Aesthetic and functional sequelae of patients operated upon for benign jaw tumours at a tertiary hospital in Cameroon

Abstract

Introduction and general objective

Benign tumours develop locally and remain confined to the tissue in which they originate. They grow slowly. However, they can grow to significant size and weight. They rarely reoccur after surgical removal. Their evolution is generally favourable. In some cases, however, they can cause serious or even morbid complications, due to their location or metabolic disorders.There are two types of management for these tumours: conservative surgery, which consists of removing the tumour with a margin of healthy surrounding tissue, while preserving the role and appearance of the organ in question; and radical surgery, which is the removal of a diseased organ and all surrounding tissues likely to be affected by the disease. These treatments can lead to loss of substance, resulting in both functional and aesthetic sequelae.

The general objective of our study was to: Determine the aesthetic and functional sequelae of patients operated on for benign jaw tumours at the Yaoundé Central Hospital.

Methodology

We conducted a descriptive cross-sectional from January 1, 2013 to January 1, 2023 with prospective data collection in the ENT and Cervico Maxillofacial Surgery Department of the Yaoundé Central Hospital. Patient recruitment was consecutive and non-exhaustive. Epidemiological, clinical and anatomopathological data were collected, as well as the various aesthetic and functional sequelae.

This study concerned all patients operated on for benign tumours presenting anatomopathological evidence and having given their informed consent at the Yaoundé Central Hospital. Patients who were lost to follow-up, deceased or who had not given consent were excluded.

Results

39 patients were recruited; 16 men and 23 women, giving a sex ratio of 0.69. The mean age was 36.18 ± 15.38 years, a minimum of 14 years and a maximum of 71 years. Ameloblastoma was the most common tumour (38.5 %). The most common method of treatment was radical surgery, and the most common material used for reconstruction was the screw-plate (86.9 %). Sequelae were found in 35 patients (89.74 %), the most common functional sequelae being impaired mastication (92.5 %). Aesthetic sequelae were mainly marked by facial asymmetry (66.7 %).

Conclusion

The fourth decade of female gender was the most represented population among patients operated on for benign tumours of the jaws. Radical surgery was more commonly used in our work. Among the aesthetic sequelae in our study, we noted facial asymmetries, scars and their location were predominantly mandibular. The most common functional sequelae were impaired mastication, nerve damage and impaired speech.

1

Introduction

Maxillofacial pathologies are multiple and diverse. They include infections, congenital malformations, trauma and tumours. A tumour is any tissue neoformation (of varying size) that resembles the normal adult or embryonic homologous tissue at the expense of which it developed, has a tendency to persist and increase and escapes the biological rules of cell growth and differentiation [ ]; it may be benign or malignant.

Benign tumours develop locally and remain confined to the tissue in which they originate. They grow slowly. However, they can grow to a significant size and weight. They rarely recur after surgical removal. Their evolution is generally favourable. In some cases, however, they can cause serious or even morbid complications, due to their location or metabolic disorders.

There are two types of treatment for these tumours: conservative surgery and radical surgery. Conservative surgery involves removing the tumour with a margin of healthy surrounding tissue, while preserving the role and appearance of the organ in question. Radical surgery, on the other hand, removes a diseased organ and all the surrounding tissues that are likely to be affected by the disease. These procedures can lead to loss of tissue, resulting in both functional and aesthetic sequelae.

In a study by Devine et al., a comparison was made between the transcutaneous approach with a labio -genic flap and the transcutaneous approach with a visor-type flap. In this study, it was found that the visor flap reported more sequelae such as impaired speech, facial asymmetry, impaired mastication and loss of tongue mobility [ ]. In India, Venkatesh et al. found hypoesthesia of the lingual nerve with a prevalence of 15 %, hypoesthesia of the inferior alveolar nerve with a prevalence of 10 %, and a decrease in the amplitude of mouth opening [ ]. In Nigeria, Anyanechi et al. report sequelae such as malocclusion, facial asymmetry and impaired mastication, with a prevalence of 58.0 % [ ].

