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ISSN : 1225-1577(Print)
ISSN : 2384-0900(Online)
The Korean Journal of Oral and Maxillofacial Pathology Vol.39 No.6 pp.657-660

Epidermoid Cyst of the Mandible: a Case Report

Jung-Won Park, Ryun-Ga Kim, Sang-Hwa Roh, Tea-Young Jung, Sang-Jun Park
Department of Oral and Maxillofacial Surgery, Inje University Busan Paik Hospital, Busan, Korea
Correspondence: Sang-Jun Park Department of Oral and Maxillofacial Surgery, Inje University Busan Paik Hospital, Busan, Korea. 75 Bokji-ro, Busan 614-735, Korea Tel: +82-51-6360, Fax:
August 20, 2015 September 16, 2015 September 30, 2015


We report a rare case of intraosseous epidermoid cyst in mandibular body. A non symptomatic patient without trauma history had a cystic lesion on mandible close to the third molar. The lesion was enucleated while extracting of left lower third molar. The microscopic findings were consistent with an epidermoid cyst.

하악골의 유피낭종 : 증례 보고

박 정원, 김 륜가, 노 상화, 정 태영, 박 상준
인제대 부산백병원 구강악안면외과



    Epidermoid and dermoid cysts of head and neck represents only about 7% of the total numbers found in the body1). And only 1.6% involves the oral cavity2). Their intraosseous presentation is extremely rare.


    A 22-year old female patient was referred to our clinic for treatment of cystic lesion on mandible. She had no symptoms, and her orthodontist, who found the lesion on the dental panoramic radiograph (Fig. 1), recommended her to see an oral and maxillofacial surgeon.

    She had no underlying diseases or notable familial histories. On clinical examination, there was no pain, swelling, trismus or neurologic deficiency. On the CT images, there was a cystic lesion sized about 1.5 cm × 0.9 cm × 1.3 cm on the left mandibular body area, which was associated, but separated, with the impacted third molar (Fig. 2). Lingual cortex was expanded and thinned, but not perforated. There was no root resorption. A differential diagnosis of dentigerous cyst or odontogenic keratocystic tumor was made. The cyst was removed after surgical extraction of the left lower third molar (Fig. 3). The cyst was communicated but clearly separated with the tooth socket (Fig. 4). And it was not attached to the tooth. Histopathological examination showed cystic lesion lined by hyperplastic squamous epithelium with lamellated keratin within the lumen (Fig. 5), which was consistent with an epidermoid cyst.


    Epidermoid cysts are considered to be either acquired or congenital.3) Acquired epidermoid cysts are also referred to as ‘implantation cysts’4), and thought to originate from either accidental or surgical inclusion of covering epithelium into deeper tissues5). But our patient had no trauma or surgical history. And the lateral location makes it difficult to suppose it’s congenital. But if ectodermal tissue was included in the mesemchyme during embryogenesis and migrated during mandibular growth, it could be found on other than the midline, though it’s congenital.

    Bodner et el. have explained that metaplasia of dentigerous cysts epithelium is the reason of intraosseous epidermoid cyst6). But in this case, the lesion did neither enclose the crown nor be attached at the cemento-enamel junction of the tooth7). Moreover, dental follicle of this tooth existed independently of the cyst. Based on these findings, there seems to be little chance of the cyst to have originated in the dentigerous cyst.

    The cyst was enucleated thoroughly and the lesion healed well. There are a few reports on epidermoid cysts transforming into malignant tumors8),9),10). Incomplete excision may lead to recurrence of cyst, and the remnants could transform. So, early detection and removal should be emphasized.

    Epidermoid cysts usually involve soft tissues, and intraosseous presentation is extremely rare.

    Stating the importance of each new case of intraosseous epidermoid cyst of the jaws, we report a new case of intraosseous epidermoid cyst affecting the mandible.



    Radiolucent cystic lesion under the left lower third molar(#38) on the dental panoramic radiograph.


    Axial and sagittal view of CT images showing separated cystic lesion on lingual side of mandible. The lingual cortex is expanded and thinned.


    The enucleated cyst.


    RTwo separated cavities; Tooth socket, A and cyst cavity, B.


    Cystic lesion lined by cornified epithelium containing lamellated keratin.



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