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| From
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Editorial
A. Abyad (Chief Editor) |
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Original
Contribution / Clinical Investigation
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Serum
level of ionized calcium in patients with migraine
during a migraine attack and times without migraine
[pdf version]
Mojtaba Kazemi, Sajad Emami, Aida Bahman, Mahshid
Zareian, Abdolreza Sotoodeh Jahromi, Somayehsadat
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Abdolhossein Madani
Comparative
study of vocational rehabilitation among governmental
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persons
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Mansour Nazari Chafjiri
A Survey of Interurban Taxi Drivers'driving
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Comparison of
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Fariba Tarhani, Azadeh Jafrasteh, Mahshid Garmsiri,
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Investigate
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Afshin Ahmadzadeh Heshmati, Ali Karbalaeikhani,
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Moral
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Fereshteh Sarmadi
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| August 2017 -
Volume 15, Issue 6 |
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Radiological and clinical
evaluation of maxillofacial cysts and tumors
in patients referred to Hospitals in Kermanshah
during 2008-2012
Nafiseh Nikkerdar (1)
Bahram Azizi (2)
Amin Golshah (3)
Maryam Asadi (4)
(1) Oral and maxillofacial Radiology Department,
School of Dentistry, Kermanshah University of
Medical Sciences, Kermanshah, Iran
(2) Oral and maxillofacial Surgery Department,
School of Dentistry, Kermanshah University of
Medical Sciences, Kermanshah, Iran
(3) Orthodontic Department, School of Dentistry,
Kermanshah University of Medical Sciences, Kermanshah,
Iran
(4) Students research committee, Kermanshah
University of Medical Sciences, Kermanshah,
Iran
Correspondence:
Nafiseh Nikkerdar
Oral and maxillofacial Radiology Department,
School of Dentistry,
Kermanshah University of Medical Sciences,
Kermanshah, Iran
Email: n.nikkerdar@kums.ac.ir
|
Abstract
Background:
Maxillofacial cysts and tumors are major
causes of jawbone destruction; and may
occasionally result in early mortality
of patients. This study purposed to radiologically
and clinically evaluate maxillofacial
cysts and tumors among Iranian patients.
Methods: A
retrospective study was conducted on medical
records of patients referred to surgical
departments of two hospitals (Bisotun
and Imam Khomeini) in Kermanshah, Iran,
from 2008 to 2012.Totally, 347 records
were reviewed and 85 cases with intraosseously
maxillofacial lesions were selected. The
information including age, gender, type
of lesion and its characteristics (number
of lesions, anatomic location, radiolucency,
and lesion border) were collected. Data
were presented by descriptive statistics
using SPSS 20 software.
Results: Overall
occurrence of maxillofacial lesions was
24.5% (85/347) including 41 cysts, 14
benign tumors, 10 malignant tumors, and
20 bone diseases in jaws. The most common
cysts, benign tumor, malignant tumor,
and jawbone disease was radicular cyst
(41.5%), ameloblastoma (57.1%), squamous
cell carcinoma (75%), and central giantcell
granuloma (65%), respectively. The posterior
region of mandible and anterior part of
maxilla were respectively identified as
the first and second most common anatomic
locations for development of the maxillofacial
lesions. The peak age of patients was
third and fourth decade for the majority
of lesions but seventh and eighth decade
for squamous cell carcinoma.
Conclusions:
Our findings are generally consistent
with those reported in the literature.
However, there are a few dissimilarities
that may be due to racial and/or environmental
differences.
Key words:
Maxillofacial, cysts, benign tumor, malignant
tumor
|
Jawbones as the main hard tissue of orofacial
region can be the sites for development of various
conditions such as cysts, neoplasms, or systemic
bone diseases. Approximately, 90% of metastatic
tumors of the orofacial region occur in jaw
bones, especially the mandible [1].
Jaw cyst is described as a pathological cavity
that contains fluid, semi-fluid, or gaseous
substance. Its frequency has been reported from
7.8% to 36% of jawbone biopsies [2]. Radicular
cyst, dentigerous cyst, and odontogenic keratocyst
(OKC) are the three most common cysts in jawbones
[3].
Odontogenic tumors are a heterogeneous group
of tumors with specific location in the mandible
and maxilla. These tumors are benign (e.g. ameloblastoma,
myxoma, odontoma, and fibroma) or malignant
such as squamous cell carcinoma (SCC). SCC has
been reported as the most prevalent malignant
tumor in jaw-bones of adult patients. While,
Burkitt’s lymphoma and rhabdomyosarcoma
are common among children and adolescents[4].
