Unilocular Area Research Articles

ODONTOGENIC FIBROMA WITH THE PRESENCE OF A CENTRAL GIANT CELLS LESION: A CASE REPORT WITH AN UNUSUAL VARIANT

The aim of this study is to report an unusual case of a variant of odontogenic fibroma with the presence of a central giant cells lesion. A 51-year-old man presented with a nodular and ulcerated lesion in the lower left alveolar ridge, with a firm consistency and bleeding. The adjacent teeth were mobile. Evolution time was 6 months. A panoramic radiograph showed a radiolucent, unilocular area, with irregular margins and radicular resorption. An incisional biopsy was initially performed due to the possibility of malignancy, but the histopathologic diagnosis was a central lesion of giant cells. Excision of the lesion was performed, and microscopic examination of the surgical specimen showed areas of odontogenic epithelium islands associated with a fibrous stroma, in addition to the multinucleated giant cells. The patient is being followed up for 1 year, with no sign of recurrence.

Abordagem cirúrgica para cisto periapical de tamanho atípico em idosa: Relato de caso

Os cistos periapicais, são formados pelo processo inflamatório do epitélio no ápice de dentes não vitais. Normalmente apresenta características de crescimento lento, assintomático e de pequena extensão. Nesse estudo, objetiva-se reportar um caso de cisto periapical com tamanho atípico, submetido à abordagem cirúrgica. Aqui, trata-se de um estudo qualitativo, descritivo, retrospectivo e realizado pela da técnica da observação direta, respeitando todos os protocolos éticos. Paciente 74 anos, feminina, compareceu ao serviço de Cirurgia e Traumatologia Buco-maxilo-facial do Hospital da Restauração Governador Paulo Guerra - Recife, encaminhada por um cirurgião-dentista após análise de exame de imagem de rotina sugestivo de lesão cística em mandíbula. Ao exame físico apresentou discreto abaulamento em cortical vestibular de corpo mandibular direito, assintomático ao toque. Através da tomografia computadorizada se constatou uma área hipodensa, unilocular, circunscrita por uma linha hiperdensa, abrangendo região de dentes 42,43,44,e 45. Com base no exame clínico, foi estabelecida a hipótese diagnóstica de cisto periapical, confirmada após análise histopatológica. Como abordagem terapêutica optou-se por realizar sob anestesia geral a enucleação, osteotomia periférica e exodontias dos dentes envolvidos. Em 08 meses de acompanhamento não apresenta sinal de recidivas. Desse modo, fica claro a importância do correto diagnóstico, bem como a eficácia da intervenção cirúrgica como tratamento de lesão periapical de grande extensão.

Surgical conservative approach of odontogenic keratocyst tumor of the jaws.

Objective Odontogenic keratocyst (OKC) can be classified as an oral lesion representing the third most common cyst of the jaws characterized by a high rate of recurrence. OKC was accepted as a neoplastic lesion in the 2005 WHO classification and it was called keratocystic odontogenic tumor (KCOT). However, in the 2017 classification of odontogenic tumors, OKC was moved back into the cyst category. This study aims to evaluate clinically, radiographically and through the histological examination the healing of a patient with OKC who underwent surgery with a marsupialization approach. Design An 83-year-old female patient, presented deformation of the right hemi-mandibular region and paresthesia of the right hemi-labium, during intraoral examination it was possible to detect an eggshell crackle on palpation of the anterior edentulous mandible, moreover, the patient reported a growth of the lesion over time that prevented her from using the removable prosthesis. Methods At the OPT it was possible to appreciate a unilocular area that extended from the parasymphyseal region to the right hemi-mandible. The CT scan showed massive erosion that only partially spared the lower cortex and involvement of the mental foramen. Results Checks following surgery show healing also confirmed by instrumental check-ups. Conclusions Surely this study offers a valid alternative to more invasive and debilitating surgical treatments.

