Comportamento Geoespacial da Leishmaniose Tegumentar Americana no Município de Tangará da Serra ­ MT / Behavior Geoespatial of American Tegumentary Leishamaniasis in the City of Tangará da Serra ­ MT

A leishmaniose é uma doença infectoparasitária de importância epidemiológica mundial, configurando-se entre os seis agravos tropicais mais relevantes. Analisar o comportamento geoespacial da Leishmaniose Tegumentar Americana no município de Tangará da Serra entre os anos de 2007 a 2013, utilizando técnicas de georreferenciamento. Estudo ecológico, transversal, descritivo quantitativo. As informações epidemiológicas foram compiladas da base de dados oficial do Sistema Nacional de Agravos Notificáveis do município de Tangará da Serra/MT. Foram notificados 391 casos, com prevalência na faixa etária de 21 a 30 anos com 86 casos (21,99%). O sexo predominante foi o masculino com 352 casos (90,02%). A forma clinica mais comum foi a cutânea com 317 casos (81,07%), 369 (94,37%) foram notificados como casos novos, 21(5,37%) como recidivas, 383(97,95%) receberam alta por cura clínica, quatro abandonos (1,02%) foram registrados, três transferências (0,76%), um óbito por outras causas (0,25%). O exame mais utilizado no diagnóstico foi o parasitológico com 294 (75,19%). A área urbana predominou com 276 registros (70,58%). A análise espacial mostrou predomínio de casos em locais, cuja vegetação predominante era de pastagem e d e outros usos. Foram demonstradas ocorrências de casos de Leishmaniose Tegumentar Americana em regiões de pastagens e outros usos, sugerindo modificação na epidemiologia da doença no município estudado. Propõe inclusão do local provável da infecção na ficha de notificação, ações conjuntas entre a vigilância ambiental e medicina veterinária no controle da doença, pesquisa de captura de vetores da leishmaniose e seguimento de dois anos do paciente após cura.

Leishmaniasis is a parasitic infectious disease of worldwide epidemiological importance, featuring as the six most important tropical diseases. Objective: To analyze the geospatial behavior of the American tegumentary leishmaniasis in the city of Tangara da Serra between the years 2007-2013, using georeferencing techniques. Ecological study, cross-sectional and quantitative descriptive. Epidemiological information was compiled from the official database of the National Notifiable Diseases of the city of Tangara da Serra/MT. 391 cases were reported, with prevalence in the age group 21-30 years, with 86 cases (21.99%); the predominant gender was the masculine with 352 cases (90.02%). The most common clinical form was cutaneous with 317 cases (81.07%), 369 (94.37%) were reported as new cases, 21 (5.37%) as recurrences, 383 (97.95%) were discharged due to clinical cure, 4 dropouts (1.02%) were recorded, 3 transfers (0.76%), 1 death from other causes (0.25%). The most commonly test used was the parasitological diagnosis with294 (75.19%). The urban area prevailed with 276 records (70.58%). Spatial analysis showed predominance of cases in places whose predominant vegetation was grazing and other uses. It was demonstred occurrence of cases of American tegumentaryleishmaniasis in areas of pastures and other uses, suggesting a change in the epidemiology of the disease in the city studied. It proposes inclusion of the probable site of infection in the notification form, joint operations between environmental surveillance and veterinary medicine in controlling the disease, leishmaniasis vectors capture research and follow-up of two years after the patient's healing

Epidemiology and georeferencing of squamous cell carcinoma cases and their relationship with pesticides / Epidemiologia e georreferenciamento dos casos de carcinoma epidermóide de boca e sua relação com agrotóxicos

ABSTRACT Objective To assess the prevalence of epidermoid carcinoma cases, georeference their locations, and seek to correlate them to areas with higher agricultural production and use of pesticides. Methods This was a cross-sectional, descriptive and retrospective study conducted by searching the histopathological reports with confirmed diagnosis of epidermoid carcinoma of the mouth issued from August 2005 to December 2011 by the public oral pathology laboratory of the State of Mato Grosso, Brazil. Data were plotted with the IBM SPSS Statistics software and spatial analysis used the ArcGIS 10.1 software. Results There were a higher number of diagnoses in 2007 (26.6%); 99 cases (75%) of patients were male; 96 cases (72.8%) were patients aged between 41 and 70 years; and the cities of Cuiabá, Várzea Grande and Rondonópolis respectively showed the highest number of occurrences. Conclusion No relationship was found between the occurrence of cases of epidermoid carcinoma and the municipalities with high agricultural production and pesticide use.

