Simple Bone Cyst and Fibrous Dysplasia Occurring Simultaneously in Both Mandibles: Case Report

김홍순,송찬종,설동주,이재욱,이백수,권용대,오주영,이정우,최병준 대한치의학회 2013 Journal of korean dental science Vol.6 No.1

Fibrous dysplasia is a benign fi bro-osseous lesion wherein normal bone is replaced with an excessive proliferation of cellular fibrous connective tissue intermixed with irregular bony trabeculae. Fibro-osseous lesions like fibrous dysplasia are often associated with non-epithelial cysts, such as simple bone cyst. The etiologic and pathogenic relationships between fi brous dysplasia and simple bone cyst have not been conclusively established. Nonetheless,the mechanism of cyst formation in fibro-osseous lesion associated with simple bone cyst can be said to differ from that of the typical simple bone cyst of the jaws. This article reports a case of bilateral lesions including fi brous dysplasia and simple bone cyst on each site and reviews the pathogenesis of cyst formation in the fibro-osseous lesion.

Simple Bone Cyst and Fibrous Dysplasia Occurring Simultaneously in Both Mandibles: Case Report

Kim, Hong-Soon,Song, Chan-Jong,Seol, Dong-Ju,Lee, Jae-Wook,Lee, Baek-Soo,Kwon, Yong-Dae,Ohe, Joo-Young,Lee, Jung-Woo,Choi, Byung-Joon Korean Academy of Dental Science 2013 Journal of korean dental science Vol.6 No.1

Fibrous dysplasia is a benign fi bro-osseous lesion wherein normal bone is replaced with an excessive proliferation of cellular fibrous connective tissue intermixed with irregular bony trabeculae. Fibro-osseous lesions like fibrous dysplasia are often associated with non-epithelial cysts, such as simple bone cyst. The etiologic and pathogenic relationships between fi brous dysplasia and simple bone cyst have not been conclusively established. Nonetheless, the mechanism of cyst formation in fibro-osseous lesion associated with simple bone cyst can be said to differ from that of the typical simple bone cyst of the jaws. This article reports a case of bilateral lesions including fi brous dysplasia and simple bone cyst on each site and reviews the pathogenesis of cyst formation in the fibro-osseous lesion.

외상성 골낭의 치험례 : A CASE REPORT

오민형,이광희,김대업 大韓小兒齒科學會 2005 大韓小兒齒科學會誌 Vol.32 No.1

외상성 골낭(Traumatic Bone Cyst)은 상피이장이 없는 비치성낭으로 감염의 증거가 없으며 많은 액체가 내장되는 특징을 가지는 병소이다. 외상성 골낭은 자각증상이 없는 병소로 10대에서 20대 사이에 호발하며 주로 남자에서 호발한다. 병소는 방사선학적으로 조개껍질 모양의 명확한 경계를 가지며 방사선 투과상을 보인다. 병소는 해면골에 위치하며 간혹 치밀골을 팽창시키거나 비박화시킨다. 병소 주변의 치아는 생활력을 유지하는 특징이 있다. 일반적으로 외상성 골낭은 방사선학적, 임상적인 기준으로 진단을 내리게 된다. 외상성 골낭의 치료법은 일반적으로 외과적인 적출술과 소파술을 시행한다. 본 두 증례 중 첫 번째 증례에서 환아는 개인치과의원에서 치수치료 도중 방사선 사진에서 방사선투과상이 발견되어 본원으로 의뢰되었으며 파노라마 방사선 사진촬영 결과 좌측 하악골에 명확한 경계를 보이는 방사선 투과상을 보였다. 두 번째 증례에서 환아는 치외치인 상악 우측 제2소구치의 농양을 동반한 종창을 주소로 내원하였다가 초진시 촬영한 파노라마 방사선 사진에서 우측 하악골에 명확한 경계의 방사선 투과상을 보였다. 두 증례 모두 임상적, 방사선학적 검사결과 외상성 골낭으로 진단받았다. 첫 번째 증례에서는 생활력을 상실한 인접치아의 치근단공에 과기구 조작을 실행하여 병소를 교통시킨 후 지속적인 세척을 시도하여 병소가 치유되는 양상을 보였고, 두 번째 증례에서는 아무런 처치 없이 지속적인 관찰결과 병소의 크기가 감소하는 양상을 보였다. 본 두 증례에서 외과적인 적출술과 소파술을 시행하지 않고 보존적인 처치를 하였음에도 병소가 치유양상을 보이기에 보고하는 바이다. Traumatic bone cyst is a nonodontogenic cyst without epithelial-ling which contains fluid in it's cavity, and it is limited by bone walls with no evidence of infection. Traumatic bone cyst is asymptomatic and appears more frequently in the second decade. Gender distribution is approximately equal, although males are affected slightly often than females. Radiographically the lesion shows a well demarcated radiolucent lesion of variable size and the lesion may have scalloped margins. The adjacent teeth to traumatic bone cyst remains vital. Traumatic bone cyst is usually treated by surgical exploration and currettage of the lesion. In the first case of this case report, the patient was refered from the local dental clinic for the radiolucent area under the left mandibular first molar. From the panorama radiograph at the first visit, the radiolucent area of the left mandible showed a well defined scalloped margin and identified as traumatic bone cyst. In the second case, the patient have visited for the chief complaint of swelling and abcess of right maxillary second premolar. In the radiographic check up with panorama radiograph, the radiolucent lesion with well demarcated scalloped margin was found in the right mandible body, and identified as traumatic bone cyst. In the first case, overinstrumentation was done through the mesial root canal to irrigate the lesion. In the second case, not any treatment was done, and watched the progression of the lesion. And in both cases, after two month, the radiolucency and the size of the lesion has decreased to show healing in progress.

