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Métodos terapêuticos no tratamento do tumor odontogénico queratoquístico: orientação para a prática clínica
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Introdução: O tumor odontogénico queratoquístico (TOQ) é uma lesão odontogénica intraóssea benigna relativamente frequente da cavidade oral. Localmente tem um comportamento agressivo e apresenta elevada propensão para recorrer após o tratamento, o que condiciona o prognóstico desta lesão. As características particulares desta lesão neoplásica têm gerado controvérsias na comunidade científica sobre quais as abordagens cirúrgicas indicadas para o sucesso no tratamento deste tumor. Objetivos: Analisar qual o tratamento ótimo para este tumor, de modo a garantir taxas de sucesso, prevenir futuras recorrências e garantir a qualidade de vida dos pacientes. Materiais e métodos: Foi conduzida uma pesquisa na Cochrane 1 resultado e PubMed 756 resultados. A seleção dos artigos de interesse foi efetuada a partir do resumo e de critérios de inclusão e exclusão. Três artigos entraram na análise final. Resultados: Cento e dezanove lesões foram identificadas (73 homens e 46 mulheres). Vinte e nove tumores encontravam-se na maxila e 91 na mandíbula; os métodos terapêuticos aplicados foram: marsupialização/descompressão, marsupialização seguida de enucleação e terapias adjuvantes (ostectomia periférica e solução de Carnoy), enucleação simples, enucleação e aplicação de solução de Carnoy, enucleação e ostectomia periférica, enucleação com ostectomia periférica e aplicação de solução de Carnoy e resseção em bloco. Discussão e conclusões: Foi possível verificar que o tratamento do tumor através de enucleação em combinação com terapias adjuvantes está associado a uma menor taxa de recorrência, quando comparado com os TOQ submetidos apenas a enucleação simples. A amostra reduzida de TOQ submetidos a resseção em bloco e marsupialização seguida de enucleação com terapias adjuvantes não permitiu obter resultados estatisticamente relevantes. São portanto necessários mais estudos com critérios bem definidos, de modo a que seja possível uma análise adequada das taxas de recorrência em função da modalidade de tratamento.
Background: The keratocystic odontogenic tumor (KCOT) is a benign intraosseous odontogenic lesion relatively frequent in the oral cavity. It has a locally aggressive behavior and exhibits a high propensity to recur after treatment, which affects the prognosis of this lesion. All the singular characteristics of this neoplasic lesion have originated controversy in the scientific community regarding which are the most indicated surgical approaches for the successful treatment of this tumor. Objectives: To analyze which is the optimal treatment for this tumor, in order to guarantee high success rates of treatment, prevent future recurrences and allow the maintenance of the patients quality of life. Materials and methods: A search was conducted in Cochrane 1 result and in PubMed 756 results. The selection of the articles was based on the abstracts and inclusion and exclusion criteria. Three were considered for the final analysis. Results: One hundred nineteen lesions were identified (73 males and 46 females). Twenty nine tumors were found in maxilla and 91 in mandible; therapeutic methods applied were: marsupialisation/decompression, marsupialisation followed by enucleation and adjunctive therapies (peripheral ostectomy and Carnoy’s solution), enucleation alone, enucleation and Carnoy’s solution, enucleation followed by peripheral ostectomy and Carnoy’s solution and resection. Discussion and conclusions: Treatment by enucleation in combination with adjunctive measures is associated with minor recurrence rates when compared with enucleation alone. The small number of KCOT that were treated with bloc resection didn’t allow us to obtain statistically relevant results. Therefore, more studies are necessary, with well established criteria, in order to allow an adequate analisys of the recurrence rates associated with each treatment modality.
Background: The keratocystic odontogenic tumor (KCOT) is a benign intraosseous odontogenic lesion relatively frequent in the oral cavity. It has a locally aggressive behavior and exhibits a high propensity to recur after treatment, which affects the prognosis of this lesion. All the singular characteristics of this neoplasic lesion have originated controversy in the scientific community regarding which are the most indicated surgical approaches for the successful treatment of this tumor. Objectives: To analyze which is the optimal treatment for this tumor, in order to guarantee high success rates of treatment, prevent future recurrences and allow the maintenance of the patients quality of life. Materials and methods: A search was conducted in Cochrane 1 result and in PubMed 756 results. The selection of the articles was based on the abstracts and inclusion and exclusion criteria. Three were considered for the final analysis. Results: One hundred nineteen lesions were identified (73 males and 46 females). Twenty nine tumors were found in maxilla and 91 in mandible; therapeutic methods applied were: marsupialisation/decompression, marsupialisation followed by enucleation and adjunctive therapies (peripheral ostectomy and Carnoy’s solution), enucleation alone, enucleation and Carnoy’s solution, enucleation followed by peripheral ostectomy and Carnoy’s solution and resection. Discussion and conclusions: Treatment by enucleation in combination with adjunctive measures is associated with minor recurrence rates when compared with enucleation alone. The small number of KCOT that were treated with bloc resection didn’t allow us to obtain statistically relevant results. Therefore, more studies are necessary, with well established criteria, in order to allow an adequate analisys of the recurrence rates associated with each treatment modality.
Descrição
Tese de mestrado, Medicina Dentária, Universidade de Lisboa, Faculdade de Medicina Dentária, 2013
Palavras-chave
Saúde oral Teses de mestrado - 2013