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      A case report of haemorrhagic-aneurismal bone cyst of the mandible

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          Abstract

          Haemorrhagic-aneurismal bone cysts (HABCs) are quite rare, benign, non-neoplastic, expansive, and vascular locally destructive lesions. They are generally considered sequelae of an earlier trauma causing an overflow of blood into the bone. HABCs are classified as pseudocysts and they should be differentiated from true cysts because their treatment is different. Since few of these cysts involve subjective symptoms, most are discovered accidentally during radiography, while a sure diagnosis is likely to be obtained only during surgery, on discovery of a non-epithelialised cavity. Here, we report a typical case of a haemorrhagic-mandibular cyst in a 13-year-old girl, which was treated by opening the cavity and scraping its walls following diagnostic arteriography and post-operative transcutaneous intralesional embolization. No further complications were recorded in the post-operative period, although the convalescence lasted for a time longer than expected, because of anemia. No further surgery was performed. She has been disease-free for two years. Evaluation of intralesional blood flow is important for HABCs because of the hemorrhagic risk in surgery. Embolization seems to be a useful procedure in the treatment of HABCs and could be tried as the treatment modality in the standard protocol for the treatment of HABCs.

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          Most cited references10

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          Root resorption by ameloblastomas and cysts of the jaws.

          Radiographs of 122 cases of a series of nonmalignant simple jaw cysts and ameloblastomas were examined and the frequency of resorption of adjacent tooth roots compared. The ameloblastomas proved to have a root resorptive potential far greater than the cystic lesions considered. Certain statistically significant differences were observed in the root resorption related to the cystic lesions. The dentigerous cyst showed a tendency to resorb roots (55%), whereas in this study no resorption was observed in primordial cysts. These differences may aid the clinician in the preoperative differential diagnosis. It is suggested that the capacity of the dentigerous cyst for root resorption may be the result of its origin from the dental follicle, which is associated with resorption of the roots of primary teeth during normal tooth succession.
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            MR features of aneurysmal bone cyst of the mandible and characteristics distinguishing it from other lesions.

            Aneurysmal bone cyst (ABC) is a relatively rare, non-neoplastic expansile lesion of bone. Bleeding may occur during an operation or biopsy for ABC, as this cyst is an aneurys with numerous pools of blood. Therefore, it is necessary to diagnose ABC before treatment or biopsy. In the present report, we describe the characteristic computed tomography (CT) and magnetic resonance imaging (MRI) features of ABC in the mandible. Based on the literature and on our own experiences, we compare with the features of ABC with the corresponding features of other lesions showing similar conventional radiographic appearances. In the present case, bone-targeting CT showed the characteristic feature, which reflected the histopathological appearance of a partially cystic meshwork divided by coarse septa. MRI showed almost homogeneous intermediate signal intensity, including a partial slight low-signal-intensity area on the T1-weighted image, and homogeneous high signal intensity, which showed a 'bubbly' appearance, on T2-weighted image. On the enhanced T1-weighted image, the intermediate signal intensity areas apart from the areas that showed slight low-signal intensity on the non-enhanced T1-weighted image, were well enhanced. This creates a 'honeycomb' appearance. The 'meshwork' appearance on bone-targeting CT, the 'bubbly' appearance on the T2WI and the 'honeycomb' appearance on Gd-T1WI may be the characteristic features of ABC.
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              Aneurysmal bone cysts of the jaws: clinicopathological features, radiographic evaluation and treatment analysis of 17 cases.

              This article re-evaluates the various clinicopathological presentations and array of radiographic features displayed by aneurysmal bone cysts (ABCs) of the jaws. In this retrospective clinical study, 17 cases of ABCs of the jaws surgically treated during an 11-year period from 1986-1997 are evaluated. The age and sex distribution, diagnostic characteristics, mode of treatment and long-term surgical results are presented and compared with the international literature. Investigation included serial clinical examinations, appropriate radiographic evaluation, CT scans and angiograms when indicated. All the patients had mandibular lesions and were managed by complete surgical curettage of the lesions. Ten were in males (58.8%) and seven (41.2%) in females. The mean age of occurrence was 21.05 years, ranging from 7 to 58 years. Clinical presentation in these patients ranged from an asymptomatic incidental radiographic finding to an expanding, rapidly progressive and destructive lesion resulting in a pathological fracture. Radiographic findings varied from unicystic radiolucencies or moth-eaten radiolucencies to extensive multilocular lesions causing bilateral expansion and destruction of the mandibular cortices. Twelve of the patients (70.5%) could recall a history of trauma. Needle aspiration with a 16 or 18 guage needle was positive, producing syringes full of blood in all but two of the cases (88.2%). Six cases (35.2%) were extremely vascular and had increased rapidly in size, and three required angiographic studies for preoperative diagnosis and differentiation from other vascular entities. Nine of the cases (52.9%) were found in the mandibular angle-ramus area. Four cases (23.5%) required extraoral surgical access for curettage while the remainder were treated intraorally. During the follow-up period, which ranged from 2-11 years, no recurrences have occurred. Restoration of facial symmetry and bone formation has been favourable in all patients, despite the fact that grafts were not used. This 11-year study shows that ABCs present with varied clinicopathological and radiographic features and thus may pose a diagnostic dilemma. As we have not noted any recurrences following surgical curettage of mandibular lesions, we feel that initial surgical resection or bone grafting is not necessary, provided that adequate access and complete curettage can be obtained.
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                Author and article information

                Journal
                Dent Res J (Isfahan)
                Dent Res J (Isfahan)
                DRJ
                Dental Research Journal
                Medknow Publications & Media Pvt Ltd (India )
                1735-3327
                2008-0255
                December 2012
                : 9
                : Suppl 2
                : S222-S224
                Affiliations
                [1 ]Department of Maxillofacial Surgery, Galeazzi Hospital, Milan, Italy
                [2 ]Department of Medical-Surgical Sciences of Communication and Behavior, Section of Maxillofacial and Plastic Surgery, University of Ferrara, Ferrara, Italy
                Author notes
                Address for correspondence: Prof. Francesco Carinci, Department of Medical-Surgical Sciences of Communication and Behavior, Section of Maxillofacial and Plastic Surgery, University of Ferrara, Corso Giovecca 203, 44100 Ferrara, Italy. E-mail: crc@ 123456unife.it
                Article
                DRJ-9-222
                10.4103/1735-3327.109763
                3692178
                23814588
                29aed7ed-4ebe-4071-8ac1-d78be14fb783
                Copyright: © Dental Research Journal

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : October 2012
                : October 2012
                Categories
                Case Report

                Dentistry
                haemorrhagic-aneurysmal cyst,mandible,arteriography,embolization
                Dentistry
                haemorrhagic-aneurysmal cyst, mandible, arteriography, embolization

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