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Revista Española de Cirugía Oral y Maxilofacial

versión On-line ISSN 2173-9161versión impresa ISSN 1130-0558

Rev Esp Cirug Oral y Maxilofac vol.31 no.1 Madrid ene./feb. 2009




Atypical Simple Bone Cyst. A Case Report

Quiste óseo simple atípico. Presentación de un caso clínico




L.R González1, F. Stolbizer2, G. Gianunzio2, N. Mauriño3, M.L. Paparella4

1 Cátedra de Cirugía y Traumatología Bucomáxilofacial III, Facultad de Odontología, Universidad de Buenos Aires. Residente del Servicio de Cirugía y Traumatología Bucomáxilofacial del Hospital Francés, Ciudad Autónoma de Buenos Aires. Argentina.
2 Jefes de Trabajos Prácticos, Cátedra de Cirugía y Traumatología Bucomáxilofacial III, Facultad de Odontología, Universidad de Buenos Aires. Servicio de Cirugía y Traumatología Bucomáxilofacial del Hospital Francés, Ciudad Autónoma de Buenos Aires. Argentina.
3 Profesor Adjunto, Cátedra de Cirugía y Traumatología Bucomáxilofacial III, Facultad de Odontología, Universidad de Buenos Aires. Jefe del Servicio de Cirugía y Traumatología Máxilofacial del Hospital Francés, Ciudad Autónoma de Buenos Aires. Argentina.
4 Especialista en Anatomía Patológica Bucal, Facultad de Odontología, Universidad de Buenos Aires. Argentina.






The simple bone cyst (reported in the literature as traumatic bone cyst, solitary bone cyst, hemorrhagic bone cyst) is an intraosseous pseudocyst devoid of epithelial lining and filled with serous and/or hematic fluid that may also be lacking.
Is a an uncommon condition that usually affects the jaws, with predilection for the lower jaw.
The aim of the present work was to report a case of traumatic bone cyst of the jaw that differs from other maxillary bone cysts in its clinical, radiologic, and histologic presentation.

Key words: Hemorrhagic bone cyst; Traumatic bone cyst; Solitary bone cyst; Simple bone cyst; Jaw.


El quiste óseo simple (sinonimia quiste óseo traumático, quiste óseo solitario, quiste óseo hemorrágico) es un pseudoquiste intraóseo desprovisto de recubrimiento epitelial con un contenido seroso y/o hemático que en ocasiones puede estar ausente.
Es una patología poco frecuente que afecta a los huesos maxilares con predilección por el maxilar inferior.
El objetivo del presente trabajo es presentar un caso de quiste óseo simple en maxilar inferior que difiere de los habitualmente encontrados en los huesos maxilares en cuanto a su presentación clínica, radiográfica e histopatológica.

Palabras clave: Quiste óseo hemorrágico; Quiste óseo traumático; Quiste óseo solitario; Quiste óseo simple; Maxilar.



The simple bone cyst is an intraosseous pseudocystic lesion devoid of epithelial lining and containing serous and/or hematic fluid that sometimes may be absent. It was first described in the maxillary bones by Lucas in 1929.1 The etiopathogenesis of simple bone cyst is uncertain and controversial, as demonstrated by the many and varied theories proposed.2-4 The most accepted hypothesis is that proposed by Howe in 1965, which is based on the idea of a traumatic injury.5 According to this hypothesis, the intraosseous hematoma arises from bleeding and lacks the capacity to organize and repair itself, resulting in liquefaction that eventually causes the formation of a neocavity.

