ABSTRACT
Objetivo: Relatar o processo de diagnóstico e tratamento de um queratocisto odontogênico (QO) em seio maxilar e a sua importância na investigação e diagnóstico de Síndrome de Gorlin-Goltz (SGG). Relato de caso: Paciente do gênero feminino, 20 anos, apresentou-se no serviço de odontologia encaminhada pela equipe de genética médica para investigar a presença de QO para definição de diagnóstico de SGG. Foi realizada radiografia panorâmica e verificou-se a presença de alterações no trabeculado ósseo em tuberosidade maxilar do lado esquerdo. Por isso, foi solicitada a tomografia computadorizada de seios maxilares e encontrou-se uma lesão bem delimitada, ocupando quase completamente o seio maxilar esquerdo em íntimo contato com a raiz do dente 27. Portanto, foi realizada biópsia incisional da lesão, acompanhada da aspiração do conteúdo. Na aspiração foi obtido um conteúdo de característica caseosa sugestivo de queratina. O laudo histopatológico da lesão foi de cisto odontogênico. Com isso, foram realizados os procedimentos de exodontia do dente 27 e a enucleação da lesão em seio maxilar pela equipe da odontologia e da otorrinolaringologia, respectivamente, em centro cirúrgico. O laudo histopatológico confirmou a presença de QO, assim foi possível confirmar o diagnóstico da SGG pela equipe da genética médica. A paciente não apresentou sinais de recidiva e nem de novos QO após 2 anos do procedimento. Considerações finais: A SGG requer atenção odontológica especial, visto a alta taxa de QO nos pacientes com essa síndrome. Exame odontológico minucioso envolvendo exame clínico e exames radiográficos devem ser realizado nas consultas de seguimento.
Objective: To report the process of diagnosis and treatment of an odontogenic keratocyst (OK) in the maxillary sinus and its importance in the investigation and diagnosis of Gorlin-Goltz Syndrome (GGS). Case report: A 20-year-old female patient presented at the Dentistry and Stomatology service, referred by the Medical Genetics team to investigate the presence of OK to define the diagnosis of GGS. Panoramic radiography was performed and the presence of alterations in the bone trabeculae in the maxillary tuberosity on the left side was verified. For this reason, computed tomography of the maxillary sinuses was also requested and a well-defined lesion was found, occupying almost completely the left maxillary sinus in close contact with the root of tooth 27. Therefore, an incisional biopsy of the lesion was performed, accompanied by puncture of the same. In the puncture, a characteristic caseous content suggestive of keratin was obtained. The histopathological report of the lesion was described by the pathologist as an odontogenic cyst. With this, tooth extraction procedures for tooth 27 and enucleation of the lesion in the maxillary sinus were carried out by the dentistry and otorhinolaryngology teams, respectively, in a surgical center. The histopathological report confirmed the presence of OK, so it was possible to confirm the diagnosis of GGS by the medical genetics team. The patient showed no signs of recurrence or new OK after 2 years of the procedure. Final considerations: GGS requires special dental attention, given the high rate of OK in patients with this syndrome. A thorough dental examination involving clinical examination and radiographic examinations should be performed at follow-up visits.
ABSTRACT
El quiste odontogénico ortoqueratinizado es un quiste odontogénico de desarrollo poco común. Los maxilares son el sitio más común de afectación. Los quistes mandibulares con queratinización, el queratoquiste odontogénico (OKC) y el quiste odontogénico ortoqueratinizado (OOC) son los que han atraído una mayor atención. Se presenta el caso de una paciente de sexo femenino de 34 años de edad, con historia de 2 meses de evolución de tumefacción de crecimiento progresivo en región de seno maxilar izquierdo acompañado de rinorrea mucopurulenta y salida se secreción purulenta por fístula oroantral. Se realiza cirugía bajo anestesia general, se constata una lesión quística de contenido queratínico en seno maxilar cuya histopatología retorna compatible con Quiste odontogénico ortoqueratinizado.
The orthokeratinized odontogenic cyst is an odontogenic cyst of uncommon development. The jaws are the most common site of involvement. Cysts of the jaw with keratinization, the odontogenic keratocyst (OKC), and the orthokeratinized odontogenic cyst (OOC) have attracted the most attention. The case of a 34-year-old female patient is presented, with a 2-month history of progressively growing swelling in the region of the left maxillary sinus accompanied by mucopurulent rhinorrhea and purulent discharge from an oroantral fistula. Surgery is performed under general anesthesia, a cystic lesion with keratin content is verified in the maxillary sinus whose histopathology returns compatible with orthokeratinized odontogenic cyst.
ABSTRACT
El quiste odontogénico ortoqueratinizado es un quiste odontogénico de desarrollo poco común. Los maxilares son el sitio más común de afectación. Los quistes mandibulares con queratinización, el queratoquiste odontogénico (OKC) y el quiste odontogénico ortoqueratinizado (OOC) son los que han atraído una mayor atención. Se presenta el caso de una paciente de sexo femenino de 34 años de edad, con historia de 2 meses de evolución de tumefacción de crecimiento progresivo en región de seno maxilar izquierdo acompañado de rinorrea mucopurulenta y salida se secreción purulenta por fístula oroantral. Se realiza cirugía bajo anestesia general, se constata una lesión quística de contenido queratínico en seno maxilar cuya histopatología retorna compatible con Quiste odontogénico ortoqueratinizado.
