Update on a rare mandibular osteolytic lesion in childhood: the buccal bifurcation cyst.

Dimos Kalyvas,Zafeiroula Yfanti,Benjamin Salmon,Reinhilde Jacobs,Golgis Ahbab,Francesca Mangione,Anastasia Mitsea,Annelore De Grauwe

doi:10.1259/bjrcr.20170109

Abstract

Buccal bifurcation cyst is a rare, uncommon buccal cystic lesion associated with the permanent mandibular first molar in children just prior to tooth eruption, and is categorized by the World Health Organization as an odontogenic cyst occurring in a vital tooth, near the buccal cervical margin of the lateral aspect of a root, as a result of an inflammatory process in a periodontal pocket. The aim of this study is to present a series of three similar mandibular buccal bifurcation cyst cases, by providing clinical, radiological and histological characterization of the lesion, in order to lead clinicians through the diagnosis, treatment and follow-up process and contribute to deeper knowledge of this rare pathological entity.

Highlights

The buccal bifurcation cyst (BCC) is a rare, uncommon buccal-located cystic lesion associated with the permanent mandibular first molar in children just prior to tooth eruption
According to the World Health Organization (WHO), the mandibular buccal bifurcation cyst (MBBC) is categorized as an odontogenic cyst and described as a cyst occurring in a vital tooth, near the buccal cervical margin of the lateral aspect of a root as a consequence of an inflammatory process in a periodontal pocket.[1]
The aim of this paper is to report a case series of three clinical situations of MBBC, by providing clinical, radiological and histological characterization of the lesion, in order to lead clinicians through the diagnosis, treatment and follow-up process and contribute to deeper knowledge of this rare pathological entity

Summary

Introduction

The buccal bifurcation cyst (BCC) is a rare, uncommon buccal-located cystic lesion associated with the permanent mandibular first molar in children just prior to tooth eruption. Case report 3 Male, 6 years old, was referred to the oral and maxillofacial surgery department of Saint Rafaël hospital of Leuven, Belgium, complaining of a painless facial swelling and small extraoral haematoma in the lower left molar area (Figure 3). Radiological examination was initially done by panoramic imaging, showing the presence of a well-defined homogeneous radiolucent round area with perilesional sclerotic edge, involving the distal root and the cervical region of the lower left molar. Further radiographic examination was carried out through a cone beam CT, confirming the buccal aspect of the lesion, and showing a resorption of the vestibular cortical plate, where a periosteal reaction was noticed. Anatomopathological examination of the cystic tissue revealed a vestibular cyst, microscopically defined by a non-keratinized- squamous epithelium, consisting of fibrinopurulent material and granulation tissue with a mixed inflammatory infiltrate, which is in consistency with the other cases described in this paper (Figure 4). Radiological and anatomopathological examination results confirmed the diagnosis of MBBC

Discussion

Radiologic characteristics: