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 Table of Contents  
LETTER TO EDITOR
Year : 2014  |  Volume : 3  |  Issue : 4  |  Page : 286-288

"Cyclopedic views" on hard and soft tissue swellings of the oral cavity


1 Department of Oral and Maxillofacial Pathology, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
2 Department of Endodontics and Conservative Dentistry, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India

Date of Web Publication16-Oct-2014

Correspondence Address:
Bina Kashyap
House No. 3, Vishnu Green Meadows, Vishnupur, Bhimavaram - 534 202, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-344X.143079

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How to cite this article:
Reddy PS, Kashyap B, Sita Rama Raju D V, Suneela S. "Cyclopedic views" on hard and soft tissue swellings of the oral cavity. Int J Health Allied Sci 2014;3:286-8

How to cite this URL:
Reddy PS, Kashyap B, Sita Rama Raju D V, Suneela S. "Cyclopedic views" on hard and soft tissue swellings of the oral cavity. Int J Health Allied Sci [serial online] 2014 [cited 2020 Mar 29];3:286-8. Available from: http://www.ijhas.in/text.asp?2014/3/4/286/143079

Sir,

The primary disease processes that give rise to swellings and tumors of the oral cavity include cysts, mucous extravasation and retention in the minor salivary glands, foci of granulation tissue and inflammation, abscesses, and connective-tissue proliferations that are well-defined or encapsulated, as well as infiltrative sarcomas. The cause of the swelling could be many ranging from infection to the malignancy. Odontogenic swelling is of great concern as it affects the oral cavity involving the bone or soft tissue. Numerous causes such as trauma, irritation due to local deposits like plaque, calculus, and food particles, and foreign materials have been listed in the literature which causes infection/inflammation in the lesser side (by proliferation of fibrovascular connective-tissue along with inflammation which may give rise to pyogenic granuloma (PG), peripheral giant cell granuloma [PGCG] and peripheral ossifying fibroma [POF]) to benign/malignant (odontogenic cysts [OCs] and tumors [OTs], pathologic leukocytic infiltrates in leukemia and oral squamous cell carcinoma) toward the advanced side. [1],[2]

Soft tissue swelling can involve any part of the oral mucous membrane and local irritants and trauma of the oral cavity being the most common cause. Hard tissue involves tumors (benign and malignant) which are a heterogenous group of tumors that are classified on a histogenic basis according to the adult tissue they resemble. Benign tumors, which more closely resemble normal tissue, have little capacity for autonomous growth. They exhibit little tendency to invade locally and are attended by a low rate of local recurrences following conservative therapy. [3],[4],[5] Malignant tumors, in contrast, are locally aggressive and are capable of invasive or destructive growth, recurrence and distant metastasis. Radical surgery is required to ensure total removal of these tumors. Very few studies are reported among Asians, especially from the Indian subcontinent. Hence, in this article, we aim to determine the epidemiology and clinic-pathologic presentation of these heterogeneous groups of lesions.

All the data recorded from January 2009 to December 2013, in the Department of Oral and Maxillofacial Surgery, Vishnu Dental College, Bhimavaram were analyzed for age and sex distribution, site of presentation, association with impacted teeth clinically as well as radiographically, method of treatment and the diagnosis, which was confirmed histopathologically. All the patients were divided into two groups: (a) Group 1 consisted of patients presenting with soft tissue swelling with or without pain and (b) Group 2 consisting bony hard swelling with or without pain.

A total of 1322 cases of the oral cavity and the jaws were retrieved, diagnosed, and treated between January 2009 and December 2013. Of these, 847 (64.07%) satisfied the criteria to be included as hard and soft tissue swellings. 407 cases were of hard tissue swellings, of which 145 (35.62%) were in maxilla, and 262 (64.37%) were in mandible and 440 were soft tissue swellings involving the gingiva, buccal mucosa, labial mucosa, and the palate. The age of patients with soft tissue lesions ranged from 18 to 58 years with a mean age of 38 years, whereas 5-75 years range was observed for hard tissue swelling with a mean age of 40 years. The overall male to female ratio was 6:5, with hard tissue showing male predominance and soft tissue showing female predominance. Mandible to maxilla ratio was 2:1 with hard tissue and with soft tissue it was 3:2.

