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RESUMEN Los odontomas son los tumores más frecuentes del área bucal y maxilofacial. Presentamos un caso clínico de una paciente femenina de 50 años, con cuadros de sinusitis a repetición y dolor en región maxilar derecha. Se le realiza tomografía axial computarizada simple de macizo facial, donde se observó una imagen amorfa de densidad variable a nivel del hueso maxilar derecho, que involucraba la porción inferior del seno, compatible con tumor odontogénico, probablemente benigno, sugestiva de un odontoma complejo.

ABSTRACT Odontomas are the most common tumours located in the oral and maxillofacial region. We present a 50-year-old female patient with recurrent sinusitis and pain in the right maxillary region. A simple computed axial tomography of the facial mass was performed, where an amorphous image of variable density was observed at the level of the right maxillary bone, involving the lower portion of the sinus, compatible with an odontogenic tumour, probably benign and suggestive of a complex odontoma.

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BACKGROUND: Hybrid odontogenic lesions combine histopathological characteristics of two or more odontogenic cysts and/or tumours. The aim of this study was to evaluate the available data on hybrid odontogenic lesions (HOL) and to analyse their epidemiological/clinical features and biological behaviour. METHODS: An electronic search was done in January 2021 using multiple databases. Eligibility criteria encompassed publications with sufficient clinical and histological information to confirm the tumours' diagnoses. RESULTS: A total of 147 articles were included in this study, comprising 203 cases. Calcifying odontogenic cyst associated with odontoma (COC/OD) (37/18.2%) was the most common HOL. Females were more affected with a mean age of 24.9 years. Lesions presented as asymptomatic swellings, with a mean evolution time of 8.2 months (0.3-96), and mean tumour size of 4.8 cm (0.3-7). Radiographic aspects frequently showed radiolucent (139/68.4%) and unilocular (52/25.6%) images with well-defined limits (48/23.6%). The lesions mostly affected mandibular pre-molars (69/34%) and mandibular molars (69/34%) regions. Enucleation (89/43.8%) and surgical excision (59/29%) were the most common treatment modalities. The mean follow-up time was 33.8 months (0.5-216 months) and recurrences were observed in four cases (1.9%), all of which were central odontogenic fibroma associated with central giant cell granuloma (COF/CGCG). CONCLUSION: COC/OD is the most common HOL and recurrence is a rare event, being usually associated with the diagnosis of COF/CGCG.

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El objetivo del presente trabajo es describir las técnicas para el diagnóstico y tratamiento de 3 casos clínicos de odontoma en pacientes ortodóncicos. En el caso 1, se trató a un paciente masculino de 17 años, que acudió para interconsulta con el servicio de ortodoncia, ya que no había erupcionado el canino superior izquierdo y el primer premolar superior izquierdo. El estudio anatomopatológico reveló odontoma complejo con áreas pindborgoides y acumulación de células fantasma. En al caso 2 se trató a un paciente femenino de 15 años. El estudio anatomopatológico reveló odontoma complejo. En el caso 3, se trató a un paciente masculino de 28 años que acudió a rehabilitación integral de su boca, y fue derivado a la cátedra de ortodoncia. En la radiografía panorámica se observó una imagen compatible con odontoma. Se remitió una muestra a anatomía patológica que confirmó el diagnóstico de odontoma. Conclusión: el conocimiento adecuado de las características clínicas, radiológicas y patológicas es necesario para un correcto diagnóstico y tratamiento. Es importante el trabajo interdisciplinario ortodoncista - cirujano para tratar estos casos (AU)

