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rev port estomatol med dent cir maxilofac . 2021;62(3):170-175 171

Quisto ósseo simples bilateral na mandíbula: Descrição de caso raro

r e s u m o

Palavras-chave: O quisto ósseo simples é uma lesão osteolítica benigna, incomum na região maxiloman-
Bilateral dibular. Sua etiologia permanece desconhecida, embora as lesões traumáticas estejam
Quisto ósseo frequentemente associadas a essa lesão. Pacientes jovens, homens e mulheres igualmen-
Mandíbula te, são os mais afetados. É assintomático na maioria dos casos, sendo diagnosticado em
radiografias de rotina. A imagem radiolúcida, uni ou multilocular, é bem definida, com
margens irregulares, principalmente na região posterior da mandíbula. A apresentação
bilateral é rara. O diagnóstico final é estabelecido durante os procedimentos cirúrgicos
quando uma cavidade óssea vazia é detetada. A curetagem simples é o tratamento de
escolha e consiste em provocar sangramento e preenchimento da cavidade com coágulo
sanguíneo. A reparação óssea será observada nos procedimentos de acompanhamento.
Assim, o objetivo deste estudo foi apresentar um caso raro de quisto ósseo simples bila-
teral em um jovem do sexo masculino, tratado com curetagem das paredes ósseas. (Rev
Port Estomatol Med Dent Cir Maxilofac. 2021;62(3):170-175)
© 2021 Sociedade Portuguesa de Estomatologia e Medicina Dentária.
Published by SPEMD. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).

The treatment of choice is a surgical curettage of the bone
Introduction
walls. This procedure produces bleeding in the cavity that leads
The simple bone cyst (SBC), also known as traumatic, solitary, to the organization of a clot, which will be the architecture of
overflow, unicameral and hemorrhagic bone cyst or idiopathic a new bone formation. 1,7,8 In the absence of tissue for histo-
bone cavity, was first described by Lucas and Blum in 1929. 1-4 pathological analysis, the clinical presentation at the time of
The World Health Organization (WHO) classifies it as part of a surgical procedure is enough to establish the diagnosis. 2,3,10,14
group of giant cell lesions and bone cysts, which also include This study aimed to present a rare case of bilateral SBC, in
central and peripheral giant cell granuloma, cherubism, and a young 14-year-old male.
aneurysmatic bone cyst. 5,6 It is an atypical intraosseous lesion
that has no epithelial lining. Therefore, it is considered a
pseudocyst. 1,4,7-9 It is usually an empty cavity, although some- Case report
times it can be filled by blood, serum, or both. 1,7,8,10
The exact etiopathogenesis of SBC remains uncertain, al- A 14-year-old male patient was referred to the Dentistry
though trauma is frequently an associated factor. 8,11 The most Course at Universidade Tuiuti do Paraná, to evaluate an
accepted theory is that an intraosseous clot, produced by trau- asymptomatic bilateral intraosseous lesion in the mandible,
ma, decomposes and liquefies leaving an empty cavity. 1-3,7,12 which was discovered by chance during the routine follow-up
However, this theory has been questioned, since most cases with radiographs of the orthodontic treatment.
describe no history of trauma. 3 The anamnesis revealed a systemically healthy, sports-
SBC usually occurs in young patients, in the first two de- man, who played football regularly. The extra and intraoral
cades of life, with no sex preference. 1,2,7 It is often found in the clinical examination did not show any changes in normality,
9
humerus, femur, and other long bones but in 1% of cases, it but the presence of an orthodontic appliance. The panoramic
affects the mandible. 2-4,7,10 Most cases of SBC are asymptom- radiography showed, in the mandible body, two bilateral
atic and do not cause cortical expansion. They are usually well-defined radiolucent areas, with irregular and sclerotic
found in routine radiographies. 2,3,8,9 The teeth associated with edges, and no signs of root resorption of the next teeth. On the
the lesion are vital and generally do not present root resorp- right side, a unilocular lesion, that was extended from the ca-
tion nor displacement. 2,3,8,13 It is observed as a radiolucent nine to the second premolar was observed. On the left side,
image, uni or multilocular, with irregular margins or well-de- there was a significantly larger lesion, which involved the first
fined cutouts. 2,7,8 The lesion is usually unique. The bilateral premolar to the third molar, extending to the base of the man-
cases are rare. Due to the lack of specific clinical and radio- dible and scaling it between the dental roots (Figure 1). Com-
14
graphic characteristics, it is important to establish the differ- puted tomography did not show expansion or rupture of the
ential diagnosis between SBC and other bone lesions of the cortical bone (Figures 2, 3). The teeth associated with the le-
jaws, such as radicular cyst, keratocyst, ameloblastoma, myx- sions tested positive for sensibility. The panoramic radiogra-
oma, aneurysmatic bone cyst, lateral periodontal cyst, cheru- phy done before the installation of the orthodontic appliance,
bism, focal osteoporotic bone marrow defect, intraosseous showed that the lesions were already present for at least six
vascular malformations, and central giant cell lesions. 2,7,9,10 months. (Figure 4).