The orthokeratinized odontogenic cyst is an odontogenic cyst of uncommon development. The jaws are the most common site of involvement. Cysts of the jaw with keratinization, the odontogenic keratocyst (OKC), and the orthokeratinized odontogenic cyst (OOC) have attracted the most attention. The case of a 34-year-old female patient is presented, with a 2-month history of progressively growing swelling in the region of the left maxillary sinus accompanied by mucopurulent rhinorrhea and purulent discharge from an oroantral fistula. Surgery is performed under general anesthesia, a cystic lesion with keratin content is verified in the maxillary sinus whose histopathology returns compatible with orthokeratinized odontogenic cyst.
ABSTRACT
Objective:To investigate the feasibility and clinical effect of the surgical approach and method of transnasal fenestration under nasal endoscope for the treatment of maxillary odontogenic cyst. Methods:The clinical data of 23 cases with maxillary odontogenic cysts treated by nasal endoscopy through nasal fenestration were retrospectively analyzed. All cases underwent nasal endoscopy and CT examination before the operation. The mucosal membrane of the parietal wall of the cyst was excised through fenestration of the nasal base. The cyst fluid was removed by decompression, and the bony opening of the nasal base was trimmed and enlarged to the edge of the cyst. The intraoperative and postoperative effects were observed. Results:All cases were well exposed under the direct vision of nasal endoscope. The top wall of the cyst was removed to maximize the communication between the cyst cavity and the nasal floor. There were no complications such as nasolacrimal duct injury, turbinate atrophy, necrosis, and facial numbness. All patients were followed up for 6-12 months, and the clinical symptoms gradually disappeared after surgery. The inferior turbinate was in good shape, the cyst cavity was smooth, the cyst wall was determined, and no cyst recurrence was observed. Conclusion:The treatment of odontogenic cyst of maxilla under nasal endoscope through nasal fenestration is convenient. It has less trauma, fewer complications and a satisfactory curative effect, which is worthy of clinical promotion.
Subject(s)
Humans , Maxilla , Retrospective Studies , Odontogenic Cysts/surgery , Endoscopy , Turbinates/surgery , EndoscopesABSTRACT
Odontogenic lesions are a heterogeneous group of diseases that presents differences in their biological behavior and the occurrence of variable inductive interactions. Calcifying odontogenic cyst (COC), or Gorlin's cyst, is a well-recognized example of these lesions. We describe a case of COC with AOT-like areas and highlights its morphological diversity. A 60-year-old pheoderma man presented with a large swelling in the anterior buccal region of the mandible. Panoramic radiography revealed a well-defined, unilocular, radiolucent lesion associated with important root resorption. Complete enucleation of the lesion was performed and the histopathological findings met the criteria for the diagnosis of COC, although the cyst exhibited unusual AOT-like features. The patient has been recurrence free for 6 months after surgery. COCs with AOT-like features are rare, and reflect the multipotentiality and complexity of the inductive effects of the odontogenic epithelium with the ectomesenchyme. Enucleation seems to be the most indicated treatment, similar to classical COC (AU)
As lesões odontogênicas são um grupo heterogêneo de patologias que apresentam diferenças no seu comportamento biológico, e ocorrência de interações indutivas variáveis. O cisto odontogênico calcificante (COC), ou cisto de Gorlin, é um exemplo bem conhecido destas lesões. Descrevemos um caso de COC com áreas adenomatóides e destacamos a sua diversidade morfológica. Paciente do sexo masculino, 60 anos de idade, apresentou um aumento de volume na região anterior da mandíbula. A radiografia panorâmica revelou uma lesão bem definida, unilocular e radiolúcida associada a uma reabsorção radicular importante. A enucleação completa da lesão foi realizada e os achados histopatológicos preencheram os critérios para o diagnóstico de COC, embora o cisto exibisse características adenomatóides pouco usuais. O paciente permanece livre de recidivas durante 6 meses após a cirurgia. Os COCs com características adenomatóides são raros, e refletem a multipotencialidade e complexidade dos efeitos indutivos do epitélio odontogênico com o ectomesênquima. A enucleação parece ser o tratamento mais indicado, semelhante ao COC clássico. (AU)
Subject(s)
Humans , Male , Middle Aged , Pathology, Oral , Surgery, Oral , Odontogenic Cysts , Odontogenic Cyst, CalcifyingABSTRACT
There is a high incidence of chronic periapical periodontitis of deciduous teeth, however, there is a low incidence of the apical cyst. This paper reports a 7-year-old child with deciduous periodontitis caused by chronic periapical periodontitis of deciduous teeth. Through literature review, the etiology, imaging characteristics, diagnosis, differential diagnosis, and treatment methods were discussed to provide the basis for clinical diagnosis and treatment.
Subject(s)
Child , Humans , Cysts , Diagnosis, Differential , Periapical Periodontitis/therapy , Tooth, DeciduousABSTRACT
Background: Glandular odontogenic cyst is an uncommon developmental cyst of odontogenic origin. Till now, around 200 cases have been reported in the English literature, out of which approximately 25 of them are associated with an unerupted tooth. Herein we present a case report of a 7-year-old boy with swelling in the anterior maxillary region which was later diag- nosed as a Glandular odontogenic cyst that mimicked a Dentigerous cyst. Case presentation: A painless swelling was noted in the anterior palatal region. Orthopantamogram was advised which re- vealed a unilocular radiolucency associated with an impacted supernumerary tooth. Provisional diagnosis of Dentigerous cyst was made. The cyst was enucleated in conjunction with peripheral osteotomy. The histopathological examination revealed a cystic capsule with non-keratinized stratified squamous epithelium with 2-4 cell layer thickness, with some areas showing epithelial plaque, microcysts, hobnail cells and few clear cells. Contemplating all the histological features, final diagnosis of Glandular odontogenic cyst was given. Conclusions: The presented case emphasizes the importance of histopathological examination of the unusual and rarely ob- served Glandular odontogenic cyst which can be missed due to similarities with other entities. Recurrence rates being very high, follow up of the cases is imperative.
