Search

Objective: To assess the pattern of distribution and age changes in odontomas in a Chinese population., Methods: Forty cases of odontomas found in Chinese patients for which the clinical notes, radiographs and histopathology reports were available were classified as either compound or complex odontomas on the basis of their radiological appearance. Thirty-nine were wholly within the alveolus and one in the maxillary antrum. The overall size of the 39 alveolar odontomas and the size of their central opacities were measured digitally from periapical radiographs., Results: Twenty-one of the 39 alveolar odontomas were complex (M/F = 8/13) and 18 compound (M/F = 10/8). The majority of cases presented in the second and third decades with an overall mean of 23 years. Thirty-eight per cent were found in the anterior maxilla. Complex odontomas had a predilection for the anterior maxilla and mandibular molar areas. The odontomas increased in size with increase in age., Conclusions: The pattern of presentation of this Chinese series is broadly in agreement with other series. Odontomas tend to increase in size with the age of the patient, suggesting continuing growth.

Objectives: A review of 117 ameloblastomas treated over a 10-year period was carried out., Study Design: Clinical records of 117 patients treated for histologically diagnosed ameloblastoma were retrieved and analyzed for age, sex, anatomic distribution, duration of lesions, clinical features, and treatment methods with results and complications., Results: Men and women were equally affected. The average age at the time of presentation was 28 years; 95.7% of the ameloblastomas occurred in the mandible; and 59% occurred in the premolar/incisor/canine region., Conclusion: Ameloblastoma occurs predominantly in the anterior mandible with equal frequency in men and women. Wide resection reduces recurrence.

A retrospective study of 20 patients aged 18 years and younger with ameloblastoma seen over a 10-year period at Harare Central Hospital, Harare, Zimbabwe, was carried out. Males and females were equally affected. The mandible was the most commonly involved bone (95%); the premolar/canine incisor area was commonly affected (69.1%). Incision biopsy was done before wide surgical resection of the involved bone. No currettage or enucleation was used as a mode of treatment. Immediate reconstruction was performed with metallic implants. Twenty percent of the lesions had a unilocular radiologic appearance that resembled a dentigerous cyst. Follow-up was poor.

Purpose: This study evaluated the type and distribution of tumors in the orofacial tissues of black African children., Patients and Methods: The hospital records of all patients aged 15 years or younger, who presented at the Lagos University Teaching Hospital (a tertiary referral center) with a histologically confirmed orofacial tumor over a 13-year period were analyzed., Results: One-fifth of all orofacial tumors during the study period occurred in the pediatric age-group. The male-female ratio was 1.4 to 1 and 11- to 15-year-olds were most frequently affected. Benign tumors (59.8%) were more prevalent than malignant tumors (40.2%). Overall, 18.4% of the tumors were of odontogenic origin, 42.5% were benign nonodontogenic tumors, and 39.1% were malignant nonodontogenic tumors. The anterior part of the mandible was frequently involved by ameloblastoma, which was the most common odontogenic tumor (6.3%). Most of the benign nonodontogenic tumors were of mesenchymal origin (46%), and most were located in soft tissues (59.5%). Burkitt's lymphoma (22.4%) was the most common malignant nonodontogenic tumor., Conclusion: The observed differences in tumor type and distribution in this study compared with previous studies may be attributable to genetic and geographic differences in the populations studied.

The clinical features of 74 patients with Burkitt's lymphoma diagnosed at the Hadassah Medical Center in Jerusalem, Israel, are described. The prompt diagnosis of a child with high grade malignant jaw involvement of non-Hodgkin's Burkitt's lymphoma is reported. The use of the open biopsy with special emphasis on the incisional biopsy is discussed in light of the incidental exfoliation of the two primary molar teeth and one permanent successor in this case.