Determining the Best Treatment for Simple Bone Cyst: A Decision Analysis

이승열,정진엽,이경민,성기혁,원성훈,최인호,조태준,유원준,여지현,박문석 대한정형외과학회 2014 Clinics in Orthopedic Surgery Vol.6 No.1

Background: The treatment of simple bone cysts (SBC) in children varies significantly among physicians. This study examined which procedure is better for the treatment of SBC, using a decision analysis based on current published evidence. Methods: A decision tree focused on five treatment modalities of SBC (observation, steroid injection, autologous bone marrow injection, decompression, and curettage with bone graft) were created. Each treatment modality was further branched, according to the presence and severity of complications. The probabilities of all cases were obtained by literature review. A roll back tool was utilized to determine the most preferred treatment modality. One-way sensitivity analysis was performed to determine the threshold value of the treatment modalities. Two-way sensitivity analysis was utilized to examine the joint impact of changes in probabilities of two parameters. Results: The decision model favored autologous bone marrow injection. The expected value of autologous bone marrow injection was 0.9445, while those of observation, steroid injection, decompression, and curettage and bone graft were 0.9318, 0.9400, 0.9395, and 0.9342, respectively. One-way sensitivity analysis showed that autologous bone marrow injection was better than that of decompression for the expected value when the rate of pathologic fracture, or positive symptoms of SBC after autologous bone marrow injection, was lower than 20.4%. Conclusions: In our study, autologous bone marrow injection was found to be the best choice of treatment of SBC. However, the results were sensitive to the rate of pathologic fracture after treatment of SBC. Physicians should consider the possibility of pathologic fracture when they determine a treatment method for SBC.

동측 대퇴골 전자간부와 간부에 발생한 단순성 골 낭종과 섬유성 골이형성증의 치료

박종석 순천향의학연구소;Soonchunhyang Medical Research Institute 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Simple bone cyst is not a neoplasm in the strict sense and may be considered a destructive lesion resulting from veractivity of osteoclasts. Simple bone cysts are usually discovered in early childhood or adolescence, usually between ages 9 and 15. The cycsts are asymptomatic and are usually detected after pathologic fracture. The cysts are common in metaphysic of long bone. The most common site is the proximal end of the humerus and femur. Pathologic fracture is the only real danger. Fibrous dyspasia is a benign pathologic condicton that affects skeletal deveopment. The lesion and its association with pigmentation of the skin and dysfunction of the endocrine system were described. Fibrous bysplasis may occur in the epiphysis, metaphysis and diaphysis of long bone. Simple bone cyst and fibrous dysplasia in the ipsilateral femur have not been reported yet. We treated 27 years old female patient haveing simple bone cyst on the intertrochanteric area and fibrous dysplasia on the shaft of the ipsilateral femur with curettage and bone graft. On postoperative 9 months, bone corporation was achieved. And patient had no pain and limitation of motion.

