A retrospectivestudy of oral andmaxillofacial biopsy lesionsin a pediatricpopulation from southern Taiwan Yuk-KwanChen, I)DS, MS Li-Min Lin, DDS, MS, PhD Hsien-Cheng Huang, DDS, MS Cheng-Chung Lin, DDS Yat-Han Yah, DDS, MS

Abstract Methodsandmaterials This is a retrospectivestudy of biopsiedoral lesions (N Biopsy records of the 9672 microscopically diag- 534)in a pediatric population(0-15years old) in southern nosed cases in the oral and maxillofacial region Taiwan.In this study, weincluded 6% of the 9672biopsies (1985-1996) were retrieved from the Oral Pathology performed~om1985 through 1996. The lesions were di- Department of Kaohsiung Medical College Teaching videdinto three groupsaccording to patients"ages, 0-5 years Hospital. All tissues including teeth obtained from a old; 6-10yearsold; and l l-15 years old The majority of patient were considered as one biopsy. A pool of 534 the sampleswere~om the oldest age group(273/518). With samples from pediatric patients (0-15 year old) were the exclusionof normaltissues (N =26), 518samples were clas- selected for detailed analysis. Age,sex, location of le- sifted into fourcategories: inflammatory lesions, cystic lesions, sions, and histologic diagnosis were compiledfor each tumoror tumor-likelesions, and other lesions. Thelargest num- case. The methodof data collection and analysis used ber oflesionsoccurred in the inflammatorylesion group (46%). was described by Skinner et al.]° with minor modifi- The12 most j~equentlyoccurring lesions contributedabout cations. The collected data were divided into three 78%of all the biopsiesin the three age groups(0-15 years groups according to age: 0-5, 6-10, and 11-15 years old). Frequenciesof the lesions of mucousextravasation phe- old. Thelesions wereclassified into four categories: nomenon,, fibrous dysplasia,and odontonia inflammatorylesions, cystic lesions, tumor or tumor- like lesions, and other. Specimenswith no particular in ourthree pediatricage groups showed a significantpropor- microscopic features were regarded as normal tissues tion in the biopsiesof the samelesions in the groupof patients and were excluded from further analysis. of all ages. Theseinformation may be valuablefor bothepide- miolog7and teaching. (Pediatr Dent 20:404-410,1998) Results A total of 534 pediatric oral biopsies (6%) were di- he studies of biopsied oral and maxillofacial agnosed from the 9672 cases performed from 1985 T lesions in the pediatric populationare relatively through 1996. The age of the pediatric patients ranged uncommon.~-6These studies were largely done from 3 monthsto 15 years old. on tumoror tumor-like lesions, but the status of other The 12 most frequently occurring lesions in the kinds of lesions were not mentioned. A few compre- pediatric patients (0-15 years old) contributed about hensive surveys on a broad spectrum of oral biopsy 78%of all the biopsies in the three groups (Table 1). lesions in pediatric age groups have been reported from It is worthnoting that the percentagesof lesions of mu- 7, 9 North 8 and South America. Regionaland racial dif- cous extravasation phenomenon(mucocele, , ferences in oral lesions were observed betweenthese mucousretention cyst, 29%), dentigerous cyst (28%), surveys. 7-9 However,limited information of this nature and fibrous dysplasia (26%)in the three pediatric age is available in Asia, thus it is useful to analyzedata on groups constituted a significant proportion of the same this subject. Theage groupsstudied in previous reports lesions in the groupof patients of all ages. In addition, were from0 to 20 years, but the range of 0 to 15 years odontoma (49%) in the three pediatric age groups was most commonlyused. Therefore, the age group we comprisednearly 50%of those in the group of patients studied was 0-15 years. Theobjective is to review the of all ages. oral biopsy specimens within a population of pediat- Withthe exclusion of the 26 normaltissues, the re- ric patients from southern Taiwanrelative to age, sex, maining 518 samples consisting of 60 different frequency, and distribution. Such information maybe diagnoseswere categorized into four groups (Table 2). valuable for both epidemiologyand teaching. The largest numberof lesions occurred in the inflam-

404 AmericanAcademy of Pediatric Pediatric Dentistry - 20:7, 1998 TABLE1. NUMBERAND PERCENTAGES OFTHE ’12 MOSTCOMMON LESIONS IN PEDIATRICPATIEnTs -

Total %of total in %of the samelesions in pediatric-agegroup all-age group Mucousextravastation phenomenon" 144 27.8% 28.6% Dentigerouscyst 50 9.65% 28.4% Odontoma 40 7.72% 49.3% Inflammation 29 5.60% 5.62% Radicularcyst 24 4.63% 3.33% Hemangioma 23 4.44% 15.9% Ameloblastoma 21 4.05% 17.5% Periapical granuloma 19 3.67% 3.64% Fibroma 16 3.09% 4.64% 15 2.90% 12.8 % Ulceration 12 2.32% 6.0% Fibrousdysplasia 10 1.93% 26.3% Total 403 77.8%

"Mucocele, ranula, mucous retention cyst. Most benign odontogenic tu- TABLE2. NUMBERAND PERCENTAGE OFTHE FOUR CATEGORIES OFLESIONS IN PEDIATRIC PATIENTS mors (Table 4) were jawbonele- Total %of total no. of biopsy sions (N = 71); in pediatric population only three were Tumor/tumorlike lesions soft-tissuelesions Odontogenic(benign) 74 (71/3)* 14.3% (three peripheral Non-odontogenic(benign) 81 (18/63)* 15.6% odontogenic tu- mors in gingiva). Non-odontogenic(malignant) 11 (9/2)* 2.1% Twolesions pre- Cystic lesions 91 17.6% dominated in Inflammatorylesions 238 45.9% the benign odon- Other lesions 23 4.5% togenic tumor category, odon- Total 518" 100% toma (N = 40), and ameloblas- "Excluding the 26 normal tissues. *Values in parentheses indicated jawbone tumors/soft tissue tumors, toma (N = 21). A slight maxilla predominance matorylesion group (46%). Themajority lesions in the (52%) of the odontomawas noted. The dominant site tumor/tumor-like category were benign cases (93%). ofameloblastomawas posterior mandibularbody (>a The purpose of dividing the lesions into three age 16) with four lesions located in the ramus. A single groups wasto note the numberof patients and the fre- maxilla lesion wasfound in the anterior region. quencyof the lesions relative to age (Table 3). The In contrast to benign odontogenic tumors, most majorityof the sampleswere in the oldest age group(273/ benign nonodontogeniclesions in this study (Table 5) 518). Mucousextravasation phenomenonwas the most were soft-tissue neoplasm(>a = 63). Eighteen jawbone commonlesion in all of the three age groups. A total of lesions were included. The most prevalent lesion was 21 distinct typesof lesions wereidentified in the 0-5-year- hemangioma(~ = 23), which comprised of capillary old group, in which mucousextravasation phenomenon (N = 8), cavernous(~ = 11), and sclerosing(i~ = 4) was the most commonlesion which was muchmore than Mostfibromas occurred in the buccal mucosa(~ = 14). the second-mostcommon lesion type, which comprised Six fibrous dysplasias werelocated in the maxilla while of only five cases of inflammation.Thirty-one distinct four were in the mandible. Pleomorphicadenoma was types of lesions were noted in the 6-10-year-oldgroup, the only benign salivary gland neoplasm which oc- and 42 in the 11-15-year-old group. curred in this series; six cases occurred in the palate

