Frequency of occurrence of odontogenic lesions of the jaws in a tertiary hospital in Nigeria

Birch D Saheeb; Ekaniyere B Edetanlen; Esezobor P Egbor

doi:10.4103/jnam.jnam_10_22

ORIGINAL ARTICLE

Year : 2022 | Volume : 1 | Issue : 2 | Page : 90-94

Frequency of occurrence of odontogenic lesions of the jaws in a tertiary hospital in Nigeria

Birch D Saheeb, Ekaniyere B Edetanlen, Esezobor P Egbor
Department of Oral and Maxillofacial Surgery, University of Benin Teaching Hospital, Benin City, Nigeria

Date of Submission	23-May-2022
Date of Decision	01-Jul-2022
Date of Acceptance	04-Jul-2022
Date of Web Publication	27-Dec-2022

Correspondence Address:
Ekaniyere B Edetanlen
Department of Oral and Maxillofacial Surgery, University of Benin Teaching Hospital, Benin City
Nigeria

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jnam.jnam_10_22

Abstract

Aims: This study aims to determine the frequency of occurrence of odontogenic lesions and compare the prevalence of odontogenic tumors and odontogenic cysts, according to age, gender, origin, malignancy, and recurrence rate among patients diagnosed with odontogenic lesions in a Nigerian teaching hospital. Materials and Methods: This is a retrospective cross-sectional study that examined all the records of the patients diagnosed histologically with jaw lesions at the Department of Oral and Maxillofacial Surgery of the University of Benin, for a period of 9 years from 2013 to 2021. The information recorded were age, gender, type of jaw, cell of origin of lesion, type of lesion, histopathological diagnosis, and the number of malignant and recurrent lesions. All data were analyzed using the IBM Statistical Package for Social Sciences (IBM SPSS), version 23.0 (IBM Corp., Armonk, NY, USA). The level of significance adopted was less than 0.05. Results: Of the 513 patients whose data were analyzed, 210 had odontogenic lesions giving a prevalence of 40.9%. The age range was 7–78 years with a mean age of 35.2 ± 15.0 years. More than half of the patients were less than 45 years old. The ratio of males to females was 1.3: 1. The prevalence of odontogenic tumors and cysts was 86.2% and 13.8%, respectively. More than half (52.4%) of the odontogenic lesions were ameloblastoma followed by ameloblastic carcinoma (8.60%), dentigerous cyst (4.80%), and calcifying odontogenic tumor being the least common (1.00%). Only 18.6% of the odontogenic lesions were malignant. There was a recurrence of 24.3% in the odontogenic lesions. The ratio of malignancy was 3.1: 1 in the odontogenic cysts and 4:1 in the odontogenic tumors, but these trends were not significant. The prevalence of recurrence of odontogenic tumors and cysts was 25.4% and 17.2%, respectively, but this finding was not significant (P = 0.31). Conclusion: There was a relatively high frequency of odontogenic lesions of 40.9% in our environment. The frequency of occurrence of odontogenic tumors was 86.2%, whereas that of odontogenic cysts was 13.8%.

Keywords: Cyst, Frequency, Lesion, Occurrence, Odontogenic, Tumor

How to cite this article:
Saheeb BD, Edetanlen EB, Egbor EP. Frequency of occurrence of odontogenic lesions of the jaws in a tertiary hospital in Nigeria. J Niger Acad Med 2022;1:90-4

How to cite this URL:
Saheeb BD, Edetanlen EB, Egbor EP. Frequency of occurrence of odontogenic lesions of the jaws in a tertiary hospital in Nigeria. J Niger Acad Med [serial online] 2022 [cited 2023 Jun 9];1:90-4. Available from: http://www.jnam.com/text.asp?2022/1/2/90/365598

Introduction

Odontogenic lesions of the jaws comprise tumors and cysts of odontogenic origin. Odontogenic tumors are lesions derived from epithelial, ectomesenchymal, or both elements that have been part of the tooth-forming apparatus.^[1],[2] Odontogenic cysts are the most common type of cysts occurring within the jaws. They arise as a result of proliferation and cystic degeneration of odontogenic epithelial rests. Some of these odontogenic cysts have shown neoplastic alterations or aggressive clinical behavior.^[3],[4] Therefore, it is advisable to always have a biopsy report of all surgically excised tissues to guide the choice of appropriate treatments.