ABSTRACT
O cisto radicular é uma lesão inflamatória associada à necrose pulpar que ocorre frequentemente em maxila. Objetivo: Descrever um caso cirúrgico detalhado de Cisto Periapical Abscedado. Relato de Caso: paciente gênero feminino, 40 anos, hipertensa, diabética Tipo II, compareceu à clínica queixando-se de dor ao ingerir alimentos frios e quentes na região da maxila, lado esquerdo. Ao exame físico, observou-se destruição coronária e presença de fístula na região do elemento dentário 23. Ao exame radiográfico, observou-se uma área radiolúcida ovalada bem circunscrita com halo radiopaco envolvendo a região apical do elemento dentário 23. Frente ao aspecto clínico e radiográfico, foram sugeridas as hipóteses diagnósticas de abscesso periapical crônico, granuloma periapical ou cisto apical abscedado. Foi realizada a exodontia do elemento 23 seguida de enucleação cística. O diagnóstico histopatológico final foi de cisto abscedado. Após 5 meses de evolução observa-se mucosa íntegra e reparo ósseo alveolar. Conclusão: É imprescindível um exame clínico cuidadoso associado ao exame radiográfico e histopatológico para analisar minuciosamente o caso a fim de oferecer ao paciente melhores condutas de tratamento. O diagnóstico de lesões intraósseas associado ao correto tratamento interrompe a evolução do processo patológico, evita danos maiores e restabelece a condição de saúde dos pacientes... (AU)
The radicular cyst is an inflammatory lesion associated with pulp necrosis that often occurs in the maxilla. Objective: To describe a detailed surgical case of Abscessed Periapical Cyst. Case Report: female patient, 40 years old, hypertensive, type II diabetic, came to the clinic complaining of pain when ingesting cold and hot foods in the left side of the maxilla. On physical examination, coronary destruction and the presence of a fistula in the region of the tooth 23 were observed. The radiographic examination showed a well-circumscribed oval radiolucent area with a radiopaque halo involving the apical region of the tooth 23. In view of the clinical and radiography, the diagnostic hypotheses of chronic periapical abscess, periapical granuloma or abscessed apical cyst were suggested. Element 23 extraction was performed followed by cystic enucleation. The final histopathological diagnosis was an abscessed cyst. After 5 months of evolution, intact mucosa and alveolar bone repair are observed. Conclusion: A careful clinical examination associated with radiographic and histopathological data is essential to systematically analyze the case in order to offer the patient better treatment. The diagnosis of intraosseous lesions associated with the correct treatment interrupts the evolution of the pathological process, avoids further damage and restores the patients' health condition... (AU)
El quiste radicular es una lesión inflamatoria asociada a necrosis pulpar que frecuentemente se presenta en el maxilar. Objetivo: Describir un caso quirúrgico detallado de Quiste Periapical Absceso. Caso Clínico: paciente femenina, de 40 años, hipertensa, diabética tipo II, acudió a la consulta quejándose de dolor al ingerir alimentos fríos y calientes en el lado izquierdo del maxilar. Al examen físico se observó destrucción coronaria y la presencia de una fístula en la región del diente 23. El examen radiográfico mostró un área radiolúcida oval bien delimitada con un halo radiopaco que involucraba la región apical del diente 23. En vista de la clínico y radiográfico, se sugirieron las hipótesis diagnósticas de absceso periapical crónico, granuloma periapical o quiste apical abscesificado. Se realizó la extracción del elemento 23 seguida de enucleación quística. El diagnóstico histopatológico final fue de quiste abscesificado. A los 5 meses de evolución se observa mucosa intacta y reparación del hueso alveolar. Conclusión: Un examen clínico cuidadoso asociado con el examen radiográfico e histopatológico es fundamental para analizar a fondo el caso con el fin de ofrecer al paciente mejores enfoques de tratamiento. El diagnóstico de lesiones intraóseas asociado al correcto tratamiento interrumpe la evolución del proceso patológico, previene mayores daños y restablece el estado de salud de los pacientes... (AU)
Subject(s)
Humans , Female , Adult , Radicular Cyst/surgery , Radicular Cyst/diagnostic imaging , Oral Surgical Procedures , Radicular Cyst/pathology , Treatment OutcomeABSTRACT
Los quistes odontogénicos son lesiones óseas, de carácter benigno, la mayoría asintomáticas, que habitualmente corresponden a un hallazgo radiológico. El tratamiento es quirúrgico y está condicionado por factores como localización, tamaño y la afectación de estructuras vecinas. El objetivo es elegir la modalidad de tratamiento que conlleve el menor riesgo de recurrencia, la mínima morbilidad, y al mismo tiempo la erradicación de la lesión. Siguiendo esta premisa han sido abordados, tradicionalmente, con técnicas abiertas con buenos resultados, pero con el advenimiento y desarrollo de la cirugía endoscópica, se empezó a usar esta técnica en forma exclusiva o en forma mixta para la resección de los quistes odontogénicos, logrando similares tasas de éxito, pero con menores complicaciones y morbilidad posoperatoria. Además, presenta una ventaja respecto del seguimiento para las recurrencias, ya que se pueden controlar endoscópicamente en la consulta ambulatoria. El objetivo de esta revisión es describir el desarrollo del rol de las cirugías endoscópicas para el tratamiento de lesiones odontogénicas maxilares.
