An unusual lesion in the mandible: a puzzling case

Abstract

Clinical Presentation

A 39-year-old African American male patient referred to oral maxillofacial surgery after multiple consultations with outside clinic for incidental finding of right posterior mandibular lesion. Patient had a history of multiple superficial biopsies with inconclusive results. Extraoral examination showed right facial swelling at the level of the mandibular angle. The patient was asymptomatic and without lymphadenopathy. The intraoral examination revealed stable and reproducible occlusion, significant mandibular expansion, and normal mucosal covering.

A panoramic radiograph revealed a well-defined, corticated multilocular radiolucent space-occupying mass with thick straight septa and scalloped borders involving the right mandible. Displacement and thinning of the cortical border of the ramus were noted. IAC is displaced. Multidetector computed tomography scan showed that the lesion occupied the whole buccolingual width of the ramus and body of the mandible. Internal density of the lesion revealed soft-tissue density on the basis of Hounsfield unit.

Differential Diagnosis

The differential diagnoses for the lesion were benign odontogenic or nonodontogenic tumor/cyst or tumor like lesion ameloblastoma, odontogenic keratocyst or brown tumor.

Diagnosis and Management

The biopsy revealed a dense fibrous connective tissue with focal myxoid degeneration and mild chronic inflammation. Due to the history of multiple nonconclusive previous biopsies, a diagnosis of idiopathic bone cavity (IBC) with irregular behavior was provided radiographic monitoring recommended and follow-up showed significant healing.

Discussion/Conclusion

IBC is a benign bone lesion that occurs in the mandible. This condition is characterized by the formation of a cyst-like structure within the bone tissue, which is often asymptomatic and discovered incidentally during radiographic examination.

This case highlights the diagnostic and therapeutic challenges associated with IBC. The clinical presentation of IBC is variable, and the lesion can be easily mistaken for other conditions, such as a tumor or a cystic lesion.

Radiographic imaging is crucial both in diagnosis and follow ups.