The Open Dentistry Journal




ISSN: 1874-2106 ― Volume 13, 2019

Benign Orofacial Lesions in Libyan Population: A 17 Years Retrospective Study



Marwa Hatem1, *, Ziad S. Abdulmajid1, Elsanousi M. Taher1, Mohamed A. El Kabir2, Mohamed A. Benrajab2, Rafik Kwafi1
1 Department of Oral Diagnosis, Oral Radiology and Oral and Maxillofacial Surgery, Libyan International Medical University, Benghazi, Libya
2 Oral and Maxillofacial Surgery Unit, Tripoli Medical Centre, Tripoli, Libya

Abstract

Objectives: To analyze the frequency and type of benign orofacial lesions submitted for diagnosis at Tripoli Medical Centre over 17 years period (1997-2013). Materials and Methods: Entries for specimens from patients were retrieved and compiled into 9 diagnostic categories and 82 diagnoses. Results: During the 17 years period, a total of 975 specimens were evaluated, it comprised a male-female ratio of 0.76:1. The mean age of biopsied patients was 36.3±18.32 years. The diagnostic category with the highest number of specimens was skin and mucosal pathology (22.87%); and the most frequent diagnosis was pyogenic granuloma (14.05%). Conclusion: Pyogenic granuloma, lichen planus, radicular cyst and fibroepithelial polyp were found to be the most predominant diagnoses. Frequencies of most benign orofacial diseases were comparable to similar studies in the literature and to those reported from the eastern region of Libya. Further surveys are needed to define the epidemiology of orofacial diseases in Libyan population.

Keywords:: Benign, histopathologica, Libya, orofacial, retrospective, specimens.


Article Information


Identifiers and Pagination:

Year: 2015
Volume: 9
First Page: 380
Last Page: 387
Publisher Id: TODENTJ-9-380
DOI: 10.2174/1874210601509010380

Article History:

Received Date: 30/12/2015
Revision Received Date: 21/9/2015
Acceptance Date: 29/9/2015
Electronic publication date: 11/12/2015
Collection year: 2015

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© Hatem et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the (https://creativecommons.org/licenses/by/4.0/legalcode), which permits unrestricted, noncommercial use, distribution and reproduction in any medium, provided the work is properly cited.


* Address correspondence to this author at the Department of Oral Diagnosis, Oral Radiology and Oral and Maxillofacial Surgery, Faculty of Dentistry, Libyan International Medical University, Benghazi, Libya; Tel: +962791755841; Fax: +218612233909; E-mail: marwaaudey@yahoo.com




INTRODUCTION

Histopathological analysis is an important complementary tool that aids in the establishment of a definitive diagnosis. It is essential that dental practitioners have a perceived knowledge of the clinical and demographic characteristics associated with the occurrence of the versatile benign orofacial lesions, since many of them may exhibit similar clinical and/or radiographic characteristics to one another or may resemble malignant conditions.

Conducting an overall and detailed medical history and a comprehensive exploration of the oral cavity is essential to obtain a correct diagnosis. This influences the prognosis and the implementation of the appropriate treatment for each patient.Although occasionally it is possible to establish a clinical diagnosis, in most cases it is essential to conduct additional simple tests that provide valuable information, such as biopsies.

Biopsy is of paramount importance in the diagnostic process of oral lesions which, by clinical examination alone, can often be difficult and inaccurate [1Porter SR, Scully C. Early detection of oral cancer in the practice Br Dent J 1998; 185(2): 72-3.
[http://dx.doi.org/10.1038/sj.bdj.4809732] [PMID: 9718803]
]. Of particular importance is the contribution of biopsy and histopathology to the early detection of premalignant and malignant Lesions. Failure to biopsy may lead to persistence of a misdiagnosed malignant lesion or other serious pathology, resulting in an unfavourable downstream course for the patient and the attending clinician [2Melrose RJ, Handlers JP, Kerpel S, Summerlin DJ, Tomich CJ. The use of biopsy in dental practice. The position of the American Academy of Oral and Maxillofacial Pathology Gen Dent 2007; 55(5): 457-61.
[PMID: 17899726]
].