Available literature on ameloblastoma of the jaw was reviewed, including publications from 1960 to 1993, and compared to the latest larger review, published by Small and Waldron in 1955. The average age of patients with ameloblastoma is 36 years. In developing countries ameloblastomas occur in younger patients. Men and women are equally affected. Women are 4 years younger than men when ameloblastomas first occur, and the tumours appear to be larger in females. Dominant clinical symptoms such as painless swelling and slow growth are non-characteristic. The ratio of ameloblastoma of the mandible to maxilla is 5 to 1. Ameloblastomas of the mandible occur 12 years earlier than those of the maxilla. Ameloblastomas occur most frequently in the molar region of the mandible. In Blacks, ameloblastomas occur more frequently in the anterior region of the jaws. Radiologically, 50% of ameloblastomas appear as multilocular radiolucent lesions with sharp delineation. Histologically, one-third are plexiform, one-third follicular; other variants such as acanthomatous ameloblastoma occur in older patients. Two percent of ameloblastomas are peripheral tumours. Unicystic ameloblastomas occurring in younger patients have been found in 6%. Detailed data on 345 patients with ameloblastoma were evaluated for clarification of therapeutic approaches. Chemotherapy and radiation seem to be contraindicated. Ameloblastomas of the maxilla should be treated as radically as possible, ameloblastomas of the mandible should also be treated radically. However, ameloblastomas which radiologically appear as unilocular lesions may be treated conservatively (enucleation, curettage), whenever all areas of the cystic lumen are controllable intraoperatively. Unicystic ameloblastomas occurring in patients 15 years younger than those with multisystic ameloblastoma may be treated conservatively except in cases with invasion of epithelium into the cyst wall. Different recurrence rates have been found for histological variants of the ameloblastoma. Follicular ameloblastomas appear to recur more often than the plexiform type. Unicystic ameloblastomas reveal lower recurrence rates than "non-unicystic" ameloblastomas. The peripheral type of ameloblastoma may be excised, since conservative therapy results in low recurrence rates. Postoperative follow-up is most important in the therapy of ameloblastoma, because more than 50% of all recurrences occur within 5 years postoperatively.

Classification of cemento-osseous lesions of the jaws has long been a dilemma for pathologists. A group of 221 cemento-osseous lesions exhibited sufficiently distinctive clinicopathologic features to be separated into a specific category: focal cemento-osseous dysplasia. This entity presents as an asymptomatic, focal, mixed radiolucent/radiopaque lesion with ill-defined borders in the tooth-bearing areas. It was found to occur with greater frequency in women (88%) and in the posterior mandible (77%). The average age at presentation was 37 years and a relative predilection for black patients was observed. At surgery these lesions were noted to be hemorrhagic, gritty, and adherent to the surrounding bone. The gross appearance of multiple hemorrhagic fragments is of diagnostic significance. Histologic features include a cellular connective tissue stroma punctuated by irregular osseous and/or cementum-like calcifications. Focal cemento-osseous dysplasia is thought to be of periodontal ligament origin and to be non-neoplastic in nature. Further surgical intervention is not necessary, but periodic follow-up is recommended, because occasional cases were observed to progress into florid osseous dysplasia. Care must be taken to differentiate focal cemento-osseous dysplasia from central cementifying and/or ossifying fibromas, which are true neoplasms and require surgical treatment.

Ten consecutive patients with liposarcoma in the oral and maxillofacial region were analyzed retrospectively. Contrary to the majority of previous reviews, a female preponderance (two males and eight females) and younger incidence peak age (33 years) were found. Tumor sites were face (three), parotid (three), oral cavity (two), and mandible (two). Using a current histologic system, seven patients were classified as myxoid, and three as well-differentiated, round-cell, and pleomorphic lesions, respectively. Three patients died of recurrent disease 7 months, 20 months, and 4 years, respectively, after treatment; one patient died of metastatic liver and lung lesions and six patients remain free of disease (2 to 3 years). Clinical and histologic features, tumor behavior, treatment options, and patient prognosis are discussed and the literature is reviewed.

Maxillofacial surgery is a new medical discipline in Ethiopia. Between May 1991 and December 1992, 108 patients with maxillofacial tumours were treated in our Department. These cases are analysed according to their age, sex, anatomical site, histopathological classification of benign and malignant tumours. More males (5.5:1) had malignant tumours than females. The age distribution of malignant tumours showed that most patients were under the age of 51. Histological classification of benign tumours revealed that fibromas and haemangiomas are common (7 cases each) and lymphoma, osteoma and Warthin's tumour are rare (1 case each). Almost all patients with giant cell tumour-like changes were female (11 out of 13). Two patients with Kaposi's sarcoma and 3 patients with non-specific lymphadenopathy of the neck and retroauricular lymph nodes have been proved to be HIV/AIDS infected.