Cystic and tumoral lesions in mandible and
maxilla are important because of resulting in
morbidities such as jaw swelling, pain and sensory
disturbances [5]; displacement of tooth [6];
occlusal alterations; and failure of eruption
of teeth [7]. Moreover, a large portion of primary
intraosseous malignancies of the jaws are originated
from pre-exciting cysts more commonly odontogenic
cysts [8]. Aggressive lesions of jaws may also
invade and destroy the walls of maxillary sinus,
floor of the orbit and nasal wall[9]. Early
death of patients with mandibular and maxillary
malignancies may occur from infection or metastatic
spread [10].
The overall and relative frequency of cystic
and tumoral lesions in jawbones differs among
various populations that may be attributed to
variations in geographic or cultural settings.
The aim of this study was to evaluate maxillofacial
cysts and tumors among Iranian patients according
to age, gender, anatomic area, and radiological
features.
This descriptive cross-sectional study was
performed by using medical records of patients
referred to the surgical department of two hospitals
(Bisotun and Imam Khomeini) in Kermanshah city,
Iran, from 1 January 2008 to 31 December 2012.
A total of 367 records were reviewed and 85
cases with intraosseously maxillofacial lesions
confirmed by histopathology diagnosis were selected.
An oral-maxillofacial radiologist examined all
associated radiographs. Demographic information
(age and gender) as well as type of lesion and
its characteristics (number of lesions, anatomic
location, radiolucency, and lesion border) were
collected.
The data were analyzed by SPSS 20 (SPSS Inc.,
Chicago, IL, USA). Descriptive statistics (frequency
and percentage) were used to represent the results.
A
total
of
85
patients
had
intraosseously
maxillofacial
lesions
including
41
cysts,
14
benign
tumors,
10
malignant
tumors,
and
20
bone
diseases
presented
in
jaws.
Therefore,
overall
occurrence
of
maxillofacial
lesions
was
24.5%
(85/347).
Radicular
cyst
was
the
most
frequent
cystic
lesion
(41.5%;
9
males,
8
females),
followed
by
OKC
(29.3%)
and
dentigerous
cyst
(14.6%).
The
most
common
benign
and
malignant
tumor
was
ameloblastoma
(57.1%;
5
males,
3
females)
and
SCC
(80%;
5
males,
3
females),
respectively.
The
first
and
second
most
common
bone
diseases
in
jaws
was
CGCG
(65%;
5
males,
8
females)
and
cement-ossifying
fibroma
(25%).
(Table
-
next
page)
The
peak
age
of
presentation
was
third
and
fourth
decade
for
radicular
cyst,
OKC,
ameloblastoma,
and
osteosarcoma;
but
seventh
and
eighth
decade
for
SCC.
Of
17
patients
with
radicular
cyst,
14
patients
had
one
cyst
and
three
patients
had
2
cysts
including
a
total
of
20
cysts.
Twelve
patients
with
OKC
included
16
cysts
(8
patients
with
1
cyst
and
4
patients
with
2
cysts).
The
other
patients
presented
with
one
lesion.
Radicular
cysts
commonly
occurred
in
the
anterior
region
of
the
maxilla
(45%).
Posterior
part
of
mandible
was
detected
as
the
most
frequent
anatomic
location
for
OKC
(68.8%),
dentigerous
cyst
(66.6%),
ameloblastoma
(75%),
SCC
(75%),
and
bone
diseases
(75%).
(Table)
Most
cysts
were
typically
observed
as
radiolucent
areas
with
well-defined
borders.
Of
benign
tumors,
ameloblastoma
and
myxoma
were
radiolucent,
but
odontoma
and
osteoma
were
radio-opaque.
Hemangioma
presented
a
mix
of
radiolucency
and
opacity.
Benign
tumors
commonly
showed
well-defined
borders.
All
malignant
tumors
presented
with
undefined
borders.
SCC
was
radiolucent
and
osteosarcoma
had
a
mixed
radiolucent/radio-opaque
view.
Most
jawbone
diseases
were
characterized
with
radiolucent
areas
and
well-defined
borders.
Click
here
for
Table
Studies
of
jawbone
cystic
and
tumoral
lesions
among
the
population
are
essential
for
identification
of
individuals
at
risk,
possible
factors
of
development,
and
for
accurate
differential
diagnosis.
Therefore,
we
aimed
to
determine
clinical
and
radiographic
pattern
of
maxillofacial
cystic
and
tumoral
lesions
among
patients
in
Kermanshah,
a
city
in
west
of
Iran.
