Abstract A cyst which arose in an autogenous iliac
crest bone graft is presented. The cyst developed
unilaterally 8 years following secondary alveolar bone
grafting. The cyst, which was lined by a pseudostrati-
fied ciliated columnar epithelium, is believed to be
the result of implantation of small particles of nasal
epithelium into the bone transplant during the grafting
Keywords Ciliated cyst · Secondary bone grafting ·
The development of a cyst, lined by pseudostratified
ciliated epithelium, in a free bone graft is very rare. To
our knowledge, this has not been reported previously.
Nastri and Hookey  reported a cyst which developed
in the chin area following augmentation of the chin with
a combined bony and cartilaginous graft harvested from
the nose, during a simultaneous nose reduction procedure
15 years earlier.
Surgically induced cysts lined by ciliated epithelium
in the maxillary sinus area are sometimes seen. Apic-
ectomies of maxillary teeth , radical operations on the
maxillary sinus , or midface osteotomies at the LeFort
I, II and III level, are suggested  as possible etiological
factors. The authors suggest that possibly small pieces of
sinus epithelium have been implanted during the operation
from which the ciliated cyst arose. It was lined by a
pseudostratified columnar epithelium.
A 19-year-old male with a bilateral cleft lip and palate was
referred to the Department of Oral and Maxillofacial Surgery by
the treating orthodontist. On a routine X-ray, a pear-shaped radio-
lucency was found in the area of the left maxillary lateral incisor.
Eight years earlier, the patient had undergone a secondary bone
grafting for the repair of the alveolar clefts using autogenous bone
taken from the iliac crest.
The lesion was asymptomatic. The lateral incisor itself was
absent. The central incisor and canine were both vital and there
was no periodontal disease. An examination of the X-rays confirmed
the presence of a pear-shaped radiolucency of 2 cm in diameter in
the transplanted bone in the area of the absent lateral incisor.
There was continuity of the alveolar process shown by a thin bony
bridge underneath the mucosa.
Retrospective examination of the periodic radiographs taken
after the bone grafting procedure, revealed the earliest appearance
of the lesion at 3 1/2 years after bone transplantation (Fig. 1 A).
Five and a half years after transplantation, the cystic radiolucency
had achieved a diameter of 4 mm (Fig. 1B). Seven and a half years
after transplantation, the radiolucency had achieved a maximal
diameter of 2 cm (Fig. 1C).
Under local anesthesia, a mucoperiosteal flap was raised. The
buccal cortical bone was thin but not perforated. The cystic lesion
was removed and the wound was closed directly. Because of the
small size of the cystic cavity, no attempt was made to fill it with
bone or any other bonelike alloplastic material (such as bioglass,
tricalcium phosphate, hydroxyapatite, etc.). The cystic cavity was
completely enclosed by bone. No parts of the roots of the
adjacent teeth were visible within the cavity. The lumen
contained fluid with some cholesterol particles. No cellular atypia
The microscopic examination revealed a cystic lesion lined for
the most part by pseudostratified ciliated columnar epithelium.
The development of a ciliated cyst in a bone transplant
from the iliac crest used in the repair of an alveolar cleft,
is an interesting phenomenon which has not previously
been described. As Sugar et al.  stated, “with a few
C. Lekkas (
) · F. van Hoeken
Hospital Leiden, Department of Oral and Maxillofacial Surgery,
2300 RC Leiden, Postbox 9600, The Netherlands
Tel.: +31-71-5262372, Fax: +31-71-5266766
Department of Oral and Maxillofacial Surgery,
Catholic University of Nijmegen, The Netherlands
Eur J Plast Surg (2001) 24:195–196
C. Lekkas · L. M. H. Smets · F. van Hoeken
Cyst arising in a free bone graft
Received: 26 June 2000 / Accepted: 26 January 2001 / Published online: 12 July 2001
© Springer-Verlag 2001