Previous studies have shown that the odontogenic cysts and tumors have different epidemiological prevalence.^{[5],[6],[7],[8],[9]} Some odontogenic cysts such as odontogenic keratocyst (OKC) and calcifying odontogenic cyst (COC) are reported to be neoplastic and considered as high recurrent rate lesions of the jaws.^[10],[11] Moreover, to date, there is a lack of consensus on the classification of these odontogenic cysts as either odontogenic cysts or odontogenic tumors.

Literature review shows a global focus of attention of researchers on the frequency of occurrence of odontogenic tumors^{[1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17]} or odontogenic cysts,^[18],[19] with few studies on odontogenic lesions.^{[20],[21],[22],[23],[24]} Furthermore, it appears that no study has compared the prevalence of odontogenic tumors with that of odontogenic cysts. This type of study will provide a better characterization of odontogenic lesions that will enhance better treatment choices and outcomes.

In the literature, it appears that there is a dearth of information on the frequency of occurrence of odontogenic lesions. Therefore, this study aims to determine the frequency of occurrence of odontogenic lesions and to compare the prevalence of odontogenic tumors and odontogenic cysts according to age, gender, origin, malignancy, and recurrence rate among patients diagnosed with odontogenic lesions in a Nigerian teaching hospital.

Materials and Methods

This is a retrospective cross-sectional study that examined all the records of the patients diagnosed histologically with jaw lesions at the Department of Oral and Maxillofacial Surgery of the University of Benin, for a period of 9 years from 2013 to 2021. The information recorded were age, gender, jaw affected, the origin of lesion, type of lesion, histopathological diagnosis, and the number of malignant and recurrent lesions. The cases with incomplete information and indefinite diagnosis were excluded. All histologically diagnosed odontogenic cysts and tumors were stratified in terms of age, gender, type of jaw, the origin of lesion, and the number of malignant and recurrent lesions.

Comparison of the mean ages between odontogenic cysts and tumors was done with an independent t-test, whereas the difference in proportion between gender, type of jaw, the origin of lesion, and the number of malignant and recurrent lesions was tested using either the χ² test or Fisher’s exact test where necessary. All data were analyzed using the IBM Statistical Package for Social Sciences (IBM SPSS), version 23.0 (IBM Corp., Armonk, NY, USA). The level of significance adopted was less than 0.05.

Results

A total of 513 records of patients with neoplastic jaw lesions were retrieved and reviewed, out of which 210 had odontogenic lesions giving a prevalence of 40.9%. [Table 1] shows the frequency of occurrence of the odontogenic lesions. The age range was 7–78 years with a mean age of 35.2 ± 15.0 years. More than half of the patients were less than 45 years old. The male to female ratio was 1.3: 1. There was a mandibular preponderance (75.7%) of the odontogenic lesions. Histological reports show that the cells of origin of most (80.0%) of the odontogenic lesions were from the epithelium followed by those from both epithelium and mesenchyme (12.9%). Of the 210 patients with odontogenic lesions, the prevalence of odontogenic tumors and cysts was 86.2% and 13.8%, respectively. More than half (52.4%) of the odontogenic lesions were ameloblastoma, followed by ameloblastic carcinoma (8.60%) and dentigerous cyst (4.80%) with calcifying odontogenic tumor being the least common (1.00%). Only 18.6% of the odontogenic lesions were malignant. There was a recurrence rate of 24.3% in the odontogenic lesion seen in this study.

Table 1: Frequency of occurrence of odontogenic lesion

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[Table 2] shows the comparison of the odontogenic cysts and tumors based on age, gender, type of jaw, cell of origin of lesion, and number of malignant and recurrent lesions. Patients with odontogenic cysts were older than those with odontogenic tumors, but these findings were not statistically significant (P = 0.49). The male patients were more than the female counterparts in those with odontogenic cysts, and this trend was also observed among those with odontogenic tumors, although this was not statistically significant (P = 0.44). The mandible was more commonly involved than the maxilla in both the odontogenic cysts and tumors. However, this was not statistically significant [Table 2]. Epithelial cells were the most implicated cells of origin compared with the mixed and mesenchymal cells, although this finding was also not significant (P = 0.05). The ratio of the frequency of benign to malignant variety was 3.1: 1 in the odontogenic cysts, while it was 4:1 in the odontogenic tumors, but these trends are not significant [Table 2]. The prevalence of recurrence of odontogenic tumors and cysts was 17.2% and 25.4%, respectively, but this finding was not significant (P = 0.31).

