Clinical analysis of the treatment of maxillary odontogenic cyst by nasal endoscope fenestration through nasal base / 临床耳鼻咽喉头颈外科杂志

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.

Queratoquistes odontogénicos maxilares en paciente con síndrome de Gorlin. Descripción de un caso y revisión de la literatura / Maxillary odontogenic keratocysts in a Gorlin síndrome patient: Case report and literatura review

Los queratoquistes maxilares son frecuentes en pacientes con síndrome de Gorlin. Su tratamiento es debatido por su alta tendencia a la recidiva. En los últimos años la cirugía endoscópica nasosinusal ha adquirido importancia en el manejo de esta patología. Exponemos en caso de un varón de 16 años afecto de este síndrome con queratoquistes maxilares donde se realiza un abordaje combinado, endonasal y transoral.

Maxillary keratocysts are frequent in Gorlin Syndrome patients. Its treatment is discussed due to the high tendency to recurrence. In the last years the sinonasal endoscopic surgery has become an important tool in the management of this pathology. We report a 16 years old boy with Gorlin Syndrome and maxillary keratocysts treated with a trans-nasal endoscopic and intra-oral combined approach.

Queratoquiste odontogénico: características diagnósticas y tratamiento quirúrgico conservador / Odontogenic keratocyst: diagnostic characteristics and coservative surgical treatment

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

Cisto do ducto nasopalatino: relato de caso / Nasopalatine duct cyst: case report

Introdução: O cisto do ducto nasopalatino é uma lesão não odontogênica com etiologia controversa. No entanto, fatores irritantes, como trauma local e infecções bacterianas, podem estimular o remanescente epitelial do ducto nasopalatino, levando a uma formação cística. Sua predileção ocorre em homens adultos entre a quarta e a sexta décadas. Geralmente é assintomático, sendo detectado por exame de rotina. O objetivo do presente estudo é apresentar e discutir um caso de cisto do Ducto Nasopalatino, analisando-se os aspectos clínicos e imaginológicos da patologia em face, comparando-o com dados provenientes da literatura corrente. Relato de caso: Como resultado este artigo apresenta a abordagem de um caso cirúrgico de cisto do Ducto Nasopalatino em face, assintomático, descoberto em exame imaginológico de rotina, biopsiado e enucleado cirurgicamente, com acompanhamento de 5 anos sem recidiva. Considerações finais: É evidente, portanto, que a literatura ainda não é unânime quanto ao aspecto epidemiológico, contudo, se reafirma a forma de abordagem cirúrgica excisional como tratamento eficaz definitivo. Faz-se necessária, portanto, a análise clínica, imaginológica e histopatológica para a confirmação diagnóstica da lesão. A observação de tais aspectos é de fundamental importância para um tratamento eficaz e definitivo, reduzindo as chances de recidiva... (AU)

Introduction: The nasopalatine duct cyst is a non-odontogenic lesion with controversial etiology. However, irritating factors, such as local trauma and bacterial infections, can stimulate the epithelial remnant of the nasopalatine duct, leading to a cystic formation. Its predilection occurs in adult men between the fourth and sixth decades. It is usually asymptomatic, being detected by routine examination. Objectives: To present and discuss a case of cyst of the Nasopalatine duct, analyzing the clinical and imaging aspects of the pathology in the face, comparing it with data from the current literature. Case Report: As a result, this article presents the approach of a surgical case of Nasopalatine Ducto cyst in the face, asymptomatic, discovered in a routine imaging exam, biopsied and surgically enucleated, with a 5-year follow-up without recurrence. Final considerations: It is evident, therefore, that the literature is not yet unanimous in terms of the epidemiological aspect, however, the form of excisional surgical approach as a definitive effective treatment is reaffirmed. Therefore, clinical, imaging and histopathological analysis is necessary to confirm the diagnosis of the lesion. The observation of such aspects is of fundamental importance for an effective and definitive treatment, reducing the chances of recurrence... (AU)

Odontogenic Keratocyst of the Posterior Maxilla: Report of an Unusual Case

ABSTRACT The odontogenic keratocyst is a developmental odontogenic cyst. It can occur anywhere in the jaws, but it is commonly seen in the posterior part of the mandible. Lesions have a propensity to grow along the internal aspect of the jaws, and clinically observable expansion of bone occurs late. These lesions have a different mechanism of growth as compared with other cysts, and may show varying radiographic appearances. This paper reports a distinctive case of an odontogenic keratocyst in a 33-year-old female patient. The cyst has an unusual radiographic presentation of two unilocular radiolucencies overlapping each other in the left maxillary premolar-molar region. The study also presents a literature review.