The objective of this work is to describe the techniques for the diagnosis and treatment of 3 clinical cases of odontoma in orthodontic patients. In case 1, a 17-year-old male patient was treated who came for consultation with the orthodontic service, since the upper left canine and the upper left first premolar had not erupted. Pathological study revealed complex odontoma with pindborgoid areas and accumulation of ghost cells. In case 2, a 15-year-old female patient was treated. The anatomopathological study revealed a complex odontoma. In case 3, a 28-year-old male patient was treated who attended comprehensive rehabilitation of his mouth and was referred to the orthodontic department. In the panoramic radiography, an image compatible with odontoma was observed. A sample was sent to pathological anatomy, which confirmed the diagnosis of odontoma. Conclusion: Adequate knowledge of the clinical, radiological and pathological characteristics is necessary for a correct diagnosis and treatment. Interdisciplinary orthodontist-surgeon work is important to treat these cases (AU)

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Objective: the present report describes the clinical, radiographic, and histopathological features of an ameloblastic fibro-odontoma (AFO) lesion. Case report: we report a clinical case of a 14-year-old boy with asymptomatic edema. Panoramic radiography detected a unilocular lesion with defined margins located in the posterior region of the mandible. The internal structure of the lesion presented several degrees of radiopacity with the involvement of the third molar. Cone-beam computed tomography revealed expanded buccal and lingual cortical bones, perforation of the lingual cortical bone, and displacement of the mandibular canal. AFO was suspected based on the radiographic and clinical characteristics. Total excision was performed and histologically examined, confirming the diagnosis of AFO. No recurrence occurred during a 24-month follow-up period. Final considerations: the evaluation of the clinical, radiographic, and histopathologic findings needs to be accurate for a correct diagnosis and appropriate treatment for case of AFO since the presentation is often asymptomatic.(AU)

Objetivo: o presente relato descreve as características clínicas, radiográficas e histopatológicas de uma lesão de fibro-odontoma ameloblástico (FOA). Relato de caso: relatamos o caso clínico de um menino de 14 anos com edema assintomático. A radiografia panorâmica detectou lesão unilocular com margens definidas e localizada na região posterior da mandíbula. A estrutura interna da lesão apresentava vários graus de radiopacidade com envolvimento do terceiro molar. A tomografia computadorizada de feixe cônico revelou as corticais ósseas vestibular e lingual expandidas, perfuração da cortical óssea lingual e deslocamento do canal mandibular. FOA foi a hipótese diagnóstica com base nas características radiográficas e clínicas. A excisão total foi realizada e examinada histologicamente, confirmando o diagnóstico de FOA. Nenhuma recorrência ocorreu durante um período de acompanhamento de 24 meses. Considerações finais: a avaliação das características clínicas, radiográficas e histopatológicas contribuíram para um diagnóstico correto e o tratamento adequado para o caso de FOA, uma vez que a lesão é frequentemente assintomática.(AU)

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Objetivo: relatar um caso raro de impacção de um incisivo decíduo inferior pela presença de odontoma composto, bem como descrever a sua abordagem clínica. Relato de caso: paciente do sexo masculino, com 4 anos de idade, apresentava ausência do incisivo lateral decíduo inferior esquerdo. O exame radiográfico mostrou impacção do incisivo não erupcionado próximo a estruturas radiopacas sugestivas de odontoma composto. O paciente foi acompanhado por dois anos, momento em que se realizou abordagem cirúrgica do caso. Após a cirurgia, a hipótese de diagnóstico de odontoma composto foi confirmada e com o acompanhamento ocorreu a erupção dos incisivos centrais permanentes inferiores. O paciente foi encaminhado para tratamento ortodôntico. Considerações finais: esse relato de caso aborda um caso raro de odontoma composto associado à não erupção de dente decíduo, uma vez que odontomas costumam ser detectados preferencialmente na segunda década de vida do paciente, sendo associados à impacção de dentes permanentes. Além disso, apresenta um protocolo de abordagem clínica para esses casos quando diagnosticados em idade precoce no paciente infantil.(AU)

