Traumatic bone cyst of the mandible of possible iatrogenic origin: a case report and brief review of the literature

The traumatic bone cyst (TBC) is an uncommon nonepithelial lined cavity of the jaws. Since it was first described by Lucas[1] in 1929, the lesion has attracted a great deal of interest in the dental literature, but its pathogenesis is still not clearly understood [1-3]. Traumatic bone cysts have been reported in the literature under a variety of names: Solitary bone cyst,[3] haemorrhagic bone cyst,[4] extravasation cyst,[5] progressive bone cavity,[6] simple bone cyst[7] and unicameral bone cyst[8]. The multitude of the names applied to this lesion attests to the lack of understanding of the true aetiology and pathogenesis. The term "traumatic bone cyst" is the most widely used today [2,9,10].The lesion is mainly diagnosed in young patients most frequently during the second decade of life [4,11-13]. The sex distribution is reported to be quite even [10,11] or men are affected somewhat more frequently [4,12,14]. The majority of TBCs are located in the mandibular body between the canine and the third molar [4,12,14,15]. The second most common site is the mandibular symphysis. Fewer cases are reported in the ramus, condyle and the maxilla, predominantly in the anterior part [11,14,16]. Clinically, the lesion is asymptomatic in the majority of cases and is often accidentally discovered on routine radiological examination [2,4,12,14,17]. Pain is the presenting symptom in 10% to 30% of the patients [4,11,12]. Other, more unusual symptoms include tooth sensitivity[11,13,14], paresthesia[2,18], fistulas[13], delayed eruption of permanent teeth[19], displacement of the inferior dental canal[2] and pathologic fracture of the mandible [20]. Expansion of the cortical plate of the jaw bone is often noted, usually buccally, resulting in intraoral and extraoral swelling and seldom causing deformity of the face. The adjacent to the lesion teeth are usually vital and there is no mobility, displacement or resorption of their roots [2,4,6,11-13]. On radiological examination, a traumat