In
this
study,
the
most
common
cystic
lesions
were
radicular
cyst(41.5%),
followed
by
OKC
(29.3%)
and
dentigerous
cyst
(14.6%)
that
is
consistent
with
results
of
other
studies[11,12].
However,
Rezvani
et
al
reported
oral
cystic
lesions
in
decreasing
frequency
as
radicular
cyst(32.83%),
dentigerous
cyst
(31.34%),
and
OKC
(26.12%)
[13].
The
study
by
Baghaei
et
al
showed
prevalence
of
dentigerous
cysts
27.2%,
radicular
cysts
18.6%
and
OKC
18.6%
[14].
This
variation
indicates
that
the
racial
and
environmental
factors
probably
influence
on
development
of
these
lesions.
Radicular
cysts
were
more
common
among
patients
in
the
third
and
fourth
decade
of
life.
This
finding
is
consistent
with
a
study
in
Italy
[3].
Arotiba
et
al
indicated
that
mean
age
of
occurrence
was
26.5
years
for
radicular
cyst
[15].
In
a
study
by
Meningaud
et
al,
patients
with
radicular
cyst
were
38.4
±
17.9
years[16].
Nevertheless,
Fomete
et
al
reported
second
decade
as
peak
age
for
radicular
cysts
among
Nigerian
patients
[17].
Radicular
cysts
occurred
most
frequently
in
the
anterior
part
of
the
maxilla
(45%)
as
reported
previously
by
Tortorici
et
al
[3],
Ramachandra
et
al
[11],
and
Koseoglu
et
al
[12].
Peak
age
incidence
of
OKC
was
third
and
fourth
decade
of
life
which
agrees
twith
the
study
on
Iranian
patients
in
Mashhad
city
[18]
as
well
as
studies
on
Indians
[11]
and
Turkish
populations
[12].
OKC
was
chiefly
located
in
the
posterior
part
of
the
mandible
(68.8%).
This
finding
is
similar
to
previous
studies
indicating
posterior
region
of
mandible
as
the
main
location
of
OKC
[11,19].
Goteti
reported
OKC
location
with
a
mandible-to-maxilla
ratio
of
1.6:1
[20].
OKC
occurs
most
often
intraosseously
in
the
third
molar
region,
angle,
and
ramus
of
mandible
but
rarely
in
soft
tissues
such
as
gum,
oral
mucosa,
or
lateral
facial
deep
region[21].
Peak
age
incidence
of
dentigerous
cysts
was
third
and
fourth
decade.
This
is
concomitant
to
most
studies
in
the
literature.
Contrarily,
Fomete
et
al
showed
common
occurrence
of
dentigerous
cysts
in
younger
patients
in
second
and
third
decades
[17].
Dentigerous
cyst
was
more
frequent
in
the
posterior
part
of
mandible
(66.6%).
This
is
comparable
to
a
study
by
Ramchandra
et
al
[11].
The
most
frequent
benign
tumors
were
ameloblastoma
(33.4%)
followed
by
odontoma
(12.5%).
Consistently,
ameloblastoma
has
been
reported
as
the
most
common
benign
maxillofacial
tumor
among
patients
in
Nigeria[22],China
[23],
and
Egypt[24].
However,
Tamme
et
al[25],
Santos
et
al
[26],
and
Ochsenius
et
al
[27]
demonstrated
the
first
and
second
most
common
benign
tumors
were
odontoma
and
ameloblastoma,
respectively.
The
peak
age
of
ameloblastoma
was
the
third
and
fourth
decade
of
life.
Peak
incidence
of
ameloblastoma
has
been
reported
third
decade
in
Indians
[19]
and
Libyans
[20],
and
fourth
decade
in
Nigerians
[22].
A
review
of
3677
cases
of
ameloblastoma
by
Reichart
et
al
indicated
that
ameloblastoma
tumors
occur
10
to
15
years
earlier
in
developing
countries
(average
27.7
years)
than
industrialized
countries
(average
39.1
years)
[28].
Ameloblastoma
was
located
more
often
in
the
posterior
region
of
mandible
(75%)
followed
by
maxilla
(25%).
A
similar,
study
on
Iranian
population
in
Mashhad
city
by
Saghravanian
et
al
revealed
that
the
most
frequent
location
of
the
tumor
was
the
posterior
part
of
mandible
(66/88)[29].
Ameloblastoma
occurrence
with
a
predilection
for
mandible
has
been
noted
in
previous
studies
[30,31].
