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ORIGINAL ARTICLE
Year : 2013  |  Volume : 12  |  Issue : 2  |  Page : 105-109  

Evaluation of the histopathology of orofacial lesions in a North-East Nigerian tertiary centre


1 Department of Oral and Maxillofacial Surgery and Oral Pathology, University College Hospital, Ibadan, Nigeria
2 Department of Oral and Maxillofacial and Dental Surgery, Federal Medical Centre, Gombe, Nigeria

Date of Web Publication22-May-2013

Correspondence Address:
V I Akinmoladun
Department of Oral and Maxillofacial Surgery, University College Hospital, Ibadan
Nigeria
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Source of Support: None, Conflict of Interest: None


Read associated Erratum: Erratum with this article

DOI: 10.4103/1596-3519.112401

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   Abstract 

Objective: The aim of this study was to evaluate the relative frequencies, types and site distribution of oro-facial lesions in a North-Eastern Nigerian tertiary centre.
Materials and Methods: The records of the Departments of Oral-Dental Surgery and Pathology of a tertiary hospital in Nigeria were reviewed and analyzed for patients with oro-facial lesions during a seven year period (January, 2001 - December, 2007). The main outcome measures were patients' age and sex, histology assessment, tissue type and location.
Results: A total of 102 (51.3%) benign lesions, 59 (29.6%) malignant lesions and 38 (19.1%) inflammatory/reactive lesions were seen. The common benign neoplasms were ameloblastoma (23.5%), fibrous dysplasia (15.7%) and pleomorphic adenoma (13.7%). The malignant lesions were mainly well differentiated squamous cell carcinomas (28.8%) and terminal duct carcinoma (11.9%). Inflammatory lesions comprised mainly of chronic osteomyelitis (15.8%) and non-specific chronic inflammatory lesions; giant cell granulomas, granulation tissues which constituted 10.5% each. There were 104 (52.3%) males and 95 (47.7%) females giving a male: female ratio of 1.1:1. The mean age of the patients was 36.1(SD΁18.9) years with a range of 1 to 85 years. Most tissue specimens were soft tissues (61.3%), while bone specimen accounted for 15.6% of all specimens analysed. There were 62 (31.2%) mandibular lesions, 24 (12.1%) palatal lesions and 15 (7.5%) parotid lesions, while maxillary antral lesions were the least, constituting only 0.5% of all lesions studied.
Conclusion: The range of diagnosed lesions from our study was diverse, though our results do not represent the actual prevalence of orofacial lesions within the general population, but simply reflect the frequency of histologically diagnosed lesions at a health center in North-East Nigeria. This survey has shown that most oro-facial lesions studied were benign neoplasms and that most of these neoplasms were from the mandible.

   Abstract in French 

Objectif: Le but de cette étude était d'évaluer les fréquences relatives, de types et de distribution sur le site des lésions d'oro-faciales dans un centre tertiaire nigérian Nord.
Matériel et Méthodes: Les dossiers des services de chirurgie dentaire Oral et la pathologie de l'hôpital tertiaire au Nigeria ont été examinées et analysées pour les patients présentant des lésions d'oro-faciale au cours d'une période de sept ans (janvier 2001 - décembre 2007). Les principales mesures de résultats étaient des patients âge et sexe, évaluation de l'histologie, type de tissu et emplacement.
Résultats: Un total de 102 (51,3 %) bénigne des lésions, lésions malignes de 59 (29,6 %) et 38 (19,1 %) des lésions inflammatoires/réactifs ont été observées. Les tumeurs bénignes courantes ont été ameloblastoma (23,5 %), la Dysplasie fibreuse (15,7 %) et l'adénome pléomorphe (13,7 %). Les lésions malignes ont été principalement bien différenciés des carcinomes épidermoïdes (28,8 %) et carcinome terminal conduit (11,9 %). Des lésions inflammatoires, composées principalement d'ostéomyélite chronique (15,8 %) et des lésions inflammatoires chroniques non-spécifiques; granulomes géants de cellules, des tissus de granulation qui représentaient 10,5 % chaque. L'ajout de chaque section est faux. Il y avait 104 (52,3 %) étaient des hommes et 95 femmes (47,7 %) ce qui donne un mâle : femelle ratio de 1. L'âge moyen des patients était de 36.1(SD±18.9) ans avec une fourchette de 1 à 85 ans. La plupart des échantillons de tissus sont des tissus mous (61,3 %), alors que les spécimens osseux représentent 15,6 % de tous les échantillons analysés. Il y avait 62 (31,2 %) des lésions mandibulaires, 24 lésions de palatines (12,1 %) et 15 lésions de parotides (7,5 %), tandis que les lésions antrales maxillaires ont été le moins, constituant seulement 0,5 % de toutes les lésions étudiées. L'ajout de chaque section est erroné.
Conclusion: La gamme des lésions diagnostiquées de notre étude était diversifiée, bien que nos résultats ne représentent pas la prévalence réelle des lésions orofacial au sein de la population générale, mais reflètent simplement la fréquence de histologiquement diagnostiqué des lésions dans un centre de santé au Nigeria au nord-est. Cette enquête a montré que plus les lésions d'oro-faciale étudiées étaient des néoplasmes bénins et que la plupart de ces tumeurs proviennent de la mandibule.
Mots clés: Histologiquement, Lésions buccofaciale, Nord Nigéria

