Odontogenic Tumours: A Clinicopathologic Appraisal of Cases seen in a Nigerian Tertiary Hospital using 2017 WHO Classification.

BACKGROUND: Odontogenic tumours (OT) are a group of diverse lesions seen in the maxillofacial region. They are categorized according to their tissues of origin as; epithelial, mesenchymal or mixed tumours. OBJECTIVES: The aim of this study is to present the proportion of odontogenic tumours seen in Lagos University Teaching Hospital using the 2017 WHO classification. METHODS: Data from cases of OT histologically diagnosed from January 2006 to December 2016 were collected from records of the Oral and Maxillofacial Surgery and Oral and Maxillofacial Pathology Departments. Information on age, sex, site of occurrence and histologic diagnosis were recorded. After reconfirmation of diagnosis, cases were categorized according to the latest World Health Organization (WHO) classification for OT. Ethical approval was obtained and data was analyzed using SPSS software for Windows (version 22: SPSS, Chicago IL). RESULTS: A total of 232 odontogenic tumours were diagnosed during the period of study, 227(97.8%) cases were benign OT and 82.8% occurred in the mandible. The mean age ± SD of patients was 32.1±13.8 years and the age range from 2-73 years. OT was slightly more common in females (119) with an almost equal male-to-female ratio of 1:1.1. Most of the patients were in the 21-30 year age group and ameloblastoma 148(63.8%) was the most common OT. The histological types of odontogenic tumours and the age group of patients were significantly associated with the site of occurrence of tumours (P=0.000* and P=0.037* respectively). CONCLUSION: Epithelial odontogenic tumours are still by far the most common odontogenic tumours.

CONTEXTE: Les tumeurs odontogènes (TO) sont un groupe de lésions diverses observées dans la région maxillo-faciale. Elles sont classées selon leurs tissus d'origine en tumeurs épithéliales, mésenchymateuses ou mixtes. OBJECTIFS: Le but de cette étude est de présenter la proportion de tumeurs odontogènes observées à l'hôpital universitaire de Lagos en utilisant la classification 2017 de l'OMS. MÉTHODES: Les données des cas d'OT diagnostiqués histologiquement de janvier 2006 à décembre 2016 ont été collectées à partir des dossiers des départements de chirurgie orale et maxillofaciale et de pathologie orale et maxillo-faciale. Les informations relatives à l'âge, au sexe, au site d'apparition et au diagnostic histologique ont été enregistrées. Après reconfirmation du diagnostic, les cas ont été classés selon la dernière classification de l'Organisation mondiale de la santé (OMS) pour l'OT. L'approbation éthique a été obtenue et les données ont été analysées à l'aide du logiciel SPSS pour Windows (version 22 : SPSS, Chicago IL). RÉSULTATS: Un total de 232 tumeurs odontogènes ont été diagnostiquées au cours de la période d'étude, 227 (97,8%) cas étaient bénins d'ergothérapie et 82,8% sont survenus dans la mandibule. L'âge moyen ± écart-type des patients était de 32,1±13,8 ans et la tranche d'âge de 2 à 73 ans. L'ergothérapie était légèrement plus fréquente chez les femmes (119) avec un ratio hommes-femmes presque égal de 1:1,1. La plupart des patients étaient âgés de 21 à 30 ans et l'améloblastome 148 (63,8%) était l'ergothérapie la plus fréquente. Les types histologiques de tumeurs odontogènes et le groupe d'âge des patients étaient significativement associés au site d'apparition des tumeurs (P=0,000* et P=0,037* respectivement). CONCLUSION: Les tumeurs odontogènes épithéliales sont encore de loin les tumeurs odontogènes les plus courantes. Mots-clés: Tumeurs odontogènes, Classification des tumeurs odontogènes, Épidémiologie.

Ameloblastoma: current etiopathological concepts and management.

Ameloblastoma is a benign odontogenic tumor of epithelial origin. It is locally aggressive with unlimited growth capacity and has a high potential for malignant transformation as well as metastasis. Ameloblastoma has no established preventive measures although majority of patients are between ages 30 and 60 years. Molecular and genetic factors that promote oncogenic transformation of odontogenic epithelium to ameloblastoma are strongly linked to dysregulation of multiple genes associated with mitogen-activated protein kinase, sonic hedgehog, and WNT/ß-catenin signaling pathways. Treatment of ameloblastoma is focused on surgical resection with a wide margin of normal tissue because of its high propensity for locoregional invasion; but this is often associated with significant patient morbidity. The relatively high recurrence rate of ameloblastoma is influenced by the type of molecular etiological factors, the management approach, and how early the patient presents for treatment. It is expected that further elucidation of molecular factors that orchestrate pathogenesis and recurrence of ameloblastoma will lead to new diagnostic markers and targeted drug therapies for ameloblastoma.

TEMPOROMANDIBULAR PAIN DYSFUNCTION SYNDROME IN PATIENTS ATTENDING LAGOS UNIVERSITY TEACHING HOSPITAL, LAGOS, NIGERIA.