Pediatric Dentistry -20.’Z 1998 AmericanAcademy of Pediatric Dentistry 405 and maxillofacial lesions (MedicalPathology contributed only an insignificant numberof Age Biopsy (M/F)" cases) but also the most important referral center for these lesions in southern Taiwan. 0-5 yrs 60/25 85 (2.4:1)* Therefore,the various types of lesions in this 6-10 yrs 86/74 160(1.2:1) report are representative of the occurrenceof 11-15yrs 142/131 273 (1.1:1) these lesions in that region. Total 288/230 518(1.3:1) It is worthwhileto note that the numbers of mucousextravasation phenomenon,den- tigerous cyst, fibrous dysplasia, and especially "M/F: male/female. *Value in brackets : male to female ratio. odontoma, were found in significant fre- quencyin the biopsies TABLE4. NUMBERAND SEX OF PEDIATRIC PATIENTS WITH ODONTOGENIC TUMORS (BENIGN) of the same lesions obtained from a sur- O-5 yrs 6-10 yrs l i-15 yrs Tatal (M/F)" vey of patients of all Bone tumors ages. This implies that Odontoma 2 9 29 40(26/14) the above-mentioned Adenomatoid odontogenic tumor 0 1 0 1(0/1) four pediatric lesions Ameloblastoma 0 0 21 21(10/11) constitute an essential Amelobtastic odontoma 0 0 2 22/0) frequency in the biop- Cementifying fibroma 0 0 4 5(5/0 sies submitted an Odontogenic myxoma 0 0 2 2(0/2) the same period (1985-1996). Soft tissue tumor The percentage Peripheral odontogenicfibroma 0 0 3 3(1/2) (6%) of the pediatric Total 2 11 6 74(42/32) oral biopsy specimens , i in the present study is "M/F: male/female. lower than in the re- ports of Skinneret al. and one in the submandibular gland. Few other non- (13%)7 and Sumitra and Das (12%).8 This may be be- odontogenic tumors were found in this category. cause only patients up to 15 years old were included The only juvenile xanthanogranuloma,11 and one of in the present series, while they included patients up the three aneurysmal bone cysts have already to 19 and 20 years old, respectively. Onthe other hand, been2 reported) it is compatible to the percentage (7%) of patients Only five distinct types of malignant lesions were the report by Keszler et al. 9 who comprised samples found in this study (Table 6). The predominant le- from birth to 15 year old. sion type was Langerhanscell histiocytosis, and all The majority of the lesions were in the inflamma- lesions were located in the mandible. tory lesion group, which concurs with two previous Most cystic lesions (Table 7) were odontogenic reports7, 8 of the samenature. However,it is different (N = 89); there were only two nonodontogenic cys- fromthe report of Keszler et al., 9 whofound cystic le- tic lesions (epidermoid cyst and nasopalatine duct sions to be the most prevalent sample group. cyst). The most commonsite ofdentigerous cyst was The percentage (93%)of occurrence of benign cases the mandible (N = 29). Radicular cysts were nearly in the tumoror tumor-like lesions category in our study equally disributed between the maxilla (N = 11) and were muchhigher than the results of Godwin(60%) the mandible (~ = 10). All of the eight keratocysts and Keszler et al. 9 (84%). On the other hand, our re- were situated in the mandible (one in the ramus, sults are similar to a report from Japan (93%).6 The one in the symphysis, six in the posterior view that pediatric jawbonetumors are usually non- mandibular body). odontogenic2, 4, 9,1~ does not apply in the present study Mucousextravasation phenomenonwas the most because 74%of the jawbonetumors in this report were commonlesion with a predilection for the lower lip odontogenic.This is similar to the findings of Sato et (~ = 106) and female patients (~ = 75). (Table al., 6 whoalso noted an odontogenic predominancein The frequency of other anomalies was low (Table 9). the jawbone tumors (88%). Discussion Odontomaand ameloblastoma comprised most of the samples in the category of benign odontogenictu- The Oral Pathology Departmentof our hospital not mors; other lesions were infrequent. A similar pattern only providesservices for almostall of the biopsiedoral of6 occurrencewas also observedin a study by Sato et al.