Reichart
et
al
reported
that
ameloblastoma
tumors
are
seen
more
frequently
in
the
anterior
region
of
the
jaws
among
Blacks
(21.6%)
compared
to
Caucasians
(12.6%)
and
Asians
(11.9%)[28].
According
to
Siar
et
al,
unicystic
and
solid/multicystic
ameloblastoma
tumors
involve
predominantly
the
body
and
posterior
region
of
mandible,
whereas
desmoplastic
ameloblastoma
preferentially
involves
the
anterior
part[32].
In
the
present
study,
the
second
most
common
benign
tumor
was
odontoma
(12.5%)
with
peak
age
of
incidence
in
the
first
and
second
decade.
Taghavi
et
al
indicated
peak
age
occurrence
of
second
decade
for
odontoma[33].
Odontoma
was
located
in
anterior
region
of
mandible
(two
cases)
and
posterior
region
of
maxilla
(one
case).
The
study
by
Isola
et
al
reported
that
odontoma
more
likely
occurred
in
mandible
than
maxilla
with
ratio
about
2:1
[34].
However,
Taghavi
et
al
showed
a
predilection
of
odontoma
for
maxilla
(59.3%)
than
mandible
[33].
The
most
common
malignant
tumor
was
SCC
detected
in
eight
patients
(80%).
Parkins
et
al
reported
that
SCC
was
present
in
64%
of
orofacial
malignant
tumors
from
Ghana
patients[35].
Similarly,
SCC
was
reported
as
the
most
common
malignant
orofacial
tumor
among
populations
in
Nigeria[36]
and
Portugal
[37].
The
present
study
showed
that
SCC
commonly
presented
in
patients
aged
60+
years.
In
previous
studies
conducted
by
Monteiro
et
al[37]
and
Bassey
et
al[4],
oral
and
maxillofacial
SCC
was
often
found
among
patients
aged
50+
years.
SCC
was
mostly
located
in
posterior
part
of
mandible
(75%).
Bassey
et
al
found
9
and
6
SCC
tumors
in
mandible
and
maxilla,
respectively
[4].
In
our
study,
osteosarcoma
was
identified
in
two
patients
(20%).
Peak
age
of
osteosarcoma
was
third
and
fourth
decades
of
life
that
is
consistent
with
a
previous
report
[4].
This
is
comparable
to
Ajayi
et
al
that
found
patients
with
sarcomas
in
orofacial
region
were
younger
than
those
with
carcinomas
[36].
The
most
systemic
bone
disease
with
involvement
of
jaws
was
CGCG.
This
condition
is
an
intraosseous
lesion
that
rarely
occurs
in
the
Head
and
Neck
region[38],
involves
the
mandible
more
than
the
maxilla
and
is
more
common
in
second
and
third
decade
of
life
[39].
Other
conditions
in
our
study
sample
were
nasolabial
cyst,
simple
bone
cyst,
residual
cyst
(2
cases
each
one),
myxoma,
hemangioma,
osteoma
(1
case
each
one),
cement-ossifying
fibroma
(5
cases),
periapical
cemental
dysplasia,
and
fibrous
dysplasia
(1
case
each).
Simple
Bone
Cyst
also
known
as
Traumatic
Bone
Cyst
is
a
non-neoplastic
osseous
lesion
that
appears
as
a
rare
pathology,
representing
approximately
1%
of
all
jaw
cysts
[40,41].
Hemangioma
is
a
benign
neoplasm
with
endothelial
origin
that
is
usually
located
in
soft
tissues
but
rarely
develops
in
bones
such
as
mandible
[42].
This
study
showed
that
cysts
were
the
most
common
lesions
in
the
maxillofacial
region
followed
by
benign
and
malignant
tumors.
The
most
common
cyst,
benign
tumor,
malignant
tumor,
and
jawbone
disease
was
radicular
cyst,
ameloblastoma,
squamous
cell
carcinoma,
and
central
giant
cell
granuloma,
respectively.
The
findings
are
generally
consistent
with
reports
in
the
literature;
and
some
variations
may
be
attributable
to
racial
and/or
environmental
factors.
Acknowledgement
This
work
was
performed
in
partial
fulfillment
of
the
requirements
for
DDS
of
Maryam
Asadi,
in
Faculty
of
dentistry,
Kermanshah
University
of
Medical
Sciences,
Kermanshah,
Iran.
We
feel
obliged
to
appreciate
and
thank
the
honorable
colleagues
in
Imam
Khomeini
and
Bisotoun
hospitals
who
cooperated
with
us
in
conducting
this
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