This paper reviews 315 cases of ameloblastoma seen and managed at the Oral and Maxillofacial Clinic of Ahmadu Bello University Hospital, Kaduna, Nigeria over a 20-year period. The data collected on age at presentation, sex distribution, clinical presentation and modalities of treatment are analysed and discussed. A male preponderance was found, with peak presentation in the third and fourth decades of life. Few patients presented with mucosal ulceration, while some presented atypically with expansion of either the lingual or buccal cortical plate of the mandible. Resection of the lesion with dento-alveolar bone and preservation of the lower border of the mandible is effective conservative management in patients with an intact lower border. We do not recommend curettage or enucleation because of the frequency of recurrence. One hundred percent success was recorded in the patients rehabilitated using autogenous bone grafts. Where practicable, bone grafting should be done immediately to avoid the common complications of displacement of bony remnants and occlusal disharmony that occur when grafting is delayed.

The differential diagnosis of the osteocondensing lesions (osteomata and exostoses) is till today a topical issue for the experts. In order to test the reliability of the etiopathogenetic theories advanced up to now, the authors carried out a research on samples of tissue coming from surgical interventions for osteomata and exostoses of the maxillofacial region resortied with optical and polarized-light microscopes (OM-PLM). This research meant to analyze the morphological and structural characteristics of newly formed tissues; a considerable attention has been devoted to the difference between primary and secondary bone and to the quality of cementing lines. Thanks to the data resulted from this study, the authors advanced interesting theories about these pathologies either from an etiological and nosological point of view.

Maxillofacial hemangiomas in young infants can be effectively detected and treated at prophylactic health centers before the tumor progressively grows, this helping do without hospital treatment. Individual methods of treatment and the most rational strategy with due consideration for the tumor shape, size and site can be chosen and the group of patients with spontaneous regression singled out and followed up.

Most dentists and dental faculties use an initial radiographic survey for the comprehensive-care patient rather than selective radiography, as recommended by professional organizations and radiation protection agencies. Survey or screening radiography has been justified in the belief that it is an essential health service designed to disclose serious occult disease and that failure to use such films might expose the dentist to successful malpractice litigation. However, incidence data indicate the chance of disclosing tumors, non-inflammatory cysts or other serious bone disease in the asymptomatic patient by screening jaw films is infinitesimal. On this basis, the practice is not justifiable as a public health measure, nor is the dentist who follows published national guidelines for prescription radiography vulnerable to successful litigation.

After operative therapy of tumors of mouth, jaws and face by patients older 70 years the frequency of complications were 26%. Local and systemic disturbances had nearly similar frequencies. Preexistent diseases, therapeutic concepts and methods of anaesthesia influenced as well frequencies of complications as postoperative lethality. In the analysed group of elderly patients the lethality was unexpected low (2,4%).

In Japan 114 cases of osteosarcoma of the maxillofacial region have been reported during the past 60 years. The average age at the onset of the disease in this region was about one or two decades later than that of osteosarcoma of other regions. Females were affected more frequently (59.6%) than males (40.4%). The mandible was more frequently affected (58.8%) than the maxilla (41.2%). Swelling was the conspicuous symptom for osteosarcoma of the maxillofacial region. Most patients received surgical treatment with or without radiation and chemotherapy; however, the prognosis is poor, regardless of the type of treatment.

This communication presents the first case report of ossifying fibroma of the jaw from Kenya and reviews the literature including the available published case reports from Africa. The relationship between ossifying fibroma and other related benign fibro-osseous lesion of the jaws is briefly discussed. Intensified research work on this condition in Africans is called for so that more cases should be published since it is reportedly more common in black race. The majority of the African cases are generally reported in advanced stages indicating neglect or delay in seeking for medical help. Since ossifying fibroma is a well encapsulated and expansile benign bone neoplasm, surgical enucleation appears to be the treatment of choice; recurrence is rare.

