International Journal of Oral Health Sciences

ORIGINAL ARTICLE
Year
: 2018  |  Volume : 8  |  Issue : 2  |  Page : 86--91

A review of oral and maxillofacial biopsies from a new academic health facility in remote Northwestern Nigeria


Adebayo Aremu Ibikunle1, Abdurrazaq Olanrewaju Taiwo1, Ramat Oyebunmi Braimah1, Mohammed Sambas Umar2,  
1 Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
2 Department of Histopathology, Faculty of Basic Clinical Sciences, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

Correspondence Address:
Adebayo Aremu Ibikunle
Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto
Nigeria

Abstract

Background: Histological diagnosis is invaluable in charting the overall management of human pathologies. Knowledge of the general trend of histological diagnosis in a population may impact the clinician's practice as well as public health policy formulation. There is a paucity of literature on biopsy-driven epidemiology of oral and maxillofacial lesions, especially in sub-Saharan Africa. Objective: This study aims to determine the pattern of biopsied oral and maxillofacial lesions at a Nigerian tertiary hospital. Materials and Methods: A 5-year retrospective review of the histological diagnoses of patients who had biopsies of oral and/or maxillofacial lesions done at our teaching hospital was done. Biopsy reports obtained within the study period were retrieved and analyzed. Analysis was performed using the IBM SPSS statistics for windows version 20 (IBM Corp, Armonk, NY) software. Results: Three hundred and sixteen biopsy reports were included in this review. A slight male preponderance was observed, with a male-to-female ratio of 1:0.96. The age ranged from 6 months to 90 years (mean ± standard deviation, 33.3 ± 19.9). The posterior mandible was the most commonly affected site 13.9% (44). Most of the lesions were neoplastic 70.9% (224) with a slight majority being malignant. Squamous cell carcinoma (SCC) was the most frequently diagnosed malignancy 11.7% (37). Most nonneoplastic lesions were inflammatory/infectious 52.8% (47). Conclusion: Nearly equal gender prevalence for oral and maxillofacial biopsies was observed. In contrast to several studies, malignancies were more frequently diagnosed than benign neoplasms. The high incidence of SCC suggests the need for population interventions targeted at screening and early diagnosis.



How to cite this article:
Ibikunle AA, Taiwo AO, Braimah RO, Umar MS. A review of oral and maxillofacial biopsies from a new academic health facility in remote Northwestern Nigeria.Int J Oral Health Sci 2018;8:86-91


How to cite this URL:
Ibikunle AA, Taiwo AO, Braimah RO, Umar MS. A review of oral and maxillofacial biopsies from a new academic health facility in remote Northwestern Nigeria. Int J Oral Health Sci [serial online] 2018 [cited 2019 Aug 20 ];8:86-91
Available from: http://www.ijohsjournal.org/text.asp?2018/8/2/86/247802


Full Text



 Introduction



Histological diagnosis is invaluable in deciding the choice of treatment and overall management of human pathologies.[1],[2],[3] This has tremendous impact on the prognostication of such diseases, morbidity and mortality.[3],[4] Having the knowledge of the general trend of histological diagnosis in a population might influence not only on the clinician's practice but also the health planning and policy formulation. Moreover, reviews of histological diagnoses may give an insight into the epidemiology of diseases in an environment which may also serve as a basis for the developing and driving health policies.

There is a paucity of literature on hospital-based biopsy-driven epidemiology of oral and maxillofacial lesions worldwide; this is especially so in sub-Saharan Africa. This study aims to provide information on the pattern of histological diagnoses of oral and maxillofacial lesions made at a Nigerian tertiary hospital.

 Materials and Methods



A retrospective review of the histological records of patients who had tissue biopsy done at our department between January 2013 and December 2017 was done. For biopsies that were repeated, only the most representative result was recorded for the patient. Fine-needle aspiration biopsies results, nonspecific results, and histopathological reports with no identified pathologies were excluded. Furthermore, cases with ambiguous or indecisive histopathology reports were excluded. The patients' gender, age, site of the tumor, and classification of the lesion were extracted from our records.

A modification of the classification used by Pinto and de Araújo[5] was utilized to classify the site affected into anterior mandible, posterior mandible, anterior maxilla, posterior maxilla, anterior and posterior mandible, anterior and posterior maxilla, upper lip, lower lip and its mucosa, upper lip and its mucosa, tongue, and floor of the mouth, cheek/buccal mucosa.[5] Where the location was not stated, they were grouped as “not specified.” The anterior maxilla and mandible refer to the segment of the maxilla or mandible between the distal aspect of the right canine and the distal portion of the left canine. The posterior maxilla and mandible refers to the segment of the maxilla or mandible between the mesial aspect of the first premolar and the distal aspect of the third molar.

The lesions were broadly classified as neoplastic and nonneoplastic. The neoplastic lesions were further divided into benign and malignant. The nonneoplastic group was additionally divided into six subgroups using a modification of the classification system employed by Guedes et al.[6] These are cystic lesions, adaptive/reactive lesions, inflammatory/infectious lesions, autoimmune/metabolic lesions, vascular lesions, and hamartomatous/congenital/developmental lesions.

 Results



A total of 316 biopsy results were included in this 5-year review. A slight male preponderance was observed, with a male-to-female ratio of 1:0.96 [Table 1]. The age ranged from 6 months to 90 years (mean ± standard deviation, 33.3 ± 19.9) [Table 1]. The modal age group of presentation was the third decade of life (21–30 years) [Figure 1]. Most of the biopsies were obtained intraorally 231 (73.1%). The anatomical site most frequently affected was the posterior mandible 13.9% (44) [Figure 2]. Majority of the biopsies were neoplastic 70.9% (224), while 29.1% (92) were nonneoplastic. Of the neoplastic lesions diagnosed, a slight majority were malignant lesions [Table 1]. A ratio of 1.1:1 was observed between the malignant and benign neoplastic lesions correspondingly. The most commonly encountered benign neoplasm was ameloblastoma 11.1% (35), while squamous cell carcinoma (SCC) was the most frequently diagnosed malignancy 11.7% (37) [Table 2].{Table 1}{Figure 1}{Figure 2}{Table 2}

Salivary gland lesions constituted 18.7% (59) of all the diagnosed biopsies [Table 2]. Most of the salivary gland tumors were malignant accounting for 64.4% (38) of all salivary gland neoplasms. Pleomorphic adenoma was the most common benign salivary gland neoplasm representing 7.9% (25) of all biopsies, while mucoepidermoid carcinoma was the most frequently diagnosed malignant salivary gland tumor accounting for 4.1% (13) of all biopsies [Table 2].

Among the nonneoplastic biopsies obtained, most were inflammatory or infectious in nature 52.8% (47), followed by the reactive lesions 13.5% (12).

 Discussion



Reviews of histological diagnoses at hospitals provide an important insight into the epidemiology of diseases. Such information may be deployed in the formulation and/or implementation of health policies.

Male preponderance was noted in this study which is similar to the reports by Bello et al.[7] and Ha et al.[8]. However, it contrasts with the report by Lima et al.[9] who reported a female preponderance and that of Sohal and Moshy[10] who reported equal sex prevalence. The observed male dominance in this study may not be a true reflection of the incidence of oral and maxillofacial lesions between the male and female genders. Our society is still largely patriarchal, and thus, males are more likely to be empowered enough to seek quality health care.[11] Moreover, out-of-pocket payment for health care is widespread in our climes, and males being generally more financially empowered are more likely to be able to access health care.[12],[13]

The age range observed in this study was similar to those of several studies reported in the literature.[7],[14],[15]

The posterior mandibular region was the most frequently involved anatomical site in this series. This is similar to the results of other studies in the literature.[16],[17],[18] These observations may be attributed to the penchant of both primary and metastatic neoplasms for the mandible.[16],[19] Furthermore, some lesions have been associated with tooth impaction, which occurs most commonly in the posterior mandible.[20],[21] The posterior mandible is also replete with active hematopoietic sites and rich capillary vessels, which may entrap metastatic tumors cells and initiation of primary tumors.[19] Moreover, odontogenic infections and chronic inflammation are prevalent in the posterior mandible.[22],[23] Promotional influence of chronic inflammation on cellular mutation, proliferation, and tumorgenesis has been previously documented in the literature.[19],[24] Interestingly, Pinto and de Araújo,[5] in a study conducted among a Brazilian population, reported the lip to be the most common site for biopsies. This disparity may be associated with the higher prevalence of lip lesions among Caucasians.

Neoplastic lesions accounted for the majority of the diagnosed lesions in this study. We opine that the seemingly low incidence of nonneoplastic lesions in this study may be related to the typical persistent growth of neoplastic lesions.[13],[25] This may result in significant morbidity and impairment of patients' quality of life, therefore compelling them to present at the hospitals.[13],[25],[26] This is especially so in our environment where patients are often hindered from presenting early due to a myriad of factors.[27],[28],[29] Pain, swelling, consequent impairment of function, and reduced quality of life are some of the major factors that eventually compel patients to present at hospitals in our climes.[30],[31]

Malignancies featured prominently among the neoplasms, constituting a slim majority. This observation agrees with some reports in the literature.[32] However, it is in disagreement with multiple studies in the literature, where higher frequencies of benign lesions were reported.[14],[15],[33],[34] This contrast may be because some of the studies were limited to pediatric populations, where benign lesions are more regularly encountered than malignancies.[10] It may also be an indication of the risk of developing malignancies compared to benign neoplasms among the study population.

Ameloblastoma was the most commonly diagnosed benign neoplasm. This is in agreement with several African studies, although, it is at dissonance with some European or American study.[15],[35],[36] Some authors have hypothesized that ameloblastoma has a predilection for persons of African descent.[37],[38] Odontomas are reported to be the most frequently diagnosed odontogenic tumors among younger age groups in several European articles.[39],[40],[41] This may be because they are generally asymptomatic and are often diagnosed during routine visits to the hospital. Routine visits to the hospital for evaluation are not a widespread practice in our climes; therefore, the frequency of these lesions may not be properly appreciated.

SCC was the most frequently diagnosed malignant neoplasm in this study. This agrees with the reports of several studies, both within and outside Africa.[26],[42],[43] This may be related to the increasing prevalence of indulgence in deleterious practices such as tobacco smoking, snuff dipping, and unsafe sex practices in our environment.[26],[44] Extraorally located SCC was not frequently encountered in this study. The reason for the relative rarity of extraorally sited SCC may be attributed to the fact that this study was done among mostly dark-skinned individuals. Melanin has been proven to confer some protection against the unwanted effects of ultraviolet rays.[45],[46]

Salivary gland lesions constituted a large proportion of the total sample size. This is in higher than figures reported by Akinyamoju et al.[47] who reported that salivary gland lesions and neoplasms constituted 11.02% (196) of oral histopathology reports in their study. This observation may be because they included histopathology reports of normal tissue in their data analysis. Ha et al.[8] and Ali et al.[14] reported even lower incidence of salivary gland lesions in their study although the former study was based on a pediatric population and the latter included a significant number of the neck, laryngeal, and thyroid gland lesions.

Majority of the salivary gland neoplasms were found to be malignant in the present study. This agrees with some reports in the literature.[48],[49],[50] In contrast, Jaafari-Ashkavandi and Ashraf[51] stated that the benign salivary gland lesions are more common.[51] In consonance with most reports in the literature, pleomorphic adenoma was the most commonly diagnosed benign salivary gland neoplasm in this study.[52],[53] Mucoepidermoid carcinoma featured as the most frequently diagnosed salivary gland malignancy in this study. Differing reports exist in the literature about the identity of the most common malignant salivary gland neoplasm. While some studies have stated that mucoepidermoid carcinoma is the most common, others have presented adenoid cystic carcinoma as the most common.[26],[50]

Inflammatory/infectious lesions represented the most common category of diagnosed nonneoplastic lesions. This is not unexpected because chronic odontogenic infections are commonly encountered in our environment.[54],[55] In our climes, it is common for infective or inflammatory lesions arising from neglected carious lesions to progress into more sinister clinical entities.[54],[56] Cystic lesions were relatively less frequently diagnosed in this study compared to other studies in the literature.

 Conclusion



Almost equal gender prevalence for oral and maxillofacial biopsies was observed in this study. The third decade of life was the modal decade of presentation. In contrast to several studies, malignancies were more frequently diagnosed than benign neoplasms, indicating that oral and maxillofacial surgeons should have a high index of suspicion while managing the patients. However, further studies are needed to explore this. Furthermore, studies to determine factors that may be responsible for this untoward observation should be implemented. The high incidence of SCC suggests that population interventions targeted at screening and early diagnosis should be explored.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Rossi A, Maione P, Bareschino MA, Schettino C, Sacco PC, Ferrara ML, et al. The emerging role of histology in the choice of first-line treatment of advanced non-small cell lung cancer: Implication in the clinical decision-making. Curr Med Chem 2010;17:1030-8.
2Haines A, Sanders D, Lehmann U, Rowe AK, Lawn JE, Jan S, et al. Achieving child survival goals: Potential contribution of community health workers. Lancet 2007;369:2121-31.
3Störkel S, Kristiansen G, Moch H. The importance of pathology and genetics for the diagnosis and therapy of renal cell carcinoma. Eur Urol Suppl 2007;6:603-10.
4Gillett IR, Johnson NW, Curtis MA, Griffiths GS, Sterne JA, Carman RJ, et al. The role of histopathology in the diagnosis and prognosis of periodontal diseases. J Clin Periodontol 1990;17:673-84.
5Pinto AS, de Araújo NS. Epidemiological survey of oral and maxillofacial complex biopsies: 13 year retrospective study. Brazilian Dent Sci 2015;18:51-8.
6Guedes MM, Albuquerque R, Monteiro M, Lopes CA, do Amaral JB, Pacheco JJ, et al. Oral soft tissue biopsies in Oporto, Portugal: An eight year retrospective analysis. J Clin Exp Dent 2015;7:e640-8.
7Bello SA, Osodin T, Oketade I, Ibikari AB, Ighile N, Enebong DJ, et al. Pattern of maxillofacial surgical conditions in North central Nigeria: A 5-year experience of an indigenous surgical mission. Niger J Clin Pract 2017;20:1283-8.
8Ha WN, Kelloway E, Dost F, Farah CS. A retrospective analysis of oral and maxillofacial pathology in an Australian paediatric population. Aust Dent J 2014;59:221-5.
9Lima Gda S, Fontes ST, de Araújo LM, Etges A, Tarquinio SB, Gomes AP, et al. Asurvey of oral and maxillofacial biopsies in children: A single-center retrospective study of 20 years in Pelotas-Brazil. J Appl Oral Sci 2008;16:397-402.
10Sohal KS, Moshy JR. Oral and maxillofacial tumours. Prof Med J 2017;24:433-40.
11Makama GA. Patriarchy and gender inequality in Nigeria: The way forward. Eur Sci J 2013;9:115-44.
12Sibani CM. Gender inequality and its challenge to women development in Nigeria: The religious approach. Unizik J Arts Humanit 2017;18:432-49.
13Ibikunle AA, Taiwo AO, Braimah RO. Oral and maxillofacial malignancies: An analysis of 77 cases seen at an academic medical hospital. J Orofac Sci 2016;8:80.
14Ali AA, Suresh CS, Al-Tamimi D, Al-Nazr M, Atassi RA, Al-Rayes I, et al. A survey of oral and maxillofacial biopsies in the Eastern province of Saudi Arabia: A 10 years' retrospective study. J Oral Maxillofac Surg Med Pathol 2013;25:393-8.
15Bassey GO, Osunde OD, Anyanechi CE. Maxillofacial tumors and tumor-like lesions in a Nigerian teaching hospital: An eleven year retrospective analysis. Afr Health Sci 2014;14:56-63.
