|Year : 2016 | Volume
| Issue : 1 | Page : 78-85
A 5 year retrospective study of biopsied jaw lesions with the assessment of concordance between clinical and histopathological diagnoses
Elif Peker1, Faruk Öğütlü1, İnci Rana Karaca1, Elif Sibel Gültekin2, Merve Çakır3
1 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gazi University, Ankara, Turkey
2 Department of Oral Pathology, Faculty of Dentistry, Gazi University, Ankara, Turkey
3 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Yeni Yüzyıl University, Istanbul, Turkey
|Date of Submission||24-Apr-2015|
|Date of Acceptance||09-Mar-2016|
|Date of Web Publication||22-Apr-2016|
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gazi University, 8. Cadde 82, Sokak No: 4 Emek, Ankara 06500
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Introduction: The jaw can be affected by several lesions that manifest in the oral cavity, but little is known about their distribution patterns in various populations. Aims and Objectives: This study presents the frequency and distribution of biopsied jaw lesions recorded in Faculty of Dentistry and gathers the information including provisional and final diagnosis of the lesions. Material and Methods: Biopsy of 1938 lesions (2008-2013) was reviewed and 1473 lesions were included in this study. The provisional diagnosis and histopathological validations of lesions were compared. Data on the location of the lesion, as well as patient demographics, were also evaluated. The lesions were divided into three major groups as 1 - developmental/reactive and inflammatory lesions of the jaw, 2 - cystic lesion and 3 - tumor and tumor-like lesions. Statistical Analysis: The variables were recorded and analysed using descriptive statistics. Results and Observations: Three hundred and ninety-six lesions were in Group 1 and periapical granuloma was the most frequent diagnosis. Seven hundred and eighty-nine lesions were in Group 2 and the radicular cyst was the most frequent diagnosis. Two hundred and eighty-eight lesions were in Group 3 and the keratocystic odontogenic tumor was the most frequent. Two hundred and ninety-one biopsied lesions were in disagreement with respect to the diagnoses on clinical and histopathological examination. Conclusion: Consequently, a provisional diagnosis of some of the malignant lesions was reactive, inflammatory, cystic or benign lesions, therefore the importance of evaluation of the specimen is emphasized.
Keywords: Clinical provisional diagnosis, demographic study, jaw lesions
|How to cite this article:|
Peker E, Öğütlü F, Karaca &R, Gültekin ES, Çakır M. A 5 year retrospective study of biopsied jaw lesions with the assessment of concordance between clinical and histopathological diagnoses. J Oral Maxillofac Pathol 2016;20:78-85
|How to cite this URL:|
Peker E, Öğütlü F, Karaca &R, Gültekin ES, Çakır M. A 5 year retrospective study of biopsied jaw lesions with the assessment of concordance between clinical and histopathological diagnoses. J Oral Maxillofac Pathol [serial online] 2016 [cited 2023 Mar 30];20:78-85. Available from: https://www.jomfp.in/text.asp?2016/20/1/78/180945
| Introduction|| |
The jaw lesions, ranging from inflammatory processes to malignant neoplasms, can be seen in all ages with or without any symptoms. The clinical signs and symptoms of these lesions differ by type, but some lesions, although benign, can resorb roots, move teeth, have a high recurrence rate and cause pain or paresthesia; thus, it is important to correctly diagnose for proper treatment.  The diagnosis of jaw lesions is established from the different clinical and radiological features though the final diagnosis is based on histopathological examination of the lesion. , In addition, reports of carcinoma arising from the cystic wall highlight the need for biopsies of these lesions.  Hence, the initial clinical diagnosis must be accurate and should not miss any premalignant or malignant pathologic features.
Because of the diversity of lesions that can arise from the odontogenic tissues, several classification schemes have been published to define their diagnostic criteria and biological behavior. At present, most of the investigations cite the World Health Organization's histological typing of odontogenic tumors, updated in 2005, when reporting isolated cases or series of these conditions. 
The aim of this study was to determine the frequency of all biopsied jaw lesions and gather the information including clinical diagnoses and final diagnoses of the lesions to compare them for an accuracy level of clinical diagnoses and to emphasize the importance of routine biopsy.
| Materials and methods|| |
This retrospective study was performed at the Faculty of Dentistry, Gazi University. The data were collected from the archives of the Department of Oral and Maxillofacial Surgery and the Department of Oral Pathology. Ethical clearance was obtained from the Ethics Committee at Gazi University. The patient records from 2008 to 2013 were reviewed considering gender, age, location of lesion, provisional and final histopathological diagnoses. The biopsy referral forms generated from the Department of Oral and Maxillofacial Surgery and their corresponding histopathologic reports from the Department of Oral Pathology were compared to assess the concordance between initial clinical provisional diagnoses and histopathologic final diagnoses of all jaw lesions. Lesions were divided into three major categories based on their final histopathologic diagnoses: Group 1: Developmental/inflammatory/reactive lesions of the jaw, Group 2: Cystic lesions and Group 3: Tumors and tumor-like lesions.