Comunicación Buco Sinusal a causa de un Quiste Odontogénico Residual / Oroantral fistula caused by a residual odontogenic cyst

Los quistes odontogénicos se dividen en dos grupos principales de acuerdo a la patogénesis de la entidad. Uno de esos grupos incluye a los quistes radiculares de origen inflamatorio. Nuestra situación es una paciente de sexo femenino que a causa de un molar superior con tratamiento endodóntico la patología quística invadió la cavidad sinusal comprometiendo las estructuras vecinas y al realizar la exodoncia se generó una comunicación bucosinusal con infección de esa entidad patológica. El diagnostico de certeza se confirmó a través de la biopsia previa, y se la intervino bajo anestesia general para la extirpación total de la patología quística (AU)

Quiste bucal mandibular infectado bilateral: reporte de caso estudiado con CBCT / Bilateral mandibular infected buccal cyst: report of a case studied by CBCT

El quiste bucal mandibular infectado (QBMI), también conocido como quiste de bifurcación, es un quiste odontogénico inflamatorio poco frecuente y descripto por primera vez por Stoneman y Worth. Ha sido incluido en la clasificación de la OMS de quistes y tumores odontogénicos en 1992. Este quiste suele darse, específicamente, en pacientes entre 6 y 13 años, y su localización más frecuente son el primer y segundo molar permanente y, eventualmente, segundo premolar. Su fisiopatología sigue sin estar clara y se han propuesto múltiples teorías. Este quiste se observa como una inflamación en el vestíbulo del molar afectado. Los síntomas frecuentes son dolor en el área afectada y supuración, pero también muchos casos permanecen asintomáticos. Radiográficamente se describe como un área radiolúcida circunferencial. El quiste está revestido con un epitelio escamoso no queratinizado con infiltrado inflamatorio de células en el tejido conectivo. La mayoría de las características clínicas e histológicas son similares a las reportadas para los quistes paradentales, de ahí la importancia de un buen diagnóstico radiográfico complementario en base a tomografía computada de haz cónico. Los enfoques conservadores suelen ser el tratamiento de elección, con la enucleación del quiste y el seguimiento del diente afectado (AU)

Mandibular infected buccal cyst (MIBC), also known as bifurcation cyst; it is a rare inflammatory odontogenic cyst first described by Stoneman and Worth. It was included in the WHO classification of cysts and odontogenic tumours in 1992. It usually occurs, specifically, in patients between 6 and 10 years of age and its most frequent location is the first and second permanent molars, and eventually the second premolar. Its pathophysiology remains unclear and multiple theories have been proposed. This cyst is seen as an inflammation in the vestibule of the affected molar. Frequent symptoms are pain in the affected area and suppuration, but many cases remain asymptomatic. Radiographically it is described as a circumferential radiolucent area. The cyst is lined with a nonkeratinized squamous epithelium with an inflammatory cell infiltrate in the connective tissue. Most of clinical and histological characteristics are like those reported for paradental cysts, hence the importance of a good complementary radiographic diagnosis based on cone beam computed tomography. Conservative approaches are usually the treatment of choice, with enucleation of the cyst and monitoring of the affected tooth (AU)

Síndrome de Gorlin-Goltz. Diagnóstico molecular, nuevos tratamientos / Gorlin-Goltz syndrome. Molecular diagnosis, new treatments