406 AmericanAcademy of Pediatric Dentistry Pediatric Dentistry - 20.’Z 1998 males and females while Budnick]6 re- ~(BENIGN!?R~TUMOR~ L!KE~LES!ON_ ~ ...... ~...... ported a slight male predominance. The O-5 yrs 6-10 yrs 11-15 yrs Total (M/F)" present study demon- Bone Tumors strated a definite male dominance. Our find- Osteoma 0 1 3 4 (2/2) Osteoblastoma 0 ing revealed a 52% 0 1 1 (0/1) rate of occurrence in Fibrous Dysplasia 0 2 8 1 0 (8/2) maxilla, which corre- Aneurysmalbone cyst 1 0 2 3 (3/0) lates with the 51% Soft tissue tumors reported by Owenset 17 Papilloma 0 2 2 4 (3/1) al., 55%by Skinner et al., 7 55%by Sato Fibroma 4 3 9 1 6 (12/4) 6, Hemangioma 4 4 15 23 (9/14) et al. and 65% by Budnick.16 Lymphangioma I i 0 2 (0/2) I’7’~8 Cystic hygroma 1 0 Nosingle case or 0 1 (1/0) only small numberof Schwannoma/neurilemmoma 0 0 2 2 (1/1) ameloblastomas were Juvenile xanthogranuloma 0 0 1 1 (1/0) foundin previousstud- Congenitalepulis 2 0 0 2 (0/2) ies.3, 8 In the present Pilomaxtrioma 0 1 0 1 (1/0) series, the percentageof Myxoflbroma ¯ 0 0 1 1 (1/0) ameloblastoma (13%) Nevus 0 0 3 3 (3/0) was muchhigher than Pleomorphic adenoma 0 1 6 7 (1/6) other related stud- Total 13 15 53 81 (46/35) ies)9, 20 Onthe other hand, the frequency "M/F:male/female. of ameloblastoma in the present study was IAULtO. NUMUtKAHU ~tl Ut ~EUllA KI~ i’AIItHISW//HHUH UUUH/U~tHI~ similar to that of Sato et al. 6 All of the ameloblastoma in O-5 yrs 6-10 yrs l l-15 yrs Total (M/F)" this report werein the Bone minors oldest age group, as found in other stud- Mucoepidermoidcarcinoma 0 0 1 1 (1/0) ies.8,19,20 In ourstudy, Langerhanscell histocytosis 2 3 2 7 (6/1) a slight female Rhabdomyosarcoma 0 0 1 1 (1/0) predominance was Soft tissue tumors found in patients Lymphoma 1 0 0 1 (1/0) with ameloblastoma, Leukemia 1 0 0 1 (1/0) whichcorrelates with 2° Total 4 3 4 11 (10/1) the report of Kahn. However,this is in contrast to a study on "M/F:male/female. Nigerian children by Godwin, 5 who re- The most commonodontogenic tumor was odontoma, ported a male predominanceand is also in contrast whichis consistent with previous reports. 7’ 8, ~4q6A to the study of Keszler and Dominguez,19 who found numberof studies7’ 8, 14, ~6, 17 indicated the secondde- no differences in the occurrence of ameloblastoma cade of life wasthe most commonperiod of occurrence. between the sexes in pediatric patients. The common Ourfinding is similar to these previousstudies. 7’ 8, ~4-17 site of occurrence was the mandible in the However,the present series showeda muchhigher rate present study, whichconcurs with other studies.6’ 19, 20 (8%) of odontomathan two studies from the US.7’ 8 A higher relative frequency of adenomatoidodon- On the other hand, the number of odontoma of the togenic tumors were supposedly seen among black present6 series was compatible to a study from Asia. Africans.21 In the report of Godwinet al., 22 28 OUtof Tworeports 7’ 15 found an equal distribution among 57 patients with adenomatoid odontogenic tumors