| Results|| |
A total of 1938 patient records were reviewed. About 251 lesions with missing data and 214 soft tissue lesions were excluded from the study and the resulting 1473 records were included in the study. The distribution of lesions between groups were group 1: 396 (26.9%), Group 2: 789 (53.6%) and Group 3: 288 (19.5%) [Figure 1]. As for gender, 795 cases were of males (54.0%) and 678 cases were of females (46.0%). The overall male to female ratio was 1:1.7. About 734 lesions were diagnosed in the maxilla (49.8%) and 739 lesions were in the mandible (50.2%). The overall mandible to maxilla ratio was 1:1. The patients' age ranged from 5 to 86 years and the mean age was 40 ± 1.9 years [Table 1].
|Figure 1: Distribution of types of jaw biopsies (n = 1473). 'Cysts' do not include keratocystic odontogenic tumor and calcifying cystic odontogenic tumors; 'tumors and tumor-like lesions' include keratocystic odontogenic tumors and calcifying cystic odontogenic tumors|
Click here to view
|Table 1: Frequency of biopsied lesions and their distribution according to location, gender, and age |
Click here to view
Overall, radicular cysts (n = 440; 29.9%) were the most common biopsied jaw lesion, followed by periapical granuloma (n = 337; 22.9%), dentigerous cysts (n = 247; 16.8%), keratocystic odontogenic tumors (KCOTs) (n = 107; 7.3%) and residual cysts (n = 76; 5.2%).
[Table 2] shows the distribution of the 396 developmental/inflammatory/reactive lesions of the jaw in Group 1. Periapical granulomas constitute more than 75 percent of this group (n = 337, 85.1%) and the mean age was 38 years. There were 37 (9.3%) hyperplastic dental follicle cases with the mean age of 28 years. Osteonecrosis, osteomyelitis and torus/exostosis were also seen in this group [Table 2]. The anterior maxilla and molar region of the mandible were shown to be most common sites for the Group 1 lesions, with an occurrence rate of 47.7% and 24.8%, respectively. The occurrence of this group of lesion was seen a little more frequently in women (58.3%). According to the statistical analysis, the incidence of Group 1 lesions was not associated with gender (P > 0.05). The frequency of group 1lesions was significantly different between different localizations in the lower jaw (P < 0.05). The most frequent localization was a molar region in the lower jaw. The frequency of Group 1 lesions was significantly different between different localizations in the upper jaw (P > 0.05). The prevalence of the Group 1 lesions was more frequent in maxilla (P < 0.001).
|Table 2: Frequency of group I lesions and their distribution according to location, patient's gender and age |
Click here to view
Within Group 2 lesions, radicular cysts were the most prevalent cyst (n = 440, 55.8%), followed by dentigerous cysts (n = 247, 31.3%) and residual cysts (n = 76, 9.6%) and their mean ages were 41.40 and 49 years, respectively. Other cysts, which were found in smaller numbers, included incisive canal cyst, mucous retention cyst, lateral periodontal cyst and traumatic bone cyst. This group of lesions were almost equally present in maxillary anterior and mandible molar regions (n = 294, 37.3% vs.n = 251, 31.8%). A greater incidence in males than females was also reported in this group (n = 494, 62.6% vs.n = 295, 37.4%) [Table 3]. The incidence of Group II lesions was associated with gender (P < 0.05). Group 2 lesions were more frequent in males (P = 0.007). The frequency of group 2 lesions was significantly different between different localizations in the lower jaw (P < 0.05). The most frequent localization was a molar region of the lower jaw (P = 0.000). The frequency of Group 2 lesions was significantly different between different localizations in the upper jaw (P < 0.05). The most frequent localization was an anterior region of the upper jaw (P = 0.000). The frequency of Group 2 lesions is significantly different between upper and lower jaws. Radicular cysts were seen more frequently in the maxilla and dentigerous cysts were seen more frequently in the mandible (P = 0.000).
|Table 3: Frequency of group II lesions and their distribution according to location, patient's gender and age |
Click here to view
The third major group includes odontogenic (n = 192, 66.7%) and benign non-odontogenic tumors (n = 96, 33.3%). Odontogenic tumors comprised of KCOT (n = 107, 37.1%) mainly. Odontoma and ameloblastoma were the second and third common lesions among odontogenic tumors group (n = 48, 16.7% and n = 21, 7.3%, respectively). The least common lesions were periapical cemental dysplasia (n = 5, 1.8%), adenomatoid odontogenic tumor (n = 5, 1.8%), cementoblastoma (n = 3, 1.0%), calcifying cystic odontogenic tumor (n = 2, 0.7%) and odontogenic fibroma (n = 1, 0.3%). The most common lesion was ossifying fibroma (OF) (n = 43, 14.9%) followed by the central giant cell granuloma (n = 28, 9.7%), osteoma (n = 21, 7.3%) and cemento-osseous dysplasia (n = 4, 1.4%) in benign non-odontogenic tumors. Nearly one-third (n = 90, 31.2%) of tumor/tumor-like lesions were seen in the molar regions of mandible. Anterior and molar regions of maxilla were other prominent anatomical sites (n = 57, 19.8% and n = 31, 10.8%). More than half of the patients (55.2%) were in the fifth decades of life. The tumor/tumor-like lesions were almost equally diagnosed in both genders [Table 4]. The incidence of benign non-odontogenic tumors in Group 3 lesions was not associated with gender and localization of the jaws while benign odontogenic tumors were more common in women with mandibular localizationbeing the most common (P < 0.05).