Introducción: El síndrome de Gorlin-Goltz o síndrome de carcinoma de nevo basocelular es un desorden hereditario autosómico dominante que predispone principalmente a la proliferación de múltiples carcinomas basocelulares, queratoquistes odontogénicos y defectos del desarrollo, causados por la mutación del gen Patched localizado en el cromosoma 9. Presentación del caso: Se reporta un paciente con características de este síndrome, en la clínica de COMF de la UNAM. El diagnóstico fue basado en los estudios clínicos, imagenológicos y moleculares. Conclusiones: El conocimiento de esta enfermedad puede orientarnos a la sospecha diagnóstica de lesión quística o premaligna en forma oportuna, lo que permite prevenir complicaciones y brindar un tratamiento integral para así mejorar la calidad de vida de este tipo de pacientes (AU)

Introduction: Gorlin-Goltz syndrome or cell-based nevus carcinoma syndrome is an autosomal dominant inherited disorder that predisposes mainly to the proliferation of multiple basal cell carcinomas, maxillary keratocysts and developmental defects, caused by the mutation of the Patched gene located on chromosome 9. Case presentation: A patient with specific characteristics compatible with this syndrome was reported in the COMF Department of the UNAM. The diagnosis was based on clinical studies, radiology and genetic studies. Conclusions: Knowledge of this problem can guide us to the diagnostic suspicion in a timely manner, thus preventing complications, and to provide an improved integral treatment of the quality of life of this type of patients (AU)

Removal of odontogenic keratocyst in maxilla through the Le Fort i osteotomy / Eliminación de queratoquiste odontogénico en el maxilar mediante la osteotomía Le Fort

The odontogenic keratocyst is a lesion with specific clinical and histopathological aspects. The World Health Organization (WHO) in 2017 reclassified it from a tumor to a cyst. It is characterized as a cyst of epithelial development of the jaws, arising from the remains of the dental blade. It represents 3 % to 11 % of all odontogenic cysts and 7 to 11 % of cysts of the gnatic bones. It stands out for its aggressive nature and high relapsing potential. Most of the cases are diagnosed in individuals between 10 and 40 years old, with a mild preference for the masculine gender, occurring more in the mandible. Radiographically, it is radiolucent and well delimited, predominantly unilocular, and may cause displacement of adjacent teeth. The present study aims to report a clinical case of a female 25 years old patient, presenting an intra-osseous lesion in the maxilla (posterior, left side), asymptomatic, with a slight increase in intraoral buccal volume, containing the tooth 28, with a diagnostic hypothesis of Odontogenic Keratocyst. The patient was submitted to the surgical decompression treatment, with cystic fluid puncture, biopsy of the lesion and posterior anatomopathological examination. The enucleation of the tumor was performed using LeFort I osteotomy of maxilla and reconstruction with titanium mesh. There is radiographic evidence of bone repair and lesion reduction. The patient is in periodic follow-up of 4 years and does not present clinical and radiographic signs of relapse. Due to the aggressiveness of the odontogenic keratocyst, the relapse rate is high. The knowledge of the techniques recommended for the treatment of Odontogenic Keratocysts and the clinical and radiographic follow-up of the patient demonstrate a gradual decrease of the lumen of the lesion and suggest local bone neoformation, favoring the prognosis of the case.

El queratoquiste odontogénico es una lesión con aspectos clínicos e histopatológicos específicos. La Organización Mundial de la Salud (OMS) en 2017 lo reclasificó de un tumor a un quiste. Se caracteriza como un quiste de desarrollo epitelial de las mandíbulas, que surge de los restos de la lámina dental. Representa del 3 % al 11 % de todos los quistes odontogénicos y del 7 al 11 % de los quistes de los huesos gnáticos. Se destaca por su naturaleza agresiva y su alto potencial de recaídas. La mayoría de los casos se diagnostican en individuos de entre 10 y 40 años, con una leve preferencia por el sexo masculino, que ocurre más en la mandíbula. Radiográficamente, es radiotransparente y bien delimitado, predominantemente unilocular, y puede causar el desplazamiento de los dientes adyacentes. El presente estudio tiene como objetivo reportar el caso clínico de una paciente de 25 años, que presenta una lesión intraósea en el maxilar (posterior, lado izquierdo), asintomática, con un ligero aumento en el volumen bucal intraoral, que contiene el diente 28, con una hipótesis diagnóstica de queratoquiste odontogénico. El paciente fue sometido al tratamiento quirúrgico de descompresión, con punción de líquido quístico, biopsia de la lesión y examen anatomopatológico posterior. La enucleación del tumor se realizó con osteotomía LeFort I de maxilar y reconstrucción con malla de titanio. Existe evidencia radiográfica de reparación ósea y reducción de la lesión. El paciente se encuentra en seguimiento periódico de 4 años y no presenta signos clínicos ni radiográficos de recaída. Debido a la agresividad del queratoquiste odontogénico, la tasa de recaída es alta. El conocimiento de las técnicas recomendadas para el tratamiento de los queratoquistes odontogénicos, y el seguimiento clínico y radiográfico del paciente, demuestran una disminución gradual del lumen de la lesión y sugieren neoformación ósea local, favoreciendo el pronóstico del caso.