Pediatric Dentistry -20.’7, 1998 American Academy of Pediatric Dentistry 407 percentage of heman- TABLE7. NUMBERANDSEX OF PEDIATRIC PATIENTS WITH CYSTIC LESIONS gioma (4%) in this study was much O-5 yrs 6-10 yrs l l-15 yrs Total (M/F)" greater than the 1% Radicutarcyst 1 4 19 24 (14/10) rate of Sumitra et Dentigerouscyst 1 18 31 50 (34/16) al., 8 and also higher Eruptioncyst* 0 1 0 1 (1/0) than the report by 5 Calcifying odontogeniccyst 0 0 2 2 (0/2) Godwin, which in- Residualcyst 0 0 3 3 (0/3) cluded only three Periodontalcyst 0 0 1 1 (1/0) hemangiomas. Both Keratocyst 0 0 8 8 (6/2) the occurrence of fi- Nasopalatineduct cyst 0 1 0 1 (0/1) broma (10%) and Epidermoidcyst* 1 0 0 1 (0/1) fibrous dysplasia (6%) Total 3 24 64 91 (56/35) are higher than in our study than in the report by Godwin(6 "M/F:male/female, tSoft tissue cysts. and5 4%respectiveiy). However,the frequency of pleomor- TABLE8. NUMBERAND SEX OF PEDIATRIC PATIENTS WITH INFLAMMATORY LESIONS phic adenoma(4%) compatible with that 5 O-5 yrs 6-10 yrs l l-15 yrs Total (M/F)" of Godwin (5%). Palatal pleomorphic Inflammation 11 13 5 29" (15/14) adenoma in children Tuberculosis 0 3 0 3 (1/2) is relatively uncom- Actinomycosis 1 0 0 1 (0/1) mon; however, a few Condensingosteitis, osteosclerosis 0 1 0 1 (1/0) cases were recently Osteomyelitis 1 2 4 7 (5/2) presented.23,24 In the 1 0 1 2 (2/0) present study, there Polyp 0 1 0 1 (0/1) were six palatal pleo- Periapical granuloma 0 2 17 19 (9/10) morphic adenomas Mucositis 0 1 0 1 (0/1) which were all in the Garre’s osteomyelitis 0 2 0 2 (1/1) 1 1-1 5-year-old Pyogenic granuloma 2 6 7 15 (6/9) group, as in the report Fibrous hyperplasia 0 1 6 7 (7/0) by Godwin) 0 2 1 3 (1/2) Langerhans cell Mucousextravasation phenomeon*21 66 57 144 (69/75) histiocytosis was the Sialadentitis 0 0 2 2 (2/0) most commonmalig- Gingival hyperplasia 0 0 1 1 (1/0) nant nonodontogenic Total 31 98 109 238 (1201118) lesion, which is con- sistent with the findings25 of Kaban. "M/F: male/female. *Mucocele,ranula, mucousretention cyst. This is in contrast to a report from Africa, in were younger than 15 years old. However,only one which the most commonmalignant nonodontogenic case ofadenomatoid odontogenic tumor was noted in neoplasmwas Burkitt’s lymphoma.5 In addition, a re- the present study, as in a report fromJapan. 6 This may port from Asia 6 noted the dominant malignant be due to the racial differences. nonodontogeniclesions was sarcoma. These differences The most frequent benign nonodontogenic tumor maybe attributed to regional or racial variations. No in this study was hemangioma.It is different from the squamouscell carcinoma was found in this series but reports from the U.S.,7’ 8 whichindicated papillomaas there was a case of mucoepidermoidcarcinoma. the most prevalent lesion. However,the present series Ninety-eight percent of the cystic lesions were lo- is similar to a study from Japan,6 which also reported cated in the jaw; which is muchhigher than reported hemangioma as the most common benign tumor. by Keszler et al. 9 (75%). The occurrence of dentiger- The low percentage of papilloma in the present ous cyst was higher (10%) than that reported study may be due to geographic variations. The Skinneret al.7 (9%)and Sumitraet al.8 (5%). The

