Ameloblastomatous Change in Radicular Cyst of The Jaw in a Nigerian Population.

OBJECTIVE: To determine the incidence, age, gender, jaw-sites and subtypes of radicular cyst, and to determine the incidence of ameloblastomatous change in radicular cyst in a Nigerian population. METHOD: A 10-year retrospective analysis of all diagnosed orofacial lesions in the Department of Oral Pathology and Medicine, University of Benin Teaching Hospital, Benin City, Nigeria. RESULTS: From the 785 diagnosed orofacial lesions within the study period; there were 54 (6.9%) cases of radicular cysts of the jaws. The peak age group was the 3(rd) decade (n=23, 42.6%) with a mean age of 31 ± 1.7 years. There were 29 (53.7%) males and 25 (46.3%) females, giving a ratio of 1.2:1. The mandible was the commonest jaw-site (n=32, 59.3%). There were 12 (22.2%) cases of periapical cyst which were significantly associated with anterior maxillary site (n=8, 14.8%) [p=0.001]. Seven (13.0%) cases of cystic ameloblastoma were diagnosed among the radicular cysts, with a predilection of the lesions for 3(rd) and 4(th) decades of life (n=6, 11.1%), and posterior mandible (n=5, 9.3%). CONCLUSION: This study showed a low incidence of radicular cyst of the jaw among orofacial lesions and a relatively higher incidence of ameloblastomatous change in radicular cyst compared to previous reports. Immuno-histochemical examination is recommended to differentiate radicular cyst with ameloblastomatous-like change from cystic ameloblastoma arising from radicular cyst.

Paediatric orofacial tumours: new oral health concern in paediatric patients.

OBJECTIVE: This study aims to determine the incidence, age, gender, orofacial sites and histological pattern of paediatric orofacial tumours in a Nigerian population. The yearly findings will be analysed to identify the interval for increase in the incidence of paediatric orofacial tumours. PATIENTS AND METHODS: A 21-year (1990 to 2010) retrospective analysis of paediatric orofacial tumours in children younger than 16 years was carried out in the Department of Oral Pathology/Oral Medicine, University of Benin Teaching Hospital, Benin City, Nigeria. RESULTS: Of the 1013 diagnosed lesions within the study period, there were 137 (13.5%) paediatric orofacial tumours, among which 71 (51.8%) cases occurred within the last 6 years (2005 to 2010). There was male predilection for the lesions (78 males to 59 females, ratio = 1.3:1). The mean age was 9 + 4.3 years, with peak age group of 11 to 15 years (n=60, 43.8%). The mandible (n=44, 32.1%), followed by the maxilla (n=42, 30.7%) and orofacial soft tissue (n=19, 13.9%) were the most common sites. The benign tumours (n=72, 52.6%) were slightly more than the malignant tumours (n=65, 47.4%). There were more malignant tumours (n=23, 16.8%) than benign tumours (n=20, 14.6%) within the last 3 years (2008 to 2010) under review. Burkitt's lymphoma (n=38, 27.7%) was the commonest malignant lesion. CONCLUSION: This study showed a recent increase in the incidence of paediatric orofacial tumours, particularly due to a higher incidence of Burkitt's lymphoma.

Periapical granuloma associated with extracted teeth.

OBJECTIVE: This article aims to determine the incidence of periapical granuloma from extracted teeth and correlate the clinical diagnoses with the histopathological types of periapical granuloma. PATIENTS AND METHODS: Over a period of eight months, a prospective study designed as a routine biopsy of recoverable periapical tissues obtained from patients who had single tooth extraction was carried out. RESULTS: One hundred and thirty-six patients participated in the study, with 75 (55.1%) histopathologically diagnosed periradicular lesions. There were 23 (16.9%) cases of periapical granuloma, with a male to female ratio of 2: 1. The lesion presented mostly between the third and fourth decades of life (n=9, 6.6%). Clinically diagnosed acute apical periodontitis was significantly associated with periapical granuloma, with predominantly foamy macrophages and lymphocytes (P<0.05). CONCLUSION: Periapical granuloma appears to be a less common periapical lesion in this study compared to the previous reports. In contrast to reports that relate to an acute flare of the lesion with abundant neutrophilic infiltration, this study has shown marked foamy macrophages and lymphocytes at the acute phase, which are significantly associated with the clinical diagnosis of acute apical periodontitis. We recommend the classification of periapical granuloma into early, intermediate, and late stages of the lesion, based on the associated inflammatory cells.