|Table 4: Frequency of group III lesions and their distribution according to location, patient's gender and age |
Click here to view
The concordance of diagnoses as a result of comparison of provisional and final diagnoses was 80.5%. In Group 1 lesions, there were 168 diagnostic disagreements (58.5%). Of these, 155 cases were diagnosed provisionally as cystic lesions (54.0%), 13 cases as tumor/tumor-like lesions (4.5%). In Group 2 lesions, there were 38 diagnostic disagreements (13.2%). In 21 cases, tumor/tumor-like lesion (7.3%) and in 17 cases, developmental/inflammatory/reactive lesions were provisional diagnoses (5.9%). In Group 3 lesions, there were 85 diagnostic disagreements (29.6%). Of these, 73 cases were diagnosed provisionally as cystic lesion (25.4%), 12 cases as developmental/inflammatory/reactive lesion (4.2%) [Figure 2].
|Figure 2: Distribution of the disagreements of provisional and final diagnoses in groups of all cases|
Click here to view
Of all these lesions, periapical granuloma was the most frequent lesion which was provisionally diagnosed as a radicular cyst. The second most common type was KCOT, which was diagnosed as dentigerous or radicular/residual cyst provisionally. Another most common type was ameloblastoma that was diagnosed provisionally as a dentigerous cyst.
| Discussion|| |
This study demonstrated the general profile of oral lesions in Turkish population. It was difficult to compare the results with other studies as they were performed in a specific group of lesion , or age.  In our study, the majority of the lesions were in the category of odontogenic/non-odontogenic cysts and it is consistent with the findings of Al Yamani et al.  and Utsumi et al.  However, some studies report that developmental/inflammatory and reactive lesions were more common than cystic lesions. ,, In our study, odontogenic cysts constitute 53.6% of all lesions. This was much more than what was reported in most studies, but current literature shows that odontogenic cysts account for between 0.8% to 45.9% of all lesions.  This finding may be related to the profile of our sample, in which most patients were referred to our university from other clinics for surgical procedures that require expertise to do. In addition, it can be assessed as a result of differences in referral practice. For odontogenic cysts, the overall mean age (42 years) was similar to the result from Johnson et al.  (43.4 years) and Meningaud et al.  (41.8 years) The overall male to female ratio (1.7:1) was similar to the results of Johnson et al.,  Meningaud et al.,  and Sharifian et al.  The overall maxilla: mandible ratio (1:1) was consistent with Grossman et al.  and Sharifian et al.  Radicular cysts (55.8%) were the most biopsied lesions followed by dentigerous cysts (31.3%) and residual cysts (9.6%) in cystic lesions and these data support the data presented by Nuñez-Urrutia et al.  from Spain and de Souza et al.  and Prockt et al.  from Brazil.
Periapical granuloma (22.8% of all lesions) was the most common lesion in Group 1 lesions; this value is lower than the results of Mendez et al.  and Koivisto et al.  This is probably due to conservative treatment protocol of the teeth with periapical lesions or lack of submission of excised specimens by our surgeons. The frequency of hyperplastic dental follicle (2.5% of all lesions) is lower than the results of Lei et al.  and Wang et al.  who reported the prevalence of hyperplastic dental follicles in biopsied oral and maxillofacial lesions in pediatric patients. This determination is quite inappropriate to our study which has an adult patient profile. For Group 1 lesions, the overall male to female ratio (1:1.3) was consistent with Daley et al.  and Eversole et al.  and maxilla: mandible ratio (1.2:1) was different from many studies. , These observations showed a female predominance and localization of periapical granuloma in the maxillary anterior region mostly. 
