Levarek Rachel E, Wiltz Mauricio J, Kelsch Robert D, Kraut Richard A
Resident, Division of Oral and Maxillofacial Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
Assistant Professor, Division of Oral and Maxillofacial Surgery, Department of Dentistry, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
J Oral Maxillofac Surg. 2014 Oct;72(10):1966-73. doi: 10.1016/j.joms.2014.04.028. Epub 2014 May 4.
The buccal bifurcation cyst (BBC) is a rare inflammatory odontogenic cyst of unknown etiology. It typically develops on the buccal aspect of the permanent mandibular first molar and occasionally on the permanent mandibular second molar in children 4 to 14 years old. Distinct clinical findings of the BBC include involvement of a vital partially or fully erupted mandibular first or second molar, swelling in the affected mandibular molar region, delayed or altered eruption pattern of the involved tooth, and an increase in periodontal pocket depth when the affected tooth is partially erupted. Specific radiographic features include a radiolucent lesion on the buccal aspect of the tooth involving the roots to a variable extent, tilting of the involved molar so that the root apices are toward the lingual cortical plate, an intact periodontal ligament space and lamina dura, a periosteal reaction on the buccal surface, and an intact inferior border of the mandible. The histopathology of the lesion has been described as similar to a radicular or inflammatory odontogenic cyst. Most of the current literature supports simple enucleation and curettage of the cyst without extraction of the involved tooth as the treatment of choice. This report presents 3 cases of BBCs that were treated with enucleation and curettage without extraction of the involved tooth, in addition to a bone graft placed primarily or secondarily as an adjunctive treatment approach to the current therapies.
颊侧分叉囊肿（BBC）是一种病因不明的罕见炎性牙源性囊肿。它通常发生在4至14岁儿童恒牙下颌第一磨牙的颊侧，偶尔也发生在下颌第二磨牙颊侧。BBC的独特临床表现包括累及一颗活力的部分或完全萌出的下颌第一或第二磨牙、患侧下颌磨牙区肿胀、受累牙齿萌出延迟或萌出模式改变，以及当患牙部分萌出时牙周袋深度增加。具体的影像学特征包括牙齿颊侧的透射性病变，不同程度地累及牙根，受累磨牙倾斜使根尖朝向舌侧皮质板，牙周膜间隙和硬骨板完整，颊侧表面有骨膜反应，下颌下缘完整。该病变的组织病理学表现与根端囊肿或炎性牙源性囊肿相似。目前大多数文献支持以单纯囊肿摘除刮治术且不拔除受累牙齿作为首选治疗方法。本报告除了介绍3例采用囊肿摘除刮治术且不拔除受累牙齿的BBC病例外，还介绍了作为当前治疗辅助手段的一期或二期植骨治疗方法。
