A Retrospective Study to Evaluate Biopsies of Oral and Maxillofacial Lesions.

BACKGROUND: The clinical manifestations of these lesions comprises pain, paresthesia, swelling, drainage, tooth loss, root resorption, and facial deformity. Alteration in oral and maxillofacial (OMF) tissues of the lesions may cause esthetically and functionally unfavourable effects in patients. AIMS AND
OBJECTIVES: To determine the frequency of odontogenic cysts, tumors, and other lesions.
MATERIALS AND METHODS: Patient's records of histopathological reports from the archives of the Department of Oral and Maxillofacial Pathology were obtained and reviewed over a period of 2 years, and therefore, the lesions were classified into four groups. In cases of recurrent lesions, only the primary diagnosis was considered. The research protocol was approved by the ethical committee of the institution.
RESULTS: About 56.4% of males had ameloblastoma, 54.9% of females had cementoma. 59.4% females had giant cell granuloma, 87.5% females had pyogenic granuloma, 77.2% females had osteoma, 65.1% of the female population were belongs to the benign fibro-osseous lesions and 50.2% of females were from fibrous dysplasia in group 3. About 58.8% females had squamous cell carcinoma in group 4.
CONCLUSION: To adequately determine the prevalence and incidence rate of OMF lesions, biopsies performed by other specialists such as otolaryngologists and plastic surgeons in OMF regions should also be evaluated. Copyright:

INTRODUCTION

Pathological changes in the hard and soft tissues can occur due to the oral and maxillofacial lesions (OMF) with the variation in the incidence rate according to age, sex, and location of the pathology and the knowledge of these factors can help in the identification of the lesion type that leads to the correct diagnosis. Clear identification of the lesions is not solely based onto these factors though clinical and radiological examination, biopsy, and histopathological examination are crucial for final diagnosis that can lead to better treatment planning. The very first edition of histological classification of odontogenic tumors was published by the WHO in 1971 which has been revised three times to date[1] that consists of five major changes in the new classification which was published in 2017, compared with the third version from 2005[2] Odontogenic cysts, which was not included into the previous classifications, are classified mainly based on their true nature.[3] Odontogenic keratocyst (OKC) and calcifying odontogenic cyst were removed from classification of odontogenic tumors and were instilled into the classification of odontogenic cysts.[4] New entities like sclerosing odontogenic carcinoma and primordial odontogenic tumor were recognized.[5] Ameloblastic fibrodentinoma, ameloblastic fibro-odontoma, and odontoameloblastoma were removed from the classification scheme completely[6] and osseous dysplasia and ossifying fibroma were renamed as cemento-osseous dysplasia and cemento-ossifying fibroma, respectively.[7] Our study was based on the aim of determining the frequency of odontogenic cysts, tumors and other lesions by collecting the details of the affected patients from the archives of the Department.

MATERIALS AND METHODS

The present study is a retrospective type of study in nature which involves 400 individuals with 225 males and 175 females subjects and their age ranged between 80 and 90 years. In this study, patient records of histopathological reports from the archives of the Department of Oral and Maxillofacial Pathology was obtained and reviewed over the period of 2 years and the lesions were classified into four groups which is mentioned below:

Odontogenic cysts

Odontogenic tumors

Bone tumors and related lesions as per the fourth edition of the WHO classification

Malignancies.

Anatomical location of the lesions and the demographic data were recorded and analyzed. The involved sites were subclassified into four regions which is as follows:

Maxillary anterior

Maxillary posterior

Mandibular anterior

Mandibular posterior.

In cases of recurrent lesions, only the first diagnosis was included in this study, and the ethical clearance was obtained from the ethical committee of the institution.

Statistical analysis

Data were analyzed using SPSS version 24.0 ((IBM, USA). The analyses were conducted at a 95% confidence level, and the P < 0.05 was considered statistically significant.

RESULTS

A total of 400 patients were included in the present study after the peer review of histopathological reports. In group 1%–32.1% females and 67.9% males were present with radicular cyst, 71.9% males with the dentigerous cyst, 73.2% males had OKC and 86.6% males had nasopalatine duct cyst. Group 2-had odontoma in 54.5% females, 60.2% of females had ossifying fibroma, 56.4% males had ameloblastoma, 54.9% of females had cementoma. About 59.4% of females had giant cell granuloma, 87.5% females had pyogenic granuloma, 77.2% females had osteoma, 65.1% female population were belongs to the benign fibro-osseous lesions and 50.2% females were from fibrous dysplasia in Group 3. 58.8% females had squamous cell carcinoma (SCC) in Group 4. In Group 1, P = 0.032 was found for dentigerous cyst, which was statistically significant. Statistically significant values were obtained in Group 2 (P = 0.021). P = 0.021 was also found statistically significant in Group 3 for pyogenic granuloma [Tables 1 and 2].