Keywords: Histopathology, orofacial lesions, Northeast Nigeria


How to cite this article:
Akinmoladun V I, Akintububo O B, Adisa A O, Ojo E O, Ayuba D. Evaluation of the histopathology of orofacial lesions in a North-East Nigerian tertiary centre. Ann Afr Med 2013;12:105-9

How to cite this URL:
Akinmoladun V I, Akintububo O B, Adisa A O, Ojo E O, Ayuba D. Evaluation of the histopathology of orofacial lesions in a North-East Nigerian tertiary centre. Ann Afr Med [serial online] 2013 [cited 2019 Dec 9];12:105-9. Available from: http://www.annalsafrmed.org/text.asp?2013/12/2/105/112401


   Introduction Top


Oral and maxillofacial pathologies are diverse and can range from inflammatory lesions to benign or malignant neoplasms. Indeed reports from different parts of the world show differences in the pattern of maxillofacial tumors seen. [1],[2] These lesions or neoplasms could arise from either soft tissue or bone or may involve both soft and hard tissue structures of the oral or maxillofacial region. Hyperplastic reactive lesions represent the most common oral lesions, excluding caries, periodontal, and periapical inflammatory disease. [3] In this group, fibrous hyperplasia represent the great majority of cases and the second most common subgroup is represented by hyperplastic reactive gingival/alveolar lesions, including inflammatory gingival hyperplasia, pyogenic granuloma, and peripheral giant cell lesion. [3] Although there are some clinical differences among the lesions in this subgroup, their etiology is essentially similar, and the presence of variable amounts of inflammatory infiltrate in all of them can determine clinical and microscopic resemblance. [4] The diagnosis of each lesion from this subgroup is aided by their clinical features but histopathology is needed for final diagnosis. The benign neoplasm of the orofacial complex can be categorized as odontogenic or nonodontogenic. [5] The demographics of these tumors are varied, e.g., studies from Nigeria [6] show that odontogenic tumors have a predilection for the lower jaw while one study from Jordan found more nonodontogenic tumors in the mandible. [7]

Head and neck malignancies constitute 5-8% of total body cancers in Europe and America but it is difficult to appreciate the problem of cancers in Nigeria because most studies available are hospital-based studies. [8] In some parts of Northern Nigeria, a yearly hospital incidence of 20-24 new cases has been reported [9] while in South-western Nigeria the yearly incidence is 33-38 new cases. [10] Etiological factors associated with cancers vary according to major risk factors in different geographical areas and between genders. [9],[10] As demographic factors change, the pattern of cancers in a place may also change. The aim of this study was to evaluate the relative frequencies, types, and site distribution of oro-facial lesions in a North-Eastern Nigerian tertiary center.


   Materials and Methods Top


This was a retrospective study that presents an analysis of cases of oro-facial lesions seen at the Department of Oral Maxillofacial and Dental Surgery of the Federal Medical Centre, Gombe. The age, gender, topography, and histology diagnosis of tissue specimen received over a 7-year period (2001-2007) were entered into the SPSS version 15 for analysis and the level of statistical significance was set at P < 0.05. Cases with incomplete demographic data or which had no histology diagnosis were excluded from the study.


   Results Top


In the period under study, 199 lesions/neoplasms were histologically confirmed in the Department of Pathology, out of which 102 (51.3%) were benign, 59 (29.6%) were malignant and 38 (19.1%) were inflammatory. This gives a hospital-based frequency of about 14 benign, 8 malignant, and 5 inflammatory lesions per year. Salivary gland neoplasms occurred mostly in the 3 rd , 5 th , and 7 th decades. Odontogenic tumors predominated the second and third decades. The carcinomas occurred mostly in the seventh decade while sarcomas were mostly in the third to fourth decades and lymphomas predominated the second decade [Figure 1].
Figure 1: Age distributions of lesions

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The malignant: Benign neoplasm ratio was 1:1.7. For the malignant cases 33 were males and 26 were females while for the benign cases 49 were males and 53 were females [Figure 2].
Figure 2: Sex distributions of lesion groups

