CONSERVATIVE SURGICAL MANAGEMENT OF ODONTOGENIC KERATOCYST: CASE REPORT
DOI:
https://doi.org/10.61164/gr624445Keywords:
MANEJO CIRÚRGICO CONSERVADOR DE QUERATOCISTO ODONTOGÊNICO: RELATO DE CASOAbstract
Odontogenic keratocyst (OK) is a developmental odontogenic cyst that is mostly asymptomatic, slow-growing, infiltrative to adjacent tissues, and has a high recurrence rate. Therefore, this study aims to report a clinical case of a 2-year follow-up of an odontogenic keratocyst. A 32-year-old male patient was referred to the Oral and Maxillofacial Surgery and Traumatology Service of the School of Dentistry of the Federal University of Mato Grosso do Sul after a radiographic finding of a radiolucent lesion associated with impacted tooth 38. The patient reported no comorbidities or complaints related to the lesion. Physical examination revealed no noteworthy changes. Panoramic radiographs revealed a radiolucent lesion measuring approximately 2 cm in its largest extent, affecting the angle and body of the left mandible, associated with teeth 36, 37, and 38, the latter being impacted horizontally. After analysis, it was decided to perform excision of tooth 38, combined with cystic decompression and placement of a rubber device to reduce the cystic cavity, allowing its definitive enucleation later without compromising the integrity of the mandible. The diagnostic hypotheses were odontogenic keratocyst, ameloblastoma, and central giant cell granuloma. Histopathological examination confirmed the diagnosis of an odontogenic keratocyst. On postoperative day 21, the decompression device was removed, and the treated region was monitored by imaging for 2 years. After a 6-month period, with tomographic regression of the lesion, the patient underwent total enucleation of the cystic remnant. Subsequently, curettage of the lesion was performed to stimulate bone formation and remove residual epithelial islands. Therefore, it can be inferred that initial conservative treatment, with decompression of the lesion and subsequent enucleation, despite presenting the possibility of recurrence of the OC, is adequate to prevent mandibular weakening or fracture and also minimize the possibility of inferior alveolar nerve paresthesia. The patient remains under follow-up, and the treatment has yielded satisfactory results to date.
Downloads
References
AL-MORAISSI, E. A. et al. What surgical treatment has the lowest recurrence rate following the management of keratocystic odontogenic tumor?: a large systematic review and meta-analysis. Journal of Cranio-Maxillofacial Surgery, v. 45, n. 1, p. 131-144, 2017. DOI: https://doi.org/10.1016/j.jcms.2016.10.013
AL-MORAISSI, E. A.; KAUR, A.; GOMEZ, R. S.; ELLIS, E. Effectiveness of different treatments for odontogenic keratocyst: a network meta-analysis. International Journal of Oral and Maxillofacial Surgery, v. 52, n. 1, p. 32-43, 2023. DOI: https://doi.org/10.1016/j.ijom.2022.09.004
BORRÁS-FERRERES, J. et al. Therapeutic management of the odontogenic keratocyst: an energetic approach with a conservative perspective and review of the current therapeutic options. Journal of Clinical and Experimental Dentistry, v. 12, n. 8, p. e794-e799, 2020. DOI: https://doi.org/10.4317/jced.56722
BORRÁS-FERRERES, J.; ALBISU-ALTOLAGUIRRE, I.; GAY-ESCODA, C.; MOSQUEDA-TAYLOR, A. Long-term follow-up of a large multilocular odontogenic keratocyst: analysis of recurrences and the applied treatments. Journal of Clinical and Experimental Dentistry, v. 16, n. 9, p. e1157-e1163, 2024. DOI: https://doi.org/10.4317/jced.62032
BRESLER, S. C.; PADWA, B. L.; GRANTER, S. R. Nevoid basal cell carcinoma syndrome (Gorlin syndrome). Head and Neck Pathology, v. 10, n. 2, p. 119-124, 2016. DOI: https://doi.org/10.1007/s12105-016-0706-9
BRITO-MENDOZA, L. et al. A comparison of Ki67, syndecan-1 (CD138), and molecular RANK, RANKL, and OPG triad expression in odontogenic keratocysts, unicystic ameloblastoma, and dentigerous cysts. Disease Markers, v. 2018, 2018. DOI: 10.1155/2018/7048531. DOI: https://doi.org/10.1155/2018/7048531
CHRCANOVIC, B. R.; GOMEZ, R. S. Recurrence probability for keratocystic odontogenic tumors: an analysis of 6427 cases. Journal of Cranio-Maxillofacial Surgery, v. 45, n. 2, p. 244-251, 2017. DOI: https://doi.org/10.1016/j.jcms.2016.11.010
MADHIREDDY, M. R. et al. Large follicular odontogenic keratocyst affecting maxillary sinus mimicking dentigerous cyst in an 8-year-old boys: a case report and review. International Journal of Clinical Pediatric Dentistry, v. 11, n. 4, p. 349-351, 2018. DOI: https://doi.org/10.5005/jp-journals-10005-1537
MOHANTY, S. et al. Surgical management of the odontogenic keratocyst: a 20-year experience. International Journal of Oral and Maxillofacial Surgery, v. 50, n. 9, p. 1168-1176, 2021. DOI: https://doi.org/10.1016/j.ijom.2021.02.015
NAIR, A. P. et al. Efficacy of gas combination cryotherapy in the management of odontogenic keratocyst of the maxilla and mandible: a pilot study. Journal of Maxillofacial and Oral Surgery, v. 21, n. 3, p. 979-989, 2022. DOI: https://doi.org/10.1007/s12663-021-01664-4
PHILIPSEN, H. P. Keratocystic odontogenic tumour. In: BARNES, L. et al. (Ed.). Pathology and genetics of head and neck tumours. Lyon: IARC Press, 2005. p. 306-307.
