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A Retrospective Study of Oral and Maxillofacial Biopsy Lesions in A

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A Retrospective Study of Oral and Maxillofacial Biopsy Lesions in A 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,dentigerous cyst, 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, ranula, 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 Dentistry 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% Pyogenic granuloma 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.
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