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Cysts of the Jaws in Pediatric Population: a 12-Year Institutional Study 1SK Padmakumar, 2VT Beena, 3Devu Aloka, 4Rupali Lav, 5R Sivakumar

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Cysts of the Jaws in Pediatric Population: a 12-Year Institutional Study 1SK Padmakumar, 2VT Beena, 3Devu Aloka, 4Rupali Lav, 5R Sivakumar OMPJ SK Padmakumar et al 10.5005/jp-journals-10037-1031 ORIGINAL RESEARCH Cysts of the Jaws in Pediatric Population: A 12-Year Institutional Study 1SK Padmakumar, 2VT Beena, 3Devu Aloka, 4Rupali Lav, 5R Sivakumar ABSTRACT hence, it is imperative for oral and maxillofacial patholo- Aim: The aim of the study was to find the clinicopathological gists to get well-acquainted with these pathologies. correlation of the cysts of the jaws in the pediatric population Cysts of the jaws are known to occur across different from the data obtained from a major tertiary dental care insti­ age and ethnic groups. Although existing literature on tution in the state of Kerala. the incidence and clinicopathological features of cysts of Materials and methods: The cases dated between 1st the jaw is extensive, little has been discussed about these January 2001 and 31st December 2012 were retrieved from the cysts occurring in the pediatric population. To the best archives of the Department of Oral Pathology and Microbiology, Government Dental College, Thiruvananthapuram, India. The of our knowledge, there is limited reported literature on data were analyzed for age, gender, site of the cyst and histo­ jaw cysts in the pediatric age group within the South pathologic type. Indian population. Results: Out of a total of 5894 biopsies received, cysts of the The present study was aimed at clinicopathological jaws accounted for 1396 (23.68%) cases. Among the cystic correlation of cysts of the jaws in the pediatric popula- lesions, pediatric cysts were found to be 187 (13.39%) in number. Of these, 125 were intraosseous cystic lesions of the tion reporting to a tertiary government dental healthcare jaws of which, 81 (64.8%) were developmental in origin, 42 educational institution located in the state of Kerala, in (33.6%) were inflammatory in origin. the southern most part of India, with a predominantly Conclusion: From the data, it is possible to conclude that Dravidian population. among all types of cysts of the jaws, developmental cysts are the most commonly encountered in the pediatric population. MATERIALS AND METHODS The lesions show a male predominance with anterior maxilla being the most common site. The past 12-year records of the Department of Oral Keywords: Odontogenic cyst, Pediatric population, Develop­ Pathology and Microbiology, Government Dental Col- mental cyst, Inflammatory cyst. lege, Thiruvananthapuram, India, were retrieved from How to cite this article: Padmakumar SK, Beena VT, Aloka D, the archives dated between 1st January 2001 and 31st Lav R, Sivakumar R. Cysts of the Jaws in Pediatric Population: December 2012. A total of 5894 biopsies were obtained, A 12­Year Institutional Study. Oral Maxillofac Pathol J 2015; out of which, cysts of the jaws accounted for 1396 cases. 6(1):532­536. Since our study was aimed at estimating the frequency of Source of support: Nil jaw cysts in the pediatric population, only cases belong- None Conflict of interest: ing to the age group 0 to 14 years were included in the sample population. INTRODUCTION All the cases were analyzed for age, gender, site of Kramer (1974) has defined a cyst as ‘a pathological cavity the cyst and histopathologic type. The hematoxylin and having fluid, semifluid or gaseous contents and which eosin stained slides were retrieved for all of these cases is not created by the accumulation of pus’.1 Epithelium- and reviewed by two investigators to confirm or modify lined cysts in bone are seen only in the jaws, with rare the diagnosis. The clinical data was cross checked for exceptions.2 Cysts of odontogenic origin are among the recurrences, in order to avoid reduplication of cases. The commonest lesions encountered in dental practice and age range was categorized into three class intervals viz. 0 to 6 years accounting mostly for primary dentition, 7 to 12 years accounting mainly for mixed dentition and 13 to 1,5Assistant Professor, 2Professor and Head, 3Junior Resident 14 years accounting mainly for the young permanent den- 4 Senior Resident tition. The site distribution of the cysts were divided into 1­5Department of Oral Pathology and Microbiology, Government three classes, class 1 including the dentoalveolar region Dental College, Thiruvananthapuram, Kerala, India involving the central incisors, lateral incisors and canines, Corresponding Author: Devu Aloka, Junior Resident class 2 spanning between mesial aspect of first premolar/ Department of Oral Pathology and Microbiology, Government first primary molar to the tuberosity in the maxilla and Dental College, Thiruvananthapuram, Kerala, India, Phone: ramus in the mandible and class 3 including both classes 09496734344, e­mail: [email protected] 1 and 2. 