Odontogenic cysts are benign bone lesions, most of them asymptomatic, which usually constitute a radiological finding. The treatment is surgical and is conditioned by factors such as location, size and involvement of nearby structures. The objective is to choose the treatment mode that presents the lowest risk of recurrence, the minimum morbidity, and at the same time, the eradication of the lesion. Following this premise, the treatment of these lesions has traditionally been approached with open techniques with good results but, with the advent and development of endoscopic surgery, this technique began to be used exclusively or in a mixed form for the resection of odontogenic cysts, achieving similar rates of surgical success, but with fewer complications and postoperative morbidity. It also has an advantage regarding follow-up for recurrences, since patients can be controlled endoscopically in the outpatient clinic. The objective of this review is to describe the development and role of endoscopic surgery for the treatment of maxillary odontogenic lesions.
ABSTRACT
RESUMEN Introducción: Los quistes dentígeros o foliculares, son quistes odontogénicos de origen epitelial. El quiste dentígero es el más común después del quiste radicular. Siempre está asociado con la corona de un diente en desarrollo, no erupcionado o retenido. Existen muy pocas publicaciones de quistes dentígeros múltiples en la edad pediátrica, y generalmente se presentan solo en la mandíbula. Objetivo: Exponer un caso clínico poco frecuente. Presentación del caso: Se presenta un paciente masculino de 6 años de edad. Clínicamente se observó una tumefacción no dolorosa relacionada con los primeros molares permanentes mandibulares no erupcionados. Radiográficamente presentó un área radiolúcida unilocular relacionada con la corona de 36 y 46 y la cortical ósea preservada. Se realizó la enucleación de ambos procesos quísticos. El diagnóstico inicial dado con los hallazgos clínicos y radiográficos se confirmó mediante el estudio histopatológico, el cual reveló quistes dentígeros. Conclusiones: La ausencia clínica de dientes permanentes en el paciente pediátrico debe ser estudiada radiográficamente para descartar la presencia de lesiones quísticas, como el caso clínico presentado, ya que es una de las causas más comunes en esta población. La completa remoción del quiste dentígero junto con el diente involucrado prevé la recidiva y la posible formación de otras lesiones de comportamiento más agresivo.
ABSTRACT Introduction: Dentigerous or follicular cysts are odontogenic cysts of epithelial origin. The dentigerous cyst is the most common after the root cyst. It is always associated with the crown of a developing, unerupted or retained tooth. There are very few publications of multiple tooth cysts in pediatric age, and they usually occur only in the jaw. Objective: Present a rare clinical case in pediatric ages. Case Presentation: A 6-year-old male patient is presented. Clinically, a non-painful swelling related to the first non-erupted mandibular permanent molars was observed. Radiographically, he presented a unilocular radiolucent area related to the crown of 36 and 46 and the bone cortical was preserved. The enucleation of both cystic processes was performed. The initial diagnosis given with the clinical and radiographic findings was confirmed by histopathological study, which revealed dentigenous cysts. Conclusions: The clinical absence of permanent teeth in the pediatric patient should be studied radiographically to rule out the presence of cystic lesions, such as the clinical case presented, since it is one of the most common causes in this population. Complete removal of the tooth cyst along with the tooth involved foresees recurrence and the possible formation of other lesions of more aggressive behavior.
ABSTRACT
El quiste odontogénico calcificante (QOC) es raro y representa <1% de todos los quistes odontogénicos, pertenece a las lesiones conocidas como "tumores de células fantasma", estos son una familia de lesiones que varían en presentación clínica de quiste o neoplasia sólida, en su comportamiento biológico de benigno a localmente agresivo o metastásico, esta diversidad ha generado extenso debate sobre la clasificación, terminología, manejo y pronóstico de estas patologías. Presentamos el caso clínico de un paciente masculino de 17 años de edad con diagnóstico de quiste odontogénico calcificante asociado a odontoma complejo situado en la región posterior del maxilar, en la literatura existen reportados solo 27 casos de QOC en esa zona. Fue tratado mediante enucleación quirúrgica, curetaje, rotación de almohadilla grasa bucal y colocación de malla de titanio para reconstruir la pared anterior del seno maxilar. El control postoperatorio clínico y radiográfico a 12 meses no muestra recidiva de la lesión además exhibe un excelente resultado funcional y estético, esto nos permite concluir que el tratamiento fue adecuado. Realizamos una revisión de la literatura en Science Direct, PubMed y Biblioteca Cochrane, con objeto de informar las características clínicas, histopatológicas, radiográficas y el tratamiento de estas lesiones.