자가 골수와 분쇄 동종골 혼합물의 경피적 주입술을 이용한 단순 골 낭종의 치료

이상훈(Sang Hoon Lee),오주한(Joo Han Oh),김준혁(June Hyuk Kim),김형민(Hyoung Min Kim),김한수(Han-Soo Kim) 대한정형외과학회 2006 대한정형외과학회지 Vol.41 No.1

목적: 단순 골 낭종의 새로운 치료법으로서 자가 골수와 분쇄 동종 해면골 혼합물의 경피적 주입법을 시도하여, 이의 치료 결과를 평가하고자 하였다. 대상 및 방법: 15명의 단순 골 낭종 환자를 대상으로 미세한 과립상으로 분쇄한 동종 해면골을 자가 골수와 혼합하여 경피적으로 병변에 주입하는 시술을 시행하였다. 평균 나이는 13.5 (4-32)세였고, 평균 추시 기간은 13.2 (8-19)개월이었다. 치료 결과의 판정은 방사선 소견 상 완전 치유(healed), 부분 치유(healed with defect), 지속(persistent), 재발 (recurrent)의 4가지로 나누어 완전 치유 및 불완전 치유를 치료에 반응이 있는 것으로 평가하였다. 결과: 15예 중 시술 후 9일경 병적 골절이 있었던 1예를 제외한 14예에서 치료에 반응이 있었다. 방사선 소견상 완전 치유는 9예에서 시술 후 평균 3개월 경에 관찰되었으며, 부분 치유된 5예에서도 잔존 낭종의 크기가 작고 증상을 유발하지 않는 등 재시술이 필요한 경우는 없었다. 낭종 지수(cyst index), 부위 및 이전 치료의 병력 유무, 나이 및 생별에 따른 치료 결과의 차이는 없었다. 결론: 단순 골 낭종에 대한 자가 골수와 분쇄 동종골의 혼합물의 경피적 주업술은 빠른 치료 반응과 높은 치료율을 보이므로 단순 골 낭종 치료에서 효과적인 치료법으로 생각한다. Purpose: This study evaluated the feasibility and efficacy of a percutaneous injection of a mixture of autogenous bone marrow and crushed cancellous bone allografts for the treatment of simple bone cysts. Materials and Methods: Fifteen patients with a simple bone cyst were enrolled in this study. The mean age was 13.5 years (range, 4-32 years), and the mean follow-up period was 13.2 months (range, 8-19 months). The radiographic signs of the resolution of the cyst were categorized as healed, healed with a defect, persistent and recurrent. The groups of healed and healed with a defect were designated the positive response groups. Results: Fourteen patients responded to the treatment. Nine patients showed complete healing that was first seen radiographically at 3 months (range, 1-6 months). Five patients showed healing with a defect, but no patient required a second injection because the cysts were small and did not cause functional pain. There was no correlation between clinical responses and age, gender, location, cyst index and previous treatment modalities. One patient had a pathological fracture, which was treated successfully by open bone grafting with flexible intramedullary nailing. Conclusion: A percutaneous injection of a mixture of autogenous bone marrow and a crushed cancellous bone allograft may be an effective treatment for simple bone cysts.

형제에서 발견된 단순골낭

안서영,안창현,최갑식 대한구강악안면방사선학회 2008 Imaging Science in Dentistry Vol.38 No.3

17-year-old and 14-year-old brothers were referred for evaluation of the cystic lesions on the mandibular anterior area with no symptoms. Neither their mother nor the brothers could recall any past trauma to those areas. Panoramic and intraoral radiographs revealed moderately defined cystic lesions on their mandibular anterior areas. Biopsies on both lesions revealed simple bone cysts. Hereditary cause or familial history of simple bone cysts could not be found in literature review. This case may have been a coincidence. However, further investigation is needed to find the cause of simple bone cysts occurring in patients those are closely related.

