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dental cyst in bone near wisdom teeth bone loss
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dental cyst in bone near wisdom teeth bone loss

A recent pan xray of my daughter's impacted wisdom teeth showed a radiolucent area of right posterior mandibule.
Records show the same on orthodontic pans from 2005 and 2007.(it was not discovered until the recent pan of june 2009)  No change in size of cyst?  The  I cat scan shows what appears to be a cyst and bone loss in the mandibule. The nerve is involved in the lesion.  My daughter is a trumpet player and does not wish to lose feeling in her lip or mouth.  The OMS suggests a biopsy first to do pathology on the cells of the lesion , the other option is to remove the wisdom teeth and see if the cyst goes away, and the third is to do something called marsupilzation.   My concern is after seeing the cat scan and bone loss and nerve involvement is if the biopsy requires drilling through her mandible is there a risk of fracture to the jaw.  How to best proceed.   The OMS said the cyst does not look like cancer because it has remained the same size for 4 years,  he thinks maybe it is a dentigerous cyst or possibly could be a amblastoma (spelling) which would need more treatment because of the recurrence rate.  
Question:  Is the biopsy the best option,  Can a needle biopsy be done instead of drilling?  Risk of fracture?  Risk of nerve damage.
Thank you very much, worried Mom
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Radiographic image can generally formulate sound clinical differential diagnosis. If the lesion is an unilocular radiolucency and well attached to third molar, dentigerous cyst is likely. If the lesion is multilocular rsdiolucency, odontogenic keratocyst or ameloblastoma are like diagnoses. Consultation with an oral pathologist and oral surgeon is advised. Needle biopsy generally does'nt yield sufficient tissue for histopathologic exam.
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