The calcifying odontogenic cyst (COC) is rare and represents <1% of all odontogenic cysts, it belongs to the lesions known as "ghost cell tumors", these are a family of lesions that vary in clinical presentation of cyst or solid neoplasia, in their behavior biological from benign to locally aggressive or metastatic, this diversity has generated extensive debate on the classification, terminology, management and prognosis of these pathologies. We present the clinical case of a 17-year-old male patient with a diagnosis of calcifying odontogenic cyst associated with a complex odontoma located in the posterior region of the maxilla, in the literature there are only 27 reported cases of (COC) in that area, he was treated by surgical enucleation, curettage, rotation of the buccal fat pad and placement of titanium mesh to reconstruct the anterior wall of the maxillary sinus. The clinical and radiographic postoperative control at 12 months does not show recurrence of the lesion, in addition it exhibits an excellent functional and aesthetic result, this allows us to conclude that the treatment was adequate. We conducted a review of the literature in Science Direct, PubMed and Cochrane, in order to report the clinical, histopathological, radiographic characteristics and the treatment of these lesions.
ABSTRACT
Introduction: The mandibular buccal bifurcation cyst is a rare inflammatory odontogenic cyst that typically develops at the buccal region of the first or second permanent mandibular molars of children aged 6 to 15 years. The tooth involved is vital and shows an increased probing depth on the buccal surface. Radiographically, it is characterized by a unilocular radiolucent area, well circumscribed on the buccal osseous cortical, that it is difficult to visualize on periapical radiography. The diagnosis is primarily clinical and radiographic, and the treatment is usually the cystic enucleation without extraction of the tooth. Objective: To report a case of spontaneous involution of a unilateral mandibular buccal bifurcation cyst. Case presentation: This report describes the clinical and radiographic characteristics of an unusual case of unilateral buccal bifurcation cyst in a 6-year-old patient, presenting as a slight expansion in the buccal region of the first permanent mandibular molar. The treatment of choice was the clinical and radiographic follow-up due to the spontaneous involution of the cyst. There were no recurrences during follow-up and the tooth remained vital and erupted normally. Conclusions: The possibility of spontaneous involution is a characteristic that must always be observed, in order to avoid unnecessary surgical procedures.(AU)
Introducción: El quiste de bifurcación bucal mandibular es un quiste odontogénico inflamatorio poco frecuente que, en general, se desarrolla en la región bucal de primeros y segundos molares mandibulares permanentes en niños de 6-15 años. El diente involucrado es vital y muestra una mayor profundidad de sondeo en la superficie bucal. Radiográficamente, se caracteriza por un área radiolúcida unilocular, bien circunscrita en la cortical ósea bucal, que es difícil de visualizar en la radiografía periapical. El diagnóstico es principalmente clínico y radiográfico y el tratamiento suele ser la enucleación quística sin extracción del diente. Objetivo: Informar un caso de involución espontánea de un quiste de bifurcación vestibular mandibular unilateral. Presentación del caso: Caso inusual de quiste de bifurcación bucal unilateral en un paciente de 6 años, que se presenta como una ligera expansión de la región vestibular del primer molar mandibular permanente. El tratamiento de elección fue el seguimiento clínico y radiográfico debido a la involución espontánea del quiste. No hubo recurrencias durante el seguimiento y el diente permaneció vital y brotó normalmente. Conclusiones: La posibilidad de involución espontánea es una característica que siempre se debe observar para evitar procedimientos quirúrgicos innecesarios(AU)
Subject(s)
Humans , Child , Adolescent , Surgical Procedures, Operative , Odontogenic Cysts/diagnostic imaging , Research ReportABSTRACT
El queratoquiste es una lesión odontogénica benigna de comportamiento agresivo, que deriva probablemente de la lámina dental. Se localiza frecuentemente en la parte posterior del hueso mandibular en la zona del tercer molar, ángulo mandibular y puede progresar hacia la rama y el cuerpo, presentando una asociación directa con órganos dentales retenidos. Existe una amplia variedad de técnicas para el tratamiento de esta lesión, como pueden ser descompresión, marsupialización, enucleación y la resección en bloque, así como también la combinación de estas con métodos coadyuvantes. El interés en esta lesión radica por su elevado índice de recidiva que se estima en un 20-30% en la población en general, sin embargo, en la actualidad se ha optado por el uso de tratamientos conservadores como la marsupialización y la descompresión que han demostrado una mayor efectividad y menor recidiva. Es por esto que tras el tratamiento de las lesiones es importante dar un seguimiento a largo plazo. El objetivo de la publicación es presentar el reporte de un caso clínico de un paciente masculino de 21 años con un diagnóstico de queratoquiste odontogénico tratado con una técnica de descompresión durante cinco meses para su posterior enucleación quirúrgica.Se ha comprobado que el tratamiento de descompresión seguido de enucleación y acompañado de métodos coadyuvantes resulta un manejo terapéutico adecuado para los queratoquistes por demostrar su menor tasa de recidiva y su comportamiento noble con estructuras vitales vecinas. Sin embargo, en todos los casos se debe realizar un seguimiento periódico para prevenir la recurrencia de la lesión.
