Abstract
Introduction
Patients presenting a recurrent benign jaw tumour have many complications, among which increased morbidities and mortalities, malignant degeneration of these benign tumours, aesthetic as well as functional sequalae and high medical bills. Hence, we sought out through a retrospective study to evaluate the patterns of these recurrences to help us appreciate and help predict recurrences to improve the overall wellbeing of these patients.
Methods
We carried out a retrospective study during the period of January 2010 to April 2020 at 3 medical centers in Yaoundé. We obtained the necessary ethical approval and administrative authorizations. All study participants having a histological diagnosis of a benign jaw tumour and presenting with at least one tumour recurrence were included in our study. The histological diagnoses were reconfirmed and we excluded all participants with pathology slides that could not be retrieved or those that could not undergo histological analysis.
Results
We retrieved 19 cases of benign tumour recurrences in this 10-year period and finally retained 14 cases of benign tumour recurrences in our study with a total of 7 different histological diagnoses. Also, all our cases of recurrences were found between the second and fifth decade with ameloblastoma having the most cases of recurrences in our study. The mean duration of recurrence for participants with one recurrence only was 6.31years ± 6.08, while those with ≥2 recurrences was 3.50years ± 2.95. Looking at the histomorphology, the mean duration of first recurrence of ameloblastoma in our study was 5 years, relatively shorter than the combined mean duration of first recurrence for all tumours recurrences which was 5.55years ± 5.49.
Conclusion
The mean duration of first, second and third recurrences were 5.55years ± 5.49, 2.17years ± 1.47 and 2.80years ± 2.88 respectively. These durations and patterns could help as surgical post operative follow up period after jaw tumour recurrences.
1
Introduction
Benign jaw tumours are a group of maxillofacial pathologies that are often asymptomatic and surgery is the main therapeutic option [ ]. This asymptomatic nature leads to sometimes fortuitous discovery by radiography or usually in the presence of a swelling in the maxillofacial region, where they can sometimes present as a radiolucency due to bone destruction hence are termed “pseudo tumours” [ ]. Despite this the diagnosis of benign jaw tumour is made following a histological examination in which they can be broadly divided into odontogenic tumours (more frequently encountered) and non-odontogenic[ ]. The World Health Organization (WHO) has issued several detailed classifications of benign jaw tumours over the year with the first in 1972 and the latest released in 2022 [ , ].
Treatment of these benign jaw tumours mainly by surgery results in complications such as tumour recurrence, malignant transformation [ ] and tumour sequalae. Recurrence of these tumours have been observed and described in our local context with a recurrence rate of 7.51 % [ , ]. Furthermore, these recurrences come with many complications such as increased morbidities as surgeons tend to become more radical to prevent future recurrences and this comes with increase chances of having maxillofacial sequelae which could be aesthetic and/or functional. These sequalae have been reported in our context by Dongmo et al. [ ].
However, early diagnosis, makes unnecessary a more aggressive therapeutic approach [ ] and this is made difficult paradoxically by the asymptomatic nature of these benign jaw tumours.
We have previously described clinical, therapeutic, radiological and histological factors implicated in benign jaw tumours recurrence [ , , , ]. However detailed study of the data on benign jaw tumour recurrence is vital as the therapeutics and prognosis of these tumours varies [ ] and this will aid in early detection.
Hence, we carried out this study to identify the time patterns of recurrences and correlate histological diagnosis of benign jaw tumours to delay of recurrence.
2
Methods
We carried out a retrospective study during the period of January 2010 to April 2020 in 3 medical centers in Yaoundé.
All study participants having a histological diagnosis of a benign jaw tumour and presenting with at least one tumour recurrence were included in our study.
The histological diagnosis was confirmed by a team of pathologists of both the initial tumours and the recurrences according to the 2005 WHO classification of head and neck tumours which was the classification at our disposal at the moment of undertaking this study. This confirmation was done for both the initial tumour diagnosis as well as the cases of recurrences, however in our study we present the diagnosis of the last histological analysis (that is the last recurrence).
We excluded all participants with pathology slides that could not be retrieved or those that could not undergo histological analysis.
We obtained ethical approval from the Ethical review board of the Faculty of Medicine and Biomedical Sciences of the University of Yaoundé I as well as administrative authorizations for our different medical centers.
3
Results
We retrieved 19 cases of benign jaw tumour recurrences in this 10-year period. Unfortunately, we could not reconfirm the histological diagnosis of 3 of these cases. In addition, 2 cases had a diagnosis of secondary ameloblastic carcinoma showing a malignant transformation of an initially benign tumour.
Hence, we retained 14 cases of benign tumour recurrences in our study.
3.1
Histomorphology and delay of recurrence
These 14 participants with recurrences had a total of 7 different histological diagnoses among them. Ameloblastoma had a mean duration of first recurrence of 5 years while Keratocystic odontogenic tumour (KCOT) had a mean duration of first recurrence of 3.3 years. The recurrence frequencies and mean duration of first recurrences are shown in Table I below.
| Variable | Number of recurrences N(%) |
Mean duration of first recurrence (in years) |
|---|---|---|
| Histological diagnostic | ||
| Ameloblastoma | 5 (31.25) | 5 |
| Ameloblastic fibroma | 2 (12.5) | 3 |
| Central giant cell granuloma | 1 (6.25) | 2 |
| Odontogenic myxoma | 1 (6.25) | 4 |
| Osteoma | 1 (6.25) | 5 |
| Keratocystic odontogenic tumour | 3 (18.75) | 3.3 |
| Cemento-osseous dysplasia | 1 (6.25) | 1 |
| Total | 14 |
All our cases of recurrences were found between the second and fifth decade with ameloblastoma having the highest number of recurrences with 5 in number as seen it Table II below.
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