RESUMO Objetivo Analisar a prevalência dos casos de carcinoma epidermóide e fazer seu georreferenciamento, buscando correlaciona-los às áreas de maior produção agrícola e utilização de agrotóxicos. Métodos Trata-se de um estudo transversal, descritivo e retrospectivo realizado por meio de pesquisa dos laudos histopatológicos com diagnóstico confirmado de carcinoma epidermóide de boca emitidos de agosto de 2005 a dezembro de 2011 pelo serviço de patologia bucal do laboratório público do Estado de Mato Grosso. Os dados foram tabulados com o software IBM SPSS Statistics e a análise espacial utilizou o software ArcGIS 10.1. Resultados Houve um maior número de diagnósticos no ano de 2007 (26,6%), 99 casos (75%) eram de pacientes do sexo masculino; 96 casos (72,8%) eram de pacientes na faixa etária compreendida entre 41 e 70 anos e os municípios de Cuiabá, Várzea Grande e Rondonópolis apresentam respectivamente o maior número de ocorrências. Conclusão Não foi encontrada relação entre a ocorrência dos casos de carcinoma epidermóide de boca e os municípios com grande produção agrícola e elevado uso de agrotóxicos.

Rehabilitation of an advanced case of adenoid cystic carcinoma.

Adenoid cystic carcinoma is a cancer of the salivary gland that primarily affects the parotid, submandibular, and accessory salivary glands. Its growth is slow and it has infiltrative nature. A 46-year-old female patient coming from the rural area presented a lesion on the palate and reported pain in the region for three years. After incisional biopsy, and histopathological diagnosis of adenoid cystic carcinoma of the cribriform type of minor salivary gland, superior hemimaxillectomy and adjuvant treatment with radiotherapy and maxillofacial prosthetic rehabilitation were performed.

Ectodermal dysplasia associated with sickle cell disease.

Ectodermal dysplasia and sickle cell anaemia are inherited disorders that affect, respectively, the tissues derived from the embryonic ectoderm and the production of erythrocytes by the bone marrow. The simultaneous occurrence of both disorders is extremely rare. This is a case of both ectodermal dysplasia and sickle cell anaemia reported in a 6-year-old. The patient had been diagnosed with sickle cell anaemia for only six months when he sought treatment presenting with the following: hypotrichosis, dry skin, periocular hyperpigmentation, protruding lips, hypodontia, and morphologically altered teeth. The clinical features combined with his medical history led to the diagnosis of ectodermal dysplasia. Dentists should be prepared to recognise patterns that escape normality to aid in the diagnosis of systemic changes, even in patients with other previous diagnoses.

10-year follow-up of calcifying odontogenic cyst in the periapical region of vital maxillary central incisor.

INTRODUCTION: Radiographic images may lead to misinterpretations of lesions of endodontic and nonendodontic origin. This report describes a case of a 10-year follow-up of a calcifying odontogenic cyst (COC) in the periapical region of a vital maxillary central incisor in a 9-year-old boy. METHODS: The patient revealed a history of a swelling in the periapical area of tooth #9. The patient denied any dental trauma or history of pain. Clinical examination revealed no mobility, but there was discrete discomfort when horizontal pressure was applied. Pulp vitality was present in all maxillary anterior teeth. Radiographs revealed an oval radiolucent lesion in the periapical region of maxillary central incisor. The therapeutic option was enucleation of the periapical lesion and histologic examination of the specimen. Microscopic findings suggested the diagnosis of a COC. RESULTS: At a follow-up visit 10 years after surgery, panoramic and periapical radiographs showed new bone formation; the patient did not have any pain, and pulp vitality was maintained in all teeth in this area. CONCLUSIONS: A COC should be part of the differential diagnosis of other jaw lesions, such as apical periodontitis. The definitive diagnosis of a COC can only be made after microscopic evaluation of the specimen. The follow-up is a helpful reference because it confirms the survival of pulp tissue and no recurrence of the COC.

