Psychological Distress Before and After Surgical Resection of Benign Orofacial Tumors: A Prospective Study.

PURPOSE: We evaluated the presence and level of psychological distress in patients before and after resection of benign orofacial tumors and identified the variables associated with this psychological distress. MATERIALS AND METHODS: The present study used the Hospital Anxiety and Depression Scale and the Rosenberg Self-Esteem Scale. A questionnaire that included these 2 scales was administered to the patients before surgery and at 1, 2, and 6 weeks after surgery. The scores at the various intervals were statistically compared, and the relationships between the variables (eg, age, gender, education, marital status, occupation, lesion size) and psychological distress were also tested. RESULTS: Of the 31 patients, 29% had abnormal levels of anxiety before surgery, and 12.9% reported abnormal depression levels before surgery. The proportion of patients with abnormal anxiety levels increased from 29% before surgery to 38.7, 38.7, and 35.5% at 1, 2, and 6 weeks after surgery, respectively. The proportion of patients with abnormal depression levels at all intervals after surgery remained the same as that before surgery (12.9%). All the patients had normal self-esteem levels both before and after surgery. Using a paired t test, the mean anxiety scores at all intervals after surgery were significantly greater than the mean anxiety score before surgery. Analyses of the relationships between the independent variables and psychological distress (anxiety and depression) found the level of education to be significantly associated with anxiety before and after surgery. In contrast, the lesion size was significantly associated with depression both before and after surgery. CONCLUSIONS: The results of the present study suggest that abnormal anxiety and depression will be present in some patients with benign orofacial tumors both before and after surgery. The patients' education level and lesion size were strongly associated with the level of psychological distress present in patients with benign orofacial tumors.

Ameloblastic carcinoma: a multicenter Nigerian study.

PURPOSE: To obtain a national profile on the prevalence and management of ameloblastic carcinoma in Nigerians. MATERIALS AND METHODS: Data were collected from the case files of patients with a histologic diagnosis of ameloblastic carcinoma from 4 tertiary referral centers in Nigeria from January 1980 to December 2008. RESULTS: Twenty patients were seen within the study period. There were 11 male and 9 female patients, with a male-to-female ratio of 1.2:1. Their ages ranged from 16 to 85 years (mean +/- SD, 41.63 +/- 19.8 years). The duration of the lesion before presentation was 6 months to 4 years. Twelve cases occurred in the posterior mandible alone, 1 case occurred in the anterior mandible alone, and 4 cases involved the anterior and posterior mandible. The posterior part of the maxilla was involved in 3 cases. A majority of the cases (17) occurred de novo, and 3 patients presented with carcinoma ex-ameloblastoma. Treatment included surgical resection with or without neck dissection. Eight patients declined treatment after diagnosis. Surgery was planned for 12 patients, but 2 patients died of intractable bleeding episodes before surgery. Mandibulectomies and maxillectomies were performed for 10 patients. Follow-up was carried out for 5 patients. Recurrence ranged from 6 to 96 months after the first surgery. Overall deaths recorded involved 6 patients. Three patients died within 3 years after the initial surgery and 1 patient died about 8 years after the initial surgery. One patient is still alive and well 1 year after surgery. CONCLUSION: Ameloblastic carcinoma is an uncommon malignancy. Most cases occur in the mandible and arise de novo. Early diagnosis and radical local excision remain the mainstay of treatment.

Ameloblastoma in Nigerian children and adolescents: a review of 79 cases.

PURPOSE: To descriptively review the clinicopathologic presentation and management of ameloblastoma in Nigerian children and adolescents and compare this with previous reports in the literature. METHODS AND MATERIALS: Data were collected from the case files of patients managed at 4 tertiary referral centers in Nigeria. RESULTS: Out of a total of 360 patients with a diagnosis of ameloblastoma, 79 were under 20 years of age at presentation (21.9%). Only 2.5% of the patients were under 10 years of age. The male-female ratio was 1.3 to 1 with a peak age incidence of 15 years in males and 17 years in females. All the tumors were intraosseous and the majority (94.9%) were situated in the mandible. The most common morphologic type was solid multicystic ameloblastoma (82.3%). The majority (66.2%) had a multilocular radiographic presentation. In most patients (57.3%), the symphysial region of the mandible was involved by the tumor. However, exclusively anterior tumors constituted only 15.2% of the cases, while tumors involving anterior and posterior jaw regions constituted 41.1%. Resection was the predominant (72.2%) form of surgical management. CONCLUSION: Ameloblastoma in Nigerian children and adolescents exhibit some peculiar clinical features: these include the predominance of males, and of the solid multicystic morphologic type. In addition, there is site predilection for the symphysial region of the mandible. Radical surgical resection remains the predominant form of treatment. Therefore, varying degrees of interference with facial growth will be present in these children.