16Nalabolu GR, Mohiddin A, Hiremath SK, Manyam R, Bharath TS, Raju PR, et al. Epidemiological study of odontogenic tumours: An institutional experience. J Infect Public Health 2017;10:324-30.
17Dunfee BL, Sakai O, Pistey R, Gohel A. Radiologic and pathologic characteristics of benign and malignant lesions of the mandible. Radiographics 2006;26:1751-68.
18Naz I, Mahmood MK, Akhtar F, Nagi AH. Clinicopathological evaluation of odontogenic tumours in Pakistan – A seven years retrospective study. Asian Pac J Cancer Prev 2014;15:3327-30.
19Kumar G, Manjunatha B. Metastatic tumors to the jaws and oral cavity. J Oral Maxillofac Pathol 2013;17:71-5.
20Shin SM, Choi EJ, Moon SY. Prevalence of pathologies related to impacted mandibular third molars. Springerplus 2016;5:915.
21Braimah RO, Ibikunle AA, Taiwo AO, Ndukwe KC, Owotade JF, Aregbesola SB. Pathologies associated with impacted mandibular third molars in sub-Saharan Africans. Dent Med Res 2018;6:2.
22Flynn TR. Principles and surgical management of head and neck infections. Bagheri SC, editor. In: Current Therapy in Oral and Maxillofacial Surgery. St. Louis: Saunders; 2012. p. 1080-91.
23Bakathir AA, Moos KF, Ayoub AF, Bagg J. Factors contributing to the spread of odontogenic infections: A prospective pilot study. Sultan Qaboos Univ Med J 2009;9:296-304.
24Hirshberg A, Leibovich P, Buchner A. Metastatic tumors to the jawbones: Analysis of 390 cases. J Oral Pathol Med 1994;23:337-41.
25Gellrich NC, Handschel J, Holtmann H, Krüskemper G. Oral cancer malnutrition impacts weight and quality of life. Nutrients 2015;7:2145-60.
26Lawal AO, Adisa AO, Effiom OA. A review of 640 oral squamous cell carcinoma cases in Nigeria. J Clin Exp Dent 2017;9:e767-e771.
27Nnonyelu N, Nwankwo IU. Social determinants of differential access to health services across five states of Southeast Nigeria. Eur Sci J 2014;10:286-96.
28Titus OB, Adebisola OA, Adeniji AO. Health-care access and utilization among rural households in Nigeria. J Dev Agric Econ 2015;7:195-203.
29Adedini SA, Odimegwu C, Bamiwuye O, Fadeyibi O, De Wet N. Barriers to accessing health care in Nigeria: Implications for child survival. Glob Health Action 2014;7:23499.
30Ogbebor OG, Azodo CC. Reasons for seeking dental healthcare services in a Nigerian missionary hospital. Sahel Med J 2016;19:38.
31Osaghae IP, Azodo CC. Characteristics of patients requesting for tooth extraction in a Nigerian secondary health-care setting. Indian J Oral Health Res 2016;2:72.
32Aregbesola SB, Ugboko VI, Akinwande JA, Arole GF, Fagade OO. Orofacial tumours in Suburban Nigerian children and adolescents. Br J Oral Maxillofac Surg 2005;43:226-31.
33Kelloway E, Ha WN, Dost F, Farah CS. A retrospective analysis of oral and maxillofacial pathology in an Australian adult population. Aust Dent J 2014;59:215-20.
34Krishnan B, Sheikh MH, Rafa el-G, Orafi H. Indications for removal of impacted mandibular third molars: A single institutional experience in Libya. J Maxillofac Oral Surg 2009;8:246-8.
35Butt FM, Ogengo J, Bahra J, Chindia ML, Dimba EA, Wagaiyu E. A 19-year audit of benign jaw tumours and tumour-like lesions in a teaching hospital in Nairobi, Kenya. Open J Stomatol 2012;2:54.
36Gedik R, Müftüoğlu S. Compound odontoma: Differential diagnosis and review of the literature. West Indian Med J 2014;63:793-5.
