Braz J Oral Sci. January/March 2005 - Vol. 4 - Number 12
Odontogenic cysts - A descriptive clinicopathological study Luís Monteiro 1 Jesus de la Peña 2 Liliana Fonseca 1 António Paiva 3 Barbas do Amaral 2 Instituto Superior de Ciências da Saúde - Norte Hospital Geral Santo António – Porto 3 South Manchester University Hospitals, U.K. 1 2
Received for publication: August 10, 2004 Accepted: October 10, 2004
Abstract Odontogenic cysts are lesions that deserve every attention, mainly because of all complications they can cause. To study their characteristics, the authors did a retrospective clinicopathological analysis of 124 oral biopsies that were diagnosed as odontogenic cysts, in Hospital Geral de Santo António – Porto. Clinical variables such as age, sex, location, clinical diagnosis and histological diagnosis were studied. Inflammatory radicular cysts were the most commons (48.4%) followed by dentigerous cysts (21.0%), residual cysts (17.7%) and keratocysts (12.1%). The most frequent clinical manifestation was swelling (62.9%). Age appears to be related to the type of cyst, expressing the etiopathologic characteristics of each one. It is concluded that a definitive diagnosis is based on a triad of radiology, clinics and histology, which presupposes a tight cooperation between the clinician and the histopathologist. Key Words: oral pathology, developmental cysts, inflammatory cysts, jaw cysts, Gorlin syndrome.
Correspondence to: Luís Monteiro Rua António Moreira da Silva, 175 4475-457 Maia Portugal E-mail:
[email protected]
670
Braz J Oral Sci. 4(12): 670-675
Introduction Cystic pathology owes a lot of its particular characteristics to the presence of teeth and its associated tissues. Its special nature tends to be related with the embryologic development of teeth and the dynamic interactions of epithelial elements with mesenquimatous elements. A cyst is a pathological fluid, semi-fluid or gaseous-filled cavity lined by epithelium that, in turn, is lined by a capsule of connective tissue. They deserve one’s attention, mainly because of all the complications they can originate, such as facial aesthetic changes, jaw fractures, infections, and occasional neoplasia of its epithelium 1-4. Many classifications of jaw cysts have been proposed and used, according to different criteria such as its embryologic origin, aetiology, pathology, or its clinicalmorphological manifestations. The World Health Organization (WHO) more recently, classifies epithelial cysts (or true cysts), as odontogenic cysts and nonodontogenic cysts. The first type includes two categories: inflammatory and developmental. Non-odontogenic cysts are also developmental cysts and include nasopalatine and nasoalveolar cysts, amongst others. Cysts without epithelial lining, also called pseudo-cysts, are nowadays considered to be non-neoplasic bone lesions and include solitary bone cysts and aneurysmal bone cysts 5. The purpose of this paper was to study the frequency of several types of odontogenic cysts and some of its clinical-pathological characteristics. Material and Methods It was performed a descriptive study. All histopathological reports (n=153) of oral cavity lesions with histological diagnosis of odontogenic cyst were reviewed. These diagnoses were made by the Anatomic Pathology Service of the Hospital Geral de Santo António (Porto), in the course of a three-year period, between January 1999 and December 2001. In all cases, histological preparations were reviewed and clinical reports were analysed, along with the complementary means of diagnosis (plain radiographs, orthopantomograms and computer tomography). Twenty-nine cases were excluded due to lack of clinical information or non-concordance of data. Therefore, 124 patients with odontogenic cysts established the final sample. Variables such as, age, sex, occupation, location, clinical manifestations, radiographic appearance, clinical and histological diagnosis, were studied. Recurrences were analysed over a follow-up period of 1 to 3 years. Classification of these lesions was made according to the WHO (Kramer and Pindborg, 1992)5. Classification of the social-professional groups was based on the British Registrar-General6. The location of the cystic lesions was
Odontogenic cysts - A descriptive anatomo-clinical study
divided into maxillary or mandibular and anterior sector (incisors and canines) or posterior sector (premolars and molars). Statistical analysis included the chi-square test to analyse the categorical variables, and the t-student test and the Kruskal-Wallis test were used to analyse the continuous variables. For this purpose it was used the SPSS 10.0 ® specific computer program. The admitted level of significance was p