The WHO classification of odontogenic keratocyst updated in 2005 and parakeratinized type is termed as KCOT. This reclassification caused changes in frequency of both odontogenic cysts and tumors.  In the present study, tumor or tumor-like lesions of the jaws constituted 17.6% of all lesions. This rate is much more than what was reported in previous reports on reviewing, according to the 1992 WHO classification. ,, KCOT, odontoma and ameloblastoma were the most frequent odontogenic tumors consecutively in this study and this finding is consistent with the study done by Gaitαn-Cepeda et al. from Mexico.  The frequency of the remaining odontogenic tumor/tumor-like lesions such as periapical cemental dysplasia, adenomatoid odontogenic tumor, cementoblastoma, calcifying cystic odontogenic tumor and odontogenic fibroma, appears to be a rare occurrence. Some studies, including the present study, reported that odontogenic tumors affect females more than males. ,,, The age range of patients varied from 7-76 years, with a mean of 38 years, similar to data reported by Luo and Li et al.  and Simon et al.  Data from the present study and earlier series ,, showed that KCOT was the most frequent odontogenic tumor, occurring mainly in the posterior mandible and in males with a definite predominance. In contrast to our data, several studies of odontogenic tumors have reported odontoma as the most prevalent odontogenic tumor. ,, It is the second prevalent one with a slight male predilection similar to Fernandes et al.  and the main location is anterior maxilla similar to that reported by Avelar et al.  and Osterne et al.  Of the odontogenic tumors, ameloblastoma ranked third with a prevalence of 8.1%, a definite female preponderance and involvement of posterior mandible. These data showed the same gender predilection as that in Chile  and Mexico  and location predilection as that in several studies. ,, Benign non-odontogenic tumors or tumor-like lesions were less common than odontogenic tumors in this study, which is in concordance with several studies. ,, OF, which is one of the subtypes of benign fibro-osseous lesions, was most common in benign non-odontogenic tumors. The frequency of OF (14.9%) is similar to the findings of Parkins et al.  (11.8%) and prevalent localization in the mandible is consistent with the results of Lerda et al.  The frequency of the central giant cell granuloma is 1.9% of all jaw lesions. These data are consistent with Ali et al.  and Koivisto et al.  but greater than Mendez et al.  from Brazil. The observed osteoma prevalence is 7.3%, most commonly reported in adults and in females which is in contrast to the findings of An et al.  and Rushton et al.  Osteomas mostly involve mandible in this study and this finding is the same as the findings of previous reports. ,,, Cemento-osseous dysplasia, which affects bone metabolism replacing normal bone by cemento-osseous tissue, constituted 0.3% of all lesions, also it was seen in woman and mandible mostly. These data are consistent with Su et al.,  Waldron,  MacDonald-Jankowski  and Kawai et al. 
The study revealed that concordance between clinical and histopathological diagnoses of all lesions was 80.5%. In this study, many of the diagnostic disagreements were in the developmental/inflammatory/reactive lesions group. Periapical granuloma, which was provisionally diagnosed as a radicular cyst, constitutes the overwhelming majority of the diagnostic disagreements. These data did not surprise us because of the same pathogenic process they have.  According to the International Classification of Diseases for Dentistry and Stomatology classification, which is an extensive classification of the diseases of the digestive system based on the originated tissues, periapical granuloma and radicular cyst are in the same subcategory as "disease of the pulp and periapical tissues." The products of pulpal infection initiate an inflammatory response and stimulate the proliferation of the rests of Malassez in the periapical granuloma and the epithelial cell mass enlargement leads to cyst formation. Most radicular cysts are small, but they can reach a large size.  Hence, it was difficult to differentiate them by clinical and radiographic appearance and these data were consistent with the results of Lia et al.  who reported a considerable degree of disagreement between the clinical, radiographic diagnoses and histological findings of these two lesions. In addition to this, differential diagnoses of periapical lesions as the lesions of non-endodontic origin should be considered because of their different treatment protocols and prognoses. Radicular cysts generally cause painful swelling but in the anterior maxilla, they can be asymptomatic because of the thin cortical bone of this anatomic site.  Therefore, pulp vitality tests may help to determine the origin of the disease.
KCOTs mimicking cystic lesions were reported by several studies published in recent years. ,,, The current study supports these studies since there were 38 cases of KCOT, diagnosed as inflammatory cystic lesions or dentigerous cysts provisionally. Clinically, KCOT presents mostly at the posterior region of the mandible in young males as an intraosseous lesion, but it might also mimic a gingival cyst with a gingival swelling.  Radiographically, KCOTs are generally unilocular with a well-defined limit and exhibits buccolingual expansion. In contrast to a radicular cyst, KCOT can indicate great growth potential and in some cases, huge dimensions have been reported.  Hence, KCOTs should be included in the differential diagnoses of cystic lesions due to their aggressive behavior and recurrence in spite of complete removal.  The emphasis on identifying whether the lesion is a cyst or KCOT is important for surgical procedures. Radicular and dentigerous cysts can completely be cured with simple enucleation, while a simple enucleation of KCOT can have recurrence rate of upto 27.8%. 