Introduction: Keratocyst is a benign odontogenic lesion with aggressive behavior, probably derived from the dental lamina. It is frequently located in the posterior part of the mandibular bone in the area of the third molar, mandibular angle and can progress towards the ramus and the body, presenting a direct association with retained dental organs. There is a wide variety of techniques for the treatment of this lesion, such as decompression, marsupialization, enucleation, and en bloc resection, as well as the combination of these with adjuvant methods. The interest in this lesion stems from its high recurrence rate, which is estimated to be 20-30% in the general population, however, at present the use of conservative treatments such as marsupialization and decompression has been chosen. demonstrated greater effectiveness and less recurrence. This is why after treating the lesions it is important to give a long-term follow-up.The objective of the publication is to present the report of a clinical case of a 21-year-old male patient with a diagnosis of odontogenic keratocyst treated with a decompression technique for five months for subsequent surgical enucleation.Conclusion: It has been proven that decompression treatment followed by enucleation and accompanied by adjuvant methods is an adequate therapeutic management for keratocysts as it demonstrates its lower rate of recurrence and its noble behavior with neighboring vital structures. However, in all cases, regular monitoring should be carried out to prevent recurrence of the lesion
Subject(s)
Humans , Male , Young Adult , Odontogenic Cysts/surgery , Odontogenic Cysts/diagnostic imaging , Radiography, Panoramic , Decompression, SurgicalABSTRACT
RESUMEN La aparición de un quiste odontogénico calcificante (QOC) en la región posterior de la maxila es infrecuente; hay pocos informes descritos en la literatura. Presentamos el caso de una paciente de 13 años que presentó una lesión extensa en la maxila izquierda (> 7,5 cm). La radiografía panorámica mostró una lesión radiolúcida unilocular bien delimitada, que se extendía desde el maxilar posterior izquierdo hasta el seno maxilar. La paciente fue sometida a descompresión, seguida de de la extirpación quirúrgica conservadora de la lesión. El análisis histológico de la pieza quirúrgica confirmó el diagnóstico de QOC. Después de un año, no se observaron recurrencias. La paciente permanece en seguimiento regular.
ABSTRACT
Cistos Periapicais são proliferações dos restos epiteliais de Malassez em decorrência do processo desenvolvimento ou inflamatório devido necrose pulpar. Apresenta-se no início de forma assintomática, e dependendo da sua evolução pode levar a expansão da corticais e reabsorção óssea. Ao exame de imagem se apresentam como uma área radiotransparente bem delimitada, circunscrita por halo radiopaco geralmente associado a região apical de uma ou mais unidades dentárias. O objetivo desse trabalho é relatar abordagem cirúrgica de enucleação e curetagem de um cisto periapical em região maxilar(AU)
Periapical cysts are proliferations of the epithelial remains of Malassez due to the development or inflammatory process due to pulp necrosis. It presents at the beginning asymptomatic, and depending on its evolution may lead to cortical expansion and bone resorption. Imaging studies present as a well-defined radiotransparent area, circumscribed by a radiopaque halo generally associated with the apical region of one or more dental units. The objective of this study is to report a surgical approach of enucleation and curettage of a periapical cyst in the maxillary region(AU)
Subject(s)
Radicular Cyst , Radicular Cyst/surgery , Bone Resorption , Odontogenic Cysts , Radicular Cyst/diagnosis , Dental Pulp Necrosis , CystsABSTRACT
Heterotopic polyodontia have been described in most domestic species. Known as a dentigerous cyst but appropriately called heterotopic polyiodontics, it rarely occurs in horses, however it is easily recognized as a congenital defect. The cysts usually associated with this condition contain part or all of dental structures. The heterotopic tooth or dental structure is usually adhered to the temporal bone and surrounded by a secretory membrane, with a accumulation of exudate and draining tract along the proximal pinna or directly over the cyst. This case report describes in a 2.5-year-old female quarter horse, weighing 430 kg, with a heterotopic polyodontia that contained two easily small's identifiable dental structures, presented for evaluation of a chronic intermittent mucopurulent exudate discharge from the right sub-auricular region in the mastoid process of the temporal bone and a drainage tract near the right pinna. The diagnosis is established with clinical, radiographic, ultrasound and confirmed by histopathological examination of the structures removed. The cystic capsule was surgically removed, measuring approximately 3.0 x 2.3 cm in diameter, filled with mucopurulent exudate and containing two dental structures within 0.5 cm in diameter and 0.2 cm in diameter. Microscopic examination revealed a cystic area covered by stratified squamous epithelium with a lympho-histio-plasmatic cell infiltrate in the dermis, which was compatible with heterotopic polyodontia. Postoperatively, there were no neuromotor sequelae and wound healing evolved positively.(AU)