37Santos Tde S, Piva MR, Andrade ES, Vajgel A, Vasconcelos RJ, Martins-Filho PR, et al. Ameloblastoma in the northeast region of Brazil: A review of 112 cases. J Oral Maxillofac Pathol 2014;18:S66-71.
38Arotiba GT, Ladeinde AL, Oyeneyin JO, Nwawolo CC, Banjo AA, Ajayi OF, et al. Malignant orofacial neoplasms in Lagos, Nigeria. East Afr Med J 2006;83:62-8.
39Iatrou I, Vardas E, Theologie-Lygidakis N, Leventis M. A retrospective analysis of the characteristics, treatment and follow-up of 26 odontomas in Greek children. J Oral Sci 2010;52:439-47.
40Skiavounou A, Iakovou M, Kontos-Toutouzas J, Kanellopoulou A, Papanikolaou S. Intra-osseous lesions in Greek children and adolescents. A study based on biopsy material over a 26-year period. J Clin Pediatr Dent 2005;30:153-6.
41de Oliveira BH, Campos V, Marçal S. Compound odontoma – Diagnosis and treatment: Three case reports. Pediatr Dent 2001;23:151-7.
42Tandon P, Dadhich A, Saluja H, Bawane S, Sachdeva S. The prevalence of squamous cell carcinoma in different sites of oral cavity at our rural health care centre in Loni, Maharashtra – A retrospective 10-year study. Contemp Oncol (Pozn) 2017;21:178-83.
43Vigneswaran N, Williams MD. Epidemiologic trends in head and neck cancer and aids in diagnosis. Oral Maxillofac Surg Clin North Am 2014;26:123-41.
44Adias TC, Ajugwo AO, Erhabor TA, Adejumo BI, Azikiwe CC. Effect of sub-lethal doses of smokeless tobacco (snuff) on some haemato-rheological parameters using Albino wistar rats. Am J Med Sci Med 2014;2:54-7.
45Brenner M, Hearing VJ. The protective role of melanin against UV damage in human skin. Photochem Photobiol 2008;84:539-49.
46Amaro-Ortiz A, Yan B, D'Orazio JA. Ultraviolet radiation, aging and the skin: Prevention of damage by topical cAMP manipulation. Molecules 2014;19:6202-19.
47Akinyamoju AO, Adeyemi BF, Adisa AO, Okoli CN. Audit of oral histopathology service at a Nigerian tertiary institution over a 24-year period. Ethiop J Health Sci 2017;27:383-92.
48Braimah RO, Soyele OO, Aregbesola SB, Rasheed MA. Pattern of histologically diagnosed orofacial tumor and disparity in number managed in a Nigerian University Teaching Hospital: A 5 years review. J Dent Allied Sci 2017;6:60.
49Ladeinde AL, Adeyemo WL, Ogunlewe MO, Ajayi OF, Omitola OG. Salivary gland tumours: A 15-year review at the dental centre Lagos university teaching hospital. Afr J Med Med Sci 2007;36:299-304.
50Lawal AO, Kolude B, Adeyemi BF. Oral cancer: The Nigerian experience. Int J Med Med Sci 2013;5:178-83.
51Jaafari-Ashkavandi Z, Ashraf MJ. A clinico-pathologic study of 142 orofacial tumors in children and adolescents in Southern Iran. Iran J Pediatr 2011;21:367-72.
52Rai S, Sodhi SP, Sandhu SV. Pleomorphic adenoma of submandibular gland: An uncommon occurrence. Natl J Maxillofac Surg 2011;2:66-8.
53Quieroz CS, Azevedo RA, Trindade-Neto AI, Pontes CG, Moura RD. An unusual pleomorphic adenoma. Rev Gaúcha Odontol 2014;62:319-24.
54Akinbami BO, Akadiri O, Gbujie DC. Spread of odontogenic infections in Port Harcourt, Nigeria. J Oral Maxillofac Surg 2010;68:2472-7.
55Fomete B, Agbara R, Osunde DO, Ononiwu CN. Cervicofacial infection in a Nigerian tertiary health institution: A retrospective analysis of 77 cases. J Korean Assoc Oral Maxillofac Surg 2015;41:293-8.
56Ibikunle AA, Taiwo AO, Gbotolorun OM, Braimah RO. Challenges in the management of cervicofacial necrotizing fasciitis in Sokoto, Northwest Nigeria. J Clin Sci 2016;13:143.