|Year : 2014 | Volume
| Issue : 3 | Page : 170-173
Prevalence of odontogenic cysts and tumors: A retrospective clinico-pathological study of 204 cases
Sujatha Ramachandra1, Poosarla Chandra Shekar2, Srinivas Prasad2, Kurrba Kiran Kumar2, Gontu Sridhar Reddy2, Kantheti Lalith Prakash2, Baddam Venkat Ramana Reddy2
1 Department of Oral and Maxillofacial Pathology, Kalinga Institute of Dental Sciences, Bhubaneswar, Odisha, India
2 Department of Oral and Maxillofacial Pathology, SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh, India
|Date of Web Publication||14-Aug-2014|
Poosarla Chandra Shekar
Department of Oral and Maxillofacial Pathology, SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh
Background: The purpose of this study was to determine the prevalence of odontogenic cysts (OCs) and tumors over a period of 5 years and 5 months and to compare with other national and international studies. Materials and Methods: Data for the study were obtained from the reports of patients diagnosed with OCs and tumors between 2007 and 2012. Case records of the patients that fit the histological classification of the World Health Organization (2005) were included in the study and the following variables were analyzed: Age, sex, anatomical location, and histological type. Results: In a total of 1331 biopsies OCs accounted for 9.6% and odontogenic tumors (OTs) 5.7% among all the lesions. Mean age of occurrence was 41.5 years for OCs and 39.5 years for OTs. Of them 57.6% of the patients were males. Most common OC was dentigerous cyst and tumor was ameloblastoma. Conclusion: This study provides epidemiological information on OCs and tumors at an institutional level. The relative frequency of these cysts and tumors can be analyzed at a global level to understand their prevalence, incidence biological behavior, and distribution.
Keywords: Ameloblastoma, dentigerous cyst, odontogenic cysts, odontogenic tumors
|How to cite this article:|
Ramachandra S, Shekar PC, Prasad S, Kumar KK, Reddy GS, Prakash KL, Reddy BV. Prevalence of odontogenic cysts and tumors: A retrospective clinico-pathological study of 204 cases. SRM J Res Dent Sci 2014;5:170-3
|How to cite this URL:|
Ramachandra S, Shekar PC, Prasad S, Kumar KK, Reddy GS, Prakash KL, Reddy BV. Prevalence of odontogenic cysts and tumors: A retrospective clinico-pathological study of 204 cases. SRM J Res Dent Sci [serial online] 2014 [cited 2020 May 25];5:170-3. Available from: http://www.srmjrds.in/text.asp?2014/5/3/170/138727
| Introduction|| |
Cysts and tumors derived from the odontogenic tissues constitute an unusually diverse group of lesions. This diversity reflects the complex development of the dental structures, since all these lesions originate through some alteration from the normal pattern of odontogenesis. Some lesions included in this category may in fact not represent neoplasia at all, but are only minor alterations in the normal process of tooth development. Lesions such as cysts are also tumors only in the broadest sense of the word and do not represent true neoplasms. 
Since a number of cystic lesions and tumors of the jaws share similar clinical and radiographic features,  the diagnosis of odontogenic cysts (OCs) and odontogenic tumours (OTs) usually requires a detailed analysis of clinical, radiographical, and histopathological findings. Despite some sampling bias, diagnostic services currently are the most reliable source of information regarding the relative frequency and clinico-pathologic features of OCs and OTs.  The treatment of choice is conditioned by a number of factors such as the size of the lesion, its location, the possible involvement of neighboring anatomical structures, or damage to dental structures. 
Despite the large number of studies on OCs, studies on OTs are relatively less in the literature and information regarding the demographic profile of these lesions in different populations is scarce. However, the present study was designed to know the relative frequency of OCs and tumors, to know their clinic-pathological characteristics, and to review the literature on this subject.
| Materials and methods|| |
All cases of OCs and tumors diagnosed histopathologically between 2006 and 2012 (June) were reviewed from the archives of the Department of Oral and Maxillofacial Pathology. The following variables were recorded: Gender, age, site, radiological features of the lesions and correlating with histological findings. To classify the location of the cysts and tumors, each jaw was divided into an anterior and a posterior zone. The anterior zone included the incisors, canines and premolars, and the posterior zone consisted of the molars and ramus/tuberosity. If a tooth could be implicated, then irrespective of the extent of the lesion, it was classified in the zone in which the tooth was located. Otherwise, it was placed in the zone according to radiographic evaluation. The data was analyzed and graphs were formulated respectively.
| Results|| |
Among 1331 biopsy reports analyzed, 128 cases of OCs (9.61%) and 76 (5.7%) OTs were diagnosed. The patient's age ranged between 12 and 69 years with a mean age of 41.5 for OCs and 8-75 years with a mean age of 39.5 years for OTs. The most common age of occurrence for both (OCs and OTs) was between 21 and 50 years [Graph 1 [Additional file 1]] and [Graph 2 [Additional file 2]].
The gender distribution showed a slight male predilection [Table 1] in OCs, while the OTs showed female predilection [Table 2]. OCs were more commonly involved in mandible (n = 82, 64.06%) than in maxilla (n = 46, 35.93%). The majority of dentigerous cysts (DCs) and odontogenic keratocysts (OKCs) were detected in the posterior mandible. The incidence of radicular cysts (RCs) was more common in anterior maxilla, [Graph 3 [Additional file 3]].