PROSTHETIC REHABILITATION IN PATIENT SUBMITTED TO RESECTION OF AMELOBLASTOMA IN ANTERIOR MANDIBULAR REGION

Ameloblastoma is a common odontogenic tumor that, even being benign, has a locally infiltrative behavior. The proposed treatment is usually based on marginal or segmental resection. Although effective, such therapeutic modalities are associated with a morbidity that impacts on function and aesthetics. A 50-year-old male patient reported asymptomatic swelling in the anterior region of the mandible. Imaging examinations (panoramic radiography and computed tomography) revealed a well delimited radiolucent/hypodense unilocular area. After histopathological confirmation, obtained through an incisional biopsy, of the clinical diagnosis of unicystic ameloblastoma, the patient underwent block resection surgery, with a safety margin, extending from the region corresponding to the teeth 42 and 45. The rehabilitation of the resected area was recovered by removable partial prosthesis, due to the patient’s financial conditions. The 2-year follow-up shows a clinically and radiographically free area of recurrence signs.

EXTENSIVE RADICULAR CYST IN THE MAXILLA: A CASE REPORT

A 15-year-old male presented with historical trauma on tooth #11, 18 months before. During physical examination facial asymmetry was observed, resulting from a swelling beneath the alae of the nose, maxilla, and upper lip at the right side and extending to the right palate and the buccal region of the teeth #11 to #13, and a temporary restoration in #11. Panoramic radiography showed an extensive radiolucent unilocular area including teeth #11 to #17. Cone beam computed tomography showed an extensive unilocular hypodense area that overpassed the midline and displaced the floor of the nasal fossa gauging 22 × 39 × 29 mm. Incisional biopsy with marsupialization was performed showing histologic features of virtual cystic cavity covered by stratified squamous epithelium, with mononuclear inflammatory infiltration and Russell corpuscles underlying the epithelium characterizing apical periodontal cyst. After 4 weeks the patient was referred for endodontic treatment and is still in follow-up. This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-Brasil (CAPES)-Finance Code 001. A 15-year-old male presented with historical trauma on tooth #11, 18 months before. During physical examination facial asymmetry was observed, resulting from a swelling beneath the alae of the nose, maxilla, and upper lip at the right side and extending to the right palate and the buccal region of the teeth #11 to #13, and a temporary restoration in #11. Panoramic radiography showed an extensive radiolucent unilocular area including teeth #11 to #17. Cone beam computed tomography showed an extensive unilocular hypodense area that overpassed the midline and displaced the floor of the nasal fossa gauging 22 × 39 × 29 mm. Incisional biopsy with marsupialization was performed showing histologic features of virtual cystic cavity covered by stratified squamous epithelium, with mononuclear inflammatory infiltration and Russell corpuscles underlying the epithelium characterizing apical periodontal cyst. After 4 weeks the patient was referred for endodontic treatment and is still in follow-up. This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-Brasil (CAPES)-Finance Code 001.

Multiple Dentigerous Cysts in a Child: A Case Report and Radiographic Follow-up

The aim of this study is to describe a case of dentigerous cysts of a young patient successfully treated as well as clinical and radiographic follow-up. A 10-year-old female patient was referred to the Buccomaxillofacial Surgery and Traumatology Service of the Regional University Hospital of Campos Gerais. The patient’s panoramic radiograph revealed a well-defined radiolucent unilocular area associated to the crown of the second permanent right lower molar, which was impacted. In addition, the permanent upper canines were enclosed, suggesting a dentigerous cyst. A conservative treatment was determined, through marsupialization of the lesions. The histopathology examination confirmed the clinical diagnosis of dentigerous cysts. Longitudinal clinical and radiographic monitoring was essential to certify the regression of the lesion, as well as bone neoformation, thus promoting the eruption and maintenance of the affected permanent teeth.

Odontogenic Keratocyst Mimicking a Periodontal Lateral Cyst

Odontogenic keratocyst (OKC) is considered a variation of a developmental odontogenic cyst, owing to its clinical behavior, histopathological aspect, and high relapse rate. It is known to affect individuals between 10 and 40 years of age, and the posterior region of the mandible is the most affected site. This present study reports the case of a 53-year-old woman, who presented with the chief complaint of increase in gum volume. During the intraoral examination, a well-defined, circumscribed, normochromic nodule located between elements 43 and 44 was observed, causing tooth displacement. A radiographic examination revealed a well-defined radiolucent, unilocular area. An excisional biopsy was performed and microscopically, a pathological parakeratinized odontogenic epithelial lined cavity was observed, leading to the diagnosis of OKC. The proposed treatment was conservative, a total enucleation. The patient is under follow-up for 1 year, without signs of recurrence.

NASOPALATINE DUCT CYST TREATMENT: REPORT OF TWO CASES

A 62-year-old male patient showed a purplish swelling in the anterior hard palate midline, measuring 1.5 cm, with pain and 40 days of evolution. CT showed a hypodense unilocular area in the incisive foramen region. A 25-year-old male patient presented a swelling in the central hard palate, with pain and 3 weeks of evolution. Radiography showed a unilocular radiolucent area with 2 cm in the anterior maxilla. In both cases, the related teeth responded to the vitality tests, the diagnosis hypothesis of nasopalatine duct cyst was proposed and needle aspiration reveals a translucent liquid. The treatment of both was surgical excision with full palatal flap and curettage. Histopathologic examination showed, in both cases, cystic capsule of fibrous connective tissue, with neurovascular bundle, lined by stratified squamous and cuboidal epithelium, establishing the diagnosis of nasopalatine duct cyst. Both patients were followed-up for 18 months with no signs of recurrence.

UNICYSTIC AMELOBLASTOMA WITH MARSUPIALIZATION TO SOLID AMELOBLASTOMA: THE RISK OF GAP MONITORING - 15-YEAR RETROSPECTIVE

Ameloblastoma is an aggressive benign odontogenic tumor and its recurrence rates vary according to the different approaches. A 26-year-old black female patient was referred to the Stomatology Clinic in 2001 with swelling of the left mandibular body. Panoramic radiograph identified a unilocular area. Incisional biopsy revealed unicystic ameloblastoma. The lesion was subjected to marsupialization. The patient disappeared and returned in 2005 with multilocular area and enucleation of the lesion. New panoramic radiographs in 2008 showed no recurrence. The patient returns for annual follow-up, only presenting increased volume with multilocular radiolucent images in the same site after 8 years. Another biopsy showed the result of solid ameloblastoma. Marsupialization has been reported as a preliminary treatment of the unicystic ameloblastoma. However, the committment of the patient to the clinic is crucial, but it does not always happen. Semiannual or annual follow-up is necessary to diagnose the initial lesion and to perform less invasive treatments.

Cryotherapy in the treatment of glandular odontogenic cyst: case report and review

Objective: The Glandular Odontogenic Cyst (GOC) is a rare benign odontogenic lesion, of considerable aggression, and often incorrectly diagnosed. We present a patient with a Glandular Odontogenic Cyst in the posterior mandible, its evolution, treatment, and follow-up. Case report: A female patient, 45 years old, was referred to the Oral and Maxillofacial Surgery and Traumatology Division at Cristo Redentor Hospital, Porto Alegre, Brazil, for the assessment of a painful edema on the right hemiface. A unilocular area with well-defined borders in the retromolar region, posterior to the third molar on the right side of the mandible. The histopathological examination suggested GOC. Final considerations: The Glandular Odontogenic Cyst needs a complete clinical assessment associated with image analyses, and especially, with histopathology for the correct diagnosis of the lesion, since the diagnosis may be mistaken in clinical and radiographic examination. There are several treatment options; however, enucleation associated with cryotherapy, in this case, was an effective method for the treatment of Glandular Odontogenic Cyst.