The adenomatoid odontogenic tumour (AOT) is a rare benign neoplasm of odontogenic origin. A review of the available published literature reports on AOT from Africa reveals that 33 cases appear to have been reported and that the tumour tends to occur in young patients, from 10-28 years with a mean age of 16.2 years. Females are affected more than males, with a female:male ratio of 3:2. 65.6% of cases were in the maxilla and 34.4% in the mandible, the majority of which (92.3%) are located in the anterior region of the jaws. 66.7% of the cases are associated with unerupted teeth. Clinically, AOT shows increasingly painless swellings which may eventually cause facial deformity. Tentative clinical diagnosis based on radiology is not pathognomonic for AOT; histopathological confirmation is necessary since incorrect diagnosis may lead to mutilating surgery whereas the lesion is benign with limited growth potential and treatment requires only simple surgical enucleation. Recurrence is rare.

Thirty-four cases of osteosarcoma involving the craniofacial bones over a period of 19 years were reviewed. They formed 6.2% of osteosarcomas occurring in the skeleton during the same period at the Tata Memorial Hospital. Mean age of occurrence was 30.9% years, with a range of 7 to 61 years. Male preponderance was noted in maxillary tumours (M:F = 2.6:1), while the mandibular tumours occurred with equal frequency in both sexes. The mandible was the bone of origin in 56%, maxilla in 32% and other craniofacial bones in 12% of patients. Histological sub-type did not affect the prognosis. Radical surgery with resection of adequate disease-free margins is the most effective mode of treatment. Morbidity and mortality is due to extensive local recurrence of disease, particularly with maxillary tumours. Metastasis to other organs occurs rarely. No statistically significant difference in survival was observed between tumours of the mandible and maxilla, or between patients above and below 20 years of age.

424 odontogenic tumors were diagnosed at the Department of Oral Pathology in Hamburg Eppendorf and the Department of Maxillofacial Surgery in Kiel between 1965 and 1989. 106 of these odontogenic tumors were found in patients of 16 years and under. More often than not the odontogenic tumors of this age group were complex and compound odontomas, totalling 67%. When comparing these with other odontogenic tumors it must be taken into consideration that--although included in the WHO classification--odontomas are often referred to as hamartomas and not real tumors, because they lack the typical features of tumors. Compared with the adult age group, the relative frequency of ameloblastic fibromas, ameloblastic fibro-odontomas and odontogenic myxomas was remarkable. Nevertheless, because of the great differences between the two age groups, direct comparisons of these findings with each other should be made with reservation.

57 patients with odontogenic tumours were treated in the Department for Oral Surgery in Berne, Switzerland from 1975-1985. One third of them was between 4-19 years of age. The greatest entity was the ameloblastic-ectomesenchymal tumour with 62%, ectomesenchymal-mesenchymal tumours did not appear during the years of growth. The average age increased in the following order: ameloblastic-ectomesenchymal, mesenchymal, ectomesenchymal-mesenchymal and ameloblastic tumours. We recommend radical surgical treatment for ameloblastomas, odontogenic myxomas and odontogenic fibromas whereas a conservative surgical approach is sufficient for all other odontogenic tumours.

Reports on the incidence of odontogenic tumours are infrequent with only a limited number of series having appeared in the literature. In this paper, the results of a multicentre retrospective study on the histologic types and relative frequencies of odontogenic tumours in Turkey are presented. The results indicated that the most frequent histologic type was ameloblastoma (36.5 per cent) and the area at greatest risk for the development of odontogenic tumours was the mandibular molar region. A Table showing the most likely type of tumour by location is also presented.

A survey of biopsied lesions of patients aged 0-16 yr who presented with oral swellings at the Lagos University Teaching Hospital over a period of 11 yr was conducted to determine the pattern of presentation of these lesions in 203 Nigerian children, 123 boys and 80 girls. 21% of the lesions were fibro-osseous lesions. There were more non-odontogenic than odontogenic tumors and very few salivary gland tumors.

A series of 21 cases of adenomatoid odontogenic tumour is reported from Sri Lanka. They formed 8.6% of odontogenic tumours, excluding odontomes, in the 10-year period reviewed. 85% of cases occurred in the anterior maxilla. Most cases were diagnosed clinically as dentigerous cysts. There were no recurrences following conservative surgery in follow-up periods ranging from 2 to 11 years.