8-year follow-up of central giant cell lesion mimicking apical periodontitis.

INTRODUCTION: Lesions of nonendodontic origin may mimic apical periodontitis. Central giant cell lesions (CGCLs) are aggressive or nonaggressive benign idiopathic intraosseous lesions of the jaw. This report describes a case of a CGCL in the periapical region of teeth #21-#26 of a 17-year-old female who sought orthodontic care because of a change in the position of tooth #23. METHODS: Clinical examination revealed mild facial asymmetry caused by increased volume in the mental region and cortical bone expansion but no cortical disruption. A panoramic radiograph showed a well-defined radiolucent osteolytic lesion involving teeth #21-#26. The cortical bone was not affected, and there was no root resorption. Incisional biopsy was performed, and the diagnosis was a CGCL. The lesion was enucleated surgically. CGCLs should be included in the differential diagnosis of jaw lesions that mimic apical periodontitis. RESULTS: The patient subsequently underwent orthodontic treatment successfully. CONCLUSIONS: The 8-year clinical and radiographic follow-up confirmed lesion remission, no recurrence, and pulp vitality of all teeth.

Unusual dermoid cyst in oral cavity.

Dermoid cysts in oral cavity are unusual lesions. Their etiology is not yet clear and can be associated with trapped cells as a result of the inclusion error resulting in the development into the ectoderm, mesoderm, and endoderm tissues. The aim of this case report is to evidence the presence of a dermoid cyst in the floor of mouth surgically removed. In the present case, the lesion showed soft consistency, floating, regular borders, smooth surface, and the same color as the adjacent mucosa, asymptomatic and measuring 4.5 × 5.5 cm in its greatest diameter. The initial diagnostic was ranula in consequence of the similarity with clinical characteristics and localization. After surgical removal lesion, a fibrotic capsule was identified with a friable material with intensive yellow color. The microscopic exam showed cystic lesion with cavity lined by squamous stratified epithelium hyperorthokeratinized. Cutaneous attachments, such as sebaceous glands and hair follicles, were present in connective adjacent tissue. Surgical intervention is elective in these situations. All dentists must have a thorough knowledge of this unusual lesion.

Animal bite injuries to the face : A Case Report.

Traumatic lacerations to the skin are problems frequently seen and treated by emergency centers around the world. Among all wounds, dog and cat bites are commonly seen. As in many mammals, different species of microorganisms are found in dog and cat mouths with a potential pathological effect to humans, as represented by rabies. The injuries have disfiguration effect with possible psychological repercussion to the patient. This article aimed presenting up to date considerations regarding the management of animal bite injuries to the face, exemplified by a case report that should be the interest of all professions that deal with facial tissues, as dentists do. How to cite this article: Simao NR, Borba AM, da Silva ALF, Vieira EMM, Carvalhosa AA, Bandeca MC, Borges AH. Animal bite injuries to the face: A Case Report. J Int Oral Health 2013; 5(4):68-72.

Particularidades do diagnóstico e tratamento do tumor odontogênico queratocístico / Diagnostic and treatment features of keratocystic odontogenic tumors

Keratocystic odontogenic tumors (KCOT) comprise a unique pathological entity characterized by aggressive/destructive behavior and propensity to recurrence. This study describes the diagnostic and treatment features of a KCOT lesion. A 22-year old man was referred for surgical treatment of pericoronitis on tooth no. 37. Panoramic radiography revealed a unilocular, large radiolucent area extending from tooth no. 36 to the left mandibular ramus. Aspiration and incisional biopsy were performed, and the tissue sample was sent for microscopic evaluation. Microscopically, a cystic lesion was observed, lined by keratinized squamous epithelium and filled with keratin lamellae, confirming the diagnosis of KCOT. Surgery was performed in an outpatient setting and involved osteotomy, detachment of the cystic lesion, and removal of teeth no. 36, 37, and 38. The patient was clinically and radiographically followed for 12 months, and no evidence of recurrence was observed. KCOTs should be considered in the differential diagnosis of lesions affecting the posterior region of the mandible. Accurate clinical, radiographic, and microscopic examinations are essential to establish the definitive diagnosis and choose the most effective therapy.