In our study, another tumor/tumor-like lesion that was diagnosed provisionally as cystic lesion was ameloblastoma. It is recognized that the radiological appearances of cysts and tumors related to an impacted tooth are similar and there is no definitive method in the differential diagnosis.  Bailey  was first to report dentigerous cyst with an ameloblastoma and then cystic lesions involving ameloblastomas reported in the studies thus far. ,,, Although some subtypes of ameloblastoma, such as unicystic ameloblastoma, have a good prognosis and simple enucleation is the adequate treatment, all of the cystic lesions must be examined histopathologically, not to miss other subtypes such as solid or mural ameloblastoma. Moreover, there are some case reports of serious pathologies mimicking benign lesions or cysts of the jaws. ,,, The remaining diagnostic disagreements of our study are similar to this reported data with the cases of lymphoma mimicking peripheral giant cell or pyogenic granuloma, squamous cell carcinoma mimicking peripheral giant cell granuloma and squamous papilloma mimicking fibroepithelial hyperplasia. This inconsistency might be due to subjective interpretation of the clinical and radiographical examination of these lesions, whereas biopsy is the definitive diagnostic tool.
Surgeons do not submit every pathological specimen that is removed by surgical procedures or tooth extractions, that mimick a dental follicle or radicular cyst or granuloma. These lesions cannot be analyzed histologically, thus some serious pathologies can be miss out. 
| Conclusion|| |
The diagnosis of oral lesions should be based on clinical, radiographic and histopathologic features. Oral and Maxillofacial Surgeons must establish the histological diagnosis of their cases by routine biopsy and provide an adequate treatment, which might involve further procedures. This will prevent unnecessary treatments and delayed surgical operations.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Whitaker SB, Waldron CA. Central giant cell lesions of the jaws. A clinical, radiologic, and histopathologic study. Oral Surg Oral Med Oral Pathol 1993;75:199-208.
Nary Filho H, Matsumoto MA, Fraga SC, Gonçales ES, Sérvulo F. Periapical radiolucency mimicking an odontogenic cyst. Int Endod J 2004;37:337-44.
Koivisto T, Bowles WR, Rohrer M. Frequency and distribution of radiolucent jaw lesions: A retrospective analysis of 9,723 cases. J Endod 2012;38:729-32.
Muglali M, Sumer AP. Squamous cell carcinoma arising in a residual cyst: A case report. J Contemp Dent Pract 2008;9:115-21.
Kramer IR, Pindborg JJ, Shear M. The World Health Organization histological typing of odontogenic tumours. Introducing the second edition. Eur J Cancer B Oral Oncol 1993;29B: 169-71.
Regezi JA. Odontogenic cysts, odontogenic tumors, fibroosseous, and giant cell lesions of the jaws. Mod Pathol 2002;15:331-41.
Mosqueda-Taylor A, Irigoyen-Camacho ME, Diaz-Franco MA, Torres-Tejero MA. Odontogenic cysts. Analysis of 856 cases. Med Oral 2002;7:89-96.
Wang YL, Chang HH, Chang JY, Huang GF, Guo MK. Retrospective survey of biopsied oral lesions in pediatric patients. J Formos Med Assoc 2009;108:862-71.
Al Yamani AO, Al Sebaei MO, Bassyoni LJ, Badghaish AJ, Shawly HH. Variation of pediatric and adolescents head and neck pathology in the city of Jeddah: A retrospective analysis over 10 years. Saudi Dent J 2011;23:197-200.
Utsumi N, Tajima Y, Oi T, Ohno J, Shikata H, Seki T, et al.
Report on clinico-pathological examinations in Meikai University (formerly Josai Dental University) Hospital (4). Meikai Daigaku Shigaku Zasshi 1990;19:383-98.
Becconsall-Ryan K, Tong D, Love RM. Radiolucent inflammatory jaw lesions: A twenty-year analysis. Int Endod J 2010;43:859-65.
Shah SK, Le MC, Carpenter WM. Retrospective review of pediatric oral lesions from a dental school biopsy service. Pediatr Dent 2009;31:14-9.
Mendez M, Carrard VC, Haas AN, Lauxen Ida S, Barbachan JJ, Rados PV, et al.
A 10-year study of specimens submitted to oral pathology laboratory analysis: Lesion occurrence and demographic features. Braz Oral Res 2012;26:235-41.
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.
Johnson NR, Savage NW, Kazoullis S, Batstone MD. A prospective epidemiological study for odontogenic and non-odontogenic lesions of the maxilla and mandible in Queensland. Oral Surg Oral Med Oral Pathol Oral Radiol 2013;115:515-22.
Meningaud JP, Oprean N, Pitak-Arnnop P, Bertrand JC. Odontogenic cysts: A clinical study of 695 cases. J Oral Sci 2006;48:59-62.
Sharifian MJ, Khalili M. Odontogenic cysts: A retrospective study of 1227 cases in an Iranian population from 1987 to 2007. J Oral Sci 2011;53:361-7.
Grossmann SM, Machado VC, Xavier GM, Moura MD, Gomez RS, Aguiar MC, et al.
Demographic profile of odontogenic and selected nonodontogenic cysts in a Brazilian population. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104:e35-41.
Nuñez-Urrutia S, Figueiredo R, Gay-Escoda C. Retrospective clinicopathological study of 418 odontogenic cysts. Med Oral Patol Oral Cir Bucal 2010;15:e767-73.
de Souza LB, Gordón-Núñez MA, Nonaka CF, de Medeiros MC, Torres TF, Emiliano GB. Odontogenic cysts: Demographic profile in a Brazilian population over a 38-year period. Med Oral Patol Oral Cir Bucal 2010;15:e583-90.
