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rev port estomatol med dent cir maxilofac . 2021;62(1):50-55 51

Queratocisto odontogénico com 14 anos de evolução: caso clínico

r e s u m o

Palavras-chave: O queratocisto odontogénico é um quisto odontogénico de desenvolvimento que, nos es-
Cisto ósseo tágios iniciais, usualmente é detetado em radiografias de rotina. Este facto aumenta a
Patologia oral responsabilidade do médico dentista no seu diagnóstico pelo que o profissional deve pres-
Radiologia oral tar atenção a todo o complexo maxilomandibular e não apenas nos dentes. Não há um
Cirurgia oral protocolo de tratamento para o queratocisto odontogénico. No entanto, devido ao seu alto
índice de recorrência, a resseção cirúrgica é recomendada, especialmente naqueles casos
com destruição óssea extensiva. A enucleação seguida da aplicação da Solução de Carnoy
é uma boa alternativa à resseção, sendo apontada como o tratamento conservador de
queratocisto odontogénico com menor taxa de recorrência. O objetivo deste estudo foi
relatar um caso de queratocisto odontogénico de grande extensão, com mais de 14 anos de
evolução, não diagnosticado em 3 diferentes radiografias panorâmicas, que foi tratado com
enucleação seguida da aplicação da solução de Carnoy. (Rev Port Estomatol Med Dent Cir
Maxilofac. 2021;62(1):50-55)
© 2021 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/).

markers such as Ki -7 and P53 can be observed. 7,9,11 The pres-
Introduction
ence of satellite cysts potentially increases the chance of re-
The odontogenic keratocyst (OK) is a developmental odonto- currence if they are not completely removed during surgery. 8
genic cyst whose nomenclature has been changing in recent Various treatment modalities have been reported, includ-
decades. The 2005 World Health Organization (WHO) classifica- ing marsupialization, enucleation with or without adjuvants,
tion of Head and Neck Tumors reclassified the odontogenic decompression, cryotherapy, and resection. 6,8,9,11-13 The goal is
keratocyst as a benign neoplasm, recommending the term to choose the treatment modality that carries the lowest pos-
“keratocystic odontogenic tumor” due to its aggressiveness, sible risk of recurrence and the least morbidity while still erad-
high recurrence rate, and association with the nevoid basal cell icating the lesion. The lesion recurrence rates vary according
carcinoma syndrome and mutations in the PTCH1 gene. How- to the chosen treatment modality, with the lowest index asso-
ever, in 2017, the WHO reclassified it as a cyst, alleging that ciated with surgical resection. Due to its high morbidity, more
mutations in the PTCH gene can occur even in non -neoplastic conservative techniques are constantly used. Among them,
lesions, such as the dentigerous cyst; besides, many research- enucleation associated with Carnoy’s solution has the lowest
1
ers have suggested that cyst resolution after marsupialization recurrence rate, being a good alternative to resection. 8,13
is not compatible with a neoplastic process. 1-5 The present study aimed to report a case of a large kerato-
OKs derive from the dental lamina and have a predilection cyst with more than 14 years of evolution in a 67 -year -old male
for males, occurring mainly in the third decade of life. 6-9 The patient that had not been diagnosed in three previous different
mandible is more affected than the maxilla, and the sites of pre- panoramic radiographs and was treated with enucleation fol-
dilection are its posterior body, angle, and ascending ramus. lowed by the application of Carnoy’s solution.
6,9
The lesion is asymptomatic and is often diagnosed on routine
radiographs. Thus, the general dentist’s attention while evaluat-
ing the maxillomandibular complex is essential and should not Case report
be limited to analyzing the teeth. OKs extend initially in the
10
7,8
anteroposterior direction, causing expansion in a late stage. In A 67 -year -old male patient was referred to our clinic to evalu-
advanced stages, pain, edema, tooth displacement, root resorp- ate a mass on his face that had been gradually enlarging for
tion, and pathologic fractures can be observed. 8,9 the last five months. Past family and medical history were
Radiographically, the OK presents as a uni - or multilocular unremarkable. The patient reported discomfort at his mandi-
lesion, with often scalloped margins, commonly associated ble’s left posterior body for more than ten years. In the past,
with impacted third molars. 7,11 Its differential diagnosis should he had his impacted lower third molar removed after being
include dentigerous cyst, ameloblastoma, radicular cyst, later- told the discomfort was due to the tooth. However, the symp-
al periodontal cyst, and nevoid basal cell carcinoma syndrome. tom persisted after the surgery, and he also started feeling a
9
Histologically, OKs usually present a very thin and uniform bad taste and sometimes could see a white/yellow liquid dis-
lining epithelium and a well -defined basal cell layer in a pali- charging from the area of the third molar. These symptoms
saded arrangement. The keratin layer is corrugated, and the persisted for a long time after the surgery, and he could not
cystic wall is thin and generally uninflamed; cell proliferation remember for how long exactly.