Objective: to report a rare case of impaction of a primary mandibular incisor due to the presence of a compound odontoma and describe its clinical management. Case report: a 4-year-old boy presented with a "missing" primary left mandibular lateral incisor. Radiographs showed impaction of the unerupted incisor by adjacent radiopaque structures consistent with a compound odontoma. The patient was recalled periodically for 2 years, at which time surgical excision was performed. The diagnosis of compound odontoma was confirmed histologically, and the permanent mandibular central incisors erupted uneventfully; the patient was referred for orthodontic treatment. Final considerations: this case report describes an unusual case of compound odontoma associated with an unerupted deciduous tooth; odontomas are rare in this age range, occurring predominantly in the second decade of life and in association with impaction of permanent teeth. We also propose a protocol for clinical management of such early-onset cases.(AU)

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Introdução: o cisto ósseo traumático (COT) é um pseudocisto que se apresenta assintomático e é descoberto frequentemente em exames de rotina. Outra lesão também presente nos maxilares é o odontoma, sendo dividido em dois subtipos, o composto e o complexo; os odontomas são geralmente descobertos como um achado acidental, visto que não apresentam sintomatologia. Objetivo: relatar um caso incomum de um COT, associado à odontoma composto (OC). Relato de caso: paciente do gênero masculino, 16 anos de idade, compareceu à clínica escola de odontologia da Universidade Federal de Campina Grande (UFCG), campus Patos, PB, referenciado pelo cirurgião-dentista após solicitar exame radiográfico para tratamento ortodôntico e observar lesão radiolúcida em região anterior da mandíbula. Durante a anamnese, o paciente não relatou nenhuma alteração sistêmica ou doença de base, mas relatou trauma de infância na região acometida. No exame clínico intraoral, não foi observado nenhum aumento de volume na região. Realizou-se palpação na região, não havendo relato de dor. Ao analisar a radiografia panorâmica, observou-se a presença de pequenas estruturas calcificadas com radiopacidade semelhante às estruturas dentárias, delimitada por uma linha radiolúcida, sugestiva de OC. Para melhor localização, delimitação, relação com estruturas anatômicas e planejamento cirúrgico da lesão, foi solicitado um exame de tomografia computadorizada de feixe cônico (TCFC). Considerações finais: com base nos achados clínicos e radiográficos, optou-se por abordagem cirúrgica da lesão cística e enucleação do OC, sob anestesia local. No pós-operatório de um ano, o paciente evoluiu satisfatoriamente sem queixas clínicas.(AU)

Introduction: traumatic bone cyst (TBC) is a pseudocyst that usually presents asymptomatically and is found frequently in routine exams. Another lesion also present in the jaws is odontoma. The odontoma is divided into two subtypes, the compound and the complex; odontomas are usually discovered as an accidental finding, since they do not present symptomatology. Objective: the present article aims to report an unusual case of a TBC associated with a composite odontoma. Case report: a 16-year-old male patient attended the Clinic School of Dentistry of the Universidade Federal de Campina Grande (UFCG), Patos-PB campus, referenced by the dentist after identify radiolucent lesion in the anterior region of the mandible on radiographic examination for orthodontic treatment. During the anamnesis, the patient did not report any systemic alteration or underlying disease, but reported trauma in the region affected in childhood. The intra oral clinical examination, was not observed any increase in volume in the region. Palpation was performed in the region, and there was no report of pain. When analyzing panoramic radiography the presence of small calcified structures with radiopacity similar to dental structures was observed, delimited by a radiolucent line, suggestive of compound odontoma. To better location, delimitation, compared with anatomy and surgical planning of the injury, it was requested an cone beam computed tomography (CBCT). Final considerations: based on the clinical and radiographic findings, we opted for a surgical approach to cystic lesion and enucleation of composite odontoma, under local anesthesia. In the one-year postoperative period, the patient progresses satisfactorily without clinical complaints.(AU)

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Odontomas are benign, non-aggressive, and the most common odontogenic tumor of the jaws. Composed of dental tissues, it can be classified as compound or complex odontomas depending on their radiological and histological features. Among them, complex odontomas are less common and usually is presented as a small and asymptomatic radiopaque mass surrounded by a radiolucent halo, found on routine radiographic examination. Although benign tumors, odontomas can reach large sizes leading to facial asymmetry and decreasing bone strength, which predisposes fractures and infection. Our aim was to present a case report of an unusual giant mandibular odontoma on the left mandibular angle and ramus successfully treated by surgical excision and highlight the importance of the earlier diagnostic to minimize damages.