Prockt AP, Schebela CR, Maito FD, Sant'Ana-Filho M, Rados PV. Odontogenic cysts: Analysis of 680 cases in Brazil. Head Neck Pathol 2008;2:150-6.
Lei F, Chen JY, Lin LM, Wang WC, Huang HC, Chen CH, Ho KY, Chen YK. Retrospective study of biopsied oral and maxillofacial lesions in pediatric patients from Southern Taiwan. J Dent Sci 2014; 9:351-358.
Daley TD, Wysocki GP, Wysocki PD, Wysocki DM. The major epulides: Clinicopathological correlations. J Can Dent Assoc 1990;56:627-30.
Eversole LR, Rovin S. Reactive lesions of the gingiva. J Oral Pathol 1972;1:30-8.
Ali MA. Biopsied jaw lesions in Kuwait: A six-year retrospective analysis. Med Princ Pract 2011;20:550-5.
Lin HP, Chen HM, Yu CH, Kuo RC, Kuo YS, Wang YP. Clinicopathological study of 252 jaw bone periapical lesions from a private pathology laboratory. J Formos Med Assoc 2010;109:810-8.
Barnes LE, Eveson JW, Reichart P, Sidransky D. World Health Organization classification of tumours. Pathology and Genetics of Head and Neck Tumours. Lyon: IARC Publishing Group; 2005.
Luo HY, Li TJ. Odontogenic tumors: A study of 1309 cases in a Chinese population. Oral Oncol 2009;45:706-11.
Ladeinde AL, Ajayi OF, Ogunlewe MO, Adeyemo WL, Arotiba GT, Bamgbose BO, et al.
Odontogenic tumors: A review of 319 cases in a Nigerian teaching hospital. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;99:191-5.
Buchner A, Merrell PW, Carpenter WM. Relative frequency of central odontogenic tumors: A study of 1,088 cases from Northern California and comparison to studies from other parts of the world. J Oral Maxillofac Surg 2006;64:1343-52.
Gaitán-Cepeda LA, Quezada-Rivera D, Tenorio-Rocha F, Leyva-Huerta ER. Reclassification of odontogenic keratocyst as tumour. Impact on the odontogenic tumours prevalence. Oral Dis 2010;16:185-7.
Okada H, Yamamoto H, Tilakaratne WM. Odontogenic tumors in Sri Lanka: Analysis of 226 cases. J Oral Maxillofac Surg 2007;65:875-82.
Simon EN, Merkx MA, Vuhahula E, Ngassapa D, Stoelinga PJ. A 4-year prospective study on epidemiology and clinicopathological presentation of odontogenic tumors in Tanzania. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;99:598-602.
Avelar RL, Antunes AA, Santos Tde S, Andrade ES, Dourado E. Odontogenic tumors: Clinical and pathology study of 238 cases. Braz J Otorhinolaryngol 2008;74:668-73.
González-Alva P, Tanaka A, Oku Y, Yoshizawa D, Itoh S, Sakashita H, et al.
Keratocystic odontogenic tumor: A retrospective study of 183 cases. J Oral Sci 2008;50:205-12.
Osterne RL, Brito RG, Alves AP, Cavalcante RB, Sousa FB. Odontogenic tumors: A 5-year retrospective study in a Brazilian population and analysis of 3406 cases reported in the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111:474-81.
Mosqueda-Taylor A, Ledesma-Montes C, Caballero-Sandoval S, Portilla-Robertson J, Ruíz-Godoy Rivera LM, Meneses-García A. Odontogenic tumors in Mexico: A collaborative retrospective study of 349 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;84:672-5.
Regezi JA, Kerr DA, Courtney RM. Odontogenic tumors: Analysis of 706 cases. J Oral Surg 1978;36:771-8.
Fernandes AM, Duarte EC, Pimenta FJ, Souza LN, Santos VR, Mesquita RA, et al.
Odontogenic tumors: A study of 340 cases in a Brazilian population. J Oral Pathol Med 2005;34:583-7.
Ochsenius G, Ortega A, Godoy L, Peñafiel C, Escobar E. Odontogenic tumors in Chile: A study of 362 cases. J Oral Pathol Med 2002;31:415-20.
Lu Y, Xuan M, Takata T, Wang C, He Z, Zhou Z, et al.
Odontogenic tumors. A demographic study of 759 cases in a Chinese population. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;86:707-14.
Odukoya O. Odontogenic tumors: Analysis of 289 Nigerian cases. J Oral Pathol Med 1995;24:454-7.
Parkins GE, Armah G, Ampofo P. Tumours and tumour-like lesions of the lower face at Korle Bu Teaching Hospital, Ghana - An eight year study. World J Surg Oncol 2007;5:48.