532 OMPJ Cysts of the Jaws in Pediatric Population: A 12-Year Institutional Study The data were collected and entered into a Microsoft Excel odontogenic keratocysts (5.6%) and among the cysts of spread sheet and descriptive statistical results were drawn inflammatory origin, radicular cysts (31.2%) were found using the SPSS version 16.0 statistical software package. to be the predominant type. In our study, we also noted that mucoceles accounted for 95.08% of the total number RESULTS of intraoral soft tissue cysts. Out of a total of 5894 biopsies received at our department Among the 125 cysts, 71 (56.8%) were in males and 54 during the 12-year-period, cysts of the jaws accounted for (43.2%) were in females. This male predominance was 1396 (23.68%) cases. Among the cystic lesions, pediatric however not significant statistically (p > 0.05). The overall cysts were found to be 187 (13.39%) in number. Of these, male:female ratio was found to be 1.3:1. The overall fre- 125 were intraosseous cystic lesions of the jaws of which, quency and gender distribution of various cysts is shown 81 (64.8%) were developmental in origin, 42 (33.6%) were in Tables 2 and 3. Graph 1 shows distribution of various inflammatory in origin and the rest of the cases included cysts of the jaws and Graph 2 shows gender distribution aneurysmal bone cysts, epidermoid cyst and nasopalatine among predominant cysts. cyst. Table 1 shows the 2005 WHO classification of cysts A recurrence was noted in five cases, two each of of the head and neck region which was the basis for our odontogenic keratocyst and radicular cyst and one of case segregation. calcifying odontogenic cyst type I-C. In addition to Among the developmental cysts, dentigerous cysts this, two neoplastic transformations of dentigerous (45.6%) were found to be the most common followed by cysts into ameloblastoma were encountered, both in females aged 13 years. Five syndromic cases were also Table 1: WHO classification of the cysts of the head and recorded. neck region (2005) I. Cysts of the jaws II. Cysts associated with The frequency and gender distribution of the maxillary antrum Table 2: cysts of the jaws A. Epithelial­lined cysts 1. Mucocele 1. Developmental origin 2. Retention cyst Type of cyst Frequency Male Female M:F (a) Odontogenic 3. Pseudocyst N % • Gingival cyst of 4. Postoperative maxillary infants cyst Dentigerous cyst 57 45.6 34 23 1.5 • Odontogenic III. Cysts of the soft tissues Odontogenic 7 5.6 5 2 2.5 keratocyst of the mouth, face and neck keratocyst • Dentigerous cyst 1. Dermoid and epidermoid Calcifying 1 0.8 1 0 NA • Eruption cyst cysts odontogenic cyst • Gingival cyst of adults 2. Lymphoepithelial • Developmental lateral (branchial) cyst Lateral 2 1.6 2 0 NA periodontal cyst 3. Thyroglossal duct cyst periodontal cyst • Botryoid odontogenic 4. Anterior median lingual Unclassified 11 8.8 6 5 1.2 cyst cyst (intralingual cyst of odontogenic cyst • Glandular odontogenic foregut origin) Cyst undergoing 2 1.6 0 2 NA cyst 5. Oral cysts with gastric or neoplastic • Calcifying odontogenic intestinal epithelium transformation cyst (oral alimentary tract cyst) (b) Nonodontogenic 6. Cystic hygroma Nasopalatine cyst 1 0.8 1 0 NA • Midpalatal raphé cyst 7. Nasopharyngeal cyst Radicular cyst 39 31.2 20 19 1.1 8. Thymic cyst of infants Residual cyst 3 2.4 2 1 2 9. Cysts of the salivary • Nasopalatine duct cyst glands: mucous Aneurysmal 2 1.6 0 2 NA • Nasopalatine duct cyst extravasation cyst; bone cyst • Nasolabial cyst mucous retention cyst; Total 125 100 71 54 1.3 2. Inflammatory origin ranula; polycystic • Radicular cyst, apical (dysgenetic) The frequency and gender distribution of the and lateral disease of the parotid Table 3: intraoral soft tissue cysts • Residual cyst 10. Parasitic cysts: hydatid cyst; Cysticercus • Paradental cyst and Type of cyst Frequency Male Female M:F cellulosae; trichinosis juvenile paradental N % cyst Epidermoid 1 1.6 1 0 NA • Inflammatory collateral cyst cyst Mucocele 58 95.6 29 29 1.0 B. Nonepithelial­lined cysts 1. Solitary bone cyst Ranula 3 4.8 0 3 NA 2. Aneurysmal bone cyst Total 62 100 30 32 Oral and Maxillofacial Pathology Journal, January-June 2015;6(1):532-536 533 SK Padmakumar et al Graph 1: Frequency of types of cysts Graph 2: Gender distribution of dentigerous cyst, odontogenic keratocyst, radicular cyst and residual cyst Table 4: The age distribution of cysts of the jaws Table 5: The mean age distribution of developmental and inflammatory cysts Type of cyst Primary Mixed Permanent dentition dentition dentition Type of cyst Mean age Standard Minimum Maximum (0-6 (7-12 (13-14 (years) deviation years) years) years) Developmental 10.14 2.5 3.5 14.0 Dentigerous cyst 5 43 9 Inflammatory 9.98 2.4 5.0 14.0 Odontogenic 0 4 3 a maxilla to mandible ratio of 1.03:1. The site distribution keratocyst Calcifying 0 0 1 of various cysts is shown in Tables 6 and 7. odontogenic cyst Lateral periodontal 0 2 0 DISCUSSION cyst Unclassified 2 6 3 Literature concerning the epidemiology of cysts in the odontogenic cyst jaws, within the pediatric population is relatively scarce.
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