Most of the published epidemiological studies on orofacial lesions including those among Libyan population [3El Gehani R, Krishnan B, Orafi H. The prevalence of inflammatory and developmental odontogenic cysts in a libyan population Libyan J Med 2008; 3(2): 75-7.
[http://dx.doi.org/10.4176/071216] [PMID: 21499462]
-6Subhashraj K, Orafi M, Nair KV, El-Gehani R, Elarbi M. Primary malignant tumors of orofacial region at Benghazi, Libya: a 17 years review Cancer Epidemiol 2009; 33(5): 332-6.
[http://dx.doi.org/10.1016/j.canep.2009.10.009] [PMID: 19932650]
] are concerned with documenting the incidence or the prevalence of specific disease entity, such as dental caries, periodontal diseases or oral mucosal lesions. Furthermore, the majority of these investigations lack histological confirmation of diagnosis. Relatively few published surveys document the range of histologically diagnosed lesions over a given time frame. Among these, three studies from the United States with 400 specimen over one year [7Greer RO Jr. Surgical oral pathology at the university of Colorado school of dentistry: a survey of 400 cases J Colo Dent Assoc 1976; 54(2): 13-6.
[PMID: 1062401]
], 4723 specimens over 20 years [8Rossi EP, Hirsch SA. A survey of 4,793 oral lesions with emphasis on neoplasia and premalignancy J Am Dent Assoc 1977; 94(5): 883-6.
[http://dx.doi.org/10.14219/jada.archive.1977.0056] [PMID: 266000]
] and 15783 specimens over 18.5 years [9Weir JC, Davenport WD, Skinner RL. A diagnostic and epidemiologic survey of 15,783 oral lesions J Am Dent Assoc 1987; 115(3): 439-42.
[http://dx.doi.org/10.14219/jada.archive.1987.0248] [PMID: 3476665]
], one study from Spain with 562 specimen over 14 years [10Sixto-Requeijo R, Diniz-Freitas M, Torreira-Lorenzo JC, García-García A, Gándara-Rey JM. An analysis of oral biopsies extracted from 1995 to 2009, in an oral medicine and surgery unit in Galicia (Spain) Med Oral Patol Oral Cir Bucal 2012; 17(1): e16-22. [Spain].
[http://dx.doi.org/10.4317/medoral.17143] [PMID: 21743423]
], another from Singapore with 2057 specimen over 5 years [11Tay AB. A 5-year survey of oral biopsies in an oral surgical unit in Singapore: 1993-1997 Ann Acad Med Singapore 1999; 28(5): 665-71.
[PMID: 10597351]
] and the largest survey comprising 44007 specimens submitted over 30 years in the United Kingdom [12Jones AV, Franklin CD. An analysis of oral and maxillofacial pathology found in adults over a 30-year period J Oral Pathol Med 2006; 35(7): 392-401.
[http://dx.doi.org/10.1111/j.1600-0714.2006.00451.x] [PMID: 16827841]
].

Moreover, there are few documentations of the occurrence of orofacial lesions in Africa and the Middle East. These include: a study of 818 benign oral masses among Jordanian population [13Al-Khateeb TH. Benign oral masses in a Northern Jordanian population-a retrospective study Open Dent J 2009; 3: 147-53.
[http://dx.doi.org/10.2174/1874210600903010147] [PMID: 19672335]
] which reported high frequencies of pleomorphic adenoma, pyogenic granuloma and fibroepithelial polyp, a survey of 385 biopsied jaw lesions in Kuwait [14Ali MA. Biopsied jaw lesions in Kuwait: a six-year retrospective analysis Med Princ Pract 2011; 20(6): 550-5.
[http://dx.doi.org/10.1159/000330023] [PMID: 21986014]
] that reported high frequencies of radicular cyst, dentigerous cyst and keratocystic odontogenic tumor and a survey of 310 oral lesions in Yemen [15Al-Maweri SA, Al-Jamaei AA, Al-Sufyani GA, Tarakji B, Shugaa-Addin B. Oral mucosal lesions in elderly dental patients in Sana’a, Yemen J Int Soc Prev Community Dent 2015; 5(Suppl. 1): S12-9.
[http://dx.doi.org/10.4103/2231-0762.156152] [PMID: 25984462]
] that reported high frequencies of benign tumors and Qad-induced white lesions. In Libya, a study of 405 benign tumors revealed that keratocystic odontogenic tumors and ameloblastoma were the most predominant diagnoses [5Byahatti SM, Ingafou MS. The prevalence of tongue lesions in Libyan adult patients J Clin Exp Dent 2010; 2: 163-8.
[http://dx.doi.org/10.4317/jced.2.e163]
].

The aim of this study was to determine the range and the demographic characteristics of benign orofacial lesions in 975 oral and maxillofacial pathology specimens, submitted for diagnosis at Tripoli Medical Centre over 17 years period (1997-2013).

MATERIALS AND METHODS

This study was approved by Libyan International Medical University Ethical Committee and data acquisition was supervised by the head of oral and maxillofacial surgery unit at Tripoli Medical Centre.

