Queratocisto odontogênico: uma abordagem cirúrgica

O queratocisto odontogênico é uma neoplasia benigna onde lesões únicas ou múltiplas são encontradas em ossos ou cavidades. O objetivo deste trabalho é relatar um caso clínico de uma lesão de queratocisto odontogênico, evidenciando corretos diagnóstico e terapêutica. O relato de caso trata-se de um paciente de 32 anos, sexo feminino, melanoderma, que deu entrada à faculdade de odontologia da Universidade Federal de Mato Grosso do Sul, no ano de 2017, apresentando lesão radiolúcida com halo esclerótico em região de ângulo de mandíbula do lado esquerdo, sem envolvimento de dentes e/ou raízes adjacentes. Foi realizada uma tomografia computadorizada, constando hipótese diagnóstica radiográfica da mencionada patologia. O plano de tratamento adotado preconizou uma intervenção conservadora de descompressão e acompanhamento pós-operatório. A paciente se encontra em pós-operatório de 19 meses cirúrgico sem queixas álgicas e/ou funcionais.Descritores: Cistos Ósseos; Descompressão; Terapêutica.ReferênciasShuster A, Shlomi B, Reiser V, Kaplan I. Solid keratocystic odontogenic tumor report of a non agressive case. J Oral Maxillofac Surg. 2012;70(4):865-70.Tsukamoto G, Sasaki A, Akiyama T, Ishikawa T, Kishimoto K, Nishiyama A, et al. A radiologic analysis of dentigerous cysts and odontogenic keratocysts associated with a mandibular third molar. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;91(6):743-47.Chan JKC, El-Naggar AK, Grandis JR, Takata T, Slootweg PJ. Who classification of head and neck tumours. World Health Organization 2017, 4th edition.Wright JM, Vered M. Update from the 4th edition of the world health organization classification of head and neck tumours: odontogenic and maxillofacial bone tumors. Head Neck Pathology. 2017; 11(1): 68-77.Gil JN, Rau Lh, Manfro R, Gasperini G, Dunker C, Chiarelli M. Ceratocisto odontogênico - caso clínico. Rev Port Estomatol Med Dent Cir Maxilofac. 2003;44(3):59-69.Regezi JÁ, Sciubba JJ. Patologia bucal: correlações clinicopatológicas. 3. ed. Rio de Janeiro: Guanabara Koogan; 2000.Larsen PE. Marsupialization for odontogenic keratocysts: Long-term follow-up analysis of the effects and changes in growth characteristics. 2002;94(5):543-53.Gambhir A, Rani G. Conservative management of keratocystic odontogenic tumour with enucleation, excision of the overlying mucosa and electrocauterization: a case report. West Indian Med J. 2014;63(7):775-78.Núñez-Urrutia S, Figueiredo R, Gay-Escoda C. Retrospective clinicopathological study of 418 odontogenic cysts. Med Oral Patol Oral Cir Bucal. 