Predisposing factors and clinico-pathological presentation of malignant lesions of the oro-facial region among patients attending the Muhimbili National Hospital in Dar-es-Salaam, Tanzania

Abstract

ABSTRACT Background The oro-facial region is made up of a complex anatomical relationship of structures of which may be a source of development of malignant lesions. Often, patients present at the oral and maxillofacial unit of Muhimbili National Hospital with a variety of malignant lesions in the oro-facial region. Majority of these patients are referred cases from upcountry district/regional hospitals and they present with advanced stages of disease with a wide range of complications. Of recent there has been a dramatic change in the characteristics and demography of some of the common malignant lesions of the oro-facial region. Such changes might be attributed to predisposition or systemic changes following exposure to certain external factors. Objective To determine the predisposing factors and clinico-pathological presentation of malignant lesions of the oro-facial region among patients attending the Muhimbili National Hospital. Study design Cross sectional descriptive hospital based study. Setting Oral and maxillofacial surgery firm, Muhimbili National Hospital. Methods All admitted and outpatients with clinically suspected malignant lesions in the oro-facial region who attended at the Muhimbili National Hospital, Oral surgery department from 1st July 2010 to 31st March 2011. Patients were interviewed using a specially designed questionnaire. Clinical examination was done, followed by fine needle aspiration cytology and/or tissue biopsy. A total of 186 patients with cytologically and/or histologically confirmed malignant lesions were included in the study. Data were entered in a computer, cleaned and analyzed using SPSS for windows version 13. vii Results A total of 186 patients, 104 (56.0%) males and 82 (44.0%) females with a ratio 1.3:1 were involved in the study. The age at the time of diagnosis ranged from 3 to 83 years with a mean age of 48.4 ± 19.2 SD years. Sixty one (32.8%) patients were aged below 40 years. The commonest observed oral and maxillofacial malignant lesion was Squamous cell carcinoma 96 (51.6%) patients followed by Kaposi’s sarcoma in 17 (9.1%) patients and carcinoma in 10 (5.4%) patients. Tobacco use was reported by 89 (47.8%) patients, of whom 62 (69.6%) patients had used tobacco for more than 20 years while 96 (51.6%) patients reported alcohol use, of whom 49 (51.0%) reported to have used alcohol more than 20 years. Thirty three (17.7%) patients were HIV positive. All patients with Kaposi’s sarcoma were also HIV positive. Malignant eccrine poroma and polymorphous low grade adenocarcinoma are rare tumours in the maxillofacial region that were encountered. Conclusion Squamous cell carcinoma was the most common malignant tumour in the oral and maxillofacial region. Use of tobacco and/or alcohol was the predisposing factors for squamous cell carcinoma. There was an increased frequency of malignant tumours in the oral and maxillofacial region among young patients. Patients presented rather late with advanced tumours that many times could only be managed by palliative therapy. All patients with Kaposi’s sarcoma were HIV positive.