RESUMO
PURPOSE: To evaluate the recurrence rate of odontogenic keratocyst (OKC) after treatment with 5-fluoracil as an adjunctive therapy and to evaluate, as well, the efficacy of this medication in reducing the incidence of inferior alveolar nerve paresthesia associated with other chemotherapeutic agents. MATERIAL AND METHODS: The research question (developed according to the patient/population, intervention, comparison, and outcomes [PICO] method) addressed was "Does the use of 5-fluorouracil as an adjunctive therapy in the treatment of OKC reduce both the recurrence rate and the incidence of inferior alveolar nerve paresthesia as compared with other chemotherapeutic agents?" A systematic review was performed by searching 4 databases: PubMed, EBSCO, Portal Evidencia, and Cochrane Reviews. Each search was conducted twice. Two independent reviewers evaluated the data. For each database, a search strategy was developed that included the following generic terms: Fluorouracil, 5-Fluorouracil, or liquid nitrogen and odontogenic cyst or odontogenic keratocyst. Three filters were applied to the searches, as well, consisting of the terms clinical trials, English papers, and Spanish papers. RESULTS: Of the 74 papers retrieved. The titles and abstracts of the selected papers were reviewed to determine whether those papers were relevant to our research question; only 3 papers were selected for this systematic review: 2 retrospective cohort studies and 1 clinical trial. Assessments risk bias and the quality of evidence were performed. CONCLUSIONS: The risk of bias and quality of evidence in this systematic review are moderate due to the study's design, although the clinical results were excellent with respect to the reduction of both OKC recurrence and paresthesia associated with this kind of cyst.
Assuntos
Cistos Odontogênicos , Tumores Odontogênicos , Humanos , Parestesia/tratamento farmacológico , Estudos Retrospectivos , Incidência , Cistos Odontogênicos/tratamento farmacológico , Nervo MandibularRESUMO
O Ceratocisto Odontogênico (CO) e o Cisto Odontogênico Ortoceratinizado (COO) apresentam características clínico-radiográficas semelhantes, porém comportamento biológico e aspectos histológicos distintos. Diferentes modalidades de tratamento têm sido propostas para essas lesões que variam desde descompressão e marsupialização seguidas de enucleação, associadas ou não à osteotomia periférica e/ou à aplicação de solução de Carnoy, à crioterapia, até a ressecção marginal ou segmentar. Contudo, a tendência a recidiva, principalmente do CO, as injúrias às estruturas adjacentes relacionas aos tratamentos conservadores e a mutilação da face do paciente associada à ressecção, são fatores de difícil resolução. O antimetabólico 5- Fluorouracil (5-FU) é amplamente utilizado para o tratamento tópico do Carcinoma Basocelular (CBC) e da Ceratose Actínica e sua ação tem sido evidenciada pela inibição da via de sinalização Hedgehog (SHH), comumente alterada nessas doenças principalmente associada à ocorrência de mutações do gene PTCH. Coincidentemente, o desenvolvimento do CO e do COO também ocorrem devido a mutações nas mesma via de sinalização. Assim sendo, neste estudo foram relatados casos clínicos de Cisto Odontogênico Ortoceratinizado e de Ceratocisto Odontogênico, ambos tratados com a técnica da marsupialização associada à aplicação tópica do 5-FU a 5%, seguido por enucleação e reaplicação tópica de 5-FU a 5%. Após acompanhamento por período superior a 2 anos, houve rápida reparação óssea, ausência de recidiva e de danos às estruturas adjacentes. Foi proposto um protocolo de tratamento conservador, utilizando-se o 5-FU a 5%, para CO e COO. (AU)