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Odontoma is the most common mixed epithelial and mesenchymal tumour-like malformation which affects maxillary bones. Clinically, Odontomas present as lesions of benign behavior, causing little or no deformity, are asymptomatic, with self-limited growth and usually detected on routine radiographs. Radiographically, they are radiopaque lesions, well-demarcated surrounded by a thin soft tissue capsule. Compound odontomas consist of numerous tooth-like structures, whereas in complex odontomas it consists of a disorganized mass of calcified tissue. The aim of this article was to report an atypical case of intracranial compound odontoma, in the middle cranial fossa, reaching the sphenoidal sinus, which has been followed for 10 years.

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Hybrid lesions of the oral cavity are infrequent and share characteristics with a number of other pathologies. both odontomas and dentigerous cysts are of odontogenic origin, but their simultaneous occurrence is rare and scarce. clinical and radiographic examinations are not conclusive, making their identification difficult, while histopathological studies can reveal their defining characteristics. the aim of this report was to describe the radiographic and histomorphological findings of a hybrid lesion formed by a complex odontoma and a dentigerous cyst, affecting the mandible of a 22-year-old man, from Cartagena, Colombia, who had no relevant medical history, and no symptoms or discomfort in the affected area.

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Se presentó el caso clínico de un niño de 8 años de edad, que acude a consulta de Estomatología del Policlínico "Mártires de Jamaica", del municipio Manuel Tames, de la provincia Guantánamo, acompañado de la madre preocupada por la no erupción del diente 21. Al examen clínico se observó ausencia clínica del 21 con espacio para su ubicación con ligero aumento de volumen en el fondo del surco vestibular a nivel de la zona de consistencia dura a la palpación. Se indicó radiografía panorámica observándose imagen radiolúcida con numerosas formaciones radioopacas en su interior que asemejan estructuras dentarias y una banda radiolúcida en su periferia que presuntivamente se diagnosticó como un odontoma compuesto, se remite al segundo nivel de atención para excéresis y diagnóstico definitivo. Se discuten algunas características de su etiología, diagnóstico y tratamiento(AU)

It was presented the clinical case of an 8-year-old boy, who was attended in the clinic of "Mártires de Jamaica" Polyclinic, in Manuel Tames municipality of Guantanamo province, accompanied by the mother concerned about the non-eruption of tooth 21 .On clinical examination, was observed absence of tooth 21 with space for its location with slight increase in volume at the bottom of the vestibular sulcus at the level of the area hard to palpation. Panoramic x-ray is indicated, with a radiolucent image with numerous radio opaque formations that resemble dental structures and a radiolucent band in its periphery presumptively diagnosed as a compound odontoma. It is referred to the second level of attention for excresis and definitive diagnosis. Some characteristics of its etiology, diagnosis and treatment were discussed(AU)

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Ameloblastic fibrosarcoma is a rare odontogenic neoplasm and is considered the malignant counterpart of ameloblastic fibroma. The diagnosis is made by histopathological and immunohistochemical evaluation, since the epithelial component remains benign and the mesenchymal component becomes malignant. Until 2012, only 72 cases were published in English-literature. This article presents a case of intraoral mass at the posterior mandible of a 23 year-old female patient. Panoramic radiography showed a multilocular radiolucent lesion with ill-defined borders and tooth involvement. The mandibular canal presented loss of architecture also. The computed tomography images (bone window) showed hypodense lesion leading to expansion, tapering and irregular destruction of cortical, and tooth involvement. Incisional biopsy was performed for histopathological evaluation. The results revealed a mixed lesion with epithelial and mesenchymal cellular proliferation. At immunohistochemical analysis, the mesenchymal portion was vimentin positive and the epithelial component was positive for cytokeratin AE1-AE3. It also showed p53 intense labeling in all tumorous cells. The final diagnosis was ameloblastic fibrosarcoma. The lesion was surgically excised with clear margins. The radiographic appearance, even imperative for treatment planning, poorly contributed to final diagnosis, which was reached by histopathological and immunohistochemical evaluations. The treatment is still controversial, without a definition regarding chemotherapy and radiotherapy as coadjutant treatment(AU)

