Cell-block as ancillary tool for the diagnosis of cystic and cyst-like jaw lesions.

BACKGROUND: The cell-block technique is a cytological diagnostic method that decreases cellular dispersion; however, its usefulness regarding intraosseous lesions is underexplored. Therefore, this study aimed to assess the diagnostic usefulness of cell-block for cystic and cyst-like jaw lesions. METHODS: Individuals with cystic or cyst-like jaw lesions who underwent aspiration biopsy were considered eligible. Aspiration of luminal content was prepared and processed by the cell-block technique. Cytological evaluations were blindly performed by two trained PhD students (in a single evaluation) and one oral and maxillofacial pathologist (OMP). Cohen's kappa statistic was used to measure inter-rater agreement. RESULTS: The sample was composed of 52 lesions, represented by 25 radicular cysts (RC), 17 odontogenic keratocysts (OKC), 5 idiopathic bone cavities (IBC), and 5 unicystic ameloblastomas (UA). The kappa coefficient of cell-block compared to histopathological diagnosis was 0.390 (95% confidence interval [95%CI], 0.195-0.585) for PhD students and 0.612 (95%CI, 0.433-0.791) for the OMP. The highest concordance rates between cell-block and histopathological diagnosis were observed for RC (PhD = 76.0%; OMP = 80.0%) and OKC (PhD = 58.8%; OMP = 76.5%). Conflicting results were found regarding IBC (PhD = 40.0%; OMP = 80.0%) and UA, that presented the overall lowest concordance rates (PhD = 20.0%; OMP = 40.0%). CONCLUSION: The cell-block technique presented a high diagnostic usefulness for detecting RC and OKC and, if associated with clinical and radiographic characteristics, might be sufficient for final diagnosis of these diseases. Regarding IBC and UA, an analysis with a higher number of cases is recommended to determine the true usefulness of the cell-block as ancillary tool for the diagnosis of these lesions.

Aspectos técnicos do tratamento do cisto ósseo traumático: relato de caso / Technical aspects of treatment of the traumatic bone cyst: case report

Objetivo: Este trabalho objetiva relatar um caso clínico de um cisto ósseo traumático, enfatizando a técnica cirúrgica. Relato do caso: Paciente gênero feminino, 15 anos de idade, foi encaminhada ao departamento de cirurgia oral e maxilofacial, Universidade Federal de Campina Grande, para avaliação de lesão intra-óssea em região anterior da mandíbula. O exame radiográfico evidenciou área radiolúcida unilocular e assintomática associada ao ápice dos incisivos inferiores esquerdo, que apresentavam vitalidade pulpar. A paciente não referia trauma na infância, apesar de apresentar cicatriz na região submentual. Foi feito o diagnóstico clínico de cisto ósseo traumático, sendo a exploração cirúrgica e curetagem do defeito ósseo o tratamento de escolha. No pós-operatório de um ano, a paciente evolui satisfatoriamente, sem queixas clínicas. Conclusão: Por apresentar comportamento não-agressivo, o cisto ósseo traumático responde adequadamente ao tratamento conservador através da curetagem cirúrgica.

Objective: This study aim report a clinical case of a traumatic bone cyst, emphasizing the surgical technique. Case report: Patient female, 15 years-old, was referred to the oral and maxillofacial surgery department, Federal University of Campina Grande, for evaluation intra-osseous lesion in the anterior mandible. Radiographic examination evidenced a unilocular area asymptomatic and associated to the apex of the under left incisive, who presented pulp vitality. The patient reported no trauma in childhood, although presenting a scar on the submental region. The clinical diagnosis of traumatic bone cyst was performed, surgical exploration and curettage of the bone defect was the treatment of choice. Postoperative period of one year, the patient progressed satisfactorily without clinical complaints. Conclusion: Presentation non-aggressive behavior, the traumatic bone cyst responds adequately to conservative treatment by surgical curettage.

Nonendodontic lesions misdiagnosed as apical periodontitis lesions: series of case reports and review of literature.