Inclusion criteria were all histopathological reports of benign orofacial specimens referred to the oral and maxillofacial surgery unit at Tripoli Medical Centre between 1997 and 2013. Case files with missing patient information or inconclusive diagnoses were excluded from the study.

Classification Criteria

Specimens were compiled into 9 diagnostic categories according to their histological presentation as following: skin and mucosal pathology, gingival and periodontal pathology, odontogenic cysts, salivary gland pathology and tumors benign tumors, bone pathology, odontogenic tumors, non odontogenic cysts and miscellaneous. The miscellaneous group contained diseases that could not be placed into any other diagnostic category.

Statistical Analysis

Data were collected and prepared in Microsoft Excel spread-sheets 2013, and simple statistical procedures carried out (mean age, standard deviation, percentage, and charts). Patient confidentiality was maintained during the study.

RESULTS

During the 17 years period, a total of 1385 histopathological specimens were received from the oral and maxillofacial surgery unit at Tripoli Medical Centre, 83 cases were excluded due to incomplete data acquisition or unclear diagnosis. Of the remaining 1302 specimens, 975(74.88%) were of benign conditions and 327(25.12%) were of malignant conditions. Fig. (1) shows the distribution of diagnoses according to their histological grouping.

Fig. (1)

Distribution of diagnoses according to histological grouping.



Fig. (2)

The distribution of age groups as related to gender.



Fig. (3)

The 10 most frequent diagnoses.



Table 1

Distribution of diagnoses according to the histological grouping.




Fig. (2) shows the distribution of age groups as related to gender. Of the 975 benign conditions, 423 were of males and 552 were of females (male: female ratio: 0.76:1). Age of biopsied patients ranged from 1 to 95 years (mean 36.3 ± 18.32 years). The distribution of diagnoses according to histological grouping is shown in Table 1.

Overall, pyogenic granuloma was the most predominant diagnosis (14.05%) followed by lichen planus (6.66%) and radicular cysts (5.84%). The most frequent pathology in each category was as following: skin and mucosal pathology: Lichen planus (65 specimens); gingival and periodontal pathology : pyogenic granuloma (137 specimens); odontogenic cysts: radicular cyst (57 specimens); salivary gland pathology and tumors: pleomorphic adenoma (45 specimens); benign tumors: fibroma (21 specimens); miscellaneous: benign non specific ulcer (42 specimens); bone pathology: central giant cell granuloma (17 specimens); odontogenic tumors: ameloblastoma (21 specimens); non odontogenic cysts: sebaceous cyst (5 specimens).

The 10 most frequent diagnoses are shown in Fig. (3); these comprised 578, nearly 60% of all specimens. Pyogenic granuloma was the most predominant diagnosis (14.05%) followed by lichen planus (6.66%) and radicular cysts (5.84%).

DISCUSSION

Most previous investigations concentrate on studying a single type of benign oral diseases or a group of closely related ones. This study investigates all benign oral lesions in a group of Libyans. Information obtained from similar surgical pathology reports are of great values to oral surgeons facing benign oral diseases on daily basis. Furthermore, results of such surveys may constitute a baseline for large-scale population based investigations.

Most published studies investigating the oral lesions are either limited to a specific disease entity like odontogenic cysts [3El Gehani R, Krishnan B, Orafi H. The prevalence of inflammatory and developmental odontogenic cysts in a libyan population Libyan J Med 2008; 3(2): 75-7.
[http://dx.doi.org/10.4176/071216] [PMID: 21499462]
], tongue lesions [5Byahatti SM, Ingafou MS. The prevalence of tongue lesions in Libyan adult patients J Clin Exp Dent 2010; 2: 163-8.
[http://dx.doi.org/10.4317/jced.2.e163]
], odontogenic tumors [4El-Gehani R, Orafi M, Elarbi M, Subhashraj K. Benign tumours of orofacial region at Benghazi, Libya: a study of 405 cases J Craniomaxillofac Surg 2009; 37(7): 370-5.
[http://dx.doi.org/10.1016/j.jcms.2009.02.003] [PMID: 19362008]
, 16Daley TD, Wysocki GP, Pringle GA. Relative incidence of odontogenic tumors and oral and jaw cysts in a Canadian population Oral Surg Oral Med Oral Pathol 1994; 77(3): 276-80.
[http://dx.doi.org/10.1016/0030-4220(94)90299-2] [PMID: 8170660]
-18Ladeinde AL, Ajayi OF, Ogunlewe MO, 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(2): 191-5.
[http://dx.doi.org/10.1016/j.tripleo.2004.08.031] [PMID: 15660091]
] or salivary gland tumors [19Pinkston JA, Cole P. Incidence rates of salivary gland tumors: results from a population-based study Otolaryngol Head Neck Surg 1999; 120(6): 834-40.
[http://dx.doi.org/10.1016/S0194-5998(99)70323-2] [PMID: 10352436]
]; or limited to a specific population group such as children [20Jones AV, Franklin CD. An analysis of oral and maxillofacial pathology found in children over a 30-year period Int J Paediatr Dent 2006; 16(1): 19-30.
[http://dx.doi.org/10.1111/j.1365-263X.2006.00683.x] [PMID: 16364089]
] elderly [21Corrêa L, Frigerio ML, Sousa SC, Novelli MD. Oral lesions in elderly population: a biopsy survey using 2250 histopathological records Gerodontology 2006; 23(1): 48-54.
[http://dx.doi.org/10.1111/j.1741-2358.2006.00090.x] [PMID: 16433642]
] or military [22Adrian JC. Surgical oral pathology in a military hospital: a survey of 1345 cases Mil Med 1975; 140(3): 182-4.
[PMID: 803664]
]. Therefore, direct comparisons with previous reports are difficult.