2010;15(5):e767-73.González-Alva P, Tanaka A, Oku Y, Yoshizawa D, Itoh S, Sakashita H, et al. Keratocystic odontogenic tumor: a retrospective study of 183 cases. J Oral Sci. 2008; 50(2):205-12.Jones AV, Craig GT, Franklin CD. Range and demographics of odontogenic cysts diagnosed in a UK population over a 30-year period. J Oral Pathol Med. 2006;35(8):500-7.Zhao YF, Wei JX, Wang SP. Treatment of odontogenic Keratocysts: a follow-up of 255 Chinese patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endodo. 2002;94(2):151-56 .Meara JG, Shah S, Li KK, Cunningham MJ. The odontogenic keratocyst: a 20-year clinicophatologic review. Laryngoscope. 1998;108(2):280-83Kulkarni GH, Khaji SI, Metkari S, Kulkarni HS, Kulkarni R. Multiple keratocysts of the mandible in association with Gorlin-Goltz syndrome: A rare case report. Contemp Clin Dent. 2014;5(3):419-21.Speight PM, Takata T. New tumour entities in the 4th edition of the world health organization classification of head and neck tumours: odontogenic and maxillofacial bone tumours. Virchows Arch. 2018;472(3):331-39.Wright JM. The odontogenic keratocyst: orthokeratinized variant. Oral Surg. 1981;51(1):609-18.Hupp JR, Ellis III E, Tucker MR. Cirurgia oral e maxillofacial contemporânea. 5. ed. Rio de Janeiro: Elsevier; 2009.Dammer R, Niederdellmann H, Dammer P, Nuebler-Moritz M. Conservative or radical tretment of keratocysts: a retrospective review. Br J Oral Maxillofac Surg. 1997;35(1):46-8.Browne RM. The pathogeneses of odontogenic cysts: a review. J Oral Pathol. 1975;4(1):31-46.de Molon RS, Verzola MH, Pires LC, Mascarenhas VI, da Silva RB, Cirelli JA et al. Five years follow-up of a keratocyst odontogenic tumor treated by marsupialization and enucleation: A case report and literature review. Contemp Clin Dent. 2015;6(Suppl 1):S106-10.Neville BW, Damm DD, Allen CM, Bouquot JE. Patologia oral e maxilofacial. 3.ed. Rio de Janeiro: Elsevier; 2009.de Souza LB, Gordón-Núñez MAG, Nonaka CFW, de Medeiros MC, Torres TF, Emiliano GBG. Odontogenic cysts: Demographic profile in a Brazilian population over a 38-year period. Med Oral Patol Oral Cir Bucal. 2010;15(4):e583-90.EL-Gehani R, Orafi M, Elarbi M, Subhashraj K: Benign tumours of orofacial region at Benghazi, Libya: a study of 405 cases. J Craniomaxillofac Surg 2009;37(7):370-75.Moura BS, Cavalcante MA, Hespanhol W. Tumor odontogênico ceratocístico. Keratocystic odontogenic tumor. Rev Col Bras Cir. 2016;43(6):466-71.Kaczmarzyk T, Mojsa I, Stypulkowska J. A systematic review of the recurrence rate for keratocystic odontogenic tumour in relation to treatment modalities. Int J Oral Maxillofac Surg. 2012;41(6):756-67.Lima GM, Nogueira RLM, Rabenhorst SHB. Considerações atuais sobre o comportamento biológico dos queratocistos odontogênicos. Rev Cir Traumatol Buco-Maxilo-fac. 2006;6(2):9-16.Madras J, Lapointe H. Keratocystic odontogenic tumour: reclassification of the odontogenic keratocyst from cyst to tumour. J Canad Dent Assoc. 2008; 74(2):165-165h.

