Solitary Bone Cyst of the Mandible Mimicking an Odontogenic Keratocyst: A Case Report and Brief Literature Review
TL;DR
A 16-year-old male in good general health presented with pain and mobility of a retained primary lower right second molar and a preoperative diagnosis of odontogenic keratocyst (OKC) was made, and the diagnosis of SBC was established operatively.
Abstract
Solitary bone cyst (SBC) is an uncommon, benign, non-neoplastic osteolytic pseudocyst without an epithelial lining. It occurs mainly in the second decade of life and predominantly in the mandible. Large lesions may mimic aggressive odontogenic lesions. A 16-year-old male in good general health presented with pain and mobility of a retained primary lower right second molar (85). Panoramic radiography showed agenesis of tooth 45 and an incidental, well-defined, 4 cm homogeneous radiolucency in the left mandibular body adjacent to teeth 33–37, all of which were vital. CT showed a 4.3 × 2 cm osteolytic lesion with clear borders in direct contact with the left inferior alveolar nerve (IAN), and a preoperative diagnosis of odontogenic keratocyst (OKC) was made. Exploration under local anaesthesia revealed an empty intraosseous cavity without lining or fluid, with the IAN exposed on its floor. The diagnosis of SBC was established operatively. Curettage of the bony walls was performed to induce intramedullary bleeding. Healing was uneventful. A one-year follow-up showed complete reossification and normal neurosensory outcome. SBC can mimic OKC or unicystic ameloblastoma on imaging. Surgical exploration is both diagnostic and therapeutic, and may avoid more aggressive treatment. Long-term clinical and radiographic follow-up is needed to confirm reossification and detect recurrence.