Lerda W, Magnano M, Ferraris R, Gerri F, Motta M, Bongioannini G. Differential diagnosis in fibro-osseous lesions of facial bones: Report of a case of ossifying fibroma and review of literature. Acta Otorhinolaryngol Ital 2002;22:295-300.
An SY, Shin HI, Choi KS, Park JW, Kim YG, Benavides E, et al.
Unusual osteoid osteoma of the mandible: Report of case and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2013;116:e134-40.
Rushton JG, Mulder DW, Lipscomb PR. Neurologic symptoms with osteoid osteoma. Neurology 1955;5:794-7.
Karandikar S, Thakur G, Tijare M, Shreenivas K, Agrawal K. Osteoid osteoma of mandible. BMJ Case Rep 2011;2011. pii: Bcr1020114886.
Ida M, Kurabayashi T, Takahashi Y, Takagi M, Sasaki T. Osteoid osteoma in the mandible. Dentomaxillofac Radiol 2002;31:385-7.
Su L, Weathers DR, Waldron CA. Distinguishing features of focal cemento-osseous dysplasias and cemento-ossifying fibromas: I. A pathologic spectrum of 316 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;84:301-9.
Waldron CA. Fibro-osseous lesions of the jaws. J Oral Maxillofac Surg 1985;43:249-62.
MacDonald-Jankowski DS. Florid cemento-osseous dysplasia: A systematic review. Dentomaxillofac Radiol 2003;32:141-9.
Kawai T, Hiranuma H, Kishino M, Jikko A, Sakuda M. Cemento-osseous dysplasia of the jaws in 54 Japanese patients: A radiographic study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:107-14.
Lia RC, Garcia JM, Sousa-Neto MD, Saquy PC, Marins RH, Zucollotto WG. Clinical, radiographic and histological evaluation of chronic periapical inflammatory lesions. J Appl Oral Sci 2004;12:117-20.
Shear M, Speight P. Cysts of the Oral and Maxillofacial Regions, Fourth Edition, Blackwell Munksgaard, Oxford, UK, 2008.
Sciubba J, Fantasia J, Kahn L. Atlas of tumor pathology. Tumors and Cysts of the Jaws. Vol. 29. AFIP Press, 2001.p. 109-10. [3 rd
Garlock JA, Pringle GA, Hicks ML. The odontogenic keratocyst: A potential endodontic misdiagnosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;85:452-6.
Ali M, Baughman RA. Maxillary odontogenic keratocyst: A common and serious clinical misdiagnosis. J Am Dent Assoc 2003;134:877-83.
Pace R, Cairo F, Giuliani V, Prato LP, Pagavino G. A diagnostic dilemma: Endodontic lesion or odontogenic keratocyst? A case presentation. Int Endod J 2008;41:800-6.
Chiang ML, Huang WH. Odontogenic keratocyst clinically mimicking an eruption cyst: Report of a case. J Oral Pathol Med 2004;33:373-5.
Chi AC, Owings JR Jr., Muller S. Peripheral odontogenic keratocyst: Report of two cases and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;99:71-8.
Payne TF. An analysis of the clinical and histopathologic parameters of the odontogenic keratocyst. Oral Surg Oral Med Oral Pathol 1972;33:538-46.
Bland PS, Shiloah J, Rosebush MS. Odontogenic keratocyst: A case report and review of an old lesion with new classification. J Tenn Dent Assoc 2012;92:33-6.
Johnson NR, Batstone MD, Savage NW. Management and recurrence of keratocystic odontogenic tumor: A systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2013;116:e271-6.
Ikeshima A, Ozawa M, Yamamoto H, Araki M, Sairenji E. Differential diagnosis between cyst and tumor. Dentigerous cyst and ameloblastoma containing teeth. J Nihon Univ Sch Dent 1990;32:19-26.
Bailey JW. Dentigerous cyst with ameloblastoma; report of a case. Oral Surg Oral Med Oral Pathol 1951;4:1122-6.
Hansasuta C. Ameloblastoma developing from a dentigerous cyst. J Dent Assoc Thai 1972;22:189-90.
Teles JC, Bevilacqua S. Ameloblastoma originating in the wall of dentigerous cyst. Report of 2 cases. Rev Bras Odontol 1970;27:21-6.
Oliveira-Neto HH, Spíndula-Filho JV, Dallara MC, Silva CM, Mendonça EF, Batista AC. Unicystic ameloblastoma in a child: A differential diagnosis from the dentigerous cyst and the inflammatory follicular cyst. J Dent Child (Chic) 2007;74:245-9.
Houston GD. Oral pathology. Ameloblastoma arising in a dentigerous cyst. J Okla Dent Assoc 2007;98:28-9.
Rodrigues CD, Villar-Neto MJ, Sobral AP, Da Silveira MM, Silva LB, Estrela C. Lymphangioma mimicking apical periodontitis. J Endod 2011;37:91-6.
de Moraes Ramos-Perez FM, Soares UN, Silva-Sousa YT, da Cruz Perez DE. Ossifying fibroma misdiagnosed as chronic apical periodontitis. J Endod 2010;36:546-8.
