Cisti parodontale laterale case report e rivisitazione della letteratura
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Cisti parodontale laterale case report e rivisitazione della letteratura Cisti parodontale laterale case report e rivisitazione della letteratura Document Transcript

  • Oral Maxillofac SurgDOI 10.1007/s10006-010-0257-2 CASE REPORTLateral periodontal cyst: report of case and reviewof the literatureMárcia de Andrade & Ana Paula Pantosi Silva &Flávia Maria de Moraes Ramos-Perez & Yara Teresinha Corrêa Silva-Sousa &Danyel Elias da Cruz PerezReceived: 10 August 2010 / Accepted: 17 November 2010# Springer-Verlag 2010Abstract Keywords Differential diagnosis . Lateral periodontalBackground As the lateral periodontal cyst (LPC) is an cyst . Reviewunusual odontogenic cyst, most papers are single casereports or series with a limited number of cases, withfew large series. The aim of this study is to report an Introductionadditional case of LPC, emphasizing the clinical, radio-graphic, and histopathological features, differential diagnosis, Lateral periodontal cyst (LPC) is an uncommon developmentand review of 264 cases reported in the English-language odontogenic cyst, representing about 0.4% of all odontogenicliterature. cysts [1] and 0.7% of all cysts of the jaw bones [2]. ThisCase report A 51-year-old male patient presented with a lesion is defined as a radiolucent lesion that grows along thewell-delimited, radiolucent, mandibular lesion, located lateral surface of an erupted vital tooth, in which anbetween the roots of the right lower lateral incisor and inflammatory etiology has been excluded, based on clinicalcanine and evidenced during routine radiographic examina- and histological features [2, 3].tion. A surgical excision was performed. Microscopically, The LPCs originate from remnants of odontogenicthere was a cystic cavity lined by simple squamous epithelium [4, 5]. These lesions are more common in adultsepithelium, compatible with LPC. during the fifth to seventh decades of life and demonstrate aDiscussion LPC is an unusual odontogenic cyst and male predilection [5], despite the fact that some studiespresents a marked predilection for occurring in the have not reported a gender preponderance [2, 6–9]. Mostmandible between the roots of canines and premolars. LPCs are located in the mandibular–premolar area, followedAccurate clinical and imaging exams should be performed by the anterior region of the maxilla [10–13]. Radiographicfor a correct approach and diagnosis. features demonstrate a well-defined, circumscribed, round or ovoid radiolucent lesion, usually with a sclerotic margin, preferentially localized between the apex and the cervical margin of the teeth [3].M. de Andrade : A. P. P. Silva : Y. T. C. Silva-Sousa : Botryoid odontogenic cyst (BOC) is considered a variantD. E. da Cruz PerezSchool of Dentistry, University of Ribeirao Preto, of the LPC, presenting as a multicystic lesion. Due to theRibeirao Preto, Sao Paulo, Brazil polycystic aspect, radiographically, most of these lesions are multilocular. In the same way, the gross aspect is similarF. M. de Moraes Ramos-Perez : D. E. da Cruz Perez to a cluster of grapes. This lesion may be extensive and hasFederal University of Pernambuco,Recife, Pernambuco, Brazil a higher risk of recurrence than LPC [14, 15]. In both lesions, LPC and BOC, the most adequate treatment is aD. E. da Cruz Perez (*) complete surgical enucleation [5].Curso de Odontologia, Universidade Federal de Pernambuco, As LPC is an uncommon lesion, most papers are singleAv. Prof. Moraes Rego, 1235, Cidade Universitária,CEP: 50670-901, Recife, Pernambuco, Brazil case reports or series with limited number of cases, withe-mail: perezdec2003@yahoo.com.br few large series (Table 1). Thus, the aim of this study is to
  • Oral Maxillofac SurgTable 1 Summary of theepidemiological features of large Authors Number of Mean age Gender SiteLPC series cases (male/female) (mandible/maxilla) Cohen et al. [7] 37 54 18:19 29:8 Rasmusson et al. [27] 32 55 22:10 28:4 Carter et al. [8] 23 49.4 12:11 19:3a Jones et al. [1] 28 48.2 16:12 NAa The site was not available in one Shear and Speight [2] 24 Range 19–71 12:12 14:10casereport an additional case of LPC, emphasizing the clinical, tumor were the most likely clinical and radiographicradiographic, and histopathological features, differential diagnoses. Under local anesthesia, complete surgical excisiondiagnosis, and review of 264 cases reported in the of the lesion was performed, without intercurrences.English-language literature. Macroscopic analysis revealed a unicystic lesion. Histopath- ologically, the lesion consisted of a cystic cavity lined by