Queratocisto odontogênico: relato de caso

O queratocisto compreende um cisto odontogenico que surge dos restos da lâmina dentaria associado a alterações genéticas no gene PTCH1, aumento expressão PCNA, Ki-67, extinção de vários genes supressores tumorais. Apresenta comportamento agressivo, invasivo, altamente redicivante e com potencial de malignização. Este relato de caso tem como objeto apresentar tratamento conservador de um queratocisto odontogenico. Paciente sexo feminino, leucoderma, 19 anos, encaminhada ao ambulatório do serviço Cirurgia e Traumatologia Bucomaxilofacial, com queixa de dormência do lábio inferior, associado dor em região mandibular direita. Foi diagnosticada com queratocisto odontogenico, onde foi submetida enucleação com piezocirurgia associado a cauterização química sob anestesia geral. O tratamento proposto foi efetivo até atual momento, a neoformação óssea é evidenciada, ausência de sinais clínicos e radiográficos de recidiva. Porém é necessário um acompanhamento a longo prazo para constatação da ausência de recidiva.Descritores: Patologia Bucal; Cistos Ósseos; Cirurgiões Bucomaxilofaciais.ReferênciasNeville BW, Damm DD, Alen CM, Bouquot JE. Patologia oral e maxilofacial. Rio de Janeiro: Elsevier; 2009.Stoelinga PJW. Keratocystic odontogenic tumour (KCOT) has again been renamedodontogenic keratocyst (OKC). Int J Oral Maxillofac Surg. 2019;48(3):415-16.Philipsen H.P. Tumor odontogenico queratocistico. In: Barne L, Eveson JA, Reichart P, Sindrasky D. Genetica e Patologia dos Tumores de Cabeça e Pescoço. São Paulo: Santos; 2009.Marin S, Kirnbauer B, Rugani P, Mellacher A, Payer M, Jakse N. Theeffectiveness of decompression as initial treatment for jaw cysts: A 10-yearretrospective study. Med Oral Patol Oral Cir Bucal. 2019;24(1):e47-52.Ali IK, Karjodkar FR, Sansare K, Salve P, Dora A, Goyal S. Nevoid Basal CellCarcinoma Syndrome - Clinical and Radiological Findings of Three Cases. Cureus.2016;8(8):e727.Alchalabi NJ, Merza AM, Issa SA. Using Carnoy's Solution in Treatment ofKeratocystic Odontogenic Tumor. Ann Maxillofac Surg. 2017;7(1):51-6.Díaz-Belenguer Á, Sánchez-Torres A, Gay-Escoda C. Role of Carnoy’s solution in the treatment of keratocystic odontogenic tumor: a systematic review. Med Oral Patol Oral Cir Bucal. 2016;21(6):e689-95.Tonietto L, Borges HOI, Martins CAM, Silva DN, Sant'Ana Filho M. Enucleation and liquid nitrogen cryotherapy in the treatment of keratocystic odontogenic tumors: a case series. J Oral Maxillofac Surg. 2011;69(6):e112-17.Freitas R, Moraes PC. Cirurgia dos Cistos da região Bucomaxilofacial. In: Freitas Rd et al. Tratado de Cirurgia Bucomaxilofacial. São Paulo: Santos; 2006.Consolaro MFM-O, Sant' Ana E, Moura Neto G. Cirurgia piezelétrica ou piezocirurgia em Odontologia: o sonho de todo cirurgião. Rev Dent Press Ortodon Ortop Facial . 2007;12(6):17-20.Scarano A, Carinci F, Lorusso F, Festa F, Bevilacqua L, Santos de Oliveira P, Maglione M. Ultrasonic vs drill implant site preparation: post-operative pain measurement through VAS, swelling and crestal bone remodeling: a randomized clinical study. Materials (Basel). 2018;11(12):2516.Medawela RMSHB, Jayasuriya NSS, Ratnayake DRDL, Attygalla AM, Siriwardena BSMS. Squamous cell carcinoma arising from a keratocystic odontogenic tumor: a case report. J Med Case Rep. 2017;11(1):335.

Huge keratocystic odontogenic tumour in medically compromised patient–a management dilemma

<p class="abstract">Keratocystic odontogenic tumour (KCOT) is a cystic lesion of the jaws with tumour behaviour. Its high prevalence rate makes it one of the commonest cystic lesions especially involving the lower jaw. The characteristic histologic features and aggressive nature corresponds to the high recurrence rate associated with KCOT. Lesion expands mostly in an anteroposterior direction and can cause extensive bone destruction before the appearance of any clinical symptoms. The characteristic radiological picture is that of a multilocular cystic lesion with the common differential diagnosis being dentigerous cyst and ameloblastoma. Here we are presenting a case of KCOT of the left lower jaw of size 10.9×7.86×8.54 cm. It is a huge multilocular cystic lesion extending from the right canine region to the left side involving the body, ramus, coronoid and condyle. Various management options are there ranging from enucleation and chemical cauterization to resection and reconstruction depending upon the size of the lesion. In this case we were not able to perform the ideal treatment option for the case because of the multiple drug allergy the patient was having, including most of the general anesthetic agents. Also the patient was not willing for any extensive procedure under general anesthesia. So we had to follow a compromised treatment plan aiming to reduce the size of the lesion, to improve the aesthetics and frequent follow up.</p>

Partial Mandibulectomy Rehabilitation of Keratocystic Odontogenic Tumour Case in Neutral Zone

Restoring the patient’s missing dentition secondary to partial mandibulectomy of KCOT is important to improve function and aesthetics. The patient presented with a significant loss of alveolar bone which makes the fabrication of rehabilitation prosthesis a significant challenge. A neutral-zone impression technique is helpful in determining the exact space to be restored without compromising aesthetics and it avoids functional muscle displacement that may displace the prosthesis. This article describes the neutral zone impression technique to record a patient's functional muscular movement in guiding the setting of acrylic teeth and denture flange in the neutral zone area. This technique is very useful for postsurgical cases with significant loss of alveolar bone.