O tumor odontogênico queratocístico (TOQ) é uma entidade patológica singular, devido ao seu comportamento agressivo/destrutivo e à sua propensão a recorrências. O presente trabalho descreve as particularidades de diagnóstico e tratamento de um TOQ. Um paciente do sexo masculino, com 22 anos de idade, foi encaminhado para tratamento cirúrgico de pericoronarite no dente 37. O exame radiográfico panorâmico revelou uma área ampla, unilocular, estendendo-se do dente 36 até o ramo esquerdo da mandíbula. Punção óssea aspirativa e biópsia incisional foram realizadas, e a amostra de tecido foi encaminhada para análise microscópica. Microscopicamente, observou-se lesão cística, revestida por epitélio escamoso queratinizado e preenchida por lamelas de queratina, confirmando o diagnóstico de TOQ. O procedimento cirúrgico foi realizado em ambiente ambulatorial e envolveu osteotomia, descolamento da luz da lesão e exodontia dos dentes 36, 37 e 38. O paciente foi acompanhado clínica e radiograficamente por um período de 12 meses, e não foi observada recorrência da lesão. O TOQ deve ser considerado no diagnóstico diferencial de alterações da região posterior da mandíbula. Exames clínicos, radiográficos e microscópicos precisos são essenciais no estabelecimento do diagnóstico e na escolha da modalidade terapêutica mais eficaz.

Differential diagnosis of apical periodontitis and nasopalatine duct cyst.

INTRODUCTION: An accurate differential diagnosis of apical periodontitis (AP) and nasopalatine duct cyst (NPDC) should be established to define the best treatment for endodontically treated maxillary anterior teeth with apical periodontitis. Three-dimensional cone beam computed tomography (CBCT) images help to plan treatment and to define an initial diagnostic hypothesis. However, endodontic treatment or retreatment may be unnecessarily prescribed when radiographs show a superimposition of the incisor foramen over the apex of maxillary central incisors, mimicking AP. Diseases of nonendodontic origin that affect the tooth apex, such as NPDC, should be included in the differential diagnosis. METHODS AND RESULTS: Four clinical cases of patients with large periapical radiolucencies and similar radiographic features are described. AP is usually a consequence of endodontic infection; in cases of NPDC, however, spontaneous epithelial proliferation, in addition to bacterial infection and trauma, may also contribute to cyst formation. The frequency and recurrence rates of NPDC are low, and its behavior is less aggressive. Surgical enucleation of the periapical lesion is recommended after nonsurgical treatment does not heal AP. CONCLUSIONS: The use of new diagnostic tools, such as CBCT imaging, may provide detailed high-resolution images of oral structures, which help to make an initial diagnostic hypothesis and to plan surgery. Histopathology is mandatory for the differential diagnosis.

Avaliação de 14 casos de carcinomaepidermoide de boca com diagnóstico tardio / Evaluation of 14 cases of oral squamous cellcarcinoma with delayed diagnosis

Introdução: Processos patológicos de diversas causas, como doençasinfecciosas, inflamatórias, imunológicas, alérgicas, sistêmicase traumáticas, acometem frequentemente a cavidade bucal. Aresponsabilidade do diagnóstico de todas essas lesões é do cirurgiãodentista.Da mesma forma, é dele a responsabilidade pelo diagnóstico docâncer de boca. A cavidade bucal permite a visão direta das estruturas,fato que facilita a identificação de lesões iniciais; consequentementedeveria haver maior probabilidade de diagnósticos precoces de lesõesbucais. Mas observam-se ainda nos dias de hoje muitos casos de câncer bucal diagnosticados tardiamente no Brasil. O atraso no diagnósticoimplica um pior prognóstico e diminuição na taxa de sobrevida dospacientes. Objetivo, relato de caso e conclusão: O objetivo destetrabalho é relatar casos clínicos de carcinomas epidermoides de bocadiagnosticados em estágio avançado no Departamento de Estomatologiado Hospital do Câncer de Cuiabá (MT, Brasil), assim como discutir asprincipais razões que levam ao atraso do diagnóstico, sugerindo açõespara modificação desse quadro.