INTRODUCTION: This study aimed to analyze cases referred from a reference service in oral pathology that were initially misdiagnosed as periapical lesions of endodontic origin and to perform a review of the literature regarding lesions located in the apical area of teeth with a nonendodontic source. METHODS: A survey was made of clinical cases derived from the service of oral pathology from 2002 to 2012. The pertinent literature was also reviewed using ScienceDirect and PubMed databases. The lesions were grouped into benign lesions mimicking endodontic periapical lesions (BLMEPLs), malignant lesions mimicking endodontic periapical lesions (MLMEPLs), and Stafne bone cavities. The clinical presentations were divided into lesions with swelling without pain, lesions with swelling and pain, and lesions without swelling but presenting with pain. RESULTS: The results showed that 66% (37/56) of cases represented benign lesions, 29% (16/56) malignant lesions, and 5% (3/56) Stafne bone cavities. The most commonly reported BLMEPLs were ameloblastomas (21%) followed by nasopalatine duct cysts (13.5%). The most frequently cited MLMEPLs were metastatic injuries (31.5%) followed by carcinomas (25%). The main clinical presentation of BLMEPLs was pain, whereas that of MLMEPLs was swelling associated with pain; Stafne bone cavities displayed particular clinical findings. CONCLUSIONS: Clinical and radiologic aspects as well as the analysis of the patients' medical history, pulp vitality tests, and aspiration are essential tools for developing a correct diagnosis of periapical lesions of endodontic origin. However, if the instruments mentioned earlier indicate a lesion of nonendodontic origin, a biopsy and subsequent histopathological analysis are mandatory.

Giant cells mandibular lesion: surgical treatment with preservation of the dentition.

Giant cell tumors of the jaw (GCTJ) are common in the long bones but rare in the craniofacial region, with only 1% of cases occurring in the latter; they account for approximately 3% to 5% of all primary bone tumors and 15% to 20% of all benign bone tumors. The biologic behavior of central giant cell lesions of the jaws ranges from quiescent to aggressive with destructive expansion, and the clinical behavior of GCTJ of the jaws is variable and difficult to predict. A number of tumors that occur in the jaws contain giant cells but are not true benign giant cell tumors. These include aneurysmal bone cyst, cherubism, simple bone cyst, osteoid osteoma, giant cell granuloma reparative, and tumor of hyperparathyroidism. This article reports a patient study of giant cell extended lesion in the left mandible from dental canine element to mandibular angle. The patient underwent excision of neoplasm and reconstruction of the mandible with an autologous bone graft of the iliac crest, but dentition was preserved over the resected area. No complications were detected, and 8 months postoperative control revealed excellent aesthetic and functional recuperation. This case is presented because of the following: (1) GCTJ is an infrequent tumor; (2) uncommon clinical presentation, severe deformity; (3) excessive size and jaw deformity; (4) fast growing; and (5) surgical treatment with preservation of the dentition in affected area.

Atypical presentations of simple bone cysts of the mandible: a case series and review of literature.

Simple bone cysts are well-defined intraosseous radiolucencies that often extend between the roots and appear clinically like empty cavities. This article aims to provide more information about this lesion with limited prominence in academic literature, to illustrate atypical cases, and to provide a review of the current literature. A series of six atypical cases of simple bone cysts is presented and their clinical, radiographic and microscopic characteristics, differential diagnosis, treatment and follow-up are discussed. Correct diagnosis of this entity is of key importance, since it presents with clinical & radiographic similarities to other bone lesions, some exhibiting more aggressive behaviour.

Evaluation of the cell block technique as an auxiliary method of diagnosing jawbone lesions

This study investigated the viability of the cell block technique as an auxiliary method of diagnosing jawbone lesions. Thirty-three clinically diagnosed jawbone lesions with a cystic appearance were subjected to aspiration. The aspirated material was processed by the cell block technique, and the lesions were biopsied and treated. Cytological findings (cell block) and histopathology analyses (gold standard) were compared by the chi-square test. There were associations between cysts and cholesterol crystal clefts, between keratocystic odontogenic tumors (KOT) and epithelial cells, and between KOT and parakeratin. The occurrence of cholesterol crystal clefts in cell block slides was correlated with cystic lesions, and the parakeratin presence was a KOT indicator. The cell block technique proved to be fast, easy-to-handle, and low-cost, making it an attractive auxiliary method for the preliminary diagnosis of jawbone lesions.