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Most of the cases occurred in the 20-29 years age group (21.6%) followed by the age group 30-39 years (16.6%). Age group 80-89 years had the least number of cases (1.0%) [Table 1].
Table 1: Age distribution of lesions

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Salivary gland and fibro-osseous lesions occurred more in females while odontogenic tumors, carcinomas, sarcomas, and lymphomas were all more common in males. Benign mesenchymal neoplasms, however, had an equal prevalence in both male and females [Figure 3].
Figure 3: Sex distributions of specific lesion types

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The common benign neoplasms were ameloblastoma (23.5%), fibrous dysplasia (15.7%), and pleomorphic adenoma (13.7%). The malignant lesions were mainly well-differentiated squamous cell carcinomas (28.8%) and terminal duct carcinoma (11.9%). Inflammatory lesions comprising mainly chronic osteomyelitis (15.8%) and nonspecific chronic inflammatory lesions, giant cell granulomas, granulation tissues which constituted 10.5% each. Carcinomas comprised 81.3% of all malignant lesions while sarcomas and lymphomas were 10.4% and 8.3%, respectively. The mandible and the maxilla had more benign than malignant or inflammatory lesions whereas the palate, cheek, and gingivae had more malignant than benign lesions [Figure 4]. Overall the mandible had more benign lesions than any other site considered while the palate had the highest number of malignant lesions and the gingival had the highest number of inflammatory lesions intraorally [Figure 4].
Figure 4: Site distributions of lesions

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Soft tissue specimen were 127 (63.8%), bone specimen were 12 (6.0%) while a combination of soft, and hard tissue specimen were 60 (30.2%). Fifty four (42.5%) of the soft tissue specimen were benign while73 (38.6%) were malignant. No malignancy was obtained from bone specimen alone but 10 (16.7%) of soft and hard tissue type were malignant [Table 2].
Table 2: Tissue location of lesion types

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Pleomorphic adenoma was most common in the age group 20-29 years and occurred more in females than male with a ratio of 1.1:1. The males with pleomorphic adenoma were at least a decade older than the females. Terminal duct carcinoma (polymorphous low grade adenocarcinoma) occurred more in males than females, ratio 1.3:1. The most common age grouping spanned from the 5 th to 7 th decades. Adenoid cystic carcinoma and mucoepidermoid carcinoma were both found more in females than males, ratio 2:1. Adenoid cystic carcinoma in females occurred more in the fifth decade whereas both mucoepidermoid carcinoma and adenoid cystic carcinoma in males were most common in the seventh decade.


   Discussion Top


It is interesting to find a hospital-based frequency for inflammatory lesions being much lower than that for benign and malignant lesions. This may be due to one of two things. Firstly, patients may not deem it necessary to seek medical attention for inflammatory lesions once the associated symptoms can be controlled by a self-prescribed medication or application of recommended herbal medicament. Indeed the preference of many patients for traditional medical care has been reported. [11] This contributes to late presentation or to no presentation at all, thereby distorting the true epidemiological picture. [11] Secondly, periapical lesions are not routinely subjected to histopathological assessment and hence are underreported in this environment. The malignant maxillofacial neoplasms in this study accounted for 29.6% of all cases but a similar study by Jones et al.[2] in the United Kingdom reported that of all oral and maxillofacial lesions seen at their center, only 5.4% were malignant. This is approximately five times lower than what is reported in this study and the reasons are likely to be multifactorial.

Intraorally, malignant lesions were most common on the palate. This is in agreement with findings by Lawoyin et al.[12] from Ibadan, who reported that the palate was the most common intraoral site (for which of the lesions), but is at variance with a report by Odukoya et al.[13] from Lagos in which the mandibular gingiva, maxillary gingiva, and hard palate were the most common intraoral sites (in descending order). Ugboko et al.[14] from Ile-Ife, Nigeria reported the alveolus (29.6%) as the most common intraoral site. In this study it is thought that malignant lesions which may have originated in the gingivae and subsequently invaded the alveolus of patients were diagnosed as maxillary or mandibular cancers, due to late presentation.

Carcinomas comprised 81.3% of all malignant lesions while sarcomas and lymphomas were 10.4% and 8.3%, respectively. This is not in agreement with other studies conducted in the south-west 15] and north-central [16] regions of Nigeria, in which lymphomas were more frequent than sarcomas. Our findings, however, corroborate the study of lymphomas in Nigeria by Berry [17] in 1964 which reported a decrease in the incidence of lymphomas from the south (an area with high annual rainfall and holoendemicity of malaria) to the north (an area with low annual rainfall) of Nigeria. The age ranges for carcinomas, sarcomas, and lymphomas in this study favorably compares to other Nigerian studies [8],[15],[18] Most individuals with head and neck carcinomas in this study were ≥40 years (69.2%) while those <40 years constituted 30.8%, a finding similar to that reported by Ajayi et al. [19] from Lagos. Tsukuda et al. however observed that of 1,104 patients with head and neck carcinomas only 4.3% were <40 years. It is possible that greater awareness of associated risk factors in that region has significantly reduced the burden of carcinomas in the population below 40 years. The mandible and the maxilla had more benign than malignant or inflammatory lesions whereas the palate, cheek, and gingivae had more malignant than benign lesions [Figure 4]. Overall the mandible had more benign lesions than any other site considered while the palate had the highest number of malignant lesions and the gingival had the highest number of inflammatory lesions intraorally [Figure 4].

