Imaging Sci Dent.  2012 Mar;42(1):35-39. 10.5624/isd.2012.42.1.35.

Aneurysmal bone cyst of the mandible managed by conservative surgical therapy with preoperative embolization

• An SY

• KMID: 1974405
• DOI: http://doi.org/10.5624/isd.2012.42.1.35

Abstract

A 9-year-old girl visited our hospital, complaining of a rapid-growing and rigid swelling on the left posterior mandibular area. Panoramic radiograph showed a moderately defined multilocular honeycomb appearance involving the left mandibular body. CT scan revealed an expansile, multilocular osteolytic lesion and multiple fluid levels within cystic spaces. Bone scan demonstrated increased radiotracer uptake and angiography showed a highly vascularized lesion. The lesion was suspected as aneurysmal bone cyst (ABC) and preoperative embolization was performed, which minimize the extent of operation and the surgical complication. The lesion was treated by surgical curettage and lateral decortication with repositioning. No additional treatment such as a surgical reconstruction or bone graft was needed. Early diagnosis of ABC is very important and appropriate treatment should be performed considering several factors such as age, surgical complication, and possibility of recurrence.

Keyword

Bone Cysts, Aneurysmal; Mandible; Embolization, Therapeutic

MeSH Terms

Aneurysm
Angiography
Bone Cysts
Bone Cysts, Aneurysmal
Child
Curettage
Early Diagnosis
Embolization, Therapeutic
Humans
Mandible
Recurrence
Transplants

Figure

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  Fig. 1 A. Cropped panoramic radiograph reveals multilocular honeycomb appearance with expansion of cortical bone on the left mandibular body area. B. Coronal contrast enhanced CT scan shows an expansile, multilocular osteolytic lesion with multiple internal septation and multiple fluid levels within cystic spaces at the left mandible. C. The blood-pool (left) and delayed phase (right) reveal an increased radiotracer uptake in the left mandibular body area.

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  Fig. 2 A. Cropped panoramic radiograph shows that the lesion grows largely and the internal septa show multilocular soap bubble appearance five months later. B. Coronal contrast enhanced CT image shows the similar features compared with the previous CT images but enlarged lesion. C. Pre-embolization angiogram demonstrates a highly vascularized lesion (left). Post-angiogram shows occlusion of the feeder vessel (right).

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  Fig. 3 The buccal cortex is decorticated (left) and the inferior alveolar nerve is preserved during curettage (right).

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  Fig. 4 A. Histopathologic examination reveals sinusoidal spaces filled with red blood cells (H&E stain, ×40). B. A multinucleated osteoclast type of giant cell is in fibrous tissue (H&E stain, ×400).

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  Fig. 5 Cropped panoramic radiograph taken 5.7 years after the operation shows a normal bony healing and no recurrence sign.

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