Queratoquiste Odontogénico en un Paciente con Displasia Cleidocraneal: reporte de un Caso / Odontogenic Keratocyst in a Patient with Cleidocranial Dysplasia: case Report

RESUMEN: La displasia cleidocraneal (DCC), es un trastorno autosómico dominante poco común, que involucra principalmente a los huesos que se osifican por vía membranosa; afectando el cierre de fontanelas craneales y el desarrollo de las clavículas, además de anomalías dentales y vertebrales. El objetivo de este manuscrito fue reportar el caso de una paciente con DCC que presentó un queratoquiste odontogénico (QQO) intrasinusal. Presentamos el caso de una paciente de 81 años, diagnosticada en su niñez con DDC, que consultó por un desajuste protésico y molestias en relación a la zona del seno maxilar derecho. Clínicamente se observó desajuste de la prótesis y aumento de volumen de márgenes poco definidos en la zona maxilar derecha, color rosa coral; que se extendía por todo el margen hemimaxilar derecho hasta el fondo de vestíbulo; doloroso a la palpación, con un mes de evolución. Se solicitó CBCT, con el que se pudo verificar la presencia de un desarrollo tumoral de contenido similar a dentículos, ubicado en la totalidad del seno maxilar derecho; extendiéndose hasta el piso de la cavidad nasal y orbitaria. Se estableció la hipótesis diagnóstica de "odontoma compuesto". Se le intervino quirúrgicamente, bajo anestesia general, realizándose una excisión de la lesión; la que era de márgenes definidos, con cambios de coloración en tonos oscuros, con la inclusión de tres piezas dentarias; de aspecto maligno. Se logró enucleación completa, dejando remanente óseo limpio. La pieza fue enviada a estudio histopatológico. En informe histopatológico, describió la presencia de una lesion quistica con pared compatible con queratoquiste.

ABSTRACT: Cleidocranial dysplasia (CCD) is an uncommon autosomal dominant disorder that mainly involves bones that ossify via the membrane, affecting the closure of cranial fontanels and the development of the clavicles, as well as presenting dental and vertebral anomalies. The aim of this manuscritpt was to report a case of a patient with CCD who presented an intrasinusal odontogenic keratocyst.We present an 81-year-old female patient, diagnosed with this syndrome in childhood, who comes to our service for a prosthetic misalignment and discomfort of the right maxillary sinus area. Clinically, there was a mismatch of the prosthesis and an increase in the volume of undefined margins under it, coral pink color, which extended all over the right hemimaxillary margin to the bottom of the vestibule, painful on palpation, with a one month evolution. A CBCT was requested, which revealed the presence of a tumor development with content similar to denticles, located in the entire right maxillary sinus, extending to the floor of the nasal and orbital cavity. The diagnostic hypothesis of "compound odontoma" was established. The patient was operated on in the central ward, under general anesthesia performing the excisional biopsy of the lesion, which showed changes in coloration in dark tones, with defined edges, with the inclusion of three teeth showing malignancy aspects. Complete enucleation was achieved, leaving tumor-free clean bone remnant. In a histopathological report, the presence of a keratocyst wall was described, which is not very compatible given the appearance of the lesion, the presence of the dental pieces included in it, and the behavior of the lesion.