Odontogenic Keratocyst (OK) and Orthoceratinized Odontogenic Cyst (OOC) have similar clinical-radiographic characteristics, but different biological behavior and histological aspects from each other. Some treatment modalities have been proposed for these lesions, ranging from decompression and marsupialization followed by enucleation, associated or not with peripheral osteotomy and/or with application of Carnoy's solution, with cryotherapy, to marginal or segmental resection. However, tendency to relapse, mainly with respect to KO, injuries to adjacent structures related to conservative treatments and mutilation of patient's face associated with resection are difficult factors to be resolved. Antimetabolic 5-Fluorouracil is widely used as topical treatment of the Basal Cell Carcinoma and Actinic Keratosis and its action has been evidenced by inhibition of the Hedgehog signaling pathway, commonly altered in these diseases mainly associated with the occurrence of PTCH gene mutations. Coincidentally, the development of OK and OOC also occurs due to mutations in the same signaling pathway. Therefore, in this study a clinical case of Orthoceratinized Odontogenic Cyst and Odontogenic Keratocyst was reported, both treated with the marsupialization technique associated with topical application of 5-FU at 5%, followed by enucleation and topical reapplication of 5-FU at 5 %. After more than 2 years of follow-up, it was noticed the occurrance of a rapid bone healing process, as well as the absence of both recurrence and damage to adjacent structures. A conservative treatment protocol was proposed, using 5-FU at 5%, for OK and OOC. (AU)
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Cistos Odontogênicos/tratamento farmacológico , Fluoruracila/uso terapêutico , Tratamento Conservador , Protocolos Clínicos , HospitaisRESUMO
La Organización Mundial la Salud (OMS) a través del Centro Internacional de Referencia de los Tumores Odontogénicos en su última clasificación 2005, ha decidido incluir al Quiste Odontogénico queratoquístico Paraqueratinizado dentro del grupo de los Tumores Odontogénicos, como Tumor Odontogénico Queratoquístico y ha permanecido el Quiste Odontogénico Queratoquístico Ortoqueratinizado, como una entidad se-parada dentro de los Quistes Odontogénicos ya existente, es decir uno pasa a ser una neoplasia benigna y otro una entidad quística.Los autores presentamos un caso clínico quirúrgico de un tumor Odontogénico Queratoquístico...
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Cistos Odontogênicos/cirurgia , Cistos Odontogênicos/classificação , Cistos Odontogênicos/diagnóstico , Biópsia/métodos , Diagnóstico Diferencial , Descompressão Cirúrgica/métodos , Classificação Internacional de Doenças , Procedimentos Cirúrgicos Bucais/métodos , Cistos Odontogênicos/tratamento farmacológico , Cistos Odontogênicos , Tomografia Computadorizada por Raios X , Organização Mundial da SaúdeRESUMO
Se presenta un paciente de 18 años de edad, remitido al Servicio de Otorrinolaringología del Hospital Clinicoquirúrgico "Comandante Manuel Fajardo", con el cuadro clínico de sinusitis recurrente y opacidad homogénea de seno maxilar izquierdo. La radiografia convencional de senos perinasales es considerada un medio diagnóstico muy importante al nivel de la atención primaria de salud, aunque también se considera necesario el ortopantograma para el diagnóstico diferencial (dientes supernumerarios, quistes dentígenos, molares retenidos). La técnica de Caldwell-Luc mejora la visibilidad y accesibilidad de las lesions, contribuye al diagnóstico, al alivio del paciente y está exenta de complicaciones(AU)
A case of 18-years old male patient with recurrent maxillary sinusitis and radiographic study with opacity in left maxillay sinus was reported. He was admitted at the Otorhinolaringology Department of "Comandante Manuel Fajardo" university clinical and surgical hospital. Conventional radiographic examination of perinasal sinus is considered a very important tool in primary health care; but also orthopantogram is required to exclude diverse diagnosis (supernumerary teeth, dentigenous cyst, and embedded tooth). The Caldwell-Luc approach improves visibility of and accesibility to lesions, contributes to make diagnosis and relieves the patient's condition without further complications. The most relevant quotations found in research works about the topic were selected(AU)