Introduction:

Maxillary cysts are pathological cavities lined with epithelium, which may or may not be of odontogenic origin. Although most are benign, some have the potential to transform into malignant neoplasms. Radicular cysts are the most frequent, representing 48.67% of cases, followed by dentigerous cysts and keratocysts. Malignant transformation of cysts, although rare, is estimated between 0.13% and 3% and is mostly associated with epithelial remnants that can give rise to malignant neoplasms, such as ameloblastomas and primary intraosseous carcinomas. Typical symptoms include pain and inflammation, however, the absence of clinical signs in some patients may result in late diagnosis and an unfavorable prognosis.

Material and method:

A systematic review was carried out according to the PRISMA guideline, formulating a clinical question about the prevalence and factors associated with malignant transformation of maxillary cysts. A comprehensive search was conducted in electronic databases (Medline/PubMed, Scopus, Cochrane, Embase, Google Scholar, and Web of Science) and grey literature, covering studies published between 2012 and 2024. Observational studies, case reports, and histopathological analyses were included. Articles without analysis of malignant transformation, those not related to odontogenic cysts, and studies with incomplete data were excluded.

Results:

The initial search identified 199 records, from which 23 relevant articles were selected. A total of 651 patients with a mean age of 46 years, with a predominance of men (59%), were reviewed. Malignant transformation was observed in 5% of odontogenic cysts, with dentigerous cysts being the most common (75%). The most frequent symptoms included persistent facial pain (75%) and localized swelling (63%). Radiographically, 85% of cases showed irregular bone expansion. Histopathologically, 90% showed keratinization and epithelial dysplasia. Risk factors included chronic infections (45%) and previous trauma (30%).

Conclusion:

Carcinogenesis in maxillary cysts is a multifactorial process that includes genetic alterations, chronic inflammation, persistent infections, trauma, and environmental factors. Although the incidence of malignant transformation is low (<3%), it can occur, especially in patients older than 50 years, manifesting radiographically as irregular bone expansion and diffuse radiolucency, and presenting histopathological characteristics such as epithelial dysplasia.

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