Descompressão cirúrgica como tratamento conservador de cisto odontogênico Inflamatório em paciente pediátrico: relato de caso clínico

Abstract

Odontogenic cysts represent the majority of lesions related to gnathic bones and in their pathogenesis, they are differentiated by the World Health Organization (WHO) into Developmental or Inflammatory Odontogenic Cysts. Inflammatory cysts comprise radicular, residual and collateral cysts and are usually associated with inflammation confined by proliferative epithelium and arising from the dental pulp, with a strong relationship with the apex of a non-vital tooth. The objective of this study is to report the importance of cystic decompression associated with enucleation in two different surgical moments as a less invasive technique in extensive cystic lesion in pediatric patients. The present clinical case is about an 11-year-old female patient who was referred to the dental clinic of the Federal University of Juiz de Fora - Governador Valadares Campus (UFJF-GV) for evaluation of an extensive lesion in the left mandibular region. After clinical and imaging examination of panoramic radiography and cone beam computed tomography (CBCT) it was possible to identify an extensive lesion in the left mandibular body of the premolars and molars region, causing dental displacement of the premolars and expansion and bulging of the cortical bone. . After the child's mother's consent, an incisional biopsy followed by the surgical decompression technique was proposed as treatment and a device was installed inside the lesion and its margin was sutured in the mucosa communicating the interior of the lesion with the oral cavity. After 6 months, a new CBCT scan showed that the lesion had significantly decreased in size. In a new surgical intervention, the lesion was completely enucleated and the histopathological analysis confirmed the hypothesis of a radicular cyst, which is rare in children. After 6 months, in a new CBCT exam, bone neoformation was observed in the entire area corresponding to the lesion without recurrence of pathology, evidencing that the treatment of surgical decompression followed by enucleation was successful. The patient was referred for orthodontic treatment to correct the dental changes caused by the lesion and to correct the malocclusion.