Mandibular Simple Bone Cyst in a Patient Involved with Moyamoya Disease

김연숙,이상신,이석근 대한구강악안면병리학회 2014 대한구강악안면병리학회지 Vol.38 No.5

An 18 years old female patient suffered from cerebrovascular occlusive disease, moyamoya disease, showed a huge cyst in her left mandibular body in the radiological observation. The lesion was asymptomatic and found during routine dental check. She had no experience of traumatic injury on her jaw. The cystic lesion was ovoid with irregular scalloping margin and multilobular image, and occupied the whole marrow space of mandibular body with slight expansion of buccal cortical bone. During operation the lesion showed an empty space covered with grayish white fibrous tissue. The luminal fibrous tissue and underlying bony tissue were curettaged and examined pathologically. In the histological observation the lesion was a pseudocyst lined by thick fibrous tissue. Some large vessels underwent atherosclerotic change, exhibiting thickened vessel walls which were partly distorted with hemorrhage and thrombi, and some small capillaries were extremely dilated with hemorrhage and subsequently resulted in perivascular ischemic change with chronic vasculitis. This mandibular cystic lesion was finally diagnosed as simple bone cyst (SBC) associated with moyamoya disease differentially from aneurysmal bone cyst (ABC), traumatic bone cyst (TBC), periapical odontogenic keratocyst, and central giant cell granuloma. Therefore, it was presumed that the thromboembolic and atherosclerotic vessels of moyamoya disease might increase the hemodynamic pressure of mandibular bone marrow tissue and subsequently was able to induce SBC.

Mandibular Simple Bone Cyst in a Patient Involved with Moyamoya Disease

김연숙,이상신,이석근 대한구강악안면병리학회 2014 대한구강악안면병리학회지 Vol.38 No.5

An 18 years old female patient suffered from cerebrovascular occlusive disease, moyamoya disease, showed a huge cyst in herleft mandibular body in the radiological observation. The lesion was asymptomatic and found during routine dental check. She hadno experience of traumatic injury on her jaw. The cystic lesion was ovoid with irregular scalloping margin and multilobular image,and occupied the whole marrow space of mandibular body with slight expansion of buccal cortical bone. During operation the lesionshowed an empty space covered with grayish white fibrous tissue. The luminal fibrous tissue and underlying bony tissue were curettagedand examined pathologically. In the histological observation the lesion was a pseudocyst lined by thick fibrous tissue. Some largevessels underwent atherosclerotic change, exhibiting thickened vessel walls which were partly distorted with hemorrhage and thrombi,and some small capillaries were extremely dilated with hemorrhage and subsequently resulted in perivascular ischemic change withchronic vasculitis. This mandibular cystic lesion was finally diagnosed as simple bone cyst (SBC) associated with moyamoya diseasedifferentially from aneurysmal bone cyst (ABC), traumatic bone cyst (TBC), periapical odontogenic keratocyst, and central giant cellgranuloma. Therefore, it was presumed that the thromboembolic and atherosclerotic vessels of moyamoya disease might increase thehemodynamic pressure of mandibular bone marrow tissue and subsequently was able to induce SBC.

고립성 골낭종의 치료

김재도,사석진,이덕희 고신대학교 의학부 1997 高神大學校 醫學部 論文集 Vol.12 No.1-2

Simple bone cyst is a true benign lesion of primary intraosseous origin that almost always begins on the metaphyseal side of the epiphyseal plate of long bone in children. The pathogenesis is yet undetermined, but its clinical importance is stressed due to prone to pathologic fracture and high recurrence rate. Regardless the variable methods of treatment have been performed, but there is no an established mode of treatment. Therefore we evaluated the results according to the mode of treatment. We have studied 9 cases of simple bone cyst which where treated from Jun. 1987 to May 1995. The average duration of follow-up was 2 years. 3 cases were treated with curettage and bone graft, and 6 cases were treated with steroid injection. The clinical results were as follows : 1. Age distribution was from 4 years to 13 years (mean age 8.4 years). There were 7 boys and 2 girls. The male to female ratio was 3.5 to 1. 2. Skeletal location was proximal humerus in 5 cases, proximal femur & diatal femur, proximal radius, and proximal ulna in 1 case respectively. 3. In cases of curettage and bone graft, 2 cases were healed, and 1 case was recurred. Then, additional steroid injection was performed. And in 6 cases of steroid injection, 3 cases were healed, 2 cases were improved, and 1 case was recurred. However, all cases were completely healed. 4. There was no difference in the results between treatment of steroid injection and curettage & bone graft. And age, sex, location, and type of the cyst did not seem to influence the results of treatment. In conclusion, the steroid injection is a simple and safe procedure, and more favorable results can be expected than other surgical methods. The steroid injection should be repeated in persisting or recurrent cases, but it is highly recommended as the method of choice in the initial treatment of simple bone cyst without accompanying a pathologic fracture.