Manejo de quiste dentígero mandibular de grandes proporciones. Presentación de un caso / Management of a mandibular dentigerous cyst of great proportions. Case presentation

Introducción: El quiste dentígero o folicular es un quiste odontogénico desarrollado frecuentemente en relación con la corona de dientes no erupcionados, con mayor porcentaje de incidencia en terceros molares inferiores. Su gran potencial de crecimiento conduce a asimetrías, parestesia, desplazamiento dentario y hasta transformación neoplásica. Por este motivo, la actitud terapéutica ante el mismo reviste singular importancia. Objetivo: Mostrar el tratamiento por enucleación, en un solo tiempo quirúrgico, con evolución favorable, de un quiste dentígero mandibular de grandes proporciones y con elevado riesgo de fractura mandibular. Presentación del caso: Paciente masculino de 45 años, que acude al Servicio de Cirugía Maxilofacial por aumento de volumen en la región mandibular izquierda; en radiografía panorámica presentaba área radiolúcida unilocular de gran tamaño, que comprometía cuerpo mandibular desde el 33 hasta alcanzar 2/3 de la rama ascendente, asociada a tercer molar retenido desplazado hacia el borde inferior mandibular. Existía además reabsorción de las raíces del 34 y 35. El paciente fue tratado en un solo tiempo quirúrgico con extracciones de dientes afectados, bloqueo intermaxilar previa colocación de férulas Gunning y enucleación del quiste por abordaje cervical, conjuntamente con exéresis del diente asociado. El diagnóstico histopatológico arrojó quiste dentígero. El paciente no sufrió complicaciones y tuvo evolución favorable. Conclusiones: Los quistes dentígeros de no ser diagnosticados a tiempo, pueden ocasionar serias alteraciones. La enucleación en un mismo tiempo quirúrgico, resulta de elección como tratamiento para garantizar la no recurrencia, siempre que se adopten todas las medidas que eviten complicaciones trans y postquirúrgicas(AU)

Introduction: The dentigerous or follicular cyst is an odontogenic cyst that frequently develops in relation to a not erupted tooth crown, with a greater percentage of incidence in the lower third molars. Its great potential growth leads to asymmetries, paresthesia, dental displacement, and even neoplastic transformation. For this reason, the therapeutic behavior with regard to this problem is of great importance. Objective: To show the treatment by enucleation of a mandibular dentigerous cyst of great proportions and elevated risk of mandibular fracture, followed in a single surgical time with a favorable evolution. Case presentation: 45 years old male patient that came to Service of Maxillofacial Surgery presenting an increase in the volume of the left mandibular zone; the panoramic radiography showed an unilocular radiolucent area of a great size, which compromised the mandibular body from tooth 33 up to reaching 2/3 of the ascending branch, associated to a retained third molar displaced to the lower mandibular edge. There was reabsorption of the roots of the 34 and 35 teeth, too. The patient was treated in a single surgical time with removals of the affected teeth, intermaxillary blocking with previous placement of Gunning splints, cyst enucleation by cervical approach, and exerecis of the associated tooth. The histopathological diagnosis showed a dentigerous cyst. The patient presented no complications, and had a favorable evolution. Conclusions: The dentigerous cysts can cause serious alterations when they are not diagnosed on time. The enucleation in a single surgical time is considered an election treatment to guarantee non-recurrence, whether all measures are taken to avoid trans and post-surgical complications(AU)

Aplicabilidade da técnica de cell block na avaliação citológica do conteúdo de lesões de aspecto cístico dos maxilares / Applicability of cell block technique for cytological evaluation of biological material collected from maxillary cystic lesions

INTRODUÇÃO: A busca por novos métodos que auxiliem e simplifiquem de maneira eficaz o diagnóstico de lesões maxilares, cistos e tumores, objetiva beneficiar os pacientes e facilitar a atuação dos profissionais da área de diagnóstico bucal. Além dos dados clínicos, radiográficos e histopatológicos classicamente utilizados nos protocolos de investigação das lesões maxilares, a adaptação de técnicas já consagradas na medicina pode ser de grande valia. A técnica de cell block se propõe a auxiliar nesse processo, pois consiste na análise citológica de materiais, efusões e líquidos, coletados de lesões passíveis de punção aspirativa, como cistos e tumores císticos dos maxilares. OBJETIVO: Demonstrar a aplicabilidade da técnica de cell block para avaliação citológica de material biológico coletado a partir de lesões císticas dos maxilares. RESULTADOS: Das 20 lesões, das quais o conteúdo foi processado pela técnica, a avaliação citológica de cinco casos de tumores odontogênicos ceratocísticos (TOCs) demonstrou a presença predominante de ceratina, sempre com áreas de paraceratina. Nos demais casos (cinco cistos dentígeros, cinco cistos radiculares e cinco cistos residuais) foi observada a presença de hemácias, células inflamatórias e fendas de cristais de colesterol. CONCLUSÃO: A avaliação citológica, a partir da técnica de cell block, foi útil no estabelecimento do diagnóstico diferencial entre TOC e demais lesões estudadas, cistos radicular, residual e dentígero.