The peak incidence is in the second decade of life.5-8 Unlike bone cysts in the long bones, where the male-female ratio is 3:1, in the jaw there is no predilection for either sex. It is located almost exclusively in the mandibular bone, most frequently in the body, followed by the symphyseal region. When simple bone cyst occurs in the upper maxilla, the anterior zone is most often affected.4,9

The lesion generally is asymptomatic and usually is discovered accidentally during routine radiographic studies. On radiography, it presents as an osteolytic lesion that is radiolucid, unilocular, with well-defined limits, and usually does not expand or thin the cortical bone. It usually extends between the roots of the teeth, which produces a festooned contour, not displacing the teeth or causing rhizolysis. These characteristics pertain exclusively to simple bone cysts. Dental vitality is rarely affected.4,10

The gross study reveals a unilocular cavity that may have septae, with serous and/or hematic content that is delimited by a very thin, fibrous membrane. The cavity sometimes can be empty. If it is located posterior to the mental foramen, the inferior dental nerve is visualized as floating in the foramen due to resorption of the bone canal.11 Surgical exploration is necessary to reach a definitive diagnosis that will produce bleeding into the cavity during maneuvers. In most cases, this will stimulate regeneration of the bone tissue. 11-13

A second surgical procedure rarely is necessary.13-15


Clinical case

A 17-year-old woman of white race was seen in the Bucomaxillofacial Surgery and Traumatology Department of the French Hospital of Buenos Aires for facial asymmetry of ten days evolution.

The clinical examination revealed increased volume of the left mandibular body that erased the vestibular sulcus. The mucosa covering the zone appeared normal (Fig. 1). The patient referred intense tenderness and a test of pulp vitality was negative for dental pieces 3.6 and 3.7.

The imaging study revealed an osteolytic, radiolucid, unilocular, septated lesion under the second left premolar that affected the mandibular body and ramus. A retained third molar was observed in relation to the cavity and the definition of the inferior dental nerve canal was lost (Fig. 2).

Tomographic slices allowed evaluation of the true extension of the lesion.

The lesion measured 8 x 3 x 2 cm and distended the vestibular bone table (Fig. 3). Surgical biopsy was performed under local anesthesia and yielded a soft tissue fragment that was notably thick.

Microscopically, fibrogranulomatous tissue was observed with myxoid areas, cholesterol crystals, old and recent hemorrhagic areas with a giant cell reaction and macrophage clumps, and hemosiderin pigment (Fig. 4). Peripherally, reactive osteogenesis with osteoid trabeculae formation (Fig. 5) was seen, with clumps of eosinophilic material of fibrinoid aspect and calcification foci (Fig. 6)

The diagnosis was simple bone cyst with characteristics similar to those of simple bone cyst of the long bone. After endodontic treatment of the devitalized teeth, the lesion was approached again in a second surgical procedure under general anesthesia to remove the retained third molar and enucleate the soft tissue that lined the cystic cavity (Fig. 7). During the surgical procedure, profuse bleeding was controlled with local maneuvers. The surgical bed showed an undamaged vasculonervous package that floated freely due to resorption of the bone canal (Fig. 8).

Follow-up at three, six, and twelve months confirmed the satisfactory evolution of the process with tissue repair (Figs. 9, 10 and 11).



Simple bone cyst (synonyms: traumatic bone cyst, solitary bone cyst, hemorrhagic bone cyst) is an infrequent pathology that affects the maxillary bones.

Since it was first described in 1929, the condition has received many denominations, many of which have their origin in attempts to explain its genesis. Although the current hypothesis of trauma as the trigger factor is the most accepted, a background of real trauma is infrequent in patients with this pathology. The international literature reports an incidence of previous trauma of 17 to 70%.3

One of the most common characteristics of the simple bone cyst is the absence of clinical manifestations, which is why the case reported here differs in many respects from the classic clinical and radiographic presentation of these lesions. Facial asymmetry as a result of alteration of the normal bone anatomy, the presence of bony partitions in the cystic cavity and a retained tooth in relation to the pathology, the painful symptoms, and the loss of vitality of the teeth involved in the lesion were uncommon characteristics. Histologically, it also differed from the usual presentation of lesions of the maxillary bones. The lesions reported here are more like the lesions of long bones.



L.R. González
Universidad de Buenos Aires.
Facultad de Odontología.
C1122AAH- Marcelo T. Alvear 2142.
Buenos Aires, Argentina.

Received: 06.11.07
Accepted: 25.11.08



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