An Unusual Representation of an Odontogenic Cyst Engulfing the Inferior Alveolar Nerve

Abstract

This report investigates the growth of an odontogenic cyst around the inferior alveolar nerve (IAN), a crucial vital structure to be approached during oral and maxillofacial surgical procedures. A unique aspect of this case was that the cyst completely engulfed the IAN rather than displacing it and left the patient asymptomatic. Under general anesthesia, complete enucleation of the cyst was performed while the IAN was dissected away. The patient had a temporary neurosensory dysfunction, which they fully recovered from. It is extremely rare for pathological entities to engulf the mandibular canal (MC); however, if the lesion is noninvasive, an excellent prognosis is likely to be expected.

Keywords: enucleation; inferior alveolar nerve; jaw lesions; mandibular canal; odontogenic cyst.

Figure 1. Preoperative orthopantomogram. The radiograph shows a unilocular radiolucent lesion that is related to the lower right molar area and is superimposed on the mandibular canal (white arrow; R, right side).

Figure 2. Preoperative cone-beam computed tomography (coronal view). (A) MC. (B-F) Consecutive cuts show the expansion of the radiolucent lesion, with the MC disappearing inside it. Also, there is focal resorption of the corresponding lingual cortical bone and thinning of the buccal cortex.

MC, mandibular canal

Figure 3. Preoperative cone-beam computed tomography of the mandible (axial view). The axial cut is at the level of the third and second molar-root apexes. The white arrow points to the right mandibular lesion. The dotted arrow points to the resorbed cortical bone on the lingual side.

Figure 4. Histologic sections of the excisional biopsy. (A) The histologic sections revealed nonkeratinized stratified squamous cystic epithelial lining (black arrow). (B) The cystic fibrous connective tissue stroma is infiltrated by mixed inflammatory cells and abundant cholesterol clefts (black arrow; hematoxylin and eosin stain, 4×).

Figure 5. A panoramic view at the one-week post-excisional biopsy and peripheral ostectomy (white arrows). The dotted arrow points to the socket of the previously extracted lower right third molar (R, right side).

Figure 6. A panoramic view at the one-year follow-up. The X-ray shows a significant bone refill (white arrow; R, right side).