A poliodontia heterotópica tem sido descrita na maioria das espécies domésticas. Conhecido como cisto dentígero, mas apropriadamente denominado poliodontia heterotópica, raramente ocorre em equinos, porém é facilmente reconhecido como defeito congênito. Os cistos geralmente associados a essa condição contêm parte ou toda as estruturas dentarias. O dente heterotópico ou estrutura dentaria é comumente encontrado aderido ao osso temporal e envolvido por uma membrana secretora, com acúmulo de exsudato e trajeto de drenagem ao longo do pavilhão auricular proximal ou diretamente sobre o cisto. Este relato descreve um caso de em um equino,fêmea, quarto de milha, com 2,5 anos de idade, pesando 430 kg, com poliodontia heterotópica que continha duas estruturas dentarias facilmente indentificadas, apresentando um orifício na região sub-auricular direita no processo mastóideo do osso temporal, com secreção mucopurulenta intermitente e crônica, próximo ao pavilhão auricular direito. O diagnóstico foi estabelecido com exame clínico, radiográfico, ultrassonográfico e confirmado pelo exame histopatológico das estruturas retiradas. A cápsula cística foi removida cirurgicamente medindo aproximadamente 3,0 x 2,3 cm de diâmetro, preenchida com exsudato mucopurulento e contendo em seu interior duas estruturas dentárias medindo cerca de 0,5 cm de diâmetro e 0,2 cm de diâmetro. O exame microscópico revelou área cística revestida por epitélio escamoso estratificado com infiltrado linfo-histo-plasmocitário na derme, compatível com poliodontia heterotópica. No pós-operatório não houve sequelas neuromotoras e a cicatrização da ferida evoluiu positivamente.(AU)
La poliodontia heterotópica ha sido descrita en la mayoría de las especies domésticas. Conocido como quiste dentígero, pero apropiadamente llamado poliodontia heterotópica, raramente ocurre en equinos, sin embargo se reconoce fácilmente como un defecto congénito. Los quistes generalmente asociados a esa condición contienen parte o la totalidad de las estructuras dentales. El diente heterotópico o estructura dental se encuentra comúnmente adherido al hueso temporal y rodeado por una membrana secretora, con acumulación de exudado y vía de drenaje a lo largo del pabellón auricular proximal o directamente sobre el quiste. En este informe se describe el caso de una hembra, cuarto de milla, de 2,5 años de edad, con 430 kg de peso, presentando poliodontia heterotópica que contenía dos estructuras dentales fácilmente identificables, con un orificio en la región subauricular derecha en el proceso mastoides del hueso temporal, secreción mucopurulenta intermitente y crónica próximo al oído derecho. El diagnóstico se estableció con examen clínico, radiográfico, ecográfico y se confirmó con el examen histopatológico de las estructuras extirpadas. La cápsula quística se extrajo quirúrgicamente midiendo aproximadamente 3,0 x 2,3 cm de diámetro, rellena con exudado mucopurulento y conteniendo en su interior dos estructuras dentales que medían aproximadamente 0,5 cm de diámetro y 0,2 cm de diámetro. El examen microscópico reveló una zona quística cubierta por un epitelio escamoso estratificado con infiltrado linfo-histo-plasmocítico en la dermis, compatible con poliodontia heterotópica. En el postoperatorio no se produjeron secuelas neuromotoras y la cicatrización de la herida evolucionó positivamente.(AU)
Subject(s)
Animals , Female , Tooth , Dentigerous Cyst/diagnosis , Horses/injuriesABSTRACT
O cisto odontogênico glandular (COG) é o cisto de desenvolvimento mais agressivo e raro dentre todos os odontogênicos, portando características epiteliais glandulares ou salivares. O presente artigo visa retratar uma abordagem mais conservadora para esta importante lesão, no sentido de minimizar a morbidade decorrente da abordagem mais radical. Paciente com 57 anos, leucoderma, assintomático e edêntulo, compareceu ao ambulatório de estomatologia com notável expansão no fundo de saco vestibular e rebordo inferior direito, com tempo indeterminado de evolução. Os exames imaginológicos revelaram uma lesão radiolúcida unilocular extensa e bem delimitada na região anterior da mandíbula. Nas condutas propedêuticas, foi realizada uma punção aspiratória positiva para líquido cístico seguido de biópsia incisional. Diante destes achados, a marsupialização foi realizada no sentido de se conseguir a redução das dimensões lesionais, seguido da enucleação com estectomia periférica após 9 meses. Nos primeiros 2 anos de proservação o paciente mantém- -se sem recidivas e em constante acompanhamento. Conclui-se que o dentista pode preferir o método conservador pela técnica de marsupialização seguida de enucleação na abordagem de extenso cisto odontogênico glandular, desde que haja colaboração do paciente nos cuidados pós-operatórios.
The glandular odontogenic cyst (GOC) is the most aggressive and rare cyst of development among all odontogenics, with glandular or salivary epithelial characteristics. This article aims to portray a more conservative approach to this important lesion, in order to minimize the morbidity resulting from the more radical approach. Patient 57 years-old, leucoderma, asymptomatic and edentulous, attended the stomatology outpatient clinic with a remarkable expansion in the vestibular bag fundus and lower right border, with indeterminate evolution time. Imaging examinations revealed an extensive and well delimited unilocular radiolucent lesion in the anterior region of the mandible. In the propaedeutic procedures, a positive aspiration puncture was performed for cystic fluid followed by incisional biopsy. In view of these findings, marsupialization was performed in order to reduce lesion dimensions, followed by enucleation with peripheral ostectomy after 9 months. In the first 2 years of proservation, the patient remains without relapses and in constant follow-up. It is concluded that the dentist may prefer the conservative method by the marsupialization technique followed by enucleation in the approach of extensive glandular odontogenic cyst, provided there is collaboration of the patient in the postoperative care.
ABSTRACT
O Ceratocisto Odontogênico (CO) é um cisto de desenvolvimento odontogênico relativamente prevalente na população e com caráter eventual de agressividade com crescimento ântero- -posterior insidioso. Trata-se de uma lesão cuja apresentação é extremamente diversa com relação à faixa etária, gênero e aspectos imaginológicos mais prevalentes. O presente trabalho relata o caso de um garoto de 11 anos de idade, portador de uma extensa lesão mandibular, envolvendo desde o dente 33 até o 46, cuja microscopia foi compatível com CO. O artigo aborda toda a conduta propedêutica conduzida pela equipe a nível ambulatorial, bem como a interdisciplinaridade com a ortodontia, possibilitando um desfecho almejado e satisfatório do caso.