Digital design of functional surgery for odontogenic cyst intruding into maxillary sinus / Desenho digital de cirurgia funcional para cisto odontogênico intrusivo em seio maxilar

Abstract Introduction Traditional Caldwell-Luc approach needs modifications for odontogenic cysts intruding into the maxillary sinus, to preserve sinus mucosa and bony contour. Recently, digital technology has been widely applied to the field of maxillofacial surgery, guiding the surgical plan and improving its accuracy. Objective This study attempted to present and evaluate the functional surgery of odontogenic cysts intruding into the maxillary sinus using a computer-assisted pre-surgical design. Methods Consecutive patients with odontogenic cysts intruding into the posterior part of the maxillary sinus were enrolled. Method I "Bony wall reimplantation method" was performed for large lesions exceeding the zygomatic alveolar crest but without apparent bone destruction of the anterior wall of the sinus, while Method II "bone removal method" was more convenient for small lesions near to the zygomatic alveolar crest. The gap was filled with a pedicled buccal fat pad after lesion removal and all cases were without inferior meatal antrostomy. Results A total of 45 cases were included in the study. 22 were operated using method I while 23 were operated with method II. Operations were completed in 20 min. Pain disappeared in 3.62 days on average, and swelling 6.47 days. Nasal bleeding occurred in 8 patients lasting 1-3 days. Suppurative inflammation was observed in 1 patient, and infection occurred after bone reposition. Other repositioned free bony wall was without resorption in CT images. Conclusions Sinus mucosa and bony wall should be conserved. Preoperative digital design can guide osteotomy effectively during the surgery. Bone reposition is not suitable for suppurative inflammation. The pedicled buccal fat pad is enough for drainage and inferior meatal antrostomy is not necessary.

Resumo Introdução A abordagem tradicional de Caldwell-Luc precisa de modificações para os cistos odontogênicos que se introduzem no seio maxilar, para preservar a mucosa sinusal e o contorno ósseo. Recentemente, a tecnologia digital tem sido amplamente aplicada ao campo da cirurgia maxilofacial, orienta o plano cirúrgico e melhora sua precisão. Objetivo Esse estudo teve como objetivo apresentar e avaliar a cirurgia funcional de cistos odontogênicos intrusivos no seio maxilar utilizando um desenho pré-cirúrgico assistido por computador. Método Foram recrutados pacientes consecutivos com cistos odontogênicos intrusivos na parte posterior do seio maxilar. O método I, "método de reimplante de parede óssea", foi feito em lesões grandes que excediam a crista zigomático-alveolar, mas sem destruição óssea aparente da parede anterior do seio, enquanto o método II, "método de remoção óssea", foi mais conveniente para pequenas lesões próximas à crista zigomático-alveolar. O espaço foi preenchido com um retalho pediculado do corpo adiposo bucal após a remoção da lesão e todos os casos foram feitos sem antrostomia meatal inferior. Resultados Um total de 45 casos foram incluídos no estudo. Vinte e dois foram submetidos à cirurgia utilizando-se o método I, enquanto que 23 foram submetidos ao método II. As operações foram concluídas em 20 minutos. A dor desapareceu em média após 3,62 dias, e o edema, depois de 6,47 dias. Hemorragia nasal ocorreu em 8 pacientes com duração de 1 a 3 dias. Processo supurativa foi observado em 1 paciente ocorrendo após a reposição óssea. Outros retalhos reposicionados livres da parede óssea não mostraram reabsorção em imagens de TC. Conclusões A mucosa sinusal e a parede óssea devem ser preservadas; o desenho digital pré-operatório pode orientar a osteotomia de forma eficaz durante a cirurgia; a reposição óssea não é adequada em processos supurativos. O retalho pediculado de corpo adiposo bucal é suficiente para a drenagem e antrostomia meatal inferior não é necessária.

