Clinicopathological presentations of oro-facial cystic lesions among patients attending treatment at muhimbili national hospital, Dar es Salaam, Tanzania.

Abstract

Background Cystic lesions are among the common causes of chronic swellings in the oro- facial region. They have the potential to grow to enormous sizes resulting in gross oro-facial tissues disfigurement and destruction. Oro-facial cystic lesions, when in the soft tissue, especially when infected can impair function such as breathing, mastication, swallowing and disfigure the face. To prevent such complications early diagnosis and adequate treatment is important. Many patients with oro-facial cystic lesions have been reporting to MNH with big lesions some of which have various degrees of infections, pressure effects and pain. Shortage of data on the magnitude and clinicopathological presentations of these cystic lesions has resulted into inadequate management of these patients at different levels of health care. Objective of the study The aim of this study was to determine clinicopathological presentations of oro- facial cystic lesions among patients attending treatment at the maxillofacial firm of the department of Dentistry of Muhimbili National Hospital for 9 months from June 2008 to February 2009. Study design This was a prospective descriptive hospital based study, which involved patients who were attending treatment at the maxillofacial firm of the department of Dentistry of MNH during the study period of 9 months from June 2008 to February 2009, and were diagnosed histologically as having oro-facial cystic lesions.

VIII

Setting

This study was carried out at the maxillofacial firm of the department of Dentistry and histopathology Unit ofMNH, Dar Es Salaam, Tanzania.

Study population

Study population was all patients who attended treatment at the maxillofacial firm of the department of Dentistry of MNH for 9 months from June 2008 to February 2009.

Methodology

Patients who attended treatment at the maxillofacial firm of MNH during the study period were clinically examined. Investigations did include plain radiographs and tissue biopsies or fine needle aspiration cytology for soft tissue cysts. For inconclusive fine needle aspiration cytology, tissue biopsy was taken from the lesions for histological evaluation.

After the biopsy taking, specimens were immediately fixed in a 10% phosphate buffered formalin in a broad bases container with a cover and within two days the specimens were sectioned, processed, paraffin embedded and stained using haematoxylin and eosin stains. After staining specimens were analyzed and reported by a pathologist.

Those patients who were diagnosed as having oro-facial cystic lesions were then informed about the study; those who agreed to participate were included in the study and were interviewed using prepared questionnaires. Those who refused to participate were excluded. After the interview patients were presented to the consultation clinic where they were scheduled for operations and follow up.

Results

During the study period of 9 months a total of 6,873 patients attended treatment at the maxillofacial firm of the department of Dentistry of MNH, where 41 (0.6%) were diagnosed as having oro-facial cystic lesions and all of them agreed to participate in the study. Out of these 41 patients, 21 (51.2%) were males and 20 (48.8%) females, with a male to female ratio of 1.1: I. The age of the patients with oro-facial cystic lesion in the present study ranged from 7 months to 75 years (mean age of26.7 years). From the questionnaires it was observed that majority 19 (46.3 %) of patients presented to MNH due to infection and pain, while 23 (53.7 %) reported due to other reasons such as increasing swellings, functional impairments and facial disfigurement. In this study 26 (63.4%) patients presented with lesions of more than 1 year and 17 (41.5%) had lesions of more than 2 years duration since was first noted. Out of all 41 patients with oro-facial cystic lesions 28 (68.5%) attended lower level health care facilities before coming to MNH, where 13 (31.7%) came directly to MNH. Majority 27 (65.8%) of the patients reported with lesions of 3 - 4 cm in the greatest diameter and jaw bones were the most 22 (53.6%) affected followed by the soft tissue cysts 19 (46.3%). Conclusion From the present study it was observed that the situation for oro-facial cystic lesions in Tanzania is to some extent different from other countries where many patients presented with lesions of big size, high rate of infections, pain and significant facial disfigurement. This situation resulted in increased cost and complications of surgical interventions, prolonged morbidity and increased chances of postoperative recurrence of the lesions. Therefore early correct diagnosis of oro-facial cystic lesions; preferably through histological diagnosis at different levels of the health care system, is an important step in making rational treatment planning, to execute adequate treatments or referrals to consultant hospitals.