Odontogenic Cysts a ClinicoPathologic Study of 80 Cases  Dr.Yahya A.Ali   maxillofacial surgeon F.I.C.M.S Lecturer in School of Dentistry University of Duhok                                              12/8/2011                                   Abstract              The purpose of this study was to determine the prevalence of odontogenic cysts in Iraqi populations in Maysan general hospital (Maysan -Iraq) and compare this prevalence with other international studies. Data for the study were obt

Odontogenic Cysts a ClinicoPathologic Study of 80 Cases Dr.Yahya A.Ali maxillofacial surgeon F.I.C.M.S Lecturer in School of Dentistry University of Duhok 12/8/2011 Abstract The purpose of this study was to determine the prevalence of odontogenic cysts in Iraqi populations in Maysan general hospital (Maysan -Iraq) and compare this prevalence with other international studies. Data for the study were obt

 

Odontogenic Cysts a ClinicoPathologic Study of 80 Cases

Dr.Yahya A.Ali   maxillofacial surgeon F.I.C.M.S Lecturer in School of Dentistry University of Duhok                                              12/8/2011

                                 Abstract

             The purpose of this study was to determine the prevalence of odontogenic cysts in Iraqi populations in Maysan general hospital (Maysan -Iraq) and compare this prevalence with other international studies. Data for the study were obtained from reports of patients diagnosed with odontogenic cysts between 2007 and 2010. Case records of patients who fit the Histological Classification of the World Health Organization (2005) were included. The following variables were analyzed: gender, age group, anatomical location and histological type. Odontogenic cysts accounted for 90 % of all lesions biopsied throughout the study period.

Mean patient age was (28) years and (61%) of the patients were males.                                  Radicular cyst was the most prevalent histological type (28.75%), followed by odontogenic keratocyst (25%) then dentigerous cyst (23.75%).

The mandible was the most prevalent site of the lesions (55%). Odontogenic cysts appear to have a distinct predilection for the male gender, the third  decade of life and are more frequent in the mandible.. 

Pain feeling and clinical expansion recorded in most of our patients. Awareness about the prevalence and characteristics of odontogenic cysts is important in primary diagnosis and treatment of these lesions.

Key words: odontogenic cysts, radicular cyst, odontogenic keratocyst,  dentigerous cyst,

 Introduction

       A cyst is defined as a pathologic cavity with liquid, semi-liquid or gaseous contents, surrounded by an epithelial tissue membrane (1). Cysts occur more often in the jaws than in any other bone because most of them originate from odontogenic epithelial remnants that remain after tooth development (2). Odontogenic cysts are one of the most common destructive lesions affecting the jaw bones (3). According to different studies, 7 to 12% of oral and maxillofacial biopsies are odontogenic cysts (4). The most common clinical feature is a painless swelling (unless the cysts become secondarily infected) and sometimes missing teeth, especially third molars(5). They grow slowly and sometimes cause tooth displacement or root resorption. They can expand cortical plate, usually in a smooth, curved manner, and change the buccal or lingual cortical plate into a thin cortical boundary. They may also displace alveolar inferior nerve canal in inferior direction or invaginate the maxillary antrum .Odontogenic cysts are often found in tooth-bearing region(6). They are classified in two groups according to their pathogenesis: inflammatory and developemental (7). Inflammatory cysts are associated with inflammation including radicular cysts but developmental cysts originate from the odontogenic epithelial remnant or apparatus that remains trapped within the jaw bone or gingival tissues including odontogenic keratocyst and dentigerous cysts (8). Radiographically odontogenic cysts present predominantly as a well defined corticated uni-multi locular radiolucencies (9). Odontogenic cysts are different in behavior, location, radiographic and clinical features(10).

 Despite the large number of studies on odontogenic cysts in the literature ,information about demographic profile and behaviors in Iraqi population is scarce.

The purpose of this study was to determine the frequency and clinical characteristics of odontogenic cysts diagnosed at oral and maxillofacial department in a city in southern Iraq and compare the findings with other similar studies following the new WHO classification.

           

Patients and Methods

      A retrospective study was conducted between April 2007 to March 2010, based on histopathological reports regarding cases of odontogenic cysts diagnosed at the oral and maxillofacial Department, oral Pathology laboratory in Maysan general hospital (Maysan-Iraq).

Demographic data and clinical characteristics including signs and symptoms of these patients were recorded. 

