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rev port estomatol med dent cir maxilofac . 2020;61(2):52-56 53

Taxa de recorrência de ceratocistos odontogénicos: caracterização
clínico‑radiográfica ao longo de um período de 48 anos

r e s u m o

Palavras-chave: Objetivos: O objetivo do presente estudo foi realizar uma análise retrospetiva e avaliar a taxa
Ceratocisto odontogénico de recorrência dos casos diagnosticados histopatologicamente como ceratocisto odontogé-
Recorrência nico em um Serviço de Patologia Oral, localizado no Nordeste do Brasil.
Técnicas de diagnóstico cirúrgico Métodos: Os dados da presente pesquisa foram obtidos a partir das fichas clínicas arquiva-
das em nosso Serviço, tendo sido coletadas informações a respeito da idade do paciente,
sexo, localização anatómica, associação com dentes, aspeto radiográfico, tipo de biópsia,
sintomatologia, tipo de tratamento, recorrência e possível associação com a síndrome de
Gorlin.
Resultados: Dos 15.670 registros de casos de lesões bucomaxilofaciais no período estudado,
106 (0,67%) foram diagnosticados histopatologicamente como ceratocisto odontogénico e a
recidiva foi verificada em 13,2% dos casos.
Conclusões: A recorrência do ceratocisto odontogénico não esteve associada à localização
anatómica, sexo do paciente ou aparência radiográfica no momento do diagnóstico. Inde-
pendentemente, o ceratocisto odontogénico foi identificado como uma lesão cística não
agressiva, com uma baixa taxa de recorrência quando tratada de forma conservadora por
descompressão e enucleação cirúrgica. (Rev Port Estomatol Med Dent Cir Maxilofac.
2020;61(2):52-56)
© 2020 Sociedade Portuguesa de Estomatologia e Medicina Dentária.
Published by SPEMD. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).

sion when presenting loss of heterozygosity in the 9q22.31
Introduction
chromosome region and that these characteristics are also
Odontogenic keratocysts (OKC) originate from the odonto- found in other developmental cysts, such as dentigerous cysts. 6
genic epithelium, particularly from dental lamina remnants, Radiographically, lesions may have either a unilocular or
presenting different growth mechanisms and biological be- multilocular aspect, according to their size, with sclerotic bor-
havior than other maxillo -mandibular complex cysts. This ders, and may or not be tooth -associated. Lesions involving
2
1
cystic lesion exhibits aggressive behavior with a high poten- the third molar crown result in a dentigerous cyst appearance.
tial for infiltration in maxillary bones and may clinically pres- Therefore, a conclusive diagnosis cannot be made preopera-
ent as a solitary lesion or in the form of multiple lesions. It tively, based only on clinical and radiographic information, so
may be associated to Gorlin -Goltz syndrome (basal cell nevus histopathological examinations are important. 3
syndrome); patients affected by this syndrome present devel- Histopathologically, OKC is characterized by the presence
opmental abnormalities, such as cerebral calcification, bifid of a pathological cavity lined by corrugated parakeratinized
ribs, and increased susceptibility to different neoplasms, like stratified squamous epithelium, with uniform thickness rang-
basal cell carcinomas. 2 ing from six to eight cell layers. The basal cells are columnar
OKC presents a predilection for the mandible, and about with palisaded nuclei, exhibiting nuclear hyperchromatism.
75% of all cases affect its posterior region. This type of lesion The interface with the surrounding connective tissue is flat,
3
can be diagnosed at any age but affects mainly the third and and a thin fibrous capsule is observed, as well as a mild in-
7
fourth decades of life, mostly in males. Due to its potential flammatory mononuclear infiltrate in some cases. Epithelial
1
for bone destruction, OKC often grows to large dimensions remains and satellite cysts can be found in the capsule, and
before causing bone expansion. It is usually asymptomatic, these have been suggested as being responsible for OKC recur-
and the presence of a fluid or semi -solid yellowish -white con- rence rates. 8
tent can be observed macroscopically. 4 Several treatment methods have been reported, from con-
In 2005, OKC was classified by the World Health Organiza- servative to radical surgery. Enucleation and marsupialization
tion (WHO) as a benign neoplasm originating from the odon- are associated with a high number of recurrences. Associated
togenic epithelium, thus justifying its aggressive behavior, and therapies have been described as able to decrease the recur-
some studies have suggested an influence of PTCH1 gene alter- rence potential of OKC, such as peripheral osteotomy, Carnoy’s
5
ations in its etiology. The current 2017 WHO classification solution treatment, electrocauterization, cryotherapy, and sur-
again classified this lesion as an odontogenic developmental gical resection. Decompression and/or marsupialization pres-
cyst, indicating that the PTCH1 gene is not specific for this le- ent high success rates compared to aggressive treatments,