While the OTs were mainly confined to posterior mandible than any other site [Graph 4 [Additional file 4]]. Most commonly encountered tumor was ameloblastoma, followed by odontoma.
| Discussion|| |
Cysts and tumors derived from the odontogenic tissues constitute an unusually diverse group of lesions. This diversity reflects the complex development of the dental structures, since all these lesions originate through some alteration from the normal pattern of odontogenesis. Many of these lesions share same clinical and radiographical features.
Therefore, the diagnosis of OCs and OTs should be based on careful examination of clinical, radiographical, and histopathological features. Most of the information regarding the prevalence of OCs and tumors comes from diagnostic services and despite some sampling bias, these services represent a reliable source of information regarding the relative frequency and clinical-pathologic features of OCs and tumors. ,
According to previous studies of Ledesma-Montes et al.  and Avelar et al.  OCs were diagnosed in 7-12% of all oral and maxillofacial biopsies, which is in agreement with the findings presented here (9.61%). In the present study, OCs occurred more commonly in males, which confirmed conclusions of other studies.  Mandible is the most frequently affected site, which is divergent with the studies of Ochsenius et al.  and de Souza et al. 
Odontogenic tumors are derived from epithelial, ectomesenchymal and/or mesenchymal elements of the tooth-forming apparatus. These heterogeneous tumors, although rare, pose a significant diagnostic and therapeutic challenge. Knowledge of relative frequency and basic clinical features will be of great use in their study and clinical management. 
In the present study, OTs occurred most commonly in females which is similar to the studies done by Fernandes,  Ochsenius et al.  but in contrast to the studies done by Adebayo et al.  Mandible being the most common affected site in our study is similar to studies conducted by Adebayo et al.  Ladeinde et al.  and contrast with studies conducted by Ochsenius et al.  and Olgac et al. 
The most common OC encountered was DC, which encountered for about 42.18%, which is in disagreement with the studies conducted by Tay.  A greater frequency of DCs was found among the male gender that is, 59.35%, which is in concurrence with Avelar et al.  Concerning the preferential site of DCs, the results of the present study (mandible) differ from those described by Waldron,  who found the upper third molars to be the most prevalent site.
In the present study, RCs accounted for 33.59% of all OCs and occupied the second place, which is in disagreement with studies done by Tay.  The prevalence among the male gender (53.48%) was slightly higher than the female gender in the present study, which is in disagreement with some studies conducted by Ochsenius et al.  According to the literature, the most affected site is the anterior region of the maxilla which is in agreement with our study.
Odontogenic keratocyst occupied third position in our study (22.65%) which is similar to studies conducted by Ramachandra et al.  and in contrast to studies conducted by Daley et al.  In relation to gender, we observed a moderate predominance of males 55.17% similar to other studies  OKCs in our study were seen most commonly in mandibular region, which is in hand in hand with the studies conducted by Ochsenius et al. 
Glandular OCs with the lowest prevalence (0.7%), which confirmed findings of studies carried out by Ochsenius et al.  and Prockt et al.  In the study carried out by Ochsenius, these lesions were more prevalent in the female gender (100% of the cases studied), which is in disagreement with the findings of the present study, in which these lesions were more prevalent among the male gender.
In the present study, ameloblastoma (68.42%) was the most common type of OT followed by odontoma (7.89%). The high frequency of ameloblastoma and low frequency of odontoma are consistent with the data from Africa, , whereas in most of the American studies,  odontoma occurred with the highest frequency. These discrepancies probably result from geographic variation, but it should be mentioned that the incidence of odontoma in some countries was likely underestimated due to the unique clinical features of this tumor.  There was a higher female prevalence among the patients with ameloblastoma in the present study, which is similar to those observed in the series from South America.  90.38% of ameloblastomas occurred in the mandible, especially posterior region.
Though, odontomas are thought to be hamartomatous lesions  we have included them in our study as they were categorized under the benign tumors of World Health Organization 2005 classification of OTs and allied lesions. They accounted for 7.89% of all those OTs in our study, which is similar to studies done at Africa.  Our study showed a higher male prevalence when compared to females, which is in accordance with Nigerian series by Adebayo et al.  but in contrast to the female preponderance reported from Brazil.  In our study all the odontomas were restricted to mandible.
Adenomatoid odontogenic tumor (AOT) accounted for 7.89% of all the OTs in our study. There was equal distribution among males and females observed in this series, which was not in accordance with the data from previous reports. , AOT occurred predominantly in mandible in our study but other studies showed equally in both jaws. 
Ameloblastic fibroma accounted for about 6.57% of all the OTs, which is not in agreement with many internationally published series , (0.6-4.5%), which is more in males and seen only in mandible.
Calcifying epithelial OTs accounted for about 3.94%, which was more when compared to other studies. ,, One case was seen in maxilla, while other restricted to mandible. Females were more affected than males.
Odontogenic myxoma composed 2.63% of all the OTs in this study and 4.7-17.7% in previous reports. , It was seen only in females, which was restricted to mandible.
Peripheral odontogenic fibroma accounted for 2.63% similar to odontogenic myxoma in our study, while this tumor was more frequent in other series. ,
| Conclusion|| |
This study provides epidemiological information on OCs and tumors institutional level. Retrospective analyses of the relative frequency of OCs and tumors in different countries will be of tremendous help in improving the understanding of these lesions, which is valuable for both oral and maxillofacial surgeons and pathologists. The differences in the frequencies of these lesions could be due to geographical variations.
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[Table 1], [Table 2]