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Objective: Odontogenic keratocysts have a high recurrence rate and aggressive clinical behavior. The event called epithelial-mesenchymal transition is a process in which the epithelial cell loses its epithelial characteristics and acquires properties typical of mesenchymal cells. Studies have already demonstrated that odontogenic keratocysts has expression of tumor markers, but the lack of clarification about its development mechanism and molecular composition makes the therapeutic options remain limited. The aim of this study is to evaluate the expression of epithelial-mesenchymal transition marker proteins in these lesions, correlating the expression of these proteins with clinical aspects of each case. Methods: Patients with odontogenic keratocysts diagnoses, treated by the Department of Oral and Maxillofacial Surgery of the Erasto Gaertner Hospital, Curitiba, Brazil in the period between 2016 and 2019 were evaluated by immunohistochemical analysis, to assess the expression of epithelial-mesenchymal transition markers (Vimentin, beta-catenin and E-cadherin) by qualitative analysis. Results: Eighteen patients were included, with a mean age of 43 years, and most of them were male. The mandible was more affected than the maxilla. No association between the clinical characteristics of the cysts and the immunohistochemical profile for epithelial-mesenchymal transition proteins was observed. Conclusion: The positivity of E-cadherin and negativity of vimentin demonstrates that its function is preserved. Loss of function of E-cadherin is associated with worse prognosis. The identification of the epithelial-mesenchymal transition process as a prognostic marker for odontogenic cysts and tumors could be an important tool for defining treatment.

The use of sodium hypochlorite (NaOCl) as irrigation solution in endodontics is widespread and accidents of apical extravasation may occur, being in most cases mild to moderate situations of simple management. However, in immunosuppressed patients, the reaction may be exacerbated, with significant systemic changes and potentially life-threatening. Even so, there is a lack of information about the management of these special cases, especially in oncopediatric cases. Therefore, the aim is to report a case of severe reaction post-accident with NaOCl in a 13-year-old adolescent undergoing chemotherapy, with significant edema, gingival necrosis, cutaneous rash, edema of the extremities, pleural effusion, and bronchopneumonia, with a 30-day evolution. It is understood that several factors, including anatomical, may predispose this situation, which can occur even with expert and experienced professionals, not necessarily associated with poor practice. The authors raise the importance of further studies to discuss the real need and indication of the use of NaOCl as an irrigating solution for these patients and suggest the adoption of extra safety measures to avoid the occurrence of similar situations.

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