Burkitt's lymphoma is a malignancy of B-lymphocyte origin that was initially described in African children with jaw tumors. These tumors often spread to involve abdominal viscera and other sites, have rapid growth kinetics, and are principally responsive to chemotherapy. Prolonged survival is predicted by site and extent of tumor, with bone marrow and central nervous system involvement being indicators of a poor prognosis. The dental practitioner plays an important role in diagnosis of jaw lesions and treatment throughout the course of the disease. An examination of 17 cases of Burkitt's lymphoma diagnosed at The North Carolina Memorial Hospital, University of North Carolina at Chapel Hill, North Carolina, over a 10-year period is undertaken and an illustrative case study is presented to demonstrate the challenge of caring for the patient with Burkitt's lymphoma.

Osteomatous jaw lesions have been reported to occur in connection with familial adenomatous polyposis (FAP) of the intestines. The disease is fatal if not treated. The aim of this investigation was to study the occurrence of bone jaw lesions in Swedish families, where some family members have developed FAP, in order to evaluate if these bone changes may be regarded as clinical markers of the disease. 132 individuals from ten families with FAP and a matched control group of 250 individuals were examined. Osteomatous lesions were diagnosed in 24 per cent in the FAP families and in 2 per cent in the controls. Individuals with verified FAP showed an increased occurrens of jaw lesions. Also in family members without verified FAP, first-degree relatives and other relatives, showed a significant higher incidence of osteomatous jaw lesions compared to the controls. Our results suggest that osteomatous jaw lesions in families with FAP are of predictive significance.

In Burkitt's lymphoma, dental structures may provide the route for Epstein-Barr virus (EBV) in saliva to penetrate the jaws, thereby promoting tumor formation. In children, EBV could enter tooth sockets exposed following deciduous tooth loss and thereby contact jaw marrow lymphocytes stimulating neoplastic transformation. Marrow contact by EBV probably also occurs through carious teeth. Jaw tumors are rare in adults because their jaw marrow is no longer hematopoietic and so lacks the lymphoid substrate for the virus. In adults, jaw marrow lymphocytosis, as accompanies infectious mononucleosis and perhaps malaria, or which could develop around the roots of carious teeth having chronic periapical infection, could provide the substrate for EBV. EBV could then contact the jaw marrow lymphocytes when teeth are extracted and so favor jaw tumor development. Therefore, prevention of dental caries might reduce jaw tumor prevalence in Burkitt's lymphoma except among children ages 6-13 whose jaw marrow would unavoidably become infected by salivary EBV when the latter is present at the time of deciduous tooth loss.

Although a great deal is known about the incidence of cancer, including oral cancer, no such study has been done on odontogenic tumors and jaw cysts. There are therefore no standardized data which would allow for comparative incidences in different countries and between different groups. In the present study, cases of ameloblastomas and dentigerous cysts derived from the records of all the hospital pathology departments and private pathology practices on the Witwatersrand, were recorded for the 10-year period 1965--1974. The population at risk (1970 census) was 974,390 Whites and 1,567,280 Blacks. The annual incidence rates, standardized against the standard world population, for ameloblastomas per million population are 1.96, 1.20, 0.18 and 0.44 for Black males, females and White males, females, respectively. The equivalent four figures for dentigerous cysts are 1.18, 1.22, 9.92 and 7.26. These figures show that ameloblastoma is very much more common in Blacks than Whites in the population at risk. Conversely, dentigerous cysts are much more common in Whites. This makes it unlikely that dentigerous cysts predispose to ameloblastoma formation. These epidemiologic observations give rise to speculation as to whether some component of the South African Black diet or other environmental substance might possibly be an etiologic factor in ameloblastoma.

Ameloblastomas are slow-growing, destuctive lesions of the jaws. They have a wide age distribution and occur in both sexes. In considering the treatment of these lesions, one must take into consideration the patient's age, the patient's concern for his (her) functional, social and aesthetic requirements. It is not unreasonable to aim at a conservative approach first, then radical surgery when the lesion recurs. Small lesions can be treated by local block excision or curettage. For large lesions and recurrences in the mandible, jaw resection and immediate bone graft is indicated. In the author's experience, split iliac crest graft gives the best clinical result.