Group 1 (soft tissue lesions) constituted 51.95% of all the swellings. Fibroma (FB) was the most frequent of group 1 tumors (30.68%), followed by PG (27.27%), POF (3.40%), PGCG (2.27%), giant cell fibroma (2.27%), mucocele (20.45%), and rest 13.63% were miscellaneous (MIS) [Graph 1 [Additional file 1]]. The mean age of patients with fibroma, in soft tissue swelling was 36 years (range: 18-72 years) with a peak incidence in the third to fourth decade. Group 2 (hard tissue lesions) constituted 45.05% of all the tumors. OC, OT, fibro-osseous lesions, bony lesions and MIS bony swellings were the most frequent intraosseous hard tissue swelling of group 2 tumors constituting 40.03%, 30.71%, 5.89%, 16.46%, and 5.89% being MIS [Graph 2 [Additional file 2]]. Bony hard lesions were most frequent in the third to fifth decade. The mean age of patients with hard tissue swelling was 36 years (range: 18-54 years) with a peak incidence in the fourth decade.

The incidence of soft and hard tissue tumors, especially the frequency of benign tumors relative to malignant ones, is nearly impossible to determine accurately. It may be attributed to the fact that many benign tumors do not undergo biopsy, hence makes direct application of data from most hospital series invalid for the general population. Benign tumors outnumber malignant ones by a wide margin. Knowing the incidence and prevalence of these lesions and their commoner sites of presentation may help clinicians to determine a likely clinical diagnosis. In our study, the most common site in case of soft tissue lesions was anterior mandible and in hard tissue was body of the mandible. There seems to be an upward trend in the incidence of hard/soft tissue lesions of odontogenic origin, but it is not clear whether this represents a true increase or reflects better diagnostic capabilities. [4],[5]

Understanding the clinical factors that affect the outcome is essential in formulating a treatment plan for the patient with soft and hard tissue swelling. In the present study, group 1 patient with soft tissue swelling presenting sessile, soft to firm, without surface ulceration and without pain were 58.69% and the remaining with pedunculated growth, soft consistency, with mild infection and painful swelling were 41.31%. All the patients with soft tissue swellings were treated with complete surgical excision. In group 2 patient, 94.28% presented with intraosseous bony hard swelling with unilocular/multilocular appearance and 5.72% were associated with or without impacted tooth. The treatment followed in group 2 patients included surgical enucleation, Cornoy's solution application, removal or extraction of the associated teeth/tooth and subtotal and total resection, with reconstruction depending on the size of the lesion.

Some of the disadvantages of inferences made from this institutional based study could be that some people suffering from lesions might not have reported to the dental college at all and may have been seen by private practitioners and other specialties. Furthermore, some patients may refuse surgical treatment and demand only the extraction of the affected tooth if tooth is involved.

In conclusion, we observed some similarities between our studies and previous studies from Africa and Asia and some differences with the reports from the Americas. Knowledge of the relative frequencies and sites of presentation of odontogenic swellings in different ethno-geographic backgrounds are essential for the early diagnosis and management of these benign lesions of which some may become potentially destructive lesions.


  Acknowledgments Top


We would like to acknowledge the management of Vishnu Dental College, Bhimavaram, along with our Principal Dr. Suresh Sajjan and Vice Principal Dr. AV Rama Raju, for their co-operation and selfless support during the study.

 
  References Top

1.
Guerrisi M, Piloni MJ, Keszler A. Odontogenic tumors in children and adolescents. A 15-year retrospective study in Argentina. Med Oral Patol Oral Cir Bucal 2007;12:E180-5.  Back to cited text no. 1
    
2.
El Gehani R, Krishnan B, Orafi H. The prevalence of inflammatory and developmental odontogenic cysts in a Libyan population. Libyan J Med 2008;3:75-7.  Back to cited text no. 2
    
3.
Neville BW, Damm DD, Allen CM, Bouquot JE, editors. Odontogenic cysts and tumors. In: Oral and Maxillofacial Pathology. Philadelphia: WB Saunders; 2002. p. 589-642.  Back to cited text no. 3
    
4.
Bataineh AB, Rawashdeh MA, Al Qudah MA. The prevalence of inflammatory and developmental odontogenic cysts in a Jordanian population: A clinicopathologic study. Quintessence Int 2004;35:815-9.  Back to cited text no. 4
    
5.
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.  Back to cited text no. 5
    




 

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