408American Academy of PediatricDentistry PediatricDentistry - 20:7,1998 ...... ~_~,, ~.v...... ~...... ~. ’ for both epidemiology TABLE9...... NUMBERAND SEX OF PEDIATRIC ...... PATIENTS WITH OTHER LESIONS and teaching. O-5 yrs 6-10 yrs l l-15 yrs Total (M/F)" References 1. Bhaskar SN: Oral tu A-V fistula 0 0 1 1 (0/1) mors of infancy and Ulceration 1 7 4 12 (10/2) childhood, a survey of Calcification/sclerosis 0 0 1 1 (1/0) 293 cases. J Pediatr 63:195-210,1963. Internal/external 0 1 0 1(1/0) 2. Dehner LP: Tumors of Simplebone cyst 0 0 3 3(0/3) the mandible and maxilla Tooth abrasion 0 0 3 3(0/3) in children. I. Clinico Hematoma 1 1 0 2(2/0) pathologic study of 46 Total 2 9 12 23 (14/9) histologically benign ...... lesions.Cancer31:364- ...... 84, 1973. "M/F: male/female. frequent site wasthe mandibularposterior region, 3. KhannaS, KhannaNN: Primary tumors of tie jaws in chil- which correlated with the findings of both Skinner et dren. J Oral Surg 37:800-804, 1979. al.7 and8 Sumitraet al. 4. DehnerLP: Tumorsof the mandibleand maxilla in children. Theoccurrence of radicular cysts (4%)in this study II. Clinicopathologic study of 46 histologically benign le- sions. Cancer 32:112-84, 1973. compatibleto that of Skinneret al., 7 (5%)but is muchlower 1 5. GodwinTA: A study of orofacial tumors in Nigerian chil- than those of Sumitra et aT.8 (8%) and Bhaskar (11%). dren. J Oral Maxillofac Surg 54:34-38, 1996. Radicularcysts occurredmore often in the maxillathan in 6. Sato M, Tanaka N, Sato T, AmagasaT: Oral and maxillo- the mandiblein somestudies 1’ 7; howeveran equal distri- facial tumors in children: a review. Br J Maxillofac Surg bution betweenmaxilla and mandiblewas noted in this 35:92-95, 1997. study. Thepresent study showeda muchhigher occurrence 7. Skinner RL, Davenport WD,Weir JC, Carr RF: A survey ofodontogenickeratocyst than the report by Sumitraet al.,8 of biopsied oral lesions in pediatric dental patients. Pediatr Dent 8:163-67, 1986. whofound only one such lesion. Ourfindings werehigher 8 9 8. Sumitra D, Das AK:A review of pediatric oral biopsies from than the 6%of Skinneret al. and 5%ofKeszler et al. a surgical pathologyservice in a dental school. Pediatr Dent Wefound that mucousextravasation phenomenonwas 15:208-211, 1993. the mostcommon lesion in the inflammatorylesions cat- 9. Keszler A, Gugliemotti MB,Dominguez FV: Oral pathology egory, as did Skinner et al. 7 and Sumitra et al. 8 Most in children, frequency,distribution and clinical significance.Acta studies7-9 reported that the lowerlip wasthe mostpre- Odontol Latinoam 5:39-48, 1990. dominantsite; our study concurswith this finding. The 10. Skinner RL, Davenport WD,Weir JC, Carr RF: Oral malig- nancyincidence observedin biopsyservice specimensover a 13- majority of the cases fromother studies occurredin fe- year period: a regional study. South MedJ 78:652-56, 1985. 7-9 males, whichwas similar to our study. Thepercentage 11. Chen Y-K, Lin LM, Lin CC, Yan YH:Intraoral juvenile xan- of chronic or acute inflammation(6%) in our study was thogranulomaof the oral cavity-a case report and literature re- lower than in the reports by Skinner et al. 7 (9%) and view. Oral Surg Oral MedOral Pathol Oral Radiol Endod81: Sumitra et al. 8 (7%). Themajority of granulomain the 450-53, 1996. current study were found in the anterior maxilla, 12. Chen YK, Lin LM, Lin CC, Lai S: Aneurysmal of whichis consistent with two previous studies. 