In this study salivary gland neoplasms occurred mostly in the 3 rd , 5 th , and 7 th decades. Pleomorphic adenoma was prevalent in the third decade while terminal duct carcinoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma occurred mostly in the 5 th -7 th decades. While the malignant salivary gland neoplasms are in agreement with reported studies, [20] the predominant age reported for pleomorphic adenoma in this study is at least one decade lower than other reports. [20],[21] No obvious reason can be proffered for this observation in this report.


   Conclusion Top


This survey shows that most oro-facial lesions diagnosed were benign neoplasms and that most of these neoplasms were from the mandible. This finding is not necessarily a reflection of orofacial disease pattern in North-east of Nigeria but findings from a center.

 
   References Top

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2.
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Arotiba GT, Ladeinde AL, Arotiba JT, Ajike SO, Ugboko VI, Ajayi OF. Ameloblastoma in Nigerian children and adolescents: A review of 79 cases. J Oral Maxillofac Surg 2005;63:747-51.  Back to cited text no. 8
    
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Ajayi OF, Ladeinde AL, Adeyemo WL, Ogunlewe MO. Odontogenic tumors in Nigerian children and adolescents-a retrospective study of 92 cases. World J Surg Oncol 2004;2:39-48.  Back to cited text no. 9
    
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Al-Khateeb T, Hamasha AA, Almasri NM. Oral and Maxillofacial tumours in North Jordanian children and adolescent: A retrospective analysis over 10 years. Int J Oral Maxillofac Surg 2003;32:78-83.  Back to cited text no. 10
    
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Tovey P, Broom A, Chatwin J, Hafeez M, Ahmad S. Patient assessment of effectiveness and satisfaction with traditional medicine, globalized complementary and alternative medicines, and allopathic medicines for cancer in Pakistan. Integr Cancer Ther 2005;4:242-8.  Back to cited text no. 11
    
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Lawoyin JO, Lawoyin DO, Aderinokun GO. Intraoral squamous cell carcinoma in Ibadan: A review of 90 cases. Afr J Med Med Sci 1997;26:187-8.  Back to cited text no. 12
    
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Odukoya O, Mosadomi A, Sawyer D. Squamous cell carcinoma of the oral cavity. A clinicopathological study of 106 Nigerian cases. J Maxillofac Surg 1986;14:267-9.  Back to cited text no. 13
    
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Ugboko V, Ajike S, Olasoji H, Pindiga H, Adebiyi E, Omoniyi-Esan G, et al. Primary Orofacial Squamous Cell Carcinoma: A Multicenter Nigerian Study. Internet J Den Sci 2004;2.  Back to cited text no. 14
    
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Adeyemi BF, Adekunle LV, Kolude BM, Akang EEU, Lawoyin JO. Head and Neck Cancer-A Clinicopathological Study in a Tertiary Care Centre. J Natl Med Assoc 2008;100:690-7.  Back to cited text no. 15
    
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Bhatia PL. Head and neck cancer in Plateau state of Nigeria. West Afr J Med 1990;9:304-10.  Back to cited text no. 16
    
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Berry CG. Lymphoma syndrome in Northern Nigeria. Bri Med J 1964;2:668-70.  Back to cited text no. 17
    
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Adebayo ET, Ajike SO, Adebola A. Maxillofacial sarcomas in Nigeria. Ann Afr Med 2005;4:23-30.  Back to cited text no. 18
    
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Ajayi O, Adeyemo W, Ladeinde A, Ogunlewe M, Effiom O, Omitola O, et al. Primary malignant neoplasms of orofacial origin: A retrospective review of 256 cases in a Nigerian tertiary hospital. J Oral Maxillofac Surg 2007;36:403-8.  Back to cited text no. 19
    
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Barnes L, Eveson JW, Reichart P, Sidrasky D. World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Head and Neck. Lyon: IARC Press; 2005.  Back to cited text no. 20
    
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Said M.S. Pleomorphic adenoma. Available from: http://emedicine.medscape.com/article/1630933-overview [Last accessed on 2010 May 22].  Back to cited text no. 21
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2]


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