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ODONTOGENIC CYSTS: A RETROSPECTIVE STUDY OF 100 CASES.

Byline: AHMAD SHAH, MUHAMMAD ILYAS and MUSLIM KHAN MOHMAND

ABSTRACT

The objective of the study was to determine the demography, frequency, male female ratio and jaw involvement in odontogenic cysts. This retrospective study was carried out from Jun 2004 to July 2008 at the Department of Oral and Maxillofacial Surgery, Khyber College of Dentistry, Peshawar. A total of 100 cysts formed the study group. The age ranged was [greater than or equal to] 20 years and were divided into five groups. The data were analyzed through SPSS 22 at the level of significance p[?] 0.05. Student-Newman-Keuls test was used to show the significant distribution in the aged groups. Chi-square statistics were used to show the association of the cyst with the jaw.

The male to female ratio was 1:1.33. The dominant age group in males was 20-29 years n=15(34.88%) while 40-49 years age group was more in females n=18(31.57%). The maxilla to mandible involvement was 1:1.33. The most prevalent odontogenic cyst was radicular cyst n=45(45%) followed by dentigerous cysts n=31(31%), odontogenic keratocysts n=14(14%), lateral periodontal cysts n=6(6%) and gingival cysts n=4(4%). The Student-Newman-Keuls test showed that the cyst distribution in the aged group (30-39years) was statistically significant in both males (p=0.017) and females (p=0.011). Chi-square statistics showed a significant association of radicular cysts with anterior of maxilla (x2= 10.369, p= 0.005), dentigerous cysts with molar area of the mandible (x2= 10.917, p= 0.004) while other odontogenic cysts were statistically not associated with location of the jaw.

Radicular cyst were the most prevalent odontogenic cyst and odontogenic cyst distribution in the aged group was statistically significant in gender.

Key Words: Odontogenic cysts, Maxilla, Mandible.

INTRODUCTION

Cyst is an epithelium lined pathological cavity filled with fluid or semisolid material. To achieve definitive diagnosis along with clinical and radiographic findings, the pathological analysis of epithelial lining and contents are generally required.1,2 The origin of cystic lesions of the jaw may be epithelial or non-epithelial, odontogenic or non-odontogenic and developmental or inflammatory. Odontogenic cysts of the jaw are developed from the proliferation or degeneration of odontogenic epithelium and usually occurred in tooth bearing areas of the jaws.3

Based on the diagnostic criteria, biological behavior and diversity of the odontogenic lesions, different classification plans have been established however, the World Health Organization's histological typing of odontogenic tumors, updated in 2005, has an upper edge over the other and still in use for classification of odontogenic lesions.4,5

Becconsall-Ryan and Love in New Zealand6 and Ali in Kuwait7 have reported a total of 4983 and 385 lesions of the jaw respectively. In order to assess the geographic factors and variables i.e, gender, age and habits as well as prevalence of the individuals in the community it is necessary to carry out the retrospective study to collect the scattered data and transfer it to health care decisions makers to take necessary steps. The aim of the study was to determine the demography, frequency, male female ratio and jaw involvement in odontogenic cysts.

METHODOLOGY

This retrospective study was carried out from Jun 2004 to July 2008 at the Department of Oral and Maxillofacial Surgery, Khyber College of Dentistry, Peshawar. During this period 100 cysts identified by initial clinical provisional diagnosis as well as through biopsies were selected. As for gender, 43 cysts were in males and 57 cysts were in females. The age selected was [greater than or equal to] 20 years and were divided into five groups i.e, 20-29 years, 30-39 years, 40-49 years, 50-59 years and 60-69 years. The patients having incomplete record and aged >70 years were excluded from the study. The data were analyzed through SPSS 22 at the level of significance p[?] 0.05. Descriptive statistics were used for frequency and percentage. Student-Newman-Keuls test was used to show the significant distribution in the age groups. Chi-square statistics were used to show the association of cyst with the jaw.

RESULTS

The male to female ratio was 1:1.33. The maxilla to mandible involvement was 57% were females and 43% were males. Distribution of cysts according to location and genders can be seen in Table 1. Fig 1 shows the percentage of odontogenic cysts according to age groups.

DISCUSSION

This study demonstrates that the overall mean age presentation was 44.7 years which is similar to the study done by Johnson et al8 (43.4 years) and Meningaud et al9 (41.8 years). The male to female ratio was 1:1.3 which is in consistent with the results of Johnson et al8, Meningaud et al9, Sharifian et al10 and Peker et al.11 The most biopsied lesions in the present study were radicular cysts (45%) followed by dentigerous cysts (31%) which support the data reported by Peker et al11 from Turkey, Nunez-Urrutia et al12 from Spain and de Souza et al13 and Prockt et al14 from Brazil.