Introduction: Pathological processes of several causes such as infectious,inflammatory, immunological, allergic, systemic and traumatic diseasesoften affect the oral cavity. The dentist is responsible for the diagnosis ofthese oral lesions. Likewise, the dentist is responsible for the oral cancerdiagnosis. The oral cavity allows direct visualization of the structures,which facilitates the identification of initial lesions and, consequently,there should be a higher probability of early diagnosis of oral lesions.However, there are still many cases of oral cancer in Brazil with delayeddiagnosis, which implies a worse prognosis and a decrease in the survivalrate of patients. Objective, case report and conclusion: The aim ofthis work is to report oral squamous cell carcinoma cases with delayeddiagnosis in the Stomatology Department of the Cuiabá Cancer Hospital(MT, Brazil), as well as to discuss the main reasons that lead to the delayin diagnosis, besides giving suggestions to modify this situation.

Use of 660-nm diode laser in the prevention and treatment of human oral mucositis induced by radiotherapy and chemotherapy.

OBJECTIVE: The aim of this multidisciplinary study was to evaluate quantitatively and qualitatively the effect of a 660-nm diode laser in the prevention and treatment of human oral mucositis (OM) in patients suffering from head and neck cancer who had undergone radiotherapy and chemotherapy. BACKGROUND DATA: OM is a severe oral lesion resulting from the toxic effects of treatment for cancer in the head and neck region. Low-level laser therapy is indicated to prevent and treat this oral complication and may be used alone or in association with conventional drug treatment, producing pain relief and wound repair. METHODS: This study included 72 patients with head and neck cancer treated at the Cancer Hospital of Mato-Grosso, Brazil, and divided into a control group (C; n = 36) and a laser group (L; n = 36). Laser therapy was performed in combination with radiotherapy and chemotherapy twice a week using a diode laser (lambda = 660 nm, power = 30 mW, spot size = 2 mm, energy = 2 J per point). RESULTS: Statistically significant differences were observed between the two groups. Patients in group L usually did not present with OM or pain, but all patients in group C presented with OM ranging from Level I to III associated with pain. This difference was significant from week 1 on, increased until week 4 and remained stable up to week 7. CONCLUSION: Laser therapy was effective in preventing and treating oral effects induced by radiotherapy and chemotherapy, thus improving the patient's quality of life.

Central mucoepidermoid carcinoma: report of a case with 11 years' evolution and peculiar macroscopical and clinical characteristics.

Central mucoepidermoid carcinomas (CMC) are uncommon tumours, comprising 2-3% of all mucoepidermoid carcinomas reported. They have been reported in patients of all ages, ranging from 1 to 78-years, with the overwhelming majority occurring in the 4th and 5th decades of life. They are histologically low-grade cancers, usually affecting the mandible as uniocular or multiocular radiographic lesions. The authors report a case of CMC of the mandible with a long evolution, and peculiar clinical and macroscopical features related with the long term evolution of the disease. A 53-year-old male patient had expansion of buccal and lingual cortices of the anterior region of the mandible, covered by ulcerated mucosa, with 11 years evolution. An incisional biopsy was performed, and the histopathological findings confirm low-grade mucoepidermoid carcinoma. The patient was treated with a mandibulectomy, followed by supraomohyoid neck dissection. There was no evidence of local recurrence, regional or distant metastasis revealed; and the patient was alive and without disease after a follow-up interval of 36 months.

Mesenchymal chondrosarcoma mimicking apical periodontitis.

This report describes the case of a patient with mesenchymal chondrosarcoma in the region of tooth #18 that mimicked apical periodontitis. Forty-five days after endodontic treatment, gingival swelling and intense pain were observed. The endodontist suspected a furcation lesion, and the treatment option that the patient chose was extraction of the tooth. Seven days after suture removal, a rapidly growing swelling was seen in the region. The patient was referred to an oral and maxillofacial surgeon, who recommended an incisional biopsy after evaluating imaging and clinical findings. Microscopic examination confirmed the diagnosis of mesenchymal chondrosarcoma. The patient underwent hemimandibulectomy with wide surgical margins. This clinical case draws attention to the fact that endodontic lesions should be carefully evaluated because malignant tumors such as mesenchymal chondrosarcoma might mimic apical periodontitis.