The following variables were studied:  histological type of cyst, anatomical location, age group and gender. Histopathological examination was made by an oral pathologist based on the criteria of the World Health Organization (2005). Data were subjected to descriptive statistical analysis using percentage and tables.

  Results

          80 presented criteria of odontogenic cysts. 49 cases (61.25%) were observed in men and 31 cases (38.75%) in women. Table-1.

       Most of odontogenic cysts were presented in the third decades of life (25) cases Table-2. The prevalence of the cysts was decreased with increasing the age.

         Radicular cyst was the most common diagnosis 23 cases (28.75%). Keratocyst 20 cases (25%) and Dentigerous cyst 19 cases (23.75%) were other most common diagnosis,     the prevalence of these lesions is shown in Table-1.

           

         Information regarding the anatomic sites involved was 44 cases (55%) affecting the mandible, most of mandibular lesions were located in premolar and molar area (posterior mandible), with 36 cases (45%) affecting the maxilla, most of maxillary lesions were located in incisors  and canine area  (anterior maxilla)  Table-3.

              All the patients had clinical symptoms in referring time except 3 patients whose lesion was accidentally diagnosed in dental radiography.

The most common clinical presentation was swelling reported in (94%) of cases Table-4, pain, tooth displacement and Bucco-lingual expansion was observed in (69%), (23%)   and (43%) of cases respectively.  

 

Table 1: Gender distribution of patients with odontogenic cyst.

 

Male

Female

%

Number 

Type of cyst

14

9

28.75%

23

Radicular cyst

12

 

8

25%

20

Keratocyst

12

7

23.75%

19

Dentigerous cyst

 

7

4

13.75%

11

Eruption cyst

4

3

8.75%

7

Residual cyst

49

31

100%

80

Total

           

 

  

 

 

 

 

Table 2: Age distribution of patients with odontogenic cyst.

                       

 

Age in years

 

Total

>51

41-50

31-40

21-30

11-20

1-10

Type of cyst

23

2

3

4

7

5

2

Radicular cyst

20

1

2

2

9

6

0

Keratocyst

19

0

1

3

5

5

5

Dentigerous cyst

11

0

0

0

1

3

7

Eruption cyst

7

0

2

2

3

0

0

Residual cyst

80

3

8

11

25

19

14

Total

 

     

Table3: Distribution of odontogenic cysts according to anatomic site

 

Total

Posterior mandible

Anterior mandible

Posterior maxilla

Anterior maxilla 

Type of cyst

23

08

05

04

06

Radicular cyst

 

20

 

13

 

01

 

02

 

04

Keratocyst

19

07

02

02

08

Dentigerous cyst

11

03

03

0

05

Eruption cyst

7

02

0

01

04

Residual cyst

80

33

11

9

27

Total

 

 

 

                               

               Table 4:  Clinical  characteristics  of  odontogenic  cysts

Swelling

    Pain

Bucco lingual expansion

Tooth displacement

 

 

100%

90%

25%

10%

Radicular cyst

 

90%

50%

10%

20%

Keratocyst

 

80%

15%

80%

70%

Dentigerous cyst

 

100%

100%

60%

0

Eruption cyst

 

100%

90%

40%

15%

Residual cyst

 

94%

69%

43%

23%

Total

 

 

                 

 

 

Discussion:

           Odontogenic cysts are one of the most common lesions affecting the jaws and many of these cysts share similar clinical and radiographic features (11) .Therefore, the diagnosis of odontogenic cysts should be based on careful examination of clinical, radiographic, and histopathologic features (12) .

         Awareness of incidence of odontogenic cysts and their prevalent sites of presentation may help practitioners to make a likely clinical diagnosis (13) .

The prevalence of male was greater than female in our study, which is in agreement with other authors like J P Meningaud et al (14) .This higher prevalence of males in our study may be explained by the fact that men usually have poorer oral hygiene, habits and are more susceptible to trauma than women.  

   The mean age at diagnosis was significantly lower than most studies (15), it may be as the result of early referee for diagnosis of these lesions or may be related to more exposure of patients to predisposing factors of odontogenic cysts in our province.