Evaluation of the cell block technique as an auxiliary method of diagnosing jawbone lesions.

This study investigated the viability of the cell block technique as an auxiliary method of diagnosing jawbone lesions. Thirty-three clinically diagnosed jawbone lesions with a cystic appearance were subjected to aspiration. The aspirated material was processed by the cell block technique, and the lesions were biopsied and treated. Cytological findings (cell block) and histopathology analyses (gold standard) were compared by the chi-square test. There were associations between cysts and cholesterol crystal clefts, between keratocystic odontogenic tumors (KOT) and epithelial cells, and between KOT and parakeratin. The occurrence of cholesterol crystal clefts in cell block slides was correlated with cystic lesions, and the parakeratin presence was a KOT indicator. The cell block technique proved to be fast, easy-to-handle, and low-cost, making it an attractive auxiliary method for the preliminary diagnosis of jawbone lesions.

Traumatic bone cyst of the mandible: a review of 26 cases.

UNLABELLED: The traumatic bone cyst is characterized by the presence of an asymptomatic sinus devoid of epithelial lining, which is rarely found in the jaws. OBJECTIVE: To describe the clinical, surgical and radiographic findings of traumatic bone cysts. MATERIAL AND METHOD: A retrospective study was made of patients diagnosed with traumatic bone cysts at an oral pathology department from 1992 to 2007. Data on the clinical, radiographic and surgical complications were gathered. RESULTS: Twenty-six cases of traumatic bone cyst were diagnosed in 15 years; 17 were male and 09 were female. Most patients were within first two decades of life and had no pain or history of trauma in the affected area. The multilocular pattern was observed in only seven cases, its radiographic appearance suggests a tumor. Air was found inside the lesion in about 70% of cases; serous fluid with blood and blood only were uncommon within the lesions. CONCLUSION: A higher prevalence in young patients, absence of a history of trauma, and a small number of lesions containing serous fluid with blood reflects the need to discuss the true pathogenesis of traumatic bone cysts.

Cisto ósseo traumático da mandíbula: revisão de 26 casos / Traumatic bone cyst of the mandible: a review of 26 cases

O cisto ósseo traumático é uma entidade patológica caracterizada pela presença de uma cavidade óssea assintomática desprovida de revestimento epitelial, sendo raramente encontrado nos maxilares. OBJETIVO: Descrever as características clínico-cirúrgicas e radiográficas dos cistos ósseos traumáticos. MATERIAL E MÉTODO: Estudo de caráter retrospectivo dos pacientes diagnosticados com cisto ósseo traumático em um serviço de patologia oral no período de 1992 a 2007. Informações referentes às características clínicas, radiográficas e cirúrgicas foram coletadas. RESULTADOS: Vinte e seis casos de cisto ósseo traumático foram diagnosticados no período de 15 anos, 17 pertencentes ao sexo masculino e 09 ao sexo feminino. A maioria dos pacientes afetados pertencia às duas primeiras décadas de vida, não relatava sintomatologia dolorosa, bem como história de trauma na região da lesão. O padrão multilocular foi observado em apenas sete casos, dando às lesões uma aparência radiográfica tumoral. A presença de ar no interior da cavidade patológica foi relatada em aproximadamente 70% dos casos, sendo rara a presença de conteúdo serossanguíneo e seroso. CONCLUSÃO: A maior prevalência de casos em pacientes jovens, a infrequente história de trauma e o pequeno número de lesões com conteúdo serossanguíneo refletem a necessidade de se discutir a real patogênese do cisto ósseo traumático.

The traumatic bone cyst is characterized by the presence of an asymptomatic sinus devoid of epithelial lining, which is rarely found in the jaws. OBJECTIVE: To describe the clinical, surgical and radiographic findings of traumatic bone cysts. MATERIAL AND METHOD: A retrospective study was made of patients diagnosed with traumatic bone cysts at an oral pathology department from 1992 to 2007. Data on the clinical, radiographic and surgical complications were gathered. RESULTS: Twenty-six cases of traumatic bone cyst were diagnosed in 15 years; 17 were male and 09 were female. Most patients were within first two decades of life and had no pain or history of trauma in the affected area. The multilocular pattern was observed in only seven cases, its radiographic appearance suggests a tumor. Air was found inside the lesion in about 70% of cases; serous fluid with blood and blood only were uncommon within the lesions. CONCLUSION: A higher prevalence in young patients, absence of a history of trauma, and a small number of lesions containing serous fluid with blood reflects the need to discuss the true pathogenesis of traumatic bone cysts.

