|Year : 2017 | Volume
| Issue : 1 | Page : 2-6
A retrospective study of cysts and tumors of the oral cavity
Monika Aroquiadasse1, Mariappan J Daniel1, Subramanian V Srinivasan1, Vannathan K Jimsha1, Jignesh Modha2, Durgadevi Pancharethinam1
1 Department of Oral Medicine and Radiology, Mahatma Gandhi Postgraduate Institute of Dental Sciences, Puducherry, Puducherry (U.T.), India
2 MPH Candidate, University of Texas Health Science Center, Houston, Texas, United States of America
|Date of Submission||05-Aug-2016|
|Date of Acceptance||27-May-2017|
|Date of Web Publication||04-Aug-2017|
Department of Oral Medicine and Radiology, Mahatma Gandhi Postgraduate Institute of Dental Sciences, Puducherry, Puducherry (U.T.)
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Introduction: Orofacial cysts and tumors are known to exhibit geographic variations in prevalence and pattern. The knowledge of the epidemiology of odontogenic cysts and tumors is limited in a developing nation like India, which may be attributed to inadequate documentation in our hospitals and health care centres. The aim of this study was to determine the frequency of different types of odontogenic cysts and tumors diagnosed at a tertiary care dental college hospital in Puducherry and compare the findings with the information reported in other parts of the world. Material and Methods: A record-based study was conducted using data from the clinical and histopathological records of the last ten years (2006–2015) from the departments of oral medicine and radiology and oral pathology in a dental college and hospital, Puducherry. Results: Of the total 974 patients, 510 were males and the age ranged from 1 to 95 years. The analysis showed that malignant lesions were the most common lesion (55.8%), distributed almost equally between males (53.6%) and females (46.3%). Malignant lesions more often occurred during the 6th and 7th decade of life. Keratocystic odontogenic tumor was the most common benign odontogenic tumor (33.3%), occurring most commonly in males involving the mandible. Among odontogenic cysts, dentigerous cyst was the most common developmental odontogenic cyst. Radicular cyst was the most common inflammatory cyst and was more prevalent among males. Conclusion: Our study is the first of its kind to assess the prevalence of any cyst and tumor that occurs in the oral cavity (both odontogenic and nonodontogenic) in an Indian population. To determine the global epidemiological burden of these lesions we urge further prevalence studies to be performed in the Indian subcontinent as well as the world.
Keywords: Cysts, oral cancer, oral cavity, tumors
|How to cite this article:|
Aroquiadasse M, Daniel MJ, Srinivasan SV, Jimsha VK, Modha J, Pancharethinam D. A retrospective study of cysts and tumors of the oral cavity. J Indian Acad Oral Med Radiol 2017;29:2-6
|How to cite this URL:|
Aroquiadasse M, Daniel MJ, Srinivasan SV, Jimsha VK, Modha J, Pancharethinam D. A retrospective study of cysts and tumors of the oral cavity. J Indian Acad Oral Med Radiol [serial online] 2017 [cited 2017 Aug 24];29:2-6. Available from: http://www.jiaomr.in/text.asp?2017/29/1/2/212097
| Introduction|| |
The oral cavity is a unique environment, peculiar in its nature and one of the most dynamic regions in the body. It is made up of structures that are the target of a wide variety of lesions that vary in location, etiology, and histogenesis, as well as presenting with variable clinical manifestations. Orofacial cysts and tumors exhibit geographic variations in the prevalence and pattern of occurrence. The knowledge of epidemiology of odontogenic cysts and tumors is limited, which may be attributed to inadequate documentation in our hospitals and health care centres. Very few prevalence studies of odontogenic cysts and tumors have been carried out in India and information is scarce., The aim of the study was to determine the frequency of odontogenic cysts and tumors diagnosed at a dental college hospital in Puducherry and compare the findings with information reported in other parts of the world.
| Materials and Methods|| |
A record-based descriptive study was conducted using the clinical and histopathological records of the cysts and tumors documented in the departments of oral medicine and radiology and oral pathology in a dental college and hospital, Puducherry in the last ten years (2006–2015). The study variables included age, gender, anatomic site of the lesion, and histopathological diagnosis. World Health Organization (WHO) criteria was adopted for the classification of odontogenic tumors and cysts. In line with the recent WHO criteria (2005), odontogenic keratocyst is categorized as odontogenic tumor, keratocystic odontogenic tumor (KCOT). Recurrent tumors and tumor-like lesions with a previously diagnosed primary site were excluded. The data collected was entered in EpiData software version 2.1 and analyzed using EpiData Analysis (EpiData Association, Odense, Denmark). The study variables were summarized using proportions (percentages) across gender, age, and anatomic site of the lesion.
| Results|| |
The study group comprised 974 patients, of which 510 (52.4%) were males and 464 (47.6%) were females. The mean (SD) age of the study participants was 37.2 (18.1) years and varied from 2 to 81 years. [Table 1] shows the gender distribution of the cysts and tumors of the oral cavity. Among developmental odontogenic cysts, 32 (59.2%) dentigerous cysts were seen in the males and 22 (40.7) in females. Radicular cyst was the most common odontogenic cyst; its prevalence in males was 88 (60.6%) and in females was 57 (39.3%).
|Table 1: Gender distribution of the cysts and tumors of the oral cavity |
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Among the odontogenic tumors, keratocystic odontogenic tumor was found to occur more commonly among males (57.1%) and ameloblastoma was found to occur more commonly in females (66.7%). Among the nonodontogenic tumors, hemangioma and fibro-osseous lesions were found to occur more commonly in females. Malignancies were the most common among all lesions in the study. Squamous cell carcinoma topped the list, and its prevalence was almost equal among males (54.5%) and females (45.5%).
[Table 2] shows the age distribution of the cysts and tumors of the oral cavity. Among the developmental cysts, dentigerous cysts were developed mostly in the second decade of life, followed by nasopalatine and nasolabial cyst in the fifth decade of life. Radicular cyst was found commonly in the third decade of life and lateral periodontal cyst in the fourth decade of life. Majority of the odontogenic tumors were present between the second and third decade of life. KCOT was found to occur in the third decade and ameloblastoma in the fourth decade of life. Fibro-osseous lesions occurred in the second and fourth decade of life. Pleomorphic adenoma was the most common benign salivary gland tumor and occurred predominantly in the fifth decade of life. Squamous cell carcinoma was frequently found in patients in the sixth decade of life. Among the malignant salivary gland tumors, mucoepidermoid carcinoma was found in the fifth and sixth decade of life and adenoid cystic carcinoma in the sixth and seventh decade of life.
[Table 3] shows the site distribution of the cysts and tumors of the oral cavity. Among the developmental cysts, dentigerous cysts showed a greater predilection to occur in the maxilla. Among inflammatory cysts, the radicular cysts were found commonly in the maxilla. [Table 4] shows that among odontogenic tumors, both keratocystic odontogenic tumor and ameloblastoma predominantly occurred in the mandible. Fibro-osseous lesions showed almost an equal predilection to occur in the maxilla and mandible. Pleomorphic adenoma most commonly occurred in the palate. Buccal mucosa was the most common site involved in oral squamous cell carcinoma followed by the mandible. Among malignant salivary gland tumors, adenoid cystic carcinoma was found to involve the mandible and mucoepidermoid carcinoma occurred equally in the maxilla and mandible.
| Discussion|| |
Studies of cysts and tumors of the oral cavity from several parts of the world indicate that knowledge of the location, frequency, and basic clinical features of these lesions is essential to assess the expression of these lesions in diverse populations as well as to identify the groups at risk. The incidence and epidemiological behavior of odontogenic lesions exhibits geographical variations in different regions of the world. These lesions occur frequently in gnathic bones and represent approximately 2.5% of all the lesions biopsied in the dental services.
The cysts derived from the odontogenic epithelium are termed as odontogenic cysts (OC). Odontogenic cysts are one of the most common lesions affecting the jaws and many of these cysts share similar clinical and radiographic features. Therefore, the diagnosis of odontogenic cysts should be based on careful examination of clinical, radiographic, and histopathologic features. They are broadly divided into inflammatory and developmental cysts. The dentigerous cysts (53.7%) and radicular cysts (66.2%) observed in this series occurred more frequently in the maxilla, however, these findings differ from the studies reported by Meningaud et al., Avelar et al., Sanatkhani et al., and Lawal et al., where the mandible was the commonly affected site. The odontogenic cysts were found to occur more in the female population. This contrasts the study results of Niranjan et al. and is in agreement with the study by Borges et al. Regarding age distribution, the peak incidence of odontogenic cysts was between 20 and 29 years, which is consistent with the findings of other studies by Niranjan et al., Ochsenius et al., Avelar et al., and Borges et al.