In the literature we consulted, we did not find any studies conducted in our context. However, several patients benefit from surgical management of benign jaw tumours. Our work therefore aims to add to the data available in the literature.

General objective

To determine the aesthetic and functional sequelae of patients operated on for benign tumours of the jaws at the Yaoundé Central Hospital.

2

Material and methods

We conducted a cross-sectional prospective descriptive study in the ENT and Cervico-Maxillofacial Surgery Department of the Yaoundé Central Hospital. We collected data over a ten-year period from January 2013 to January 2023. Our study population entailed patients operated on for benign tumours of the jaws at the Yaoundé Central Hospital during our recruitment period. Any patient who had undergone surgery for a benign tumour at the ENT and Cervico Maxillofacial Surgery Department of the Yaoundé Central Hospital presenting anatomopathological evidence was included in our study. Patients lost to follow-up, deceased and patients who did not give their consent were excluded.

Before starting the study, we obtained research authorisation and ethical clearance from the institutional ethical review board of the Faculty of Medicine and Biomedical Sciences (FMBS) at the University of Yaoundé I.

3

Results

Sociodemographic characteristics of our population

In our study (n = 39), we retained 16 men (41.0 %) and 23 women (51.0 %) with a sex ratio of 0.69.

Age distribution of study participants

In our study, patients ranged in age from 14 to 71 years, with a mean age of 36.18 ± 15.38 years. Patients aged between 34 and 44 were the most numerous, as shown in Fig. 1 below.

Fig. 1
Age distribution of study participants.

3.1

Clinical profile of our population

  • 1.

    Delay in consultation

In our series (n = 23) 59.0 % of patients were consulted after more than 12 months. Similarly, almost all of our patients presented with swelling (97.4 %, n = 38). Most of our patients were referred cases (71.8 %, n = 28).

  • 2.

    Clinical presentation of our study participants

All the patients in this study had lesions with well-defined boundaries. The majority of lesions were on the right side (56.4 %) and on the body of the mandible (80.64 %). The size of the lesions varied, with the majority being medium-sized (4–10 cm, 58.9 %) and a significant proportion larger than 10 cm (41.0 %). Lesions were predominantly firm (64.1 %), with more than half of patients experiencing pain (56.41 %). A minority of patients had nerve damage (15.8 %). Regarding the histological diagnosis, ameloblastoma was the most represented tumour in our study with 38.5 %(n = 15)

  • 3.

    Anatomopathological classification of benign jaw tumours in our study participants

In our study, we used the WHO 2022 classification of benign tumours of the jaws. Ameloblastoma was the most represented tumour (35.9 %), followed by fibrous dysplasia (10.3 %) and dentigerous cyst (10.3 %). Osteoma, odontoma and ameloblastic fibroma were the least represented tumours (2.6 %) as seen in Table 1 .

  • 4.

    Surgical management of study participants

Table 1
Anatomopathological profile of tumours observed in our study.
Variables Number (N = 39) Percentage (%)
Ameloblastoma 15 38.5
Odontogenic fibroma 2 5.1
Fibrous dysplasia 4 10.3
Dentigerous cyst 4 10.3
Naso-palatine duct cyst 4 10.3
Inflammatory collateral cyst 2 5.1
Central giant cell granuloma 2 5.1
Odontoma, complex type 1 2.6
Odontogenic keratocyst 1 2.6
Ameloblastic fibroma 1 2.6
Osteoma 1 2.6
Calcifying epithelial Odontogenic Tumour 1 2.6
Simple bone cyst 1 2.6

In our study, the extraoral approach was the most commonly used (61.53 %) and the intraoral approach was the less commonly used (38.47 %). In our series, 23 patients were treated by radical surgery (56.4 %) and 17 patients (43.6) were treated by conservative surgery ( Table 2 ). In conservative surgery, enucleation with curettage and cauterisation was predominant (82.4 %). For radical surgery, segmental resection of the mandible was more common (50 %). In this study, 11 patients had segmental resection of the mandible amongst which 2 had mandibular disarticulation.

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Mar 29, 2025 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Aesthetic and functional sequelae of patients operated upon for benign jaw tumours at a tertiary hospital in Cameroon

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