El fibrosarcoma ameloblástico es una neoplasia odontogénica poco frecuente y es considerada la contraparte maligna del fibroma ameloblástico. El diagnóstico se realiza mediante la evaluación histopatológica e inmunohistoquímica, ya que el componente epitelial sigue siendo benigno y el componente mesenquimal se convierte en maligno. Hasta 2012, solo 72 casos fueron publicados en la literatura inglesa. En este artículo se presenta un caso de masa intraoral en la mandíbula parte posterior, de una paciente de 23 años de edad. La radiografía panorámica mostró una lesión radiolúcida multilocular con bordes mal definidos y con un diente incluso en la lesión. El canal mandibular también presentaba pérdida de la arquitectura. La tomografía computarizada (TC) (ventana de hueso) presentó lesión hipodensa que provocaba una expansión que se estrechaba y destruía irregularmente la cortical, además envolvía la pieza dentaria. Se realizó biopsia incisional para evaluación histopatológica. Los resultados revelaron una lesión mixta con proliferación celular epitelial y mesenquimal. En el análisis inmunohistoquímico, la porción mesenquimal fue positivo para vimentina y el componente epitelial fue positivo para citoqueratina AE1-AE3. También mostró marcación intensa para p53 en todas las células tumorales. El diagnóstico final fue de fibrosarcoma ameloblástico. La lesión fue extirpada quirúrgicamente con márgenes de seguridad. El aspecto radiológico, aunque imprescindible para la planificación del tratamiento, poco contribuyó al diagnóstico final, que fue alcanzado por las evaluaciones histopatológicas e inmunohistoquímicas. El tratamiento sigue siendo controvertido, sin una definición respecto de la quimioterapia y la radioterapia como tratamiento coadyuvante(AU)

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Odontomas are the most common odontogenic tumours of the maxillary bones, characterised by a slow growth and benign behaviour. They are usually small, asymptomatic and diagnosed after routine radiographic examination. The aim of this study was to report a case of a compound odontoma in the anterior maxilla of a 7-year-old girl, which was causing the impaction of the maxillary right central and lateral incisors, as well as the prolonged retention of the corresponding primary teeth. We also aimed to review the literature about these tumours, since they are not part of the dentist's day-to-day clinical practice. The clinical and radiographic features, the diagnosis and treatment of the case were discussed in this work.

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Maxillary antrolithiasis is characterized by masses of tissue of endogenous or exogenous origin that calcify within the maxillary sinuses. Aspergillosis is a fungal disease in which the maxillary sinus is a primary site of infection. Aspergillosis mycetoma, its noninvasive form, is the most prevalent modality of the disease in the maxillary sinuses. In approximately half of the cases reported in the literature, calcification of the fungal mycelia, which later became antroliths, was verified. This article reports a rare case of the accidental discovery of a maxillary antrolith associated with noninvasive aspergillosis in an immunocompetent and asymptomatic 56-year-old woman. The diagnosis and therapeutic procedures used in treating the patient are discussed as well as the probable iatrogenic origin of the fungal pathology.

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The ameloblastic fibro-odontoma is defined as a tumour with the general features of the ameloblastic fibroma but that also contains enamel and dentine. AFO normally presents as a painless swelling in the posterior portion of the maxilla or mandible. Radiographs show a well-defined radiolucent area containing various amounts of radiopaque material of irregular size and form. The most appropriate treatment for a large AFO has not been completely determined. This paper reports four large AFO cases and reviews the relevant literature regarding the clinical and surgical features of this lesion.