7’ 8 We the mandible--a case report. Clin Dent J 9:42-46, 1990. found the mostcommon site of this lesion wasthe gin- 13. ChuongR, KabanLB: Diagnosis and treatment of jaw tumors 7 in children. J Oral Maxillofac Surg 13:323-32, 1985. giva, whichconcurs with Skinneret al. andSumitra et aT.8 14. Geer RO, Mierau GW,Favara BE: Tumors of the Head and In condusion,little data of this naturehas beenreported Neckin Children: Clinicopathologic Perspectives. NewYork; fromAsia. Severalsalient points regardingregional and ra- Praeger Publishers 89-96, 1983. dal differencesare highlightedby the data in this study.The 15. Geer RO, Mierau GW:Tumors of the oral mucosaand jaws in differences indudethe majority of lesions wereoccurred infants and children. Denver; University of ColoradoMedical in the inflammatory lesions category. The dominant Center health SciencesPress, 1980. 16. Budnick SD: Complexand compoundodontomas. Oral Surg jawbonepediatric tumor is odontogenic, with a high Oral MedOral Patho142: 501-506, 1976. rate of odontomasand ameloblastomasbut a low rate 17. OwensBM, Schuman NJ, Mincer HH, Turner JE: Dental od- of adenomatoid odontogenic tumors. The most fre- ontomas:a retrospective study of 104cases. J Clin Pediatr Dent quent benign non-odontogenic tumor was 21:261-64, 1997. hemangioma and the most common malignant 18. BlackwoodHJJ: Odontogenictumors in the child. Br DentJ 119: counterpart was Langerhans cell histiocytosis. In 431-38, 1965. addition, a high occurrenceofodontogenic keratocyst was 19. Keszler A, DominguezFV: Aineloblastoma in childhood. J Oral Maxillofac Surg 44:609-613, 1986. found. Thus, this information may be valuable 20. KahnMA: Ameloblastoma in young persons: A clinicopatho-

PediatricDentistry -20.’7, 1998 AmericanAcademy of Pediatric Dentistry 409 logic analysis and etiologic investigation. Oral Surg Oral Med 23. Lopez-Cederin JL, Gonzalez-LandaG, Birichinaga B: Pleo- Oral Pathol 67: 706-715, 1989. morphicadenoma of the palate in children: report of a case. 21. Philipsen HP, Reichart PA, Zhang KH: Adenomatoid od- Int J Oral Maxillofac Surg 25:206-207, 1996. ontogenic tumor: Biologic profile based on 499 cases. J Oral 24. De Courten A, Lombard T, Samson J: Pleomorphic ad- Pathol Med 20:149-58, 1991. enomaof the palate in a child: 9-year follow-up. Int J Oral 22. Godwin TA, Juwon TA, Ademola AO, Oluseyi FA: The Maxillofac Surg 25:293-95, 1996. adenomatoidodontogenic tumor: An analysis of 57 cases in 25. KabanLB: Jaws tumors in children. In: Kahan LB, ed. Pe- a black African population. J Oral Maxillofac Surg 55:146- diatric oral and maxillofacial surgery. Philadelphia: PA 48, 1997. Saunders p 384, 1990.

Pediatric Dentistry is soliciting manuscriptsfor its new clinical section. The clinical section will contain informationaddressing the privatepractice of contemporarypediatricdentistry including unusual restorativeprocedures,interesting appliancetherapy, newtechnologies, and the use, needs, and benefits of newdental materials. If you would like to submita manuscriptto the clinical section, please follow the Instructions to Contributors and send your completedmanuscript to the AAPDHeadquarters Oj~ce.

410 American Academy of Pediatric Dentistry Pediatric Dentistry - 20.’Z 1998