Table 1

Distributions of groups based on sex

Lesion	Female	Male	P
Group 1
Radicular cyst	32.1	67.9	0.062
Dentigerous cyst	28.1	71.9	0.511
Odontogenic keratocyst	26.8	73.2	0.678
Nasopalatine duct cyst	13.4	86.6	0.067
Lateral periodontal cyst	0	100	0.344
Group 2
Odontoma	54.5	45.5	0.567
Ossifying fibroma	60.2	39.8	0.720
Ameloblastoma	43.6	56.4	0.334
Cementoma	54.9	45.1	0.834
Adenomatoid odontogenic tumor	100	0	0.231
Odontogenic myxoma	100	0	0.367
Ameloblastic fibroma	100	0	0.345
Group 3
Giant cell granuloma	59.4	40.6	0.267
Pyogenic granuloma	87.5	12.5	0.065
Osteoma	77.2	22.8	0.289
Benign fibro-osseous lesion	65.1	34.9	0.743
Fibrous dysplasia	50.2	49.8	0.615
Brown tumor	0	100	0.106
Osteomyelitis	100	0	0.473
Florid osseous dysplasia	100	0	0.472
Benign spindle cell tumor	0	100	0.151
Lymphangioma	0	100	0.151
Group 4
Squamous cell carcinoma	58.8	41.2	0.855
Malignant melanoma	100	0	0.403
Mucinous adenocarcinoma	0	100	0.166
Osteosarcoma	100	0	0.402

Table 2

Distributions of groups based on age and anatomical location

Lesion	Mean±SD (years)	P
Group 1
Radicular cyst	36.75±13.29	0.167
Dentigerous cyst	42.61±13.41	0.032*
Odontogenic keratocyst	44.36±16.37	0.804
Nasopalatine duct cyst	44.36±16.97	0.122
Lateral periodontal cyst	36.00±13.55	0.961
Total	36.60±13.47	0.257
Group 2
Odontoma	25.36±18.68	0.267
Ossifying fibroma	35.44±14.20	0.249
Ameloblastoma	42.33±15.64	0.151
Cementoma	51.00±11.72	0.070
Adenomatoid odontogenic tumor	16.00±1.61	0.970
Odontogenic myxoma	45	0.090
Ameloblastic fibroma	13	0.989
Total	32.01±16.61	0.021*
Group 3
Giant cell granuloma	41.05±22.74	0.148
Pyogenic granuloma	45.06±19.74	0.021*
Osteoma	40.00±15.98	0.667
Benign fibro-osseous lesion	36.00±8.41	0.861
Fibrous dysplasia	33.00±19.69	0.158
Brown tumor	12.50±2.11	0.160
Osteomyelitis	60	0.989
Florid osseous dysplasia	35.00±18.79	0.989
Benign spindle cell tumor	18	0.743
Lymphangioma	36	0.966
Total	41.29±16.81	0.282
Group 4
Squamous cell carcinoma	67.60±14.42	0.428
Malignant melanoma	53	0.743
Mucinous adenocarcinoma	81	0.225
Osteosarcoma	12	0.228
Total	60.37±24.72	0.321

* P<0.05 is significant: SD: Standard deviation

DISCUSSION

In our study, the foremost common group of lesions was odontogenic cysts followed by bone tumors, odontogenic tumors, and malignant tumors of the jaw which was in accordance with a study[8] conducted in Iran, in which odontogenic cyst were more commonly observed followed by groups of benign bone pathologies odontogenic tumors, and malignant tumors of the jaw. In a retrospective study conducted in Turkey, cystic lesions were found to compose 17.13%, tumors and related lesions composed 8.25%, malignant tumors composed 1.72%, inflammatory and reactive lesions were composed of 35.69% and other lesions were consists of 37.2% of the entire findings.[9] During a study, it was found that the frequent odontogenic cysts in their investigation were radicular cysts (61.4%), followed by dentigerous cysts (20.1%) and odontogenic keratocysts (6.4%), which is similar in our research.[9] Tekkesin et al.[10] evaluated 5088 odontogenic and nonodontogenic cysts and reported that the most common cyst present was the radicular cyst, followed by the OKC and dentigerous cyst, these researchers claimed that the Turkish populations have high risk of aggressive cysts and gave all the credits to the more frequent appearance of the OKC as compared to the dentigerous cyst. Another study in the southeast region of Turkey mentioned 63% of the cysts as radicular cysts, 26.9% as dentigerous cysts, 6.1% as odontogenic keratocysts, 3.4% as residual radicular cysts, and 0.6% as nasopalatine cysts.[11] In our study, cysts were found in men more frequently as compared to the women, and the similar results were found in other studies conducted in our country, where the incidence remained higher in males. Another study[12] where cysts were more commonly seen in male patients (57.7%) consistent with 5,088 biopsies, with similar results.[13] Male predominance (53.8%) in a study involving a Turkish population most of the cysts were located into the mandibular region, with commonly affected sites being the mandibular posterior region and maxillary anterior region, followed by mandibular anterior and maxillary posterior region.[13] Radicular cysts affecting the maxillary anterior region are more often, while dentigerous cysts and OKC were more commonly observed within the mandibular posterior region, almost like in other reports within the literature.[14151617] Within the literature, it was reported that odontogenic tumor rates range from 1.2% to 2.5% of all biopsies across studies.[171819] The most frequent odontogenic tumors were odontoma, cemento-ossifying fibroma, ameloblastoma, adenomatoid odontogenic tumor, cementoma, odontogenic myxoma, and ameloblastic fibroma, in the present study. As previously mentioned, OKC was considered a cyst in step with the second edition of the WHO classification, while it absolutely was considered a tumor within the third edition. In our study, cases of malignant tumors of the jaw were also observed among all of pathologies, with the most frequent lesion being SCC while osteosarcoma, mucinous adenocarcinoma, and malignant melanoma were reported in one case each. In an exceedingly multicenter study in Turkey, 0.37% of the tumors were malignant.[20]

CONCLUSION

Biopsies done by the other specialists like otolaryngologists and plastic surgeons into the OMF regions should also be considered and evaluated, the results of biopsies by our department was only reported in the study, which is not adequate to determine the prevalence and incidence of OMF lesions and the furthermore extensive studies are needed with larger sample size.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.