Multiple radiolucencies with focal radiopacities in both jaws: a rare case report

Abstract

Clinical Presentation

A 30-year-old Black female patient presented with the chief complaint of “my face is swollen.” The patient had no history of systemic diseases and was otherwise asymptomatic. Panoramic radiograph and cone beam computed tomography study revealed multifocal, multiple multilocular, low attenuation, expansile lesions in the maxilla and mandible in all 4 quadrants. These radiolucencies showed well-defined borders, areas of thinning and disruption of the cortices and scalloping between roots of teeth with areas of loss of periodontal ligament space but no radiographic evidence of resorption or displacement. Foci of irregular shape with high attenuation at apical regions of multiple teeth were noted as well.

Differential Diagnosis

Differential diagnoses included simple bone cysts (SBC) with cemento-osseous dysplasia and brown tumors of hyperparathyroidism.

Diagnosis and Management

Biopsy specimens from right maxilla #4-5 area and left mandible #18-19 area, in March 2020, revealed vital bone and surgically there were empty cavities upon entering both biopsy sites, rendering a diagnosis compatible with SBC for both biopsies. In September 2022, biopsies on right maxilla #5 area and anterior mandible revealed sclerotic vital bone and a benign fibro-osseous lesion. Surgical exploration found empty cavities for both biopsy sites. The patient's blood test showed normal parathyroid hormone and calcium levels, which rule out brown tumors of hyperparathyroidism. A diagnosis of multiple SBCs with benign fibro-osseous lesion favoring cemento-osseous dysplasia was made. Follow-up panoramic and cone beam computed tomography images in April 2023 showed remarkable new bone formation in the cystic cavities that had been surgically entered before, validating the diagnosis and management of this case.

Conclusion

Multiple SBCs has been reported mostly in mandible with slight female predominance. However, multilocular appearance and maxillary location is quite uncommon. The unique and scarce occurrence of multifocal simple bone cysts in both maxilla and mandible presenting with bone expansion merits reporting.