Gondak RO, Rocha AC, Neves Campos JG, Vargas PA, de Almeida OP, Lopes MA, et al.
Unicystic ameloblastoma mimicking apical periodontitis: A case series. J Endod 2013;39:145-8.
Bagul N, Mamatha GS, Mahalle A. Plasmablastic lymphoma of gingiva mimicking a reactive lesion: A case report. Case Rep Dent 2012;2012:259307.
Boffano P, Ruga E, Gallesio C. Keratocystic odontogenic tumor (odontogenic keratocyst): Preliminary retrospective review of epidemiologic, clinical, and radiologic features of 261 lesions from University of Turin. J Oral Maxillofac Surg 2010;68:2994-9.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]
|This article has been cited by|
||The Accuracy of Clinical Diagnosis in Biopsied Premalignant and Malignant Oral Lesions
| ||Rojin Khaksar, Mohammad-Ali Ranjbar, Zohreh Jaafari-Ashkavandi |
| ||Journal of Maxillofacial and Oral Surgery. 2022; |
|[Pubmed] | [DOI]|
||Efficiency and Safety of Dental Implantation in the Area of Hyperdense Jaw Lesions: A Narrative Review
| ||Kimya Taghsimi, Andrey Vyacheslavovich Vasilyev, Valeriya Sergeevna Kuznetsova, Angelina Vladimirovna Galtsova, Varditer Agabekovna Badalyan, Igor Ivanovich Babichenko |
| ||Dentistry Journal. 2022; 10(6): 107 |
|[Pubmed] | [DOI]|
||Dental MRI of Oral Soft-Tissue TumorsOptimized Use of Black Bone MRI Sequences and a 15-Channel Mandibular Coil
| ||Adib Al-Haj Husain, Esra Sekerci, Daphne Schönegg, Fabienne A. Bosshard, Bernd Stadlinger, Sebastian Winklhofer, Marco Piccirelli, Silvio Valdec |
| ||Journal of Imaging. 2022; 8(5): 146 |
|[Pubmed] | [DOI]|
||The presentation of recurrent odontogenic keratocysts of the mandible with an emphasis on the tooth-bearing area: a systematic review and meta-analysis
| ||Y. Slusarenko da Silva, P.J.W. Stoelinga, M.G. Naclério-Homem |
| ||Oral Surgery. 2021; 14(2): 191 |
|[Pubmed] | [DOI]|
||Chronic inflammatory periapical diseases: a Brazilian multicenter study of 10,381 cases and literature review
| ||Aline Maria do COUTO, Daniela Pereira MEIRELLES, Alline Teixeira VALERIANO, Douglas Silva de ALMEIDA, Êmile de MORAES, Sandra Beatriz Chaves TARQUINIO, Aline Carvalho BATISTA, Elismauro Francisco de MENDONÇA, Nádia do Lago COSTA, Pollianna Muniz ALVES, Cassiano Francisco Weege NONAKA, Lucas Guimarães ABREU, Maria Cássia Ferreira de AGUIAR |
| ||Brazilian Oral Research. 2021; 35 |
|[Pubmed] | [DOI]|
||Spontaneous Bone Regeneration after Enucleation of Mandibular Cysts: Retrospective Analysis of the Volumetric Increase with a Full-3D Measurement Protocol
| ||Andrea Vitale, Salvatore Battaglia, Salvatore Crimi, Chiara Ricceri, Gabriele Cervino, Marco Cicciù, Francesco Saverio De Ponte, Rosalia Maria Leonardi, Alberto Bianchi |
| ||Applied Sciences. 2021; 11(11): 4731 |
|[Pubmed] | [DOI]|
||Is odontogenic keratocyst an endodontic enigma? A rare case report of management of odontogenic keratocyst in anterior mandible
| ||BR Prashanth, MythreyeeS Vidhya, Rupali Karale, GVinay Kumar |
| ||Journal of Oral and Maxillofacial Pathology. 2020; 24(4): 7 |
|[Pubmed] | [DOI]|
||Tratamento cirúrgico e conservador de cisto periapical de grande proporção: relato de caso
| ||Maraísa Aparecida Pinto Resende, Neuza Maria Souza Picorelli Assis, Augusto César Sette-Dias, Evandro Guimarães de Aguiar, Bruno Salles Sotto-Maior |
| ||HU Revista. 2018; 43(2): 191 |
|[Pubmed] | [DOI]|
||Epidemiological and Clinicopathological Analysis of 92 Odontogenic Tumors: A 5-year Retrospective Study
| ||Ipsita Sharma, Deepa Venkatesh, Geetanjali Bawa, Syed Vaseemuddin, Amit Joseph, Jimmy K Sangtani |
| ||The Journal of Contemporary Dental Practice. 2017; 18(11): 1056 |
|[Pubmed] | [DOI]|