Quiste odontogénico inflamatorio: aislamiento de Pseudomonas stutzeri. Relevancia diagnóstica / Isolation of Pseudomonas stutzeri from an odontogenic inflammatory cyst: Diagnostic relevance

Pseudomonas stutzeri se encuentra ampliamente distribuido en el medio ambiente, ocupando diversos nichos ecológicos; pero su aparición en procesos infecciosos de interés clínico es el de patógeno oportunista. El aislamiento de P. stutzeri en un quiste inflamatorio odontogénico es un verdadero hallazgo microbiológico que no presenta antecedentes en la bibliografía científica odontológica. En este caso particular, el aislamiento se obtuvo a partir de material quirúrgico proveniente de un quiste odontogénico inflamatorio ubicado en la pieza dentaria 1.2 con necrosis pulpar concomitante. Se emplearon técnicas diagnósticas complementarias como radiografías, tomografías, estudios anatomopatológicos y microbiológicos. Los resultados permitieron clasificar el proceso como quiste inflamatorio infectado con P. stutzeri. La tipificación y la caracterización del perfil de sensibilidad de la cepa aislada permitieron adecuar la terapéutica antibiótica de manera específica. El análisis microbiológico permitió establecer la etiología del proceso infeccioso, la adecuación del tratamiento y el restablecimiento de los tejidos comprometidos.

Pseudomonas stutzeri is distributed widely in the environment, and occupies different ecological niches. However, it is found in clinically relevant infections as an opportunistic pathogen. Isolation of P. stutzeri from an odontogenic inflammatory cyst is an uncommon microbiological finding that has not been reported to date. In the case presented here, the bacterium was isolated from surgical material obtained from excision of an inflammatory odontogenic cyst located in the tooth 1.2, and presenting with concomitant pulp necrosis. Complementary techniques such as radiographs, CAT scans, and histopathological and microbiological studies were used to establish definitive diagnosis. The obtained results allowed classifying the process as an inflammatory cyst infected by P. stutzeri. Biotyping and characterization of the susceptibility profile of the isolated strain allowed adjusting the antibiotic therapy more specifically. The microbiological studies allowed establishing the etiology of the infectious process, adjusting the treatment plan, and re-establishing tissue integrity.

Tumor odontogénico queratoquístico en seno maxilar: reporte de un caso clínico / Keratocystic odontogenic tumor in the maxillary sinus: report of a clinical case

El tumor odontogénico queratoquístico, es una patología que se encuentra asociada a la retención de un órgano dentario, en especial al tercer molar, es reconocido por su potencial destructivo y extenso, erosionando placas corticales que envuelven mucosa y tejidos blandos, la etiología del tumor odontogénico queratoquístico está probablemente relacionada con el desarrollo de la lámina dental (o restos de Serres) y con una mayor recidiva dentro de los tumores odontogénicos, siendo motivo de su reclasificación en el 2005 por la OMS. Se presenta casoclínico de un tumor odontogénico queratoquístico en el seno maxilarderecho, se exponen los métodos utilizados para la exploración clínica,radiológica y el tratamiento quirúrgico elegido.

The keratocystic odontogenic tumor is a condition associated withtooth retention, particularly of the third molar. It is recognized as beingpotentially highly destructive, by eroding cortical plates overlying theoral mucosa and soft tissues. The etiology of keratocystic odontogenictumor is probably related to the development of the dental lamina (orremains of Serres) and the recurrence rate is high compared to that ofother odontogenic tumors, the reason for their reclassifi cation by theWHO in 2005. We present a clinical case of a keratocystic odontogenictumor in the right maxillary sinus, including an explanation of themethods used for clinical and radiological examination, and the chosensurgical treatment.

Application of endoscopy to treat mandibular keratocystic odontogenic tumors

The aim of this study was to evaluate the feasibility of endoscopy to remove keratocystic odontogenic tumors (KCOTs) with virtual 3D mandibular images. Fifteen patients (mean age, 40.27±14.58 years) who underwent endoscopic mandibular KCOT enucleation between May 2009 and October 2009 were included. Virtual 3D mandibular reconstructions derived from computed tomography (CT) imaging were generated for all patients. Recurrence and pathological fracture were evaluated as the primary outcome variables at 1 and 12 months after operation. Secondary infection and inferior alveolar nerve injury were evaluated as the secondary outcome variables at 1 and 6 months after operation. None of the 15 patients exhibited signs of recurrence or pathological fracture after operation. During long-term follow-up, no symptoms of inferior alveolar nerve injury or secondary infection were observed and no signs of recurrence were found in any of the patients. Endoscopy helps surgeons to remove mandibular KCOTs with small incisions. Moreover, endoscopy can provide clear and magnified views and help to avoid damage to the inferior alveolar neurovascular bundle. Therefore, under the support of preoperative virtual 3D mandibular images, the application of endoscopy to remove the tumors should be considered to be a treatment option for KCOTs.