Keratocyst Odontogenic (KO) is a cyst of odontogenic development relatively prevalent in the population and with an eventual aggressive character with insidious antero-posterior growth. It is a lesion whose presentation is extremely diverse in relation to age, gender and most prevalent imaging aspects. This paper reports the case of an 11 - year - old boy with an extensive mandibular lesion, evolving from tooth 33 to 46, whose microscopy was compatible with KO. The article deals with all the propaedeutic conduct conducted by the team at the outpatient level, as well as the interdisciplinarity with orthodontics, enabling a desired and satisfactory outcome of the case.
ABSTRACT
The present case report is a case of peripheral dentinogenic ghost cell tumor (PDGCT), an extremely rare solid benign neoplastic variant of calcifying cystic odontogenic tumor of the gingiva mimicking clinically as pyogenic granuloma, fibroma, peripheral ossifying fibroma, and peripheral giant-cell granuloma. A 24-year-old male reported with painless, firm, solitary, sessile, smooth-surfaced, nonulcerative, nonpulsatile, well-defined swelling measuring ≈12 mm × 9 mm in the interdental gingiva of the teeth #13 and #14 extending to the mucogingival junction. Intraoral periapical radiographic showed a normal trabecular pattern with mild radiolucency without bony expansion, periapical lesion, and resorption of the adjacent teeth. The diagnosis was established by histopathologic examination. Very few cases of this entity have been documented in the literature. The present case report aims to document this rare entity and emphasizes on the fact that histopathological examination of every localized gingival growth should be included in the treatment planning to differentiate with other commonly found lesions
ABSTRACT
RESUMEN Introducción: La malignización de quiste dentígero a carcinoma intraóseo primario es infrecuente, poco documentada en la literatura. Corresponde del el 1 por ciento al 2,5 por ciento del total de tumores odontogénicos y es exclusiva de los huesos maxilares. Más común en hombres sobre 50 años de edad. Las características clínicas se asocian a edema, movilidad de piezas dentarias, parestesia, y la mayoría ocurre en ausencia de dolor, características que hacen difícil su diagnóstico y presentan un desafío para los patólogos. Objetivo: Revisar la prevalencia de carcinoma intraóseo primario derivados de quiste dentígero en los últimos 15 años publicados en PubMed Métodos: Se realizó una revisión de la literatura en un periodo que considera los últimos 15 años. Se consultó la base de datos PubMed utilizando los términos: "dentigerous cyst prevalence", "primary intraosseous squamous cell carcinoma", "dentigerous primary intraosseous squamous cell carcinoma". Se incluyeron artículos en inglés y español. De los 217 artículos, se suscribió a 39 para hacer el cruce de datos. Análisis e integración de los resultados: Para reconocer una enfermedad tan agresiva como el carcinoma intraóseo primario derivado de quiste dentígero hay que estudiar sus características clínicas, radiográficas y sintomatología. Su íntima relación con el quiste dentígero, el cual es el más prevalente de los quistes del desarrollo hace fundamental el profundo conocimiento de ambos. El carcinoma intraóseo primario se presenta como un desafío para los clínicos por su baja sintomatología y pobre sobrevida, con un total de 44 823 quistes odontogénicos estudiados, 9806 se diagnosticaron como quistes dentígeros, y 22 se malignizaron a carcinoma intraóseo primario, para un 0,32 por ciento del total. Conclusiones: La malignización de quiste dentígero a carcinoma intraóseo primario tiene una baja incidencia, pero se presenta silente haciendo difícil su diagnóstico precoz. Se recomienda biopsia de protocolo para cada caso de quiste dentígero y así evitar la baja sobrevida que produce el carcinoma intraóseo primario(AU)
ABSTRACT Introduction: Malignancy of dentigerous cyst into primary intraosseous carcinoma is infrequent and scantily documented in the literature. It represents 1 percent to 2.5 percent of the total odontogenic tumors and is exclusive of maxillary bones. It is more common among men aged around 50 years. Its clinical characteristics are edema, tooth mobility and paresthesia, and in most cases an absence of pain. These features hamper its diagnosis and pose a challenge to pathologists. Objective: Review the prevalence of primary intraosseous carcinoma derived from dentigerous cysts as published in PubMed in the last 15 years. Methods: A literature review was conducted of papers published in the last 15 years. The database PubMed was consulted using the following search terms: "dentigerous cyst prevalence", "primary intraosseous squamous cell carcinoma", "dentigerous primary intraosseous squamous cell carcinoma". The papers included were in English or Spanish. Of the 217 papers obtained, 39 were selected for data crossing. Data analysis and integration: Recognition of a condition as aggressive as primary intraosseous carcinoma derived from a dentigerous cyst requires examination of its clinical and radiographic characteristics as well as its symptoms. Its close relationship to dentigerous cyst, the most prevalent of developmental cysts, makes it necessary to gain an accurate and deep understanding of both. Primary intraosseous carcinoma poses a challenge to clinicians due to its low symptomatology and poor survival. Of the total 44 823 odontogenic cysts studied, 9 806 were diagnosed as dentigerous cysts and 22 maligned into primary intraosseous carcinoma, for 0.32 percent of the total. Conclusions: Malignation of a dentigerous cyst into primary intraosseous carcinoma has a low incidence and a silent presentation, which hampers its early diagnosis. Protocol biopsy is recommended for each case of dentigerous cyst to prevent the poor survival caused by primary intraosseous carcinoma(AU)