Odontogenic tumors have a unique histological structure, reflecting various stages of odontogenesis and are located mainly in the jaws. The reported relative frequency of odontogenic tumors is generally low: India (4.13%), Asia (2.14%), South America (1.82%), North America (1.55%), Europe (0.74%); the highest values being in Africa, Nigeria (9.6–19%).
KCOT was the most predominant benign odontogenic tumor and accounted for 42 cases (4.3%) observed in this series. This is in agreement with the findings in some studies conducted by Avelar et al., Luo et al., Pereira et al., and Servato et al., where KCOT was reported as the most prevalent odontogenic tumor and is discordant with an Indian study reported by Niranjan et al. Expectedly, inclusion of this lesion as odontogenic tumor increased the overall proportion of odontogenic tumors in the series in agreement with the increment observed by Servato et al. in a Brazilian study. Results may also have been influenced by consideration of para-keratinized odontogenic keratocyst as KCOT, which has an impact in terms of frequency of odontogenic cyst diagnosis. Both ameloblastoma (73.3%) and KCOT (83.3%) showed a greater predilection to occur in the mandible in this series.
Most of the odontogenic tumors (87.2%) occurred during the second to fifth decade and were seen to show a predilection in the female population, which is in agreement with the study reported by Servato et al. Fibro-osseous lesions accounted for approximately 13.0% and occurred over the second and the fourth decade. The often observed female predominance was present, as in the study by William et al., however, predilection for the maxilla reported in literature was not observed in the present study. There was no significant difference in terms of occurrence in the mandible (50%) and maxilla (46.8%) in this series.
In our study, malignant lesions were the most common lesion (55.9%), which sharply contrasts previous reports from Nigeria by Bassey et al. In general, studies from the west and developing countries reported higher proportion of malignant jaw lesions than benign lesions when compared to reports from Africa. This observed difference may be explained in terms of relatively lower life expectancy among Africans compared to their western counterparts.
In our study, squamous cell carcinoma (50.5%) was the most common malignant histopathological diagnosis of the malignant lesions in this series. India has some of the highest cancer rates in the world. The incidence of mouth cancer among men in Puducherry was 8.9 per 100000, one of the highest rates in the world for men. This high prevalence of oral cancer may be due to the increased tobacco usage in Puducherry. The other confounding factors such as socioeconomic status and educational status of the study participants were not analyzed and is a limitation in this study. Healthy life style practices and balanced diet can prevent or delay the incidence of cancer. Moreover, it is estimated that approximately 50% of the cancers are curable if they are detected early and treated in an appropriate manner. Screening has a major role in early diagnosis. Unfortunately, early detection tools and treatment and technology that have helped control cancer in developed nations are often not readily available in many developing countries such as India. In the developing world, approximately 80% of cancer patients are at the stage of terminal disease when they are diagnosed. Various factors contribute to the situation including poverty, poor hygiene, lack of awareness, and complex social dynamics. Moreover, there is a huge shortage of specialist and radiotherapy facilities in our country.
The observed peak age of occurrence was the 6th and 7th decade, and the most common lesion site being the buccal mucosa. In our study, other malignant tumors in the order of prevalence included malignant salivary gland tumors, viz., mucoepidermoid carcinoma, adenoid cystic carcinoma, and rare cases of lymphoma and sarcomas were also present (2.9%). Fibro-osseous lesions showed a female predominance, however, predilection for the maxilla, as reported in literature, was not observed in the present study.
Our study shows the distribution for over a decade and could act as a viable record for prevalence studies in our sample population. To the best of our knowledge, our study is the first of its kind to assess the prevalence of any cyst and tumor occurring in the oral cavity (both odontogenic and nonodontogenic) in an Indian population. The limitation of our study is that being a single-center hospital-based study it determines the relative frequency of the cysts and tumors in our sample population and does not assess the actual prevalence.
| Conclusion|| |
The global prejudice in health care can be attributed to the changing epidemiological trends in health care, growing populations, emerging health issues, increasing commercial interests of the private health sector, and the ever shrinking financial resources. Health research is not a luxury and is said to be an essential need that no nation can afford to ignore. Regular epidemiologic monitoring of the oral cavity lesions within a population is important for initiation of preventive approaches and future planning. More awareness campaigns are necessary, especially at the primary healthcare level, to educate the populace on the need for early presentation at treatment centres. To determine the global epidemiological burden of these lesions we urge further prevalence studies to be performed in the Indian subcontinent and the world.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Borges LB, Fechine FV, Mota MR, Sousa FB, Alves AP. Odontogenic lesions of the jaw: A clinical-pathological study of 461 cases. Rev Gaúch Odontol 2012;60:71-8.
