de Moraes Antonia Taiane Lopes, Soares Haroldo Arid, Viana Pinheiro João de Jesus, Ribeiro Ribeiro André Luís
School of Dentistry, Federal University of Pará (UFPA), Belém, PA, Brazil.
Oral Diagnostic Service, Doctor Carmino Caricchio Municipal Hospital, São Paulo, Brazil.
Int J Surg Case Rep. 2020;67:239-244. doi: 10.1016/j.ijscr.2020.01.031. Epub 2020 Jan 27.
Odontogenic pathological lesions can generally be divided into cysts and tumors. Calcifying odontogenic cyst (COC) is a non-aggressive odontogenic cyst, however, in a few occasions, COC can show excessive growth and destruction. This study describes an uncommon aggressive presentation of a large COC and discusses the treatment strategies used to achieve a favorable result.
A 11-year-old child sought treatment for a painless growth on his mandible that caused facial asymmetry. On clinical and imaging examination, a large radiolucent lesion was observed in a panoramic x-ray involving the right side of the mandible. Radiopaque areas were observed within the lesion. Treatment comprised of an initial marsupialization followed by surgical removal of the lesion. Follow up extended for more than 10 years and no signs of recurrence were observed.
Initial marsupialization was successfully employed in order to decrease the lesion, inducing bone formation, and reducing the risk of mandibular fracture and inferior alveolar nerve damage. Four months after marsupialization, the lesion substantially reduced its volume and enucleation with peripheral ostectomy was carried out. This approach allowed a safer surgical removal of the lesion and achieve an excellent result.
Although some authors consider marsupialization as an unnecessary step that delays final treatment, when well indicated, it facilitates surgical treatment, promotes and preserves normal tissues, reduces the necessity of surgical reconstruction and costs, yet showing excellent results.
牙源性病理损害一般可分为囊肿和肿瘤。牙源性钙化囊肿（COC）是一种非侵袭性牙源性囊肿，然而，在少数情况下，COC可表现出过度生长和破坏。本研究描述了一例大型COC罕见的侵袭性表现，并讨论了为取得良好效果而采用的治疗策略。
一名11岁儿童因下颌无痛性肿物导致面部不对称前来就诊。临床和影像学检查发现，全景X线片显示右侧下颌骨有一个大的透射性病变，病变内可见不透光区。治疗包括先行袋形术，随后手术切除病变。随访超过10年，未见复发迹象。
最初采用袋形术成功缩小了病变，诱导了骨形成，并降低了下颌骨骨折和下牙槽神经损伤的风险。袋形术后4个月，病变体积显著减小，并进行了外周骨切除术摘除囊肿。这种方法使病变的手术切除更安全，并取得了良好效果。
尽管一些作者认为袋形术是一个不必要的步骤，会延迟最终治疗，但在恰当应用时，它有助于手术治疗，促进并保留正常组织，减少手术重建的必要性和成本，且效果良好。
