Intraosseous Epidermoid Cyst Associated With Impacted Teeth in the Right Mandible

Intraosseous epidermoid cyst (IEC) is a rare benign lesion of the jaw. Its clinical and imaging features closely resemble those of common odontogenic cysts, making diagnosis extremely challenging. The definitive diagnosis relies on postoperative histopathologic examination supplemented by immunohistochemical analysis if necessary.

A 29-year-old female patient presented with cystic lesions in the right mandible. Preoperative CBCT showed a clearly defined, monolocular, low-density shadow in the right mandible accompanied by impacted teeth. The cyst and cyst wall were completely excised via an intraoral approach. During surgery, the cyst cavity contained gray-white, bean dreg-like keratosis. Histopathologic examination confirmed the diagnosis of an epidermoid cyst, characterized by keratinized stratified squamous epithelium without skin appendages lining the cyst wall. No recurrence was observed during postoperative follow-up.

Intraosseous epidermoid cysts of the jaw are extremely rare. Their clinical manifestations and imaging findings are nonspecific and frequently confused with odontogenic cysts and odontogenic keratocysts. Preoperative CBCT can accurately assess the extent and relationship of the lesion with adjacent structures. However, the final diagnosis depends on postoperative histopathologic examination, supplemented by immunohistochemistry as needed. Complete cystectomy via an intraoral approach is a safe and effective treatment with an excellent prognosis.