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El fibroodontoma ameloblástico (FOA) es una neoplasia benigna poco frecuente, con crecimiento lento y expansivo. Se presentan dos casos diagnosticados por hallazgo durante un examen radiográfico efectuado por retraso de la erupción dentaria, en los que se aplicaron diferentes criterios de tratamiento quirúrgico. Se revisan las características clínicas y anatomopatológicas de esta rara entidad.(AU)

The Ameloblastic Fibroodontoma is an unfrequent benign neoplasma characterized by slow growth and swallowing. This report describes two cases diagnosed during a radiographicexam conducted by delayed tooth eruption. In these cases, different surgical treatments were applied, with satisfactory final results in both. The clinical and pathological features of thisrare entity are revised.(AU)

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Tumoural and cystic lesions are common findings in the daily practice of dental professionals and maxillofacial radiologists. However, simultaneous lesions are rare and represent a diagnostic challenge to overcome. Among tumoural pathologies, odontomas are the most common odontogenic tumour of the jaws. Cystic transformation or development from the tumoural capsule are well recognized in situations such as ameloblastomas originated from a dentigerous cyst. Otherwise, despite literature reports, dentigerous cysts arising from odontomas are very rare and could lead to misdiagnosis. Here, we report a case of a complex odontoma associated with a dentigerous cyst in the maxillary sinus, focussing on the tomographic features and a differential imaging approach to the diagnosis of these lesions.

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The detection of osteomas in the maxillofacial region may be the initial clinical finding in Gardner's syndrome (GS). The most common location of osteomas is in the skull, but the lesion can also occur in the jaws. We present a case of a 47 year old male patient with GS who was referred for radiological evaluation. Extraoral examination revealed an epidermoid cyst and the patient had a history of intestinal polyps. A panoramic radiograph demonstrated numerous osteomas and diffuse sclerosis of the mandible, and compound odontomas with impacted teeth. CT scan allowed the localization and extension of the osteomas, and showed other sites in the maxillofacial region as well. CT images also revealed a different behaviour of osteoma, invading the mandibular canal.

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El fibroodontoma ameloblástico es una lesión extremadamente rara que involucra tejidos duros dentarios (esmalte, dentina y cemento), aparece generalmente en una edad promedio entre los 12 y un límite que puede llegar alrededor de los 40 años de edad y posee una predilección por la zona de los molares y premolares de ambas arcadas, de igual forma en ambos sexos y con similar conducta biológica. Se presenta un caso clínico de una paciente de 23 años de edad con una gran lesión patológica, su tratamiento y evolución.(AU)

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El odontoma compuesto es un tumor odontogénico -para algunos autores hamartoma-, que puede ser causa de retención de dientes permanentes. Se presenta una paciente de 13 años con ausencia clínica de 2.1. El diente se hallaba retenido y la radiografía evidenció una imagen compatible con un odontoma. El diangóstico y el plan de tratamiento interdisciplinario se realizó en la Cátedra de Odontología Integral Niños de la Facultad de Odontología de la Universidad de Buenos Aires, con la participación de profesionales de las áreas de odontopediatría, radiología, ortodoncia, cirugía, anatomía patológica y psicología. En este trabajo se muestra el manejo interdisciplinario que se realiza en la Cátedra con el fin de resolver las patologías quirúrgicas de baja y mediana complejidad que presentan los pacientes e integrar a los alumnos a la formación humanística con procedimientos técnico-científicos (AU)

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Los odontomas son tumores odontogénicos de hallazgo muy frecuente y son generalmente asintomáticos. Presentaremos un caso de un odontoma compuesto complejo en una mujer de 41 años de edad que provocó la retención de dos piezas dentarias. Un diagnóstico temprano de la lesión permite adoptar mejores medidas para un mejor pronóstico (AU)

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