Melanin pigmented periradicular lesions of extracted teeth: a report of 3 cases and review of the literature.

This article reports 3 cases of melanin pigmented lesions among 75 histologically diagnosed periradicular lesions of extracted teeth. Case 1 was a 25-year old male who presented with one week history of toothache involving a tender carious left mandibular second molar tooth (37), with periapical radiolucency and diagnosed clinically as acute apical periodontitis. The lesion was diagnosed histologically (using Haematoxylin and Eosin) as periapical granuloma, while histochemical examination (using Masson-Fontana technique) showed the presence of round/oval shaped melanin pigmented macrophages (melanophage) in the lesion. Case 2 was a 54-year old male with one week history of toothache associated with tender carious right maxillary first molar tooth (16) with periapical radiolucency. A clinical diagnosis of acute apical periodontitis was made, but histological and histochemical examination showed a melanin pigmented periapical granuloma with spindle shaped melanophage. Case 3 was a 28-year old female who presented with 4 days history of toothache, involving the tender left mandibular first molar tooth (36). The lesion had periapical radiolucency and a clinical diagnosis of acute apical periodontitis. On examination histologically and histochemically, the lesion was diagnosed as an intraosseous melanocytic naevi with dark-brown nests of round naevus cells. In conclusion, this article shows the rarity of melanin pigmented periradicular lesions in the jaws. The cases reported suggest that the trigger for formation of melanin-pigmented cells in the periradicular lesions may be related to the acute phase of the lesions. Further study is recommended to determine if the remnants of the migratory neural crest cells are the precursors of melanin-pigmented cells in the periradicular region.

Methotrexate-induced erythema multiforme: a case report and review of the literature.

BACKGROUND: Mucosal affectation may be a direct cytotoxic or cytostatic effect of methotrexate. OBJECTIVE: To highlight the diagnostic procedure and treatment intervention erythema multiforme complicating methotrexate-induced allergic stomatitis. CASE REPORT: The patient was a 60-year-old man suffering from stomatitis that rapidly developed into erythema multiforme. The patient had been prescribed methotrexate to treat rheumatoid arthritis. The patient presented with painful ulceration of the vermillion border of the upper and lower lips covered with necrotic tissues. We made a tentative diagnosis of methotrexate induced allergic stomatitis. On the patient's second visit to the clinic, the lesion had developed into crusted and haemorrhagic ulceration with erythematous patches on the lips. The patient was now complaining of weakness, fever and occasional seizure attack. Examination of the upper and lower extremities revealed bilateral bullous eruptions. The definitive diagnosis was that of erythema multiforme complicating methotrexate induced allergic stomatitis. withdrawal of the methotrexate yielded positive result with complete resolution of the lesions after 12 days of drug withdrawal. CONCLUSION: Early diagnosis of adverse drug reactions is essential for effective treatment, to avoid untoward systemic complications.

Periradicular burkitt's lymphoma: a report of 2 cases from Nigeria and review of the literature.

This article reports two cases of periradicular Burkitt's lymphoma from Nigeria, to emphasize the difficulties in differentiating the early lesion from other periradicular lesions with similar clinical and radiological findings Case 1, is a 4-year-old boy who presented with a one-month history of a painless, hard, posterior mandibular swelling (right), which was causing loosening and displacement of deciduous teeth (84 and 85). Histopathological examination of periradicular tissues from extracted tooth (85), confirmed the diagnosis of early periradicular B urkitt's lymphoma. Case 2, is a 6-year-old boy who presented with one-week history of a loose, extruded right mandibular first molar tooth (46) and an exfoliated left mandibular first molar tooth (36). After two weeks of follow-up, the patient developed bilateral mandibular swelling at the molar region, as well as peri-orbital and bilateral pedal oedema. Incisional biopsy of the oral lesion at the region of exfoliated left first mandibular molar (36) was useful for histopathological diagnosis of early Burkitt's lymphoma of the jaw. In the face of limited diagnostic tools such as clinico-radiological assessment, cytology or incisional biopsy for incipient periradicular lesions, a high index of suspicion of Burkitt's lymphoma of the jaw may be helpful in early diagnosis and treatment of a lesion, presenting in a child as periradicular radiolucency or mixed radiolucency and radiopacity, with associated loosening and displacement of teeth.