          In agreement with many studies the most common cyst in our study was radicular cyst, radicular cysts are inflammatory lesions caused by infection of the tooth pulp chamber. Toxins exit the apical foramen and infect the connective tissue of the periodontal ligament. (16) Radicular cysts are the most prevalent odontogenic cysts according to all studies reviewed, with slight variations(17). In our study, radicular cysts accounted for (28.75) % of all cases but the percentage was not as high as these studies (18), this difference may show the effect of socioeconomic factors on frequency of odontogenic cysts. On the other hand the radicular cysts are usually treat in private and did not refer to our department, it is possible that the socioeconomic conditions of the population might influence the relative frequency of inflammatory and developmental odontogenic cysts. Koseoglu BG et al  observed a higher frequency of developmental odontogenic cysts in patients seen at a private clinic and a higher proportion of inflammatory odontogenic cysts in patients attended at a public health service (19).

Most of mandibular lesions were located in posterior region and odontpgenic keratocyst was more prevalent in mandible, which has been reported as the most common location of odontogenic cysts (20). odontpgenic keratocyst were the second most common odontogenic cyst in our series (27%) in contrast to other studies such as Neville BW (21) .

 Maxillary odontogenic cysts were more prevalent in anterior region which in agreement with many studies (22,23) , but differs from those reported by Myoung H, et al(24) .The concordance between our own findings and the different published articles regarding distribution by dental arch  may be explained by the high prevalence of traumatisms and conservative treatments carried out for esthetic reasons in anterior teeth (25).

      The most common clinical feature was swelling and pain, the vast majority of ontogenic cysts of the jaws, cause slowly progressive painless swellings. There are no symptoms until they become quite large or infected, the swelling becomes painful and may rapidly increase in

size, partly due to inflammatory edema , this finding was in agreement with most of studies (26) .

     The results of our study were in concordance with earlier studies in some aspects, but some differences were also observed which is probably relates to differences in lifestyle, racialism and living environment.

Conclusions

          In conclusion, the present results show a similar frequency of odontogenic cysts in the Iraqi population studied here and other populations around the world, with inflammatory cysts being identified as the most frequent odontogenic cyst. Radicular cysts, odontogenic keratocysts cysts and dentigerous cyst are the most common odontogenic cysts, accounting for (77.5)% of all odontogenic cysts. Further studies including large series of odontogenic cysts  should be performed in different regions of the world in order to determine the global epidemiologic profile of these lesions.

 

 

 

References

 

1. Lelia-Batista de Souza, Manuel-Antonio Gordon-Nunez. Odontogenic cysts: Demographic profile in a Brazilian population over a 38-year period. Med Oral Patol Oral Cir Bucal 2010;15(4):583-90.

2. Jones AV, Craig GT, Franklin CD. Range and demographics of odontogenic cysts diagnosed in a UK population over a 30-year period. J Oral Pathol Med. 2006;35:500-7.

3. Ali MA. Expression of extracellular matrix metalloproteinase inducer in odontogenic cysts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 106:258-63.

4. Ochsenius G, Escobar E, Godoy L, Peñafiel C. Odontogenic cysts: analysis of 2,944 cases in Chile. Med Oral Patol Oral Cir Bucal. 2007;12:E85-91.

5. Cawson, R.A., E.W. Odell and S.R. Porter, 2002. Cawsons Essentials of Oral Pathology and Oral Medicine. 7th Edn., Churchill Livingstone, Edinburgh, ISBN-10: 0443071055, pp: 402 pages.

6. De Souza, L.B., M.A. Gordon-Nunez, C.F.W. Nonaka, M.C. de Medeiros, T.F. Torres and G.B.G. Emiliano, 2010. Odontogenic cysts: Demographic profile in a Brazilian population over a 38-year period. Med. Oral Patol. Oral Cir. Bucal., 15: e583-90..

7. Mosqueda-Taylor A, Irigoyen-Camacho ME, Diaz-Franco MA, Torres-Tejero MA. Odontogenic cysts. Analysis of 856 cases. Med Oral. 2002;7:89-96.

8. Meningaud JP, Oprean N, Pitak-Arnnop P, Bertrand JC. Odontogenic

cysts: a clinical study of 695 cases. J Oral Sci. 2006;48:59-62.

9. Parra FC, Amado RC, Lambertucci JR, Rocha J, Antunes CM, Pena SD. Color and genomic ancestry in Brazilians. Proc Natl Acad Sci U S A. 2003;100:177-82.

10. Edamatsu M, Kumamoto H, Ooya K, Echigo S. Apoptosis-related factors in the epithelial components of dental follicles and dentigerous cysts associated with impacted third molars of the mandible. Oral Surg Oral Med

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نشر في 2013-07-29