INTRODUCTION: The search for new methods that aid and optimize the diagnosis of cystic and tumoral maxillary lesions aims to benefit both patients and professionals from oral diagnosis. In addition to clinical, radiographic and histological findings traditionally used in research protocol for maxillary lesions, the adaptation of widely used medical techniques may be very helpful. The cell block procedure streamlines this process, inasmuch as it consists of cytopathological analysis of materials, liquids and effusions, collected from aspirated lesions such as maxillary cysts and cystic maxillary tumors. OBJECTIVE: To demonstrate the applicability of cell block technique for cytological assessment of biological material collected from cystic maxillary lesions. RESULTS: The cytological evaluation revealed that five out of 20 lesions, whose content had been processed by this technique, were odontogenic keratocystic tumors (TOCs), predominantly with keratin and always with parakeratin areas. In the other cases (five dentigerous, five radicular and five residual cysts) there were erythrocytes, inflammatory cells, and cholesterol clefts. CONCLUSION: The cytological assessment through cell block technique was useful as to establishing the differential diagnosis between TOC and other lesions, radicular, residual and dentigerous cysts.

Queratoquiste odontogénico / Odontogenic keratocyst

El queratoquiste odontogénico constituye un tipo histológico de los quistes odontogénicos del desarrollo cuya mayor incidencia ocurre entre la segunda y tercera décadas de la vida, y puede tener un segundo momento de frecuente aparición hacia la quinta década. Las zonas del tercer molar inferior y el àngulo mandibular son las mayormente afectadas, desde donde la lesión progresa hacia la rama y el cuerpo. Entre los otros quistes odontogénicos este presenta gran importancia debido a la alta tasa de recurrencia ubicada entre el 25 y 60 por ciento además de presentar características histopatológicas que lo diferencian de otras lesiones quísticas. Se reporta un caso en un paciente de sexo femenino, de 33 años de edad, que al examen clínico y radiogràfico, presentó una lesión circunscrita al cuerpo de la mandíbula del lado izquierdo, en el àrea de brote del segundo premolar, radiolucida unilocular. Después de los exàmenes clínicos, radiogràficos e histopatológicos se diagnosticó: queratoquiste odontogénico. Se realizó tratamiento quirúrgico con resultados satisfactorios y sin señales clínicas ni radiogràficas de recidiva hasta el momento, el defecto óseo fue reconstruido con Hidroxiapatita HAP-200 sin reacción adversa al implante(AU)

Odontogenesis keratocyst is a histological type of developmental odontogenic cysts whose incidence occurring between the second and the third decades of life with a potential second appearance in fifth decade. The lower third molars and the mandibular angle areas are the more involved and from there the lesion progresses to branch and body. Among the other types of cysts this is very important due to the high rate of relapse located between the 25 and the 60 percent and by its histopathologic features differentiating it from other cystic lesions. The case of a female aged 33 is presented, which in clinical and radiographic examination had a lesion circumscribed to radiolucent unilocular left mandibular area in the second premolar eruption. After clinical radiographic and histopathologic examinations an odontogenic keratocyst was diagnosed. Surgical treatment was applied with satisfactory results and until now without clinical and radiographic relapse signals(AU)

Cisto nasolabial: apresentação de um caso e descrição em imagens por TC e RM / Nasolabial cyst: presentation of a clinical case with CT and MR images

O cisto nasolabial é um cisto não odontogênico raro que se desenvolve na região inferior da asa nasal, com patogênese ainda incerta. Esta lesão, que possui crescimento lento e dimensões variáveis (1,5-3cm), caracteriza-se clinicamente por uma tumefação flutuante na região do sulco nasolabial ao redor da asa do nariz, causando uma elevação do lábio superior. Seu diagnóstico pode ser feito basicamente pelo quadro clínico e, se necessário, complementando-se com exames auxiliares por imagens. O presente trabalho relata o caso de uma paciente do sexo feminino de 48 anos, que se queixava da presença de uma massa consistente na região da asa esquerda do nariz e cujas características clínicas eram compatíveis com cisto nasolabial. As imagens de TC demonstraram uma formação expansiva com densidade de tecido mole, localizadas na região nasal esquerda medindo cerca de 1,2cm de diâmetro e apresentando contornos nítidos e bem definidos e densidade homogenia ao redor de 50 UH. Já as imagens de RM mostraram uma lesão de aspecto circular localizada em tecido mole, apresentando hiperintensidade nas imagens ponderadas em T1, T2 e no recurso de supressão da gordura, sendo a hipótese diagnóstico de cisto nasolabial, confirmado pelo exame histopatológico depois da cirurgia.

The nasolabial cyst is an uncommon non-odontogenic cyst that develops in the lower region of the nasal ala; its pathogenesis is uncertain. This lesion grows slowly and measures between 1.5 and 3 cm; it is characterized clinically by a floating tumefaction in the nasolabial sulcus, which elevates the upper lip. The diagnosis is based on the clinical findings and, if necessary, image exams. This paper reports a case of a white 48-year-old Brazilian female patient that presented a firm tumor in the left ala of the nose; the clinical features suggested a nasolabial cyst. CT scans revealed an expanding tumor with soft tissue density located in the left ala of the nose. It measured 1.2 cm in diameter and had a clear and well-defined outline; its homogeneous density was about 50 HU. MR images revealed a circular lesion located in soft tissue; T1 and T2 weighted signals were hyperintense, as were images after fat suppression. The diagnosis was a nasolabial cyst, which was confirmed by histopathology after surgery.