Bassey GO, Osunde OD, Anyanechi CE. Maxillofacial tumors and tumor-like lesions in a Nigerian teaching hospital: An eleven year retrospective analysis. Afr Health Sci 2014;14:56-63.
Ramachandra P, Maligi P, Raghuveer H. A cumulative analysis of odontogenic cysts from major dental institutions of Bangalore city: A study of 252 cases. J Oral Maxillofac Pathol 2011;15:1-5.
] [Full text]
Niranjan KC, Shaik Z. Clinicopathological correlation of odontogenic cysts and tumours in a South Indian population over a 20-year period. Int J Dent Res 2014;2:32-6.
Kleihues P, Cavenee WK, editors. Pathology and genetics of tumours of the nervous system. International Agency for Research on Cancer. Lyon: IARC Press; 2000.
de Souza LB, Gordón-Núñez MA, Nonaka CF, de Medeiros MC, Torres TF, Emiliano GB. Odontogenic cysts: Demographic profile in a Brazilian population over a 38-year period. Med Oral Patol Oral Cir Bucal 2010;15:583-90.
Shear M, Speight P. Cysts of the oral and maxillofacial regions. 3rd
ed. Oxford: Blackwell Munksgaard; 2007.
Meningaud JP, Oprean N, Pitak-Arnnop P, Bertrand JC. Odontogenic cysts: A clinical study of 695 cases. J Oral Sci 2006;48:59-62.
Avelar RL, Antunes AA, Carvalho RW, Bezerra PG, Neto PJ, Andrade ES. Odontogenic cysts: A clinicopathological study of 507 cases. J Oral Sci 2009;51:581-6.
Sanatkhani M, Zarch HH, Pakfetrat A, Falaki F. Odontogenic cysts: A clinical and radiographic study of 58 cases. Aust J Basic Appl Sci 2011;5:329-33.
Lawal AO, Adisa AO, Sigbeku OF. Cysts of the oro-facial region: A Nigerian experience. J Oral Maxillofac Pathol 2012;16:167-71. [Full text]
Ochsenius G, Escobar E, Godoy L, Peñafiel C. Odontogenic cysts: Analysis of 2.944 cases in Chile. Med Oral Patol Oral Cir Bucal 2007;12:85-91.
Butt FMA, Ogengo J, Bahra J, Chindia ML, Dimba EAO, Wagaiyu E. A 19-year audit of benign jaw tumours and tumour-like lesions in a teaching hospital in Nairobi, Kenya. Open J Stomatol 2012;2:54-9.
Luo HY, Li TJ. Odontogenic tumors: A study of 1309 cases in a Chinese population. Oral Oncol 2009;45:706-11.
Costa D, Mauricio A, Faria P, Silva L, Mosqueda-Taylor A, Lourenco S. Odontogenic tumors: A retrospective study of four Brazilian diagnostic pathology centers. Med Oral Patol Oral Cir Bucal 2012;e389-94.
Servato JPS, de Souza PEA, Horta MCR, Ribeiro DC, de Aguiar MCF, de Faria PR, et al
. Odontogenic tumours in children and adolescents: A collaborative study of 431 cases. Int J Oral Maxillofac Surg 2012;41:768-73.
Williams AO, Browne RM, Akinosi JO. Fibro-osseous lesions of the jaw in Nigeria. J Natl Med Assoc 1974;66:185.
Mudur G. India has some of the highest cancer rates in the world. BMJ 2005;330:215.
Pal SK, Mittal B. Fight against cancer in countries with limited resources: The post-genomic era scenario. Asian Pac J Cancer Prev 2004;5:328-33.
Fathalla MF, Fathalla MM. A Practical guide for Health Researchers. Cairo: World Health Organization, Regional Office for the Eastern Mediterranean; 2004.
[Table 1], [Table 2], [Table 3], [Table 4]