BACKGROUND: Temporomandibular joint pain dysfunction syndrome (TMJPDS) is the most common temporomandibular disorder. This condition presents with symptoms of pain, restricted jaw movement and joint noise. Other symptoms include otalgia, headache, neck pain and trismus. AIM: To determine the pattern of Temporomandibular joint pain dysfunction syndrome patients managed at the Lagos University Teaching Hospital, Lagos, Nigeria. METHODOLOGY: A descriptive study of patients with signs and symptoms of Temporomandibular joint pain dysfunction syndrome attending the Oral Medicine Clinic of Lagos University Teaching Hospital. RESULTS: Twenty-one patients with Temporomandibular joint pain dysfunction syndrome were enrolled into the study, out of which 10(48%) were females and 11(52%) were males. The age range was 23-81years with a mean of 45.2 ± 18.9 years. Majority of the patients 20(95.2%) complained of pain around the joint, in the pre-auricular region, in the muscles of mastication and the ear. While 7(35%) complained of clicking sounds, 10(47.6%) complained of pain on mouth opening and during mastication only. In all 5(23.8%) had impaired movement of the jaws, mouth opening was normal in 18(85.7%) but reduced in 3(14.3%) patients. Over half of patients 12(57%) experienced clicking sounds, there was tenderness around the temporomandibular joint in 16(76.2%) cases, pain in the ear of 7(33.3%) patients and 13(61.9%) people presented with tenderness of the muscles of mastication. Conservative management of all the cases resulted in resolution of the symptoms. CONCLUSION: Temporomandibular joint pain dysfunction syndrome has diverse clinical presentation and though distressing, it responds to prompt and effective conservative management.

PATTERN OF ASSAULT-RELATED MAXILLOFACIAL INJURIES TREATED AT THE GENERAL HOSPITAL, LAGOS, NIGERIA.

BACKGROUND: The human face often constitutes the first point of contact in various human interactions and it is frequently the preferred target for blows in assault cases. AIM: To analyze the pattern of assault-related maxillofacial injuries treated at the General Hospital, Lagos over a period of one year. METHODOLOGY: This is one year prospective study of assault-related maxillofacial injuries treated at the Department of Oral-Maxillofacial Surgery, Dental Centre, General Hospital, Lagos, Nigeria. A face-to-face interviewer-administered structured proforma was used to obtain information from study subjects. RESULTS: Thirty-three patients with maxillofacial injuries met the inclusion criteria for this study. Their age ranged between 16 and 48 years with a mean age of 28.2 ± 7.4 years. There were 25(75.8%) males and 8(24.2%) females with a male/female ratio of 3:1. Majority of the patients, 24(72.7%) did not have any skilled employment while the remaining 9(27.3%) were road transport workers, specifically commercial bus drivers and motorcycle riders. The most frequently seen soft tissue injury was contusion which accounted for 17(51.5%) cases while 13 (39%) of the patients sustained mandibular fracture which was the most common hard tissue injury. CONCLUSION: Assault-related maxillofacial injuries are most common amongst young adult males who are not skillfully employed; this can be attributed to the increased disposition to violence in males in our environment.

Analysis of Elastic Tissue in Histological Variants of Pleomorphic Salivary Adenoma seen at the Lagos University Teaching Hospital over a period of 35 Years.

BACKGROUND: Pleomorphic salivary adenoma (PSA), is known for its morphologic diversity. While reports of elastic tissue in PSA have been documented, the distribution of this tissue in histological variants of the tumour has not been documented. Perhaps such features may influence biological behaviour of these variants. OBJECTIVE: To classify PSA in our series into histological variants, and determine possible variation in elastic tissue distribution in them. METHODS: Eighty eight histologically diagnosed cases of PSA in the oral biopsy archives of the department of Oral Biology and Pathology, Lagos University Teaching Hospital, were retrieved. New H&E sections were cut to reconfirm diagnosis and Verhoeff-Van Gieson's stained sections were cut for demonstration of elastic tissue. Seifert et al.'s (1976) histological classification was applied and elastic tissue presence was determined and quantified for each case. Parameters studied included; sex, age, site, histological subtypes and presence of elastic tissue. Statistical analysis was undertaken using the EPI-INFO version 3.4. RESULTS: Male:female ratio was 1:1.3. Most cases (63.6%) occurred in the age group of 21-40 years. Generally, palate (42.0%) was the most commonly affected site, while 53.4% of cases were in the minor salivary glands. Seifert et al. classified subtype II lesions were the most frequently observed (39.7%) and elastic tissue was confirmed in 91.0% of cases. No association was noted between proportion of elastic tissue and histological variants. CONCLUSION: Seifert et al subtype II was the most frequently observed and no association was observed between proportion of elastic tissue and the histological variant of PSA.

Clinicohistopathological analysis of 5 Nigerian cases of malignant fibrous histiocytoma of the jaws.

BACKGROUND: Malignant fibrous histiocytoma (MFH), is a soft tissue sarcoma that occurs predominantly in the soft tissue of the extremities. It rarely occurs in facial bones. Few cases in the jaws have been reported. OBJECTIVE: To report and review the relevant clinicopathologic features of 5 cases of jaw MFHin Nigerians. METHODS: All cases in the records of the Department of Oral Pathology of the Lagos University Teaching Hospital which were histologically diagnosed as MFH were retrieved. Hematoxylin and eosin slides of cases were re-examined to confirm diagnosis. Information retrieved included age, sex, location, x-ray, estimated duration, recurrence, and histological presentation. Data was analyzed using SPSS statistical package. RESULTS: Age ranged between 12-42 years with a male sex predilection (3 cases/60.0%) and sole maxillary site predilection (5 cases/100.0%). Estimated duration of lesion ranged from 2 -12 months. Two cases recurred post surgical treatment. All cases presented as the storiform-pleomorphic type with one case presenting with a delicate/scanty connective tissue stroma. Chronic inflammation was scanty in the two cases that recurred. CONCLUSION: MFH of the jaws is rare among Nigerians. Its clinico radiological presentation maymimick other more aggressive or less benign lesions of the jaws thereby resulting in misdiagnosis and in appropriate patient management.