Table 2: Bivariate analysis of odontogenic lesions according to the type of lesions

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Discussion

The current WHO classification of odontogenic tumors is based on the clinical behavior of the lesion.^[25] Although OKCs and COCs were considered to be cystic lesions in this study, some authors^[2],[3],[5] are reluctant to agree on this notion. We grouped them as cysts because not all the OKCs and COCs behave aggressively similar to a neoplasm.^[22] Furthermore, there are a few lesions that histologically show the proliferation of the odontogenic epithelium, but the pattern does not fit into the diagnostic criteria of any of the odontogenic neoplasms. Hence, a revised classification of odontogenic tumors and cysts that would incorporate the molecular pathology of the lesion would be apt.

Odontogenic tumors and cysts of the jaws represent one of the most prevalent groups of oral and maxillofacial lesions. The prevalence of odontogenic lesions in the present study was 40.9%. This is greater than the 12.9% and 19.6% reported by Mosadomi^[21] in Nigeria and Baghaei et al.^[22] in Iran, respectively. Mosadomi reported a lower value of 12.9% and mentioned that their study does not share the view that jaw tumors are more common among Africans instead that their study agrees with the “harvesting” theory that jaw tumors, which are generally slow-growing, painless, and non-life-threatening, are “showing up” more at treatment centers throughout Africa, thus giving a clinician the chance to see many cases of jaw lesions over a relatively short time.^[21] It does appear that this statement is no longer tenable as the findings of this study do not support the continued validity of the statement.

In this study, more than half of the patients were less than 45 years old and the mean age was 35.2 ± 15.0 years. This mean age is comparable with the 33.7 ± 6.8 and 36.7 ± 17 years reported by Monteiro et al.^[20] and Deepthi et al.,^[24] respectively. The reason for this finding could be attributable to the active nature of epithelial and ectomesenchymal cells in this decade of life. The striking male preponderance encountered in this study is in agreement with what has been reported in other studies,^[11],[17] but is in contrast to others who reported female preponderance.^[5],[23] Baghaei et al.^[22] reported a higher prevalence of odontogenic cysts and tumors in males and females, respectively.

The findings of this study are in agreement with previous studies that have reported a predilection of odontogenic lesions for the mandible.^[21],[22] This could be related to the presence of a higher number of primitive ectomesenchymal cells in the mandible. Furthermore, the mandible was reported to be more exposed to irritations or inflammatory activities that can play a role in the pathogenesis of odontogenic lesions.^[11] Deepthi et al.,^[24] however, reported the maxilla to be more affected by odontogenic cysts.

Most previous studies done among the Caucasians^{[8],[9],[12],[17],[20]} and Asians^{[2],[13],[14],[15]} reported a higher prevalence of odontogenic cysts compared with odontogenic tumors, but the present study reported contrary findings of 86.2% and 13.8% in odontogenic tumors and cysts, respectively. The commonest odontogenic tumor in this study was ameloblastoma which was also reported by previous studies,^[11],[14] but other studies reported odontomas.^[21],[22] Similar to the previous studies,^[5],[7],[12] the frequency of occurrence of dentigerous cysts was most common in this study, although it was in contrast to other studies^[13],[17] that reported radicular cysts to be the commonest cysts.

The frequency of occurrence based on histogenesis appears to be rare in the literature; thus the present study assessed the frequency of odontogenic lesions based on the cells of origin. This makes the comparison of these findings to be limited because there is a dearth of comparative research. The prevalence of odontogenic lesions of epithelial cells origin was found to be higher in both odontogenic cysts and tumors in the study. The benign odontogenic lesions were mostly encountered in this study, and this is in agreement with previous studies.^[5],[7] The reason for this low prevalence of malignant odontogenic lesions could be that cases that were seen were those that arose from preexisting lesions. For example, ameloblastic carcinoma was the commonest malignant odontogenic lesion and it can either arise de novo or from preexisting benign lesion.^[11] The 24.3% of the lesions seen during the period were recurrent lesions. This value is higher than the 6.9% reported by Monteiro et al.^[20] in a Portuguese population. In the odontogenic cysts, the recurrence rate was 17.2%, while it was 25.4% in the odontogenic tumors in this study. The high recurrence rate seen for odontogenic cysts could be related to the consideration of OKCs and COCs as cystic lesions. This study has some limitations as some relevant data must have been missed due to its retrospective nature. This is a single center study and hence the findings should be interpreted with caution.

In conclusion, there was a relatively high frequency of odontogenic lesions of 40.9% in our environment. The frequency of occurrence of odontogenic tumors was 86.2%, whereas that of odontogenic cysts was 13.8%.

Acknowledgment

We want to thank our colleagues in the department for the permission to retrieve the case notes of their patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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