Reclassification and treatment of odontogenic keratocysts: A cohort study

Abstract: The odontogenic keratocyst (OKC) is a recurrent cyst that has been recently reclassified from an odontogenic tumor to an odontogenic cyst. The aim of the present study was to investigate its treatment and address issues related to its association with nevoid basal cell carcinoma syndrome (NBCCS). Lesions from the cohort of patients included in the present study consisted of 40 OKCs, of which 27 lesions were treated by enucleation (GE) and 13 underwent decompression (GD). Complementary treatment occurred in 38 (95%) lesions, of which 10 underwent isolated peripheral ostectomy (GO) and 28 underwent peripheral ostectomy combined with Carnoy's solution (GC). Thirteen lesions were associated with NBCCS (GS), while the others (n=27) were non-syndromic lesions (GnS). The recurrence-free periods (RFP) in the sample groups were compared using the Kaplan-Meier function and log-rank test at a significance level of 5% (p < 0.05) and were used to calculate the cumulative risk of recurrence (CRR) in each postoperative year. During the follow-up period, which had a mean of 43.5 months (range: 12-102 months), six (15%) recurrences were diagnosed. There was no significant difference among the RFP for the compared groups (p > 0.05) or increased CRR for the decompression (15.4%) over five years. Application of Carnoy's solution did not increase the efficacy of the peripheral ostectomy, but was related to a CRR of 0% for the syndromic lesions over five years. Therefore, 1) decompression did not increase the recurrence risk; 2) peripheral ostectomy demonstrated a similar efficacy as the combination with Carnoy's solution; 3) the association of NBCCS did not seem to significantly influence OKC recurrence; and 4) syndromic lesions seem to behave in the same manner as non-syndromic lesions when submitted to complementary treatments.

Tratamiento de marsupialización de un quiste odontogénico inflamatorio en un niño de 5 años con preservación de los gérmenes dentarios permanentes / Marsupialization of a inflammatory dentigerous cyst in a 5-year-old child with preservation of the permanent tooth germs

El quiste radicular ha sido catalogado como un quiste inflamatorio, como resultado de una necrosis pulpar por un proceso de caries, con una reacción inflamatoria periapical. Avanza lentamente y en los primeros estadios puede ser asintomático. Debido a esto pueden tener grandes dimensiones.A continuación, presentamos una situación de un quiste radicular inflamatorio en relación con el segundo molar temporario inferior en un paciente de 5 años de edad. La ortopantomografía muestra una gran radiolucidez unilocular con un borde bien definido en la región periapical del segundo molar temporario inferior que se extiende desde la raíz hasta el primer molar temporario con desplazamientode los gérmenes de los premolares permanentes hacia la basal mandibular del sector derecho.

Tumor odontogénico queratoquístico: revisión bibliográfica y presentación de un caso / Keratocystic odontogenic tumor: review of the literature and report of a case

La Organización Mundial la Salud (OMS) a través del Centro Internacional de Referencia de los Tumores Odontogénicos en su última clasificación 2005, ha decidido incluir al Quiste Odontogénico queratoquístico Paraqueratinizado dentro del grupo de los Tumores Odontogénicos, como Tumor Odontogénico Queratoquístico y ha permanecido el Quiste Odontogénico Queratoquístico Ortoqueratinizado, como una entidad se-parada dentro de los Quistes Odontogénicos ya existente, es decir uno pasa a ser una neoplasia benigna y otro una entidad quística.Los autores presentamos un caso clínico quirúrgico de un tumor Odontogénico Queratoquístico...