POGREL, M. A. The keratocystic odontogenic tumor. Oral and Maxillofacial Surgery Clinics of North America, v. 25, n. 1, p. 21-30, 2013. DOI: https://doi.org/10.1016/j.coms.2012.11.003
POGREL, M. A.; JORDAN, R. C. K. Marsupialization as a definitive treatment for the odontogenic keratocyst. Journal of Oral and Maxillofacial Surgery, v. 62, n. 6, p. 651-655, 2004. DOI: https://doi.org/10.1016/j.joms.2003.08.029
SOLUK-TEKKESIN, M.; WRIGHT, J. M. The World Health Organization classification of odontogenic lesions: a summary of the changes of the 2017 (4th) edition. Turkish Journal of Pathology, v. 34, n. 1, p. 1-10, 2018.
SOLUK-TEKKESIN, M.; WRIGHT, J. M. The World Health Organization classification of odontogenic lesions: a summary of the changes of the 2022 (5th) edition. Turkish Journal of Pathology, v. 38, n. 2, p. 168-184, 2022. DOI: https://doi.org/10.5146/tjpath.2022.01573
STOELINGA, P. J. W. The odontogenic keratocyst revisited. International Journal of Oral and Maxillofacial Surgery, v. 51, n. 11, p. 1420-1423, 2022. DOI: https://doi.org/10.1016/j.ijom.2022.02.005
TITINCHI, F. Protocol for management of odontogenic keratocysts considering recurrence according to treatment methods. Journal of the Korean Association of Oral and Maxillofacial Surgeons, v. 46, n. 5, p. 358-360, 2020. DOI: https://doi.org/10.5125/jkaoms.2020.46.5.358
WORLD MEDICAL ASSOCIATION. WMA Declaration of Helsinki – Ethical principles for medical research involving human participants. Helsinki, 1964. Atualizada em out. 2024. Disponível em: https://www.wma.net/policies-post/wma-declaration-of-helsinki/
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Lucas Silva de Lima , Gustavo Silva Pelissaro, Alana Oswaldina Gavioli Meira dos Santos Botega, Gleyson Kleber do Amaral-Silva, Daniella Moraes Antunes, Ellen Cristina Gaetti Jardim
This work is licensed under a Creative Commons Attribution 4.0 International License.
Autores que publicam nesta revista concordam com os seguintes termos:
- Autores mantém os direitos autorais e concedem à revista o direito de primeira publicação, com o trabalho simultaneamente licenciado sob a Licença Creative Commons Attribution que permite o compartilhamento do trabalho com reconhecimento da autoria e publicação inicial nesta revista;
- Autores têm autorização para assumir contratos adicionais separadamente, para distribuição não-exclusiva da versão do trabalho publicada nesta revista (ex.: publicar em repositório institucional ou como capítulo de livro), com reconhecimento de autoria e publicação inicial nesta revista, desde que adpatado ao template do repositório em questão;
- Autores têm permissão e são estimulados a publicar e distribuir seu trabalho online (ex.: em repositórios institucionais ou na sua página pessoal) a qualquer ponto antes ou durante o processo editorial, já que isso pode gerar alterações produtivas, bem como aumentar o impacto e a citação do trabalho publicado (Veja O Efeito do Acesso Livre).
- Os autores são responsáveis por inserir corretamente seus dados, incluindo nome, palavras-chave, resumos e demais informações, definindo assim a forma como desejam ser citados. Dessa forma, o corpo editorial da revista não se responsabiliza por eventuais erros ou inconsistências nesses registros.
POLÍTICA DE PRIVACIDADE
Os nomes e endereços informados nesta revista serão usados exclusivamente para os serviços prestados por esta publicação, não sendo disponibilizados para outras finalidades ou a terceiros.
Obs: todo o conteúdo do trabalho é de responsabilidade do autor e orientador.
