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

change, tooth mobility, or displacement are non-existent and the surrounding soft tissue, and recurrence is easily identi-
10
there is no root resorption in most cases. 2,9,11 Pathological frac- fied when it occurs. The placement of lyophilized bovine
3
tures are reported in 0.6% of the cases. In the present case, bone, autologous blood with autogenous bone, hydroxyapa-
there was an imminent risk of injury to the left side if the di- tite, bioglass, platelet-rich fibrin, cryogenic therapy, cortico-
agnosis had been postponed. Mandibular fracture and damage steroid injection and surgical resection are some of the other
to the lower alveolar nerve can occur in the presence of con- proposed therapies. 8,11,12,14 A simple curettage is the treat-
siderable bone resorption, due to the substantial growth of the ment of choice, with bone repair within 6 months and with
lesion. 2 an excellent prognosis. 3,7,9
A radiolucent image, with an irregular shape, well-circum- The spontaneous regression of the lesion can occur, and
scribed, and with well-defined borders is observed in radio- this fact would justify its low incidence in older age groups. 2,3,14
graphs. 2,8,13 Lesions can be presented with an uni- or multiloc- However, the non-surgical intervention, with only radiograph-
12
ular pattern, but unilocular is the most common. 1,3,7,9,11 The ic follow-up throughout life, does not rule out other injuries.
multilocular lesions may be associated with unerupted and/ Besides, the patient is frequently exposed to radiation, and a
7,9
or impacted teeth and are similar to tumors. The presence pathological fracture can occur. 3,12
of inter radicular scaling, as observed in the lesion on the left Post-surgical follow-up, with radiographic exams is neces-
side of the present case, is highly suggestive of SBC, but it is sary. Panoramic radiographs are taken shortly after the surgi-
9
not pathognomonic. Staggering around the roots of adjacent cal procedure. Some authors recommend within 1, 3, and 6
3
teeth is evident in 40% of the lesions. The majority of cases months and 1 year after surgery. 2,4,10,11 On the other hand, for
do not present bone expansion, but thinning of the cortical other authors it is more reasonable to perform the first radio-
3
may be observed. Multiple lesions are more commonly asso- graphic examination between 12 and 17 months after surgery
1,3
ciated with bone expansion, but they are rare. In a study with because this is the period within which most cases with heal-
132 SBC, multiple lesions accounted for 13% of cases. Damage ing were confirmed, 15 Longer follow-up periods, from 22.8 to
15
to the mandibular canal will depend on the extent of the le- 25.3 months, have also been described. 3
sions and expansion of the cortical bone. 2 Altough recurrence of SBC of the jaws is assumed to be
The differential diagnosis should include odontogenic and extremely rare, 2,7,13 one study found an overall recurrence rate
nonodontogenic cysts and tumors, such as radicular cyst, ker- of 26%. According to some radiographic findings, it is possible
15
3
atocyst, ameloblastoma, myxoma, lateral periodontal cyst, and to predict the prognosis for SBC. Studies show that in multi-
other lesions such as aneurysmal bone cyst, cherubism, focal locular lesions, the recurrence rate is 65.4%, versus 4.8% in
8
osteoporotic bone marrow defect, intraosseous vascular mal- cases of unilocular lesions. Multiple lesions are also associat-
formations, and central giant cell lesions. 7,10 The final diagno- ed with a higher probability of recurrence. 15 Larger lesions,
sis is established during the surgical procedure, by seeing the with an inter radicular staggering, which makes it difficult to
empty bone cavity, characteristic of SBC, excluding all the form enough blood clot for bone repair, have a greater proba-
3
above lesions. 1,2,10 The lesion, when discovered in the begin- bility to persist or reappear; in the present case, despite the
ning, can reveal fluids inside. As it progresses, it usually be- lesion on the left side having shown these characteristics,
comes empty. 8 complete local bone formation was observed and, after 8
Histopathological examination can detect fibrotic connec- months, there was no sign of recurrence of the lesion.
1
tive tissue and normal bone tissue. Some authors describe the Cases of bilateral SBC are rare in the literature. A thorough
lesion as fragments of fibrovascular connective tissue, choles- analysis of clinical and radiographic findings, combined with
terol fissures, giant foreign body cells, with a protein portion surgical treatment, contributes to the correct diagnosis and
of the cystic content containing bilirubin, similar to serum. 2,8 resolution of the lesion. In the present case this was achieved
Others say that the histology of the SBC reveals only a connec- through a conservative surgical approach, based on simple
tive tissue membrane that lines the entire pathological cavity. 7 curettage, recommended by many authors, which guaranteed
The content for histological analysis is usually scarce. 7,9 a good prognosis for the patient. Finally, there is a need for
There is no protocol for the treatment of SBC in the max- more comprehensive research to better elucidate the true
12
illofacial region, however, a simple curettage is the most pathogenesis and the most appropriate treatment for SBC.
recommended procedure. 1-3,7-9 It also establishes the final
1,8
diagnosis of the lesion. The procedure consists of surgical
exploration of the cystic cavity, which will display an empty Conflict of interest
or semi-empty space, followed by careful curettage of the
bone walls, inducing bleeding and blood clot formation, fill- The authors have no conflicts of interest to declare.
ing the entire cavity, and ending with the suture of the
wound. 1-3,8 The new bone is similar to the one obtained with
the placement of a local bone graft. 14 Bleeding around the Ethical disclosures
lesion is enough to trigger cell differentiation and, conse-
quently, the regeneration of bone tissue in the affected region Protection of human and animal subjects. The authors
in a short time. 1,3,10 declare that the procedures followed were in accordance with
The use of bone grafting materials to fill the cavities is the regulations of the relevant clinical research ethics com-
also reported in the literature. (10-12,14) For some authors it mittee and with those of the Code of Ethics of the World Med-
presents advantages, as early bone healing, preservation of ical Association (Declaration of Helsinki).