The odontogenic tumours represent a group of interesting and fascinating changes in tissue which demonstrate a confusing picture of uncontrolled odontogenesis. A lack of knowledge of actiology, extraordinary rarity, polymorphism in their nature and lack of agreement on a commonly accepted nomenclature and classification put nearly insurmountable difficulties in the way of every experiment to gather and analyse the clinical behaviour of the different forms of these tumours. Initially, differential diagnostic criteria defining each form of tumour were derived from representative combined statistics in the world literature; simply registered findings as to age, sex, site and "characteristic" X-ray appearances were evaluated and registered tubularly. The "Histological Tying of Odontogenic Tumours, Jaw Cysts, and Allied Lesions", published by WHO in 1971, was chosen and taken as the basis for our evaluation, together with the sparse data in the literature concerning the absolute and relative frequency of these tumours.

Osteosarcoma of bone is a tumor composed of malignant cells that produce osteoid. Some tumors show predominant chondroid or fibromatoid ground substance. All, however, are highly malignant and about 80 per cent produce death with metastases. The roentgenogram affords important evidence for the correct diagnosis of many of them. Differential diagnosis should include consideration of those sarcomas with many benign giant cells and the group of "telangiectatic" osteosarcomas that may contain only small diagnostic areas. Malignant fibrous histiocytoma is now considered as a possible diagnosis for some malignant bone tumors, but the exact criteria for the diagnosis of this condition are still somewhat obscure. Newer modalities of adjunctive treatment, such as resection of pulmonary metastases, chemotherapy, and immunotherapy, give promise of improving the prognosis for osteosarcoma.

In this investigation the efficacy of dental radiography for the detection of occult intraosseous lesions of the face and jaws was evaluated. An analysis of 30 million health insurance records indicated that the period prevalence of malignant lesions was less than 5 cases/million/year, and for benign lesions approximately 100 cases/million/year. Data from a controlled observer-performance study showed that radiographic sensitivities ranged between 50% and 80%. The cost per true-positive finding was estimated to be +8.6 million per malignant case and +430,000 per benign case. An assessment of the dosimetric literature indicated that the benefits of radiographic screening as a means for early detection of a malignancy appear to be counterbalanced by the risk of causing a radiation-induced malignancy. Taken together, these data demonstrate that dental radiography is not efficacious for the purpose of detecting occult lesions.

An unselected biopsy material of 31 Nigerian Igbo patients with cancer of the oral cavity is presented. The descending order of localization was gingiva, palate, tongue and floor of mouth. Burkitt's tumour was limited to the jaw and affected older rather than younger children. There was scarcely any preponderance of squamous cell carcinoma in males. It would appear that cancer of the oral cavity is not a great problem in the Igbos and that potent carcinogens concerned with the causation are lacking in the community.

Tumors, tumor-like lesions and cysts of the oral cavity and jaw bones seen over a 5-year period, 1969-1974, in the Department of Oral Surgery and Pathology, Lagos University Teaching Hospital, Lagos, Nigeria, are reviewed using the World Health Organization's guidelines for histologic classifications. The histopathologic distribution of the 286 lesions seen over this period was as follows: tumors of non-odontogenic tissues, 180 cases (62.9%); tumors of odontogenic tissue, 37 cases (12.9%); cysts and periapical granulomas, 67 cases (23.4%) and tumors of debatable odontogenic origin, two cases (0.8%). On the strength of available evidence, this report does not share the view that jaw tumors are more common among Africans; instead, the report's conclusion agrees with the "harvesting" theory: that jaw tumors, which are generally slow-growing, painless and non life-threatening, are "showing up" more at treatment centres throughout Africa, thus giving a clinician the chance to see many cases of jaw lesions over a relatively short time.

Over a 13-year period at the University College Hospital in Ibadan, 152 cases of primary tumors of the jaw (excluding Burkett's lymphoma) were reported. These cases, which consisted entirely of Nigerian children under 19 years of age, were then reviewed and analyzed. The majority of the jaw tumors were benign with fibro-osseous lesions and ameloblastoma predominating.Common clinical features were late presentation and disfigurement which made aggressive surgery imperative. All cases of malignant tumors terminated fatally.