[Oral cancer epidemiology in a public laboratory in Mato Grosso State, Brazil]. / Epidemiologia do câncer de boca em laboratório público do Estado de Mato Grosso, Brasil.

This study analyzed oral cancer epidemiology based on histopathology reports from a public laboratory in Mato Grosso, Brazil, after a specific policy was implemented for treating oral and facial diseases in the State. This was a cross-sectional epidemiological study, based on 1,324 histopathology reports issued from January 2005 to December 2006. The study identified 44 cases of oral cancer, or 3% of all oral lesions, and analyzed them in relation to the following variables: histological type, gender, age, and patient's place of residence (capital versus rest of State). The most common histological type was squamous cell carcinoma. Most of the diagnoses occurred in men in their 50s and 60s living in the interior of the State. During two years in operation, this public oral pathology service had recorded a considerable number of oral cancer cases.

Epidemiologia do câncer de boca em laboratório público do Estado de Mato Grosso, Brasil / Oral cancer epidemiology in a public laboratory in Mato Grosso State, Brazil

O objetivo deste trabalho foi analisar a epidemiologia do câncer de boca, dos casos diagnosticados pelo laboratório público do Estado de Mato Grosso, Brasil, após a instituição da política de atenção às doenças da boca e da face do estado. Trata-se de um estudo epidemiológico transversal. O objeto estudado foi o laudo histopatológico, pesquisando-se um total de 1.324 laudos emitidos entre janeiro de 2005 e dezembro 2006. Verificaram-se os casos de câncer de boca, o seu percentual em relação ao universo das lesões bucais e as seguintes variáveis: tipo histológico, sexo, idade e procedência dos pacientes (capital ou do interior). Após a análise dos dados verificaram-se 44 lesões de câncer de boca, representando 3 por cento dos diagnósticos. O tipo histológico mais incidente foi o carcinoma epidermóide. A maioria dos diagnósticos foi referente aos homens na 5ª e 6ª décadas de vida residentes no interior do estado. Conclui-se com este estudo que em dois anos de funcionamento o serviço público de patologia bucal registrou um considerável número de casos de câncer de boca.

This study analyzed oral cancer epidemiology based on histopathology reports from a public laboratory in Mato Grosso, Brazil, after a specific policy was implemented for treating oral and facial diseases in the State. This was a cross-sectional epidemiological study, based on 1,324 histopathology reports issued from January 2005 to December 2006. The study identified 44 cases of oral cancer, or 3 percent of all oral lesions, and analyzed them in relation to the following variables: histological type, gender, age, and patient's place of residence (capital versus rest of State). The most common histological type was squamous cell carcinoma. Most of the diagnoses occurred in men in their 50s and 60s living in the interior of the State. During two years in operation, this public oral pathology service had recorded a considerable number of oral cancer cases.

Ameloblastoma suggesting large apical periodontitis.

This case report describes the endodontic treatment of a large apical periodontitis with well-defined margins adjacent to teeth #22-24. After the initial endodontic treatment, continued expansion of the mandible cortical bone was observed, indicating a need to surgically enucleate the lesion and submit it for histopathologic examination. The microscopic examination indicated a diagnosis of ameloblastoma. Ameloblastoma is a benign epithelial neoplasm of odontogenic origin, and depending on the stage of development, it can mimic a periapical lesion and therefore should be considered in establishing an endodontic differential diagnosis. The definitive diagnosis for some periapical lesions can only be made by a histopathologic examination.