simple nonkeratinizing squamous epithelium, although in someCase report regions, the cavity was lined by a double layer of cells (Figs. 2 and 3). Clear cells were also observed. Moreover, inflamma-A 51-year-old male patient was attended to in a private tory cells were not observed in the connective tissue from thedental clinic due to a radiolucent mandibular lesion, cystic wall. According to clinical, radiographic, and histo-evidenced during routine radiographic examination. The pathological features, a diagnosis of LPC was established.patient denied pain or any other symptoms. On intraoral After the treatment and adequate postoperative exams, theexam, there was a painless, well-circumscribed, slight patient was lost to follow-up.swelling, sited in the gingival mucosa between the rightlower lateral incisor and canine, which presented a hardconsistency and was covered by normal mucosa. Discussion Periapical radiography revealed a well-circumscribed,radiolucent, unilocular lesion, located in the mandible, The LPC is an uncommon odontogenic cystic lesion of thelaterally and between the roots of the right lower lateral jaws, which develops in the alveolar bone along the lateralincisor and canine, without corticated margins, measuring surface of a vital tooth [3, 5, 7, 16]. Most cases areabout 1.0 cm in diameter. In addition, a slight divergence of discovered on routine radiological examination, sincethe roots of the teeth was observed (Fig. 1). Thermal test usually, these lesions are initially asymptomatic, as it wasrevealed pulpal vitality of the two teeth adjacent to the observed in our case. However, the lesions can present alesion. Additionally, periodontal exam excluded a lesion of gingival swelling during their development and growth [5,inflammatory origin. LPC and the keratocystic odontogenic 12, 13].Fig. 1 Well-circumscribed, radiolucent, unilocular lesion located inthe mandible between the roots of the right lower lateral incisor and Fig. 2 Cystic cavity lined by simple and double squamous epithelia.canine, with slight divergence of the roots H&E, ×200, original magnification
  • Oral Maxillofac Surg shape and sclerotic margins, sited on the root lateral surface of vital teeth, mainly lower premolars [12, 24]. Neverthe- less, Senande et al. [9] reported a series of 11 cases, of which eight occurred in the anterior region of the maxilla and presented an inverted pear-like image. Divergence of the roots of teeth is a common finding, but root resorption has not been documented [2, 30]. Although most of the LPCs did not reach more than 1.0 cm in diameter [4, 27], there are reports of lesions involving the entire lateral region of the tooth root [5, 7, 9]. The occurrence of bilateral LPCs is very rare [21]. The differential diagnosis of LPC includes gingival cyst, lateral radicular cyst, keratocystic odontogenic tumor, pseudocysts, and radiolucent odontogenic tumors. The gingival cyst is a rare soft tissue odontogenic cyst thatFig. 3 Cystic cavity lined by a double layer of epithelial cells. Noinflammatory cells were observed. H&E, ×400, original magnification presents similar epidemiological features to the LPC, with a peak frequency in the sixth decade of life, occurring most commonly in the mandibular premolar–canine region. In contrast, the gingival cyst shows a slight female predilection In the present study, we reviewed the epidemiological [2, 31]. Particularly in LPCs that cause gingival swelling, aand clinical features of 264 cases of LPC published in the gingival cyst should be excluded using adequate radiographicEnglish-language literature [1–13, 16–29]. Moreover, these examination and, eventually, with the transoperative findingdata were compared with that presented in the current case. [2, 13, 18]. The radicular cyst may develop along the lateralMost cases occurred in patients between the fifth and root surface, being named lateral radicular cyst. This lesionseventh decades of life. The mean age of the available cases occurs due to pulp necrosis and an infected lateral accessorywas 50.8 years (ranging from 18 to 82 years) [1, 3, 5–9, root canal or presents a periodontal origin [2]. The LPC must11–13, 16–27], similar to the present case, considering that, be distinguished from lateral radicular cysts in order to avoidin 71 cases, this aspect could not be evaluated in detail [2, unnecessary endodontic therapy. Sometimes, LPC is mis-4, 10, 28, 29]. The LPC presents a male predilection, with a diagnosed as a chronic lesion of endodontic origin [32].male/female preponderance of 1.3:1, according to 221 cases Thus, in all cases of radiolucencies located between roots,where this information was available [1–3, 5–9, 11–13, 