The current study demonstrates that radicular cysts were most frequently involved in the anterior of maxilla which supports the study done by Jamshidi et al15, Jones et al16, Koseoglu et al17 and Acikgoz et al.18 In this study majority of the radicular cysts were reported in the females which contradicts the studies done by Tortorici et al19, Acikgoz et al18 and Jamshidi et al.15 Jones et al16 showed a similar gender predilection.

TABLE 1: DISTRIBUTION OF CYSTS ACCORDING TO LOCATION AND GENDERS

###Maxilla###Mandible###Gender

Cyst###Anterior###Pre-###Molar###Anteri-###Premo-###Molar###Ra-###Male###Female###Total

type###n(%)###molar###n(%)###or n(%)###lar n(%)###n(%)###mus###n(%)###n(%)

###n(%)###n(%)

Radicu-###23###2###3###6###3###8###0###19###26###45

lar

Cyst###(51.11%)###(4.44%)###(6.67%)###(13.33%)###(6.67%)###(17.78%)###(44.18%)###(45.61%)###(45%)

Denti-###5###0###4###1###2###19###0###14###17###31

gerous

Cyst###(16.13%)###(12.9%)###(3.23%)###(6.45%)###(61.29%)###(32.55%)###(29.82%)###(31%)

Odonto-###0###0###1###0###0###6###7###6###8###14

genic

Kerato-###(7.1%)###(42.9%)###(50%)###(13.95%)###(14.03%)###(14%)

cyst

Lateral###3###1###0###0###2###0###0###2###4###6

Perio-###(50%)###(16.67%)###(33.33%)###(4.65%)###(7.01%)###(6%)

dontal

Cyst

Gingival###0###1###0###2###1###0###0###2###2###4

Cyst###(25%)###(50%)###(25%)###(50%)###(50%)###(4%)

Total###31(31%)###4(4%)###8(8%)###9(9%)###8(8%)###33(33%)###7(7%)###43(43%)###57(57%)###100(100%)

Present study revealed that dentigerous cysts were the second most common cyst with female predilection and mostly involved the posterior of the mandible. Jamshidi et al15 showed that dentigerous cysts ranked third in the cystic lesions and most common location was the posterior of the mandible with equal occurrence in male and female which does not support this study.In contrary to the present study Jones et al16 and Koseoglu et al17 reported a higher prevalence of dentigerous cyst in males and Prockt et al14 reported an equal prevalence in males and females. Jones et al16, Koseoglu et al17, Kondell and Wiberg20, Luo et al21, Gonzalez-Alva et al22 and Osterne et al23 revealed that the most frequent location of odontogenic keratocyst was posterior of the mandible, consistent with this study.

Present study reported that odontogenic keratocysts had female predilection and ranked third in the cystic lesions which disagree the studies done by Jamshidi et al15 and Jones et al.16 Koseoglu et al17 showed an equal gender predilection.Current study reported that lateral periodontal cysts accounts 6% of all odontogenic cysts which is different from the study of Altini et al.24 The most dominant site involved by lateral periodontal cysts in this study was anterior of maxilla which is not in line to the studies by Ortega et al25 and Nikitakis et al.26 Formoso Senande et al27 showed that lateral periodontal cysts predominantly occurred in maxilla which support this study and had a male predilection which contradict current study. Nikitakis et al26 reported an equal propensity in gender.

Malali et al28 reported that the most dominant location of the gingival cysts was canine and premolar region of the mandible, consistent with this study and accounts 0.5% of all odontogenic cysts which contradict present study.

In the current study most of the lesions were recognized in the mandible and they were sparsely distributed. Apart from certain contradictions this study showed similarities with previous studies and the variability in the results may be due to different factors namely from geographic to specimen submission. However, the results cannot be anticipated for a true prevalence of intra-oral cystic lesions within the general population and it merely reflects the frequency of odontogenic cystic lesions of the jaw. Most of the surgeons throw away after the surgical procedures, the most important specimen which should be submitted for histopathological purpose resulting in the inaccuracy of the record and thereafter have difficulties for the researchers.

It is advisable to collect data sheet from patients and keep the record of every specimen to facilitate the researchers to conduct a comprehensive study and to acquire specific preventive and therapeutic measures against such diseases.

CONCLUSION

Radicular cysts were found the most prevalent odontogenic cysts and significantly associated with anterior of maxilla followed by dentigerous and odontogenic keratocysts in the posterior of the mandible. Odontogenic cysts were significantly associated with the age group.

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Publication:Pakistan Oral and Dental Journal
Article Type:Report
Geographic Code:9PAKI
Date:Dec 31, 2016
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