O papel do cirurgião plástico na Síndrome de Gorlin / The role of the plastic surgeon in the treatment of Gorlin syndrome

Introdução: A síndrome de Gorlin ou síndrome do nevo carcinoma basocelular é uma doença multissistêmica infrequente, com um potencial de desenvolvimento de anormalidades de amplo espectro, como também de desenvolvimento de outras neoplasias. A mesma é autossômica dominante, com alta penetrância e grande variabilidade de expressão, manifesta-se em todos os grupos étnicos, sendo mais prevalente em caucasianos, e com relação entre os sexos de 1:1. Objetivo: Discorrer sobre esta afecção pouco comentada em nosso meio e que pode estar sendo subdiagnosticada e subtratada tanto pelo cirurgião plástico como pelos demais profissionais supostamente envolvidos. Método: Realizada revisão da literatura selecionando artigos sobre síndrome de Gorlin, no banco de dados da Medline/Pubmed de 2009-2013, e descrição da casuística do serviço do Hospital das Clínicas de Ribeirão Preto - USP. Conclusão: A síndrome de Gorlin é uma síndrome multissistêmica, com um amplo espectro de manifestações e grande potencial de mutilação relacionada principalmente ao tratamento de suas três principais alterações/ características. O cirurgião plástico desempenha papel importante na sua detecção e pode colaborar no tratamento abrangente com seguimento adequado aos seus portadores.

Introduction: Gorlin syndrome or nevoid basal cell carcinoma syndrome is a rare multisystemic disease with a potential to cause a broad spectrum of abnormalities and other cancers. It is an autosomal dominant disease with a high penetrance and large variability of expression, manifesting in all ethnic groups but more prevalent in Caucasians, and presenting at a sex ratio of 1:1. Objective: The aim of this study was to discuss Gorlin syndrome, which is little commented on in the literature , and is possibly being underdiagnosed and undertreated by plastic surgeons and other professionals. Method: A literature review was done by selecting articles about Gorlin syndrome from the Medline/PubMed database from 2009 to 2013, and a case-by-case description from the records of the

Odontogenic Keratocyst of Maxillary Premolar Region: A Case Report.

Odontogenic keratocysts (OKC) are enamel organ or dental lamina derived cysts and are not thought to be associated with any infection. They mainly occur in second and third decades of life. The purpose of this case report is to describe a rare case of OKC in a 10-year-old girl, associated with upper left unerupted maxillary first premolar. It involved maxillary sinus leading to erosion of left orbital floor. It also led to the displacement of adjacent maxillary canine and maxillary left second premolar above the unerupted maxillary left third molar. Due to the aggressive nature of the cyst, it was enucleated and followed-up.

Keratocystic odontogenic tumor: clinicopathological aspects and treatment / Tumor odontogénico queratoquístico: aspectos clínico-patológicos y tratamiento

The keratocystic odontogenic tumor is a benign intraosseous neoplasm derived from remnants of the dental lamina and it occurs with high frequency. Regarding histological characteristics, it has a high recurrence rate which is one of the main therapeutic problems. Also, it presents high local aggressiveness, expressed in cortical expansion, delayed eruption and displacement of teeth, blood vessels and nerves. At present, there are various treatments, being ideal the one which presents the lowest risk of recurrence with low morbidity for the patient. In this review, the main histopathological, clinical and therapeutic aspects of this oral pathology are discussed.

El tumor odontogénico queratoquístico es una neoplasia intraósea benigna que deriva de restos de la lámina dental, y que se presenta con alta frecuencia. Sus características histológicas le confieren una elevada tasa de recidiva, siendo este uno de sus principales problemas terapéuticos. Presenta además una considerable agresividad local, la cual se expresa con la expansión de corticales óseas, retardo en la erupción y desplazamiento de dientes, vasos sanguíneos y nervios. En la actualidad existen diversos tratamientos, siendo el ideal aquel que presente el menor riesgo de recidiva con una baja morbilidad para el paciente. En la presente revisión se discuten los principales aspectos histopatológicos, clínicos y terapéuticos de esta patología oral.