition. G. Panoramic radiograph one year after operation.

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