16– pulp vitality test and a careful periodontal inspection of the28]. However, some series did not found a gender involved teeth should be performed. In the present case,predilection [2, 6–9]. detailed clinical and radiographic exams were carried out. Regarding the site of the lesion, in 203 of 264 cases of LPC The keratocyst odontogenic tumor (KOT) occurs mostevaluated, this feature was recorded. Of these cases, 150 commonly in the posterior region from the mandible,(73.9%) were located in the mandible, whereas the maxilla mainly in patients in their second and third decades of life,was affected in 53 cases (26.1%) [1, 3, 5–9, 11–13, 16–18, despite a peak frequency in the fifth decade that has been23–29], as occurred in this case, which was sited in the also reported [1, 2]. Although LPC is more frequent inmandible. All series but one found a maxilla predilection for older patients, KOT comprises one of the main differentialLPC [9]. diagnoses of LPC, since 22.9% of the cases occur in the Considering the cases located in the mandible, the most root lateral surface [30]. Radiographically, the collateralaffected region is the premolar–canine–incisor area, mainly KOT may present very similar features to LPC, and afterbetween the premolars [2, 3, 5–8, 11–13, 16–18, 23–26, 29]. the exclusion of an inflammatory origin, the lesion shouldOf the evaluated mandibular cases, only five cases occurred be surgically removed and sent for histopathologicalin the molar region [3, 7, 9, 29]. As occurred in most analysis to confirm the definitive diagnosis [2, 30, 33].previously reported cases, the current case was located Other lesions have been reported in the root lateral surface,between the mandibular canine and lateral incisor. Now, such as ameloblastoma and simple bone cyst, which maybased on the available maxillary cases, most of them show similar features to LPC [33]. In the same way, theoccurred in the anterior region [7, 18, 23, 29]. The maxillary definitive diagnosis is established after histopathologicalpremolar and molar areas are rarely affected, with seven [7, analysis or surgical exploration, as in simple bone cyst12, 23] and two cases [7, 23] reported, respectively. cases. The radiographic appearance of the lesion is a well- Microscopically, LPC presents as a cystic cavity lined bycircumscribed radiolucency, presenting a round or oval a thin layer of epithelium and supported by a connective
  • Oral Maxillofac Surgtissue. Usually, no inflammatory cells are observed, although 4. Altini M, Shear M (1992) The lateral periodontal cyst: an update. J Oral Pathol Med 21:245–250some cases present scarce inflammation in the fibrous capsule. 5. Nart J, Gagari E, Kahn MA, Griffin TJ (2007) Use of guidedThe epithelium is cuboidal to stratified squamous, non- tissue regeneration in the treatment of a lateral periodontal cystkeratinizing, as observed in the present case [4, 5, 7, 12, 13, with a 7-month reentry. J Periodontol 78:1360–136426]. Frequently, there are epithelial thickenings or plaques, in 6. Standish SM, Shafer WG (1958) The lateral periodontal cysts. J Periodontol 29:27–33addition to the presence of many clear cells rich in glycogen, 7. Cohen DA, Neville BW, Damm DD, White DK (1984) The lateralwhich are found either in plaques or in the superficial layers periodontal cyst. A report of 37 cases. J Periodontol 55:230–234of the lining of epithelium [2, 3, 23]. In this case, although 8. Carter LC, Carney YL, Perez-Pudlewski D (1996) Lateralepithelial plaques were not found, clear cells were observed periodontal cyst. Multifactorial analysis of a previously unreported series. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 81:210–in superficial layers. Other excessively rare microscopic 216findings have also been described, such as a case with an 9. Formoso Senande MF, Figueiredo R, Berini Aytés L, Gay Escodaabundant amount of melanin in the epithelial cells [23] and C (2008) Lateral periodontal cysts: a retrospective study of 11another that presented a squamous cell carcinoma arising in cases. Med Oral Patol Oral Cir Bucal 13:E313–E317 10. Fantasia JE (1979) Lateral periodontal cyst. An analysis of forty-the epithelial lining of the LPC [16]. six cases. Oral Surg Oral Med Oral Pathol 48:237–243 BOC is considered a variant of LPC. Radiographically, 11. Holder TD, Kunkel PW Jr (1958) Case report of a periodontalmost of them are polycystic (multilocular), but there are cyst. Oral Surg Oral Med Oral Pathol 11:150–154several unilocular cases reported. Different from the LPC, 12. Kerezoudis NP, Donta-Bakoyianni C, Siskos G (2000) The lateral periodontal cyst: aetiology, clinical significance and diagnosis.BOC usually are