Buccal bifurcation cyst (paradental cyst) defined by ultrasonography and cone-beam computed tomography

Exploring mandibular buccal bifurcation cysts: a case series and a comprehensive literature review

OBJECTIVE

The objective of this study was to explore the clinical and microscopic findings of mandibular buccal bifurcation cysts (MBBCs) in an original case series and to perform a literature review of this lesion.

STUDY DESIGN

Paraffin-embedded tissue blocks from patients microscopically diagnosed with MBBCs were retrieved from 4 oral and maxillofacial pathology archives. Data, including clinical, radiographic, and microscopic characteristics, treatments used, and follow-up status, were collected from the pathology records.

RESULTS

A total of 23 cases were examined, consisting of 10 male subjects (43.47%) and 13 female subjects (56.52%). The mean age of the subjects was 10.52 years, with a range from 6 to 42 years. The majority involved the first molar, accounting for 19 cases (82.60%), whereas the second molar was affected in 4 cases (17.39%). Only 2 cases presented with bilateral lesions (8.69%), with the remaining 21 cases showing unilateral occurrence (91.30%). Treatment predominantly involved enucleation, utilized in 16 cases (69.56%). The average follow-up period was 6.5 months, ranging from 1 to 27 months.

CONCLUSIONS

This study highlights the diagnostic challenges and treatment considerations associated with MBBC, emphasizing the importance of a conservative approach, particularly in young patients, to preserve dental function and normal facial growth.

Clinical, Radiographic, and Histological Features of Buccal Bifurcation Cysts: A Systematic Review to Aid Accurate Diagnosis and Treatment Decisions

OBJECTIVE

This systematic review delves into the nuanced landscape of buccal bifurcation cysts (BBCs), emphasizing their clinical significance amid the diagnostic challenges in oral and maxillofacial pathology. We trace the evolution of BBC classification from historical perspectives to its current status in the World Health Organization's classification system, aiming to equip dental professionals with crucial insights for accurate diagnosis and effective management.

METHODS

This systematic review (PROSPERO: CRD42023405169) followed PRISMA guidelines to examine the epidemiological characteristics of BBCs. Observational studies were included, while reviews, meta-analyses, and experimental studies were excluded. A comprehensive search across five databases identified eligible studies. Two independent reviewers screened articles, resolving disagreements by consensus or a third reviewer. Data extraction included clinical, histological, and imaging findings. Risk of bias was assessed using Murad's framework for case reports/series and the Newcastle-Ottawa Scale for other study types, with studies rated as low, moderate, or high quality.

RESULTS

The information presented here is crucial for preventing past treatment errors associated with BBC. In addition, this review confirms that BBCs predominantly affect the posterior mandible of pediatric patients and exhibit consistent clinical and histopathological features, aiding in their differentiation from similar maxillofacial lesions. Thus, well-informed clinicians should be able to diagnose BBC and make a proper treatment choice after familiarizing themselves with this review, which will ultimately lead to a favorable prognostic outcome and reduced risk of lesion recurrence.

CONCLUSION

This study provides a comprehensive analysis of BBC, aiming to enhance clinical understanding and ultimately improve patient care.

The use of intraoral ultrasound in the evaluation of the benign lesions in pediatric patients

Ultrasonography (US) or diagnostic sonography is a radiographic technique that uses sound waves with frequencies higher than 20 kHz to demonstrate soft tissues such as muscles, internal organs, joints, and tendons. The US has various applications in dentistry such as cervical lymph node examination, salivary gland examination, periodontal examination, maxillofacial fracture examination, temporomandibular joint examination, and orofacial swelling examination. One of the most important advantages of the US is it does not produce any ionizing radiation. Since the US does not produce any ionizing radiation, it is a favorable technique especially for the patients who are susceptible to ionizing radiation such as pregnant patients and pediatric patients. In this article, we presented benign tumor lesions that were examined with the US in children and conducted a review of the literature.

Current Perspectives on Paradental Cyst: A Literature Review

Paradental cyst (PC) is an uncommon type of odontogenic cyst of inflammatory origin, which develops near the cervical margin of the outside of the root of a vital tooth. The category of paradental cyst includes the buccal bifurcation cyst, which is found in the buccal area adjacent to the mandibular first or second molars in children. A conclusive diagnosis of a PC needs to correlate the surgical, radiographic, and histologic findings. When strict diagnosis is neglected, they can be easily misdiagnosed and mistreated. PCs associated with mandibular first and second molars and those associated with the mandibular third molar may have slightly different clinical manifestations but have almost completely different treatment principles due to the distinction in location. For the third molars, removal of both the tooth and the cyst is preferred. However, when the first or second molars are affected, it may be advisable to perform enucleation of the lesion while preserving the associated tooth. There are also more conservative methods to retain vital permanent teeth within the mandibular arch. Additionally, the cyst wall primarily consisted of granulation tissue firmly attached to the periodontal ligament space. The exact origin of these cysts was a subject of ongoing debate, but they were believed to primarily arise from either the reduced enamel epithelium or the inflammatory proliferation of junctional/sulcular epithelium, which originate from the superficial mucosa during tooth eruption. The aim of the present review was to update information on clinical manifestations, diagnosis and treatment strategies of cysts and discuss their pathogenic mechanisms. Raising familiarity with the distinctive features is beneficial for accurately diagnosing these lesions and effectively caring for the patients.