Case Report

Chin Med Sci J

2022; 37(2): 164-166
doi:10.24920/003957

Mandibular Buccal Bifurcation Cyst: Report of Two Cases

Yaoran Liu1, Jirong Chen2, Lei Wang1, Kexiong Ouyang1, Luo Huang1*
1
Department of Oral and Maxillofacial Surgery, 2Department of Periodontics, Affiliated Stomatology Hospi-
tal of Guangzhou Medical University, Guangzhou Key Laboratory of Basic and Applied Research of Oral
Regenerative Medicine, Guangzhou 510140, China

ABSTRACT
Mandibular buccal bifurcation cyst is a rare inflammatory odontogenic cyst. We reported two cases who complained
of painful swelling of extraoral soft tissue. Intraoral examination revealed the partially erupted mandibular
first molar. Cone beam computed tomography showed a well-defined cystic lesion surrounding the first molar.
Histopathologic images showed the cyst wall was infiltrated by a large number of plasma cells, neutrophils and
eosinophils, and lined with a thin layer of non-keratinized stratified squamous epithelium. Finally, the two patients
were diagnosed as mandibular buccal bifurcation cyst and treated with cyst enucleation and curettage.

Key words: buccal bifurcation cyst; odontogenic cyst; permanent first molar

INTRODUCTION ter swelling relieved, surgical treatment was performed

Mandibular buccal bifurcation cyst (MBBC) main-
ly occurs in the permanent mandibular first molar,
followed by the permanent second molar, and can
also be found in the premolar of the mandible. To our
knowledge, this typical odontogenic cyst has not been
reported in domestic literature. In this report, we ret-
rospectively analyzed the clinical characteristics, di-
agnosis, and treatment of MBBC of two cases, looking
forward to convering more clinically useful information
about this lesion.
CASE DESCRIPTION
Case 1: A 6-year-old girl with a history of left
cheek swelling for more than 20 days was admitted
to our hospital. An extraoral swelling in her left cheek
and the intraoral partially erupted lower left first molar
were found. However, redness and swelling of mucosa
and gum as well as decayed teeth were not observed.
Cone beam computed tomography (CBCT) showed a
low-density radiolucent cyst located at the buccal side
of the left mandibular first molar, extending to the
germ of the left mandibular second molar (Fig. 1). Af-
under general anaesthesia. A triangular flap was pre-
pared from the mesial side of the mandibular second
deciduous molar to the distal margin of the mandibular
first molar. An osteotomy was carried out in order to
expose the lesion. Then, the cyst was enucleated and
curettaged. The histopathological result of the cyst wall
obtained from the upper 1/3 of the root of the mandib-
ular first molar showed fibrous connective tissue wall
that lined with non-keratinized stratified squamous
epithelium and infiltrated by a large number of plasma
cells, neutrophils and eosinophils (Fig. 2A).
Case 2: An 8-year-old boy with a history of re-
peated swelling and pain in his left cheek for 3 months
and a fistula for 1 month was admitted. The physical
examination showed that his cheek was obviously
swollen with purulent discharge from the buccal fistula.
The intraoral presentation was similar to Case 1. CBCT
showed a low-density lesion located at the buccal side
of the left mandibular first molar where a gutta-percha
tip was filled in (Fig. 3). Under general anesthesia, the
cyst was curettaged. Although no complete cyst wall
was seen, the residual fibrous tissue was scraped for
pathologic examination, which showed fibrous connec-
tive tissue wall that lined with a thin layer of non-ke-

Received June 24, 2021, accepted January 25, 2022, published online April 22, 2022.
*Corresponding author E-mail: ranran02132021@126.com
Vol. 37, No. 2 Chinese Medical Sciences Journal 165

Figure 1. Cone beam computed tomography of the mandible: Axial view (A) showing a low-density lesion located at the
buccal side of the left mandibular first molar extending to the germ of the mandibular second molar (arrow). Coronal view (B,
C) showing the same findings described above (arrows).

permanent mandibular first molars in children, and the

Figure 2. Histological features of Case 1 (A) and Case 2 (B)
under microscope (HE staining, × 50). Fibrous connective
tissue wall that lined with non-keratinized stratified squa-
mous epithelium and infiltrated by a large number of plas-
ma cells, neutrophils and eosinophils (A) and lymphocytes
and plasma cells (B).
ratinized stratified squamous epithelium and infiltrated
by numerous lymphocytes and plasma cells (Fig. 2B).
In combination of symptoms, radiological and
pathological results, the two patients were diagnosed
as MBBC. After operative treatment, they were fol-
lowed up for one and a half years. All symptoms dis-
appeared and radiological images showed normal bone
repair (Fig. 4).
DISCUSSION
The MBBCs of the two cases both occurred in the
clinical, radiographic and histopathological characteris-
tics conformed to the features of MBBC. Therefore, we
established the diagnosis of MBBC.
MBBC is an inflammatory odontogenic cyst that
usually develops on the buccal side of the permanent
first molar of the mandible. The clinical features in-
clude half erupted first molar, swelling of the lower
cheek on the affected side, changed or delayed erup-
tion pattern of the affected tooth, and increased peri-
odontal pocket of the partially erupted tooth[1]. CBCT
is used to display the expansion of the buccal cortical
bone and the direction of tooth root growth. Under mi-
croscope, the cyst wall shows a chronic inflammatory
infiltration and is lined by a non-keratinized stratified
squamous epithelium[1-4].
The treatment of MBBC has undergone major
changes. Initially, the treatment is enucleation of cyst
with extraction of the involved tooth[5,6]. The current
preferred treatment for MBBC is to enudeate the cyst
without removing the tooth affected. Furthermore,
Levarek et al.[7] successfully placed bone grafts as an
adjunctive treatment after cyst enucleation and curet-
tage. In addition, several cases regress without any
treatment, suggesting its potential self-limiting nature,
but this phenomenon is not observed in adults or the

Figure 3. Cone beam computed tomography of the mandible: Axial view (A) showing a low-density lesion located at the
buccal side of the left mandibular first molar where a gutta-percha tip was filled in (arrow). Coronal view (B, C) showing
the same findings described above (arrows).
166 Chinese Medical Sciences Journal
Figure 4. Post-operation radiological images of Case 1 (A) and Case 2 (B). Cone beam computed tomography showing
normal bone repair (arrows).
maxilla[8-10].
The two cases were considered as MBBC based
on clinical, radiographic and histopathological results.
The cysts were curettaged without removing the af-
fected teeth. After one and a half-year postoperative
follow-up, all of the symptoms disappeared and normal
bone repair were discovered.
Conflict of interest
None.
Patient consent
Writen informed consents were obtained from the
guardians of the two reported patients.
Author contributions
Liu YR designed and collected cases, conduced litera-
ture search as well as wrote the manuscript. Chen JR
analyzed pathological results. Wang L collected and
analyzed figures. Ouyang KX provided advice on the
research. Huang L provided advice and revised the
manuscript.
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(Edited by Junying Yao)