symptomatic, causing swelling, pain, and Endod Dent Traumatol 16:144–150rarely, paresthesia [15]. Histopathological features of BOC 13. Angelopoulou E, Angelopoulos AP (1990) Lateral periodontalpresent some differences when compared to those of LPC. cyst. Review of the literature and report of a case. J PeriodontolThe lesion is multicystic, showing septa of thin fibrous 61:126–131 14. Greer RO Jr, Johnson M (1988) Botryoid odontogenic cyst:connective tissue. The diagnosis of BOC, as in LPC, is clinicopathologic analysis of ten cases with three recurrences. Jbased on histopathological features [2]. Oral Maxillofac Surg 46:574–579 Surgical enucleation is the most appropriate treatment for 15. Gurol M, Burkes EJ Jr, Jacoway J (1995) Botryoid odontogenicLPC, with preservation of the involved teeth, as it was cyst: analysis of 33 cases. J Periodontol 66:1069–1073 16. Baker RD, DOnofrio ED, Corio RL, Crawford BE, Terry BCperformed in this case. Recurrence is rare [2]. In contrast, (1979) Squamous-cell carcinoma arising in a lateral periodontalalthough the BOC cases are also treated by surgery, the cyst. Oral Surg Oral Med Oral Pathol 47:495–499recurrence rate of BOC may range between 18% and 30% 17. Harless CF Jr (1965) Lateral periodontal cyst: report of two cases.[14, 15]. Oral Surg Oral Med Oral Pathol 20:684–689 18. Wysocki GP, Brannon RB, Gardner DG, Sapp P (1980) In conclusion, LPC is an unusual odontogenic cyst, most Histogenesis of the lateral periodontal cyst and the gingival cystfrequently found in men during the sixth decade of life, and of the adult. Oral Surg Oral Med Oral Pathol 50:327–334presents marked predilection for occurrence in the mandible 19. Gregg TA, OBrien FV (1982) A comparative study of thebetween the roots of canines and premolars. Accurate gingival and lateral periodontal cysts. Int J Oral Surg 11:316– 320clinical and imaging exams should be performed for a 20. Levin LS, Allen PS, Fetterhoff CK (1983) Lateral periodontalcorrect approach and diagnosis. cyst: a case report. J Md State Dent Assoc 26:18–20 21. Legunn KM (1984) Bilateral occurrence of the lateral periodontal cyst: a case report. Periodontal Case Rep 6:56–59Acknowledgments Dr. Silva-Sousa and Dr. Perez are research 22. Ross VA, Craig RM Jr, Vizuete JR (1986) A radiolucent lesionfellows of the National Council for Scientific and Technological adjacent to the roots of the mandibular right first and secondDevelopment (CNPq). premolars. J Am Dent Assoc 112:235–236 23. Buchner A, David R, Carpenter W, Leider A (1996) Pigmented lateral periodontal cyst and other pigmented odontogenic lesions.Conflict of interest The authors declare that they have no conflict of Oral Dis 2:299–302interest. 24. Tolson GE, Czuszak CA, Billman MA, Lewis DM (1996) Report of a lateral periodontal cyst and gingival cyst occurring in the same patient. J Periodontol 67:541–544 25. Lehrhaupt NB, Brownstein CN, Deasy MJ (1997) Osseous repairReferences of a lateral periodontal cyst. J Periodontol 68:608–611 26. Meltzer JA (1999) Lateral periodontal cyst: report of a case with 1. Jones AV, Craig GT, Franklin CD (2006) Range and demographics of 1-year reentry. Int J Periodontics Restor Dent 19:299–303 odontogenic cysts diagnosed in a UK population over a 30-year 27. Rasmusson LG, Magnusson BC, Borrman H (1991) The lateral period. J Oral Pathol Med 35:500–507 periodontal cyst. A histopathological and radiographic study of 32 2. Shear M, Speight PM (2007) Cysts of the maxillofacial regions. cases. Br J Oral Maxillofac Surg 29:54–57 Blackwell Munksgaard, Oxford, p 222 28. Shear M, Pindborg JJ (1975) Microscopic features of the lateral 3. Mendes RA, Van der Wall I (2006) An unusual clinicoradio- periodontal cyst. Scand J Dent Res 83:103–110 graphic presentation of a lateral periodontal cyst–report of two 29. Filipowicz FJ, Page DG (1982) The lateral periodontal cyst and cases. Med Oral Patol Oral Cir Bucal 11:E185–E187 isolated periodontal defects. J Periodontol 53:145–151
  • Oral Maxillofac Surg30. Ali M, Baughman RA (2003) Maxillary odontogenic keratocyst: a 32. Peters E, Lau M (2003) Histopathologic examination to confirm common and serious clinical misdiagnosis. J Am Dent Assoc diagnosis of periapical lesions: a review. J Can Dent Assoc 69:598–600 134:877–883 33. Hisatomi M, Asaumi J, Konouchi H, Yanagi Y, Matsuzaki H, Kishi K31. Cairo F, Rotundo R, Ficarra G (2002) A rare lesion of the (2003) Comparison of radiographic and MRI features of a root- periodontium: the gingival cyst of the adult–a report of three diverging odontogenic myxoma, with discussion of the differential cases. Int J Periodontics Restor Dent 22:79–83 diagnosis of lesions likely to move roots. Oral Dis 9:152–157