The number of benign orofacial specimens histologically analyzed at Tripoli Medical Centre over 17 years period accounted for 70.4% (975 specimens) of all submitted specimens. Overall, there was a slightly higher tendency for orofacial lesions to occur in females, with the male: female ratio at 0.76:1. This was also reported by Tay [11Tay AB. A 5-year survey of oral biopsies in an oral surgical unit in Singapore: 1993-1997 Ann Acad Med Singapore 1999; 28(5): 665-71.
[PMID: 10597351]
], Jones and Franklin [12Jones AV, Franklin CD. An analysis of oral and maxillofacial pathology found in adults over a 30-year period J Oral Pathol Med 2006; 35(7): 392-401.
[http://dx.doi.org/10.1111/j.1600-0714.2006.00451.x] [PMID: 16827841]
] and Torres-Domingo et al. [23Torres-Domingo S, Bagan JV, Jiménez Y, et al. Benign tumors of the oral mucosa: a study of 300 patients Med Oral Patol Oral Cir Bucal 2008; 13(3): E161-6.
[PMID: 18305435]
]. However, males were more commonly affected by certain conditions; these include odontogenic and non odontogenic cystic lesions.

Skin and Mucosal Pathology

This category contained the highest number of biopsied specimens. Lichen planus was ranked the most predominant diagnosis among the skin and mucosal lesions, and the second most frequently diagnosed pathology with 65 (6.6%) specimens. Similar results were reported by Rossi and Hirsch [8Rossi EP, Hirsch SA. A survey of 4,793 oral lesions with emphasis on neoplasia and premalignancy J Am Dent Assoc 1977; 94(5): 883-6.
[http://dx.doi.org/10.14219/jada.archive.1977.0056] [PMID: 266000]
], Tay [11Tay AB. A 5-year survey of oral biopsies in an oral surgical unit in Singapore: 1993-1997 Ann Acad Med Singapore 1999; 28(5): 665-71.
[PMID: 10597351]
], Jones and Franklin [12Jones AV, Franklin CD. An analysis of oral and maxillofacial pathology found in adults over a 30-year period J Oral Pathol Med 2006; 35(7): 392-401.
[http://dx.doi.org/10.1111/j.1600-0714.2006.00451.x] [PMID: 16827841]
] and Cury et al. [24Cury PR, Porto LP, dos Santos JN, et al. Oral mucosal lesions in Indians from Northeast Brazil: cross-sectional study of prevalence and risk indicators Medicine (Baltimore) 2014; 93(27): e140.
[http://dx.doi.org/10.1097/MD.0000000000000140] [PMID: 25501053]
]. However, Sixto-Requeijo reported substantially higher number of cases [10Sixto-Requeijo R, Diniz-Freitas M, Torreira-Lorenzo JC, García-García A, Gándara-Rey JM. An analysis of oral biopsies extracted from 1995 to 2009, in an oral medicine and surgery unit in Galicia (Spain) Med Oral Patol Oral Cir Bucal 2012; 17(1): e16-22. [Spain].
[http://dx.doi.org/10.4317/medoral.17143] [PMID: 21743423]
]. There was a higher tendency for this disease to occur in females as reported in previous studies [12Jones AV, Franklin CD. An analysis of oral and maxillofacial pathology found in adults over a 30-year period J Oral Pathol Med 2006; 35(7): 392-401.
[http://dx.doi