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Case Study Project

Oral Pathology- Case 1
Presented by:
Carrie Oubre
Josefina Cottle

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Oral Pathology Case 1

Our case involves a patient who is an 18-year-old male his dentist office for a routine
checkup. A radiograph was taken on the right side of his mandible. During the radiographic
examination a solitary, well-defined radiolucency was noticed. The lesion appears large with
inter-radicular scalloping and circumscribed borders. The location appears around and between
the roots of the adjacent teeth and does not have any effect on those teeth. When questioning the
patient he reported not having any type of pain or discomfort. Patient also stated that while
boxing he received a blow to the lower jaw but patient did not specify which area of his lower
jaw. His vital signs and general medical health are in good state. Based on the clinical and
radiographic evaluations the diagnostic possibilities are as follows: odontogenic keratosis,
primordial cyst, simple bone cyst, ameloblastoma, central giant cell granuloma.
First possible diagnosis is an odontogenic keratosis, which is also known as keratosis
odontogenic tumor. This is a cyst that may occur at any age, from the very young to the very
elderly. In most cases, the mandible is affected more frequently than the maxilla. In the
mandible, the majority of the cysts occur in the ramus-third molar area. The patient usually is
asymptomatic but may have soft tissue swelling, expansion of bone, and pain. The cyst may also
get secondarily infected. Radiographically, most OKCs are unilocular presenting a well-defined
peripheral rim. Scalloping of the border is also a frequent finding.
Second possible diagnosis is the primordial cyst which is at times derived from the
odontogenic keratosis. Clinically, this lesion is asymptomatic. This lesion first starts generating
at an early stage in life but usually is not found until late childhood (between ages: 10 & 30).
This cyst is a rare type that is usually located posteriorly near the 3rd molars or angle of the

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mandible. This lesion is thought to be formed from the disintegration of a tooth follicle before
formation of enamel and the dentin matrix. Due to the degeneration of the tooth germ this cyst
usually appears in an edentulous area and potentially could expand bone and displace teeth. In
other cases, this circumstance could possibly arise from a supernumerary tooth bud. This lesion,
if examined on a radiograph, would appear as a well-demarcated, round or oval radiolucency
with a sclerotic/reactive border and can often times be unilocular or multilocular.
Third posible diagnosis would be the simple bone cyst, also known as traumatic bone
cyst/ hemorrhagic bone cyst. This is a pathologic cavity in the bone that is not lined with
epithelium. Clinically, this lesion does not present any symptoms for the patient and is typically
discovered on routine radiographs. The reason for this lesion occurring in the oral cavity is
uncertain. There have been studies that associate this lesion with trauma. This lesion is also
found in fairly young individuals. Radiographically, this lesion is a well-defined unilocular or
multilocular radiolucent lesion that characteristically shows scalloping around the roots of teeth.
Fourth possible diagnosis is an ameloblastoma; they are benign locally aggressive tumors
that arise from the mandible and less commonly from the maxilla. Ameloblastoma typically
occur as hard painless lesions near the angle of the mandible in the region of the 3rd molar tooth.
Although benign, it is a locally aggressive neoplasm with a high rate or recurrence.
Ameloblastoma are usually associated with dentigerous and unerupted teeth. Radiographically
it is classically seen as a multilocualted "soap-bubble" lesion with well -demarcated borders and
no matrix calcification. Occasionally erosion of the adjacent tooth roots can be seen which is
highly specific. When larger it may also erode through cortex into adjacent soft tissues.

Our fifth and last possible diagnosis is a central giant cell granuloma (CGCG) (also known

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as giant cell reparative cyst / granuloma) occurs almost exclusively in the mandible. It is most
frequently seen in young women and typically presents in the 2nd and 3rd molars. Usually located
in the anterior part of the jaw. Radiographically it begins as a small radiolucent region, and
gradually as it enlarges thin trabeculae of bone become apparent, giving it a honeycomb multilocular appearance. The lesion may demonstrate expansion, root resorption and erosion through
the overlying cortex.

In conclusion, when reviewing the possible diagnoses we have found that the lesion that best
associates with our patient would be the simple bone cyst. Trauma is the usual cause of this type
of cyst and as stated in the case above, the patient reported a blow to the region in question. This
cyst also shows radiographically as scalloping near the roots of the teeth as presented in the case
study. This cyst does not have a true epithelial lining and is not considered a true cyst, but rather
a pseudo cyst. Treatment would involve surgical exploration of the cyst and curettage of the
fluid-filled cavity. The prognosis is usually a favorable one with no reoccurrences of the simple
bone cyst.

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Work Cited/ References

Dr. Frank Gaillard et al. Retrieve from

http://radiopaedia.org/articles/central-giant-cell-granuloma
Dr. Henry Knipe and Dr. Frank Gaillard et al. Retrieved from
http://radiopaedia.org/articles/ameloblastoma
Ibsen, O. A. (2014) Oral Pathology for the Dental Hygienist. St. Louis, Missouri: Linda Duncan
Robert O Greer Jr, DDS. April 30, 2014. Odontogenic Keratocyst Pathology. Retrieved from
http://emedicine.medscape.com/article/1731868-overview#aw2aab6b4
Varun Pandula, DDS. February 9,2012. Primordial Cyst. Retrieved from
http://www.juniordentist.com/primordial-cyst.html