The Buccal Bifurcation Cyst Enigma- A Case Report

Introduction: The buccal bifurcation cyst (BBC) has proven to be an enigma while diagnosing cystic mandibular lesions in children. It is usually confused with entities such as Dentigerous cyst, residual cyst, etc. Only after a thorough histopathologic examination can it be rightly diagnosed. Case Presentation: A six year old boy reported with a mandibular swelling on the right side of the jaw. It was non- tender on palpation. RVG showed a normally developing tooth 46 with normal alveolar bone. Further investigations - Ortho pantomogram (OPG) and Cone-beam computed tomography (CBCT) suggested the presence of a well- circumscribed cystic lesion with respect to the tooth 46. A conservative surgical enucleation of the lesion under local anesthesia was planned. Management: After administering local anesthetic to achieve inferior alveolar nerve block, a muco-periosteal flap was raised in the area of interest to remove the cystic contents and lining. Flap closure was done followed by suturing and Coe-Pak dressing. The patient reported for regular follow up appointments till two years, which yielded that the surgical site and bone defect were healed with subsequent apical closure of the roots of tooth 46. Conclusion: Meticulous diagnosis protocol and treatment planning are the mainstays of satisfactory treatment delivery in BBC. If not diagnosed properly, it may lead to the unnecessary extraction of the developmentally important first permanent molars.