Asynchronous idiopathic bone cavity: a case report.

Idiopathic bone cavity (IBC) is a non-odontogenic intra-osseous lesion that affects the jaws and others bones. The aetiology of IBC remains unknown. IBC is frequently observed as a single radiolucent area with a corticated, well-defined border, a scalloped shape and a minimal effect on the surrounding structures. A case report of asynchronous IBC in a 17-year-old woman is presented. The first lesion occurred in the mandibular symphysis region, and the second IBC occurred in the right mandibular ramus. Both lesions were surgically treated, and the patient has been disease-free for 5 years.

Quiste mandibular de grandes dimensiones: tratamiento sin endodoncia, seguimiento a 9 años / Large mandibular cyst: an approach without endodontic treatment, a 9-year follow-up

Los quistes de los maxilares son cavidades patológicas con una pared conjuntivo-epitelial con contenido líquido, semilíquido o pastoso. A veces se manifiestan clínicamente o se descubren por hallazgos radiográficos. En la presente publicación se presenta un caso de un quiste maxilar asintomático, descubierto radiográficamente, cuyo tamaño abarca desde el canino derecho hasta la rama ascendente opuesta, con conservación de la vitalidad pulpar de las piezas involucradas, a las que no se les realizó tratamiento endodóntico previo o posterior.

Quistes de los maxilares en niños: un análisis clínico / Jaw cysts in children: a clinical analysis

Objetivo: Realizar una evaluación epidemiológica de los quistes odontogénicos en pacientes de 0 a 14 años de edad, verificando cuáles son las lesiones de mayor incidencia entre estas edades. Métodos: Fueron evaluadas 100 fichas histopatológicas de lesiones diagnosticadas como quistes de naturaleza odontogénica, enfatizando las características clínicas (género, edad, tipo de lesión quística, localización anatómica y tamaño de la lesión) y radiográficas. Resultados: Fue observado que el género masculino, con edad media de 9, 78 años, así como las regiones posterior de mandíbula y anterior de la maxila fueron más comprometidos. El quiste dentígero fue la lesión más común, seguida del quiste radicular. Se observó además, que en la muestra evaluada el aspecto radiográfico unilocular y las lesiones asintomáticas fueron las más frecuentes. Conclusiones: Se concluyó que es muy importante realizar este tipo de estudios, una vez que a través de ellos podemos conocer la frecuencia e incidencia de diversas lesiones, principalmente en pacientes pediátricos, en los cuales poco se conoce sobre la prevalencia de las lesiones quísticas de los maxilares.

Objective: To realize an epidemiologic survey of odontogenic cysts in patients from 0 to 14 years old in order to find out the most prevalent lesions of each age period. Methods: 100 histopathologic files of lesions diagnosed as cysts of odontogenic origin were retrieved emphasing their clinic (cystic lesion pattern, gender, age, anatomical site and lesion lenght) and radiographic features, which the surgical specimens were forwarded for the Oral Pathology Service of UFRN. Results: It could be identified that either the male gender, with an age average of 9,78 years, or the mandible posterior and the anterior maxilla region were more involved. Dentigerous cyst was the most prevalent lesions, followed by the radicular cyst. Moreover, a unilocular radiolucence and asymptomatic lesions were more common in the sample. Conclusions: To sum up, it can be infered the outstanding relevance of studies like the present since that it is through than that it can be reached the knowledge of the frequency and incidence of several lesions, especially in paediatric patients in as much as the few knowledge of the cystic lesion prevalence in their jaws.

Quistes de los maxilares: revisión bibliográfica / Maxillary cysts: bibliographical review

Se realiza una revisión sobre el tema de los quistes de los maxilares con el objetivo de ampliar los conocimientos sobre este tema, debido a los trastornos que estos pueden ocasionar tanto estética como funcionalmente y la afectación que pueden producir en la integridad del componente maxilofacial, de ahí la importancia de un diagnóstico y tratamiento adecuados(AU)

He/she is carried out a revision on the topic of the cysts of the maxillary ones with the objective of enlarging the knowledge on this topic, due to the dysfunctions that these they can cause so much aesthetic as functionally and the affectation that you/they can take place in the integrity of the component maxilofacial, of there the importance of a diagnosis and adapted treatment(AU)

Quiste óseo traumático / Traumatic bone cyst

El quiste óseo traumático (QOT) es una cavidad en la mandíbula ósea no revestida por epitelio, siendo considerado un falso quiste. El propósito de los autores es el relato de un caso clínico, donde ha sido posible con una buena anamnesis y examen radiográfico convencional, obtener el diagnóstico más probable de la lesión como es QOT, que orientó toda la presentación del caso. La lesión ha disminuido y se estabilizó

Lesiones en posición globulomaxilar / Lesions in globulomaxillary position

Se describen dos casos de lesiones con características clinicorradiográficas de lesiones en posición globulomaxilar. Dicha entidad ocurre con cierta frecuencia pero no corresponde a la lesión clásicamente denominada quiste globulomaxilar. A partir de la presentación de dos casos clínicos se realiza una revisión de la literatura actualizada en el tema

Lesiones en posición globulomaxilar / Lesions in globulomaxillary position

Se describen dos casos de lesiones con características clinicorradiográficas de lesiones en posición globulomaxilar. Dicha entidad ocurre con cierta frecuencia pero no corresponde a la lesión clásicamente denominada quiste globulomaxilar. A partir de la presentación de dos casos clínicos se realiza una revisión de la literatura actualizada en el tema (AU)

Quiste dentígero inflamatorio: reporte de un caso / Inflammatory dentigerous cyst: report of a case

Los quistes dentígeros son unos de los más prevalentes entre los quistes odontogénicos. Su verdadera histogénesis permanece sin aclarar, la mayoría de los autores apoya un origen de desarrollo, pero tambiéns e ha creído que existe un origen inflamatorio. El propósito de este artículo es presentar un caso de quiste dentígero inflamatorio asociado con un segundo premolar mandibular en una pciente de 10 años de edad, relacionado con un diente primario con tratamiento pulpar y explicar la patogénesis de este nuevo tipo de quiste dentígero

Defecto mandibular de Stafne / Stafne's mandibular defect

El defecto mandibular de Stafne ha sido descripto por muchos autores. Es, tal vez, una de las entidades óseas más antiguas de las que se tenga evidencia, aunque fue Edward Stafne quien en 1942, por primera vez reconoció y detalló sus características. La costumbre llevó a denominarlo quiste óseo estático o quiste latente, pero ambas denominaciones son incorrectas, ya que no es un verdadero quiste, sino un defecto por compresión de la glándula submaxilar. Se lo descubre en la mandíbula, en el tercio posterior de la tabla lingual, debajo del conducto dentario, en el área del tercer molar, por delante del ángulo. Hecho el diagnóstico diferencial con otras entidades, no está indicada la cirugía, pero es aconsejable un control radiográfico a distancia. La sialografía de la glándula submaxilar es, a veces, un recurso valioso para confirmar el defecto

Defecto mandibular de Stafne / Stafnes mandibular defect

El defecto mandibular de Stafne ha sido descripto por muchos autores. Es, tal vez, una de las entidades óseas más antiguas de las que se tenga evidencia, aunque fue Edward Stafne quien en 1942, por primera vez reconoció y detalló sus características. La costumbre llevó a denominarlo quiste óseo estático o quiste latente, pero ambas denominaciones son incorrectas, ya que no es un verdadero quiste, sino un defecto por compresión de la glándula submaxilar. Se lo descubre en la mandíbula, en el tercio posterior de la tabla lingual, debajo del conducto dentario, en el área del tercer molar, por delante del ángulo. Hecho el diagnóstico diferencial con otras entidades, no está indicada la cirugía, pero es aconsejable un control radiográfico a distancia. La sialografía de la glándula submaxilar es, a veces, un recurso valioso para confirmar el defecto (AU)