Diagnóstico e tratamento de extenso cisto dentígero mandibular em um paciente pediátrico / Diagnosis and treatment of extensive mandibular dentigerous cyst in a pediatric patient

Introdução: lesões gnáticas pediátricas são comumente assintomáticas e diagnosticadas em exames de imagem de rotina. Entretanto, algumas podem cursar com dor, assimetria facial, destruição óssea e rápida evolução, requerendo diagnóstico preciso e precoce. Objetivo: o objetivo desse estudo é reportar o processo de diagnóstico e tratamento de um extenso cisto dentígero (CD) em um paciente pediátrico. Relato do caso: um menino de 5 anos idade apresentou queixa de aumento de volume doloroso na região posterior de mandíbula com tempo de evolução de 4 meses. A tomografia computadorizada demonstrou uma imagem hipodensa, bem delimitada, envolvendo a coroa do dente 37, causando a expansão da cortical vestibular e erosão da cortical lingual, com aproximadamente 3cm. Com as hipóteses diagnósticas de fibroma ameloblástico ou CD, a lesão foi enucleada totalmente. Microscopicamente, observou-se uma lesão cística com revestimento epitelial odontogênico, áreas de hiperplasia e exocitose, além de cápsula de tecido conjuntivo densamente colagenizado, com áreas de hemorragia e infiltrado inflamatório linfoplasmocitário. Resultados: baseado nas características clínicas, imagenológicas e histopatológicas, o diagnóstico final foi de CD inflamado. O paciente continua em acompanhamento clínico e radiográfico, com ausência de recidiva. Conclusão: CD inflamados em pacientes pediátricos podem apresentar comportamento peculiar e mimetizar outras lesões de natureza odontogênica. O diagnóstico precoce permite uma menor morbidade associada aos tratamentos cirúrgicos.

Introduction: pediatric gnathic lesions are commonly asymptomatic and diagnosed in routine imaging exams. However, some of them may cause pain, facial asymmetry, bone destruction and rapid evolution, requiring accurate and early diagnosis. Objective: the aim of this study is to report the diagnosis and treatment of an extensive dentigerous cyst (DC) in a pediatric patient. Case report: a 5-year-old boy complained of painful swelling in the posterior region of the mandible with an evolution time of 4 months. Computed tomography showed a hypodense, well-delimited image involving the crown of tooth 37, causing buccal cortical expansion and lingual cortical erosion, measuring approximately 3cm. With the diagnostic hypotheses of ameloblastic fibroma or DC, the lesion was completely enucleated. Microscopically, a cystic lesion with an odontogenic epithelial lining with areas of hyperplasia and exocytosis was observed, in addition to a densely collagenous connective tissue capsule, with areas of hemorrhage and lymphoplasmacytic inflammatory infiltrate. Results: based on clinical, imaging and histopathological characteristics, the final diagnosis was inflamed DC. The patient remains under clinical and radiographic follow-up, with no recurrence. Conclusion: inflamed DC in pediatric patients may show a peculiar behavior and mimic other odontogenic lesions. Early diagnosis allows for lower morbidity associated with surgical treatments.

Computed tomography angiography-assisted embolization of arteriovenous malformation prior to dental extractions in a patient with Sturge-Weber syndrome.

Sturge-Weber syndrome is a developmental condition characterized by hamartomatous vascular proliferation involving the tissues of the brain and face. Hemangiomatous proliferations and arterial venous malformations are common intraoral alterations that may be fatal due to incontrollable bleeding when performing surgical procedures in the face. The goal of this case report is to present the management of a 21-year-old woman with Sturge-Weber syndrome in whom it was necessary to perform embolization guided by computed tomography angiography before multiple tooth extractions.

Treatment of a central giant cell lesion in the mandible.

Central giant cell lesion (CGCL) is a benign intraosseous lesion that usually accompany the gnathic bones in the anterior region, mostly crossing the midline. Its clinical features involve cortical expansion, tooth displacement, and root resorption. Pain may occur in 20% of cases. Histopathological characteristics are like other pathological entities, being necessary discarding them. In this case, a 53-year-old female presented an expansive legion in the anterior mandible with tooth displacement and pain. After incisional biopsy, the result was CGCL. Surgical planning involved manufacturing a biomodel, bending the reconstruction plate to give the correct mandibular arch perimeter. After that, it was performed a segmental resection and installation of a reconstruction plate using a cervical approach. The patient is under follow-up with no signs of recurrence or complications.

Peripheral odontogenic keratocyst: Report of two new cases and review of the literature.

Peripheral odontogenic keratocyst (POKC) is a rare soft tissue entity showing the same histological characteristics of odontogenic keratocyst. Herein, we report two cases of POKC affecting the gingiva/alveolar mucosa. Case 1. A 43-year-old female was referred for evaluation of a painless well-defined nodular, sessile, non-tender swelling in the right maxillary buccal gingiva. No radiological alterations were observed. The patient was submitted to excisional biopsy and histological diagnosis was POKC. There were no signs of local recurrence after a 4-year follow-up. Case 2. A 63-year-old female was referred for evaluation of a painless well-defined nodular, sessile, yellowish swelling in the anterior mandibular alveolar mucosa. No radiological alterations were observed. The patient was submitted to excisional biopsy and histological diagnosis was POKC. Patient recovery was uneventful but she did not return for follow-up. POKC should be considered in the differential diagnosis of gingival cystic swellings and can be managed through conservative surgery. Key words:Odontogenic keratocyst, peripheral, gingiva, alveolar mucosa.