Cisto de Gorlin: revisão de literatura / Gorlin's cyst: review of literature

O Cisto Odontogênico Epitelial Calcificante(COEC) é uma lesão incomum que apresenta comportamentoclínico variável e características histopatológicas peculiares,além de uma grande diversidade de terminologias, devido àssuas variáveis clínica, radiográfica e microscópica. Podeaparecer associado com outros tumores odontogênicos,mudando suas características. Somente em 1971 o COEC,também conhecido com Cisto de Gorlin, foi reconhecido pelaOMS como entidade patológica distinta, e classificado comolesão cística não neoplásica pelo Centro de ReferênciaInternacional para a Definição e Classificação Histológica dosTumores Odontogênicos, Cistos dos Maxilares e Lesões Afinsda OMS. Atualmente a Organização Mundial de Saúde define oCisto de Gorlin como tumor odontogênico, incluindo todas assuas variantes. Objetivo: Faremos neste trabalho uma revisãode literatura sobre o COEC e relataremos um caso clínico destaentidade, enfatizando aspectos clínicos, radiográficos ehistopatológicos relevantes para o diagnóstico e tratamentodesta patologia. Conclusão:O Cisto de Gorlin é uma entidadepatológica distinta, incomum e com características clínicas,radiográficas e histopatológicas variáveis; acomete tantomandíbula como maxila, preferencialmente na região anterior enão existe predileção por sexo ou raça, surgindo na maioria doscasos na 4a década de vida; apesar da ocorrência maisevidente em adultos, o COEC pode acometer crianças e oCirurgião-Dentista deve estar atento para realizar o diagnóstico desta patologia

Immunohistochemical study of the orthokeratinized odontogenic cyst: a comparison with the odontogenic keratocyst.

OBJECTIVE: Orthokeratinized odontogenic cyst (OOC) is a developmental cyst that occurs in the maxilla and the mandible and is defined by the World Health Organization as the uncommon orthokeratinized type of odontogenic keratocyst (OKC). However, studies have shown that OOC has peculiar clinicopathologic aspects and biologic behavior when compared with other developmental odontogenic cysts, especially OKCs. Therefore, in this study, the immunohistochemical profile of the OOC was delineated and compared with that of the OKC. STUDY DESIGN: Twelve cases of OOC were submitted to a panel of antibodies composed of cytokeratins (10, 13, and 14) and extracellular matrix proteins: fibronectin, types I and III collagen, and tenascin. For comparative means, 12 cases of OKC also were submitted to the same panel of antibodies. RESULTS: The results obtained showed that OOCs expressed cytokeratin 10 and showed variable expression of cytokeratins 13 and 14. Fibronectin and collagen types I and III also were expressed in OOC in a fibrillar aspect. OKC showed only the superficial keratin layer positive to cytokeratin 10 and the basal and suprabasal layers with variable expression of cytokeratin 14, and cytokeratin 13 was present in the upper epithelial layers. The extracellular matrix proteins showed a nonfibrillar expression. Tenascin was immunoexpressed only in OKC. CONCLUSION: The immunohistochemical profile of the studied cysts clearly showed that OOC presents a well-formed cystic enveloping, whereas the OKC profile is compatible with a more aggressive biologic behavior.

Cisto odontogênico ortoqueratinizado: critérios de diagnóstico / Orthokeratinized odontogenic cyst: criteria for diagnosis

O cisto odontogênico ortoqueratinizado (COO) é um cisto de desenvolvimento de origem odontogênica, encontrado nos ossos maxilares e considerado pela Organização Mundial da Saúde como uma variante ortoqueratinizada do queratocisto odontogênico (QO). Os critérios histopatológicos preconizados para o diagnóstico do COO são ainda controversos e não-uniformes. Neste estudo, os casos diagnosticados como QOs pelo Serviço de Patologia Bucal da Faculdade de Odontologia da Universidade de São Paulo (FOUSP), no período de janeiro de 1995 a dezembro de 1999, foram submetidos a uma reavaliação diagnóstica, para estabelecimento definitivo do diagnóstico de COO. Considerou-se como COO o grupo desses espécimes que exibia, consistentemente, os mesmos aspectos histopatológicos, a saber: limitante com ortoqueratinização em toda a sua extensão, sempre superposta à camada granulosa evidente e acompanhada de estratos espinhoso e basal pouco proeminentes, o último sem tendência à polarização ou paliçada e com a ausência de cristas epiteliais e de cistos satélites. Essa especificação diagnóstica de um COO foi denominada pelos autores do critério de "Wright modificado". Do total de 1917 cistos odontogênicos e não-odontogênicos diagnosticados, 172 (8,9 por cento) foram classificados como QOs e destes, seis (0,31 por cento do total de cistos e 3,48 por cento do total de QOs) preencheram os requisitos do critério de "Wright modificado" para o diagnóstico de COO. As modificações propostas proporcionaram o estabelecimento de critérios histopatológicos mais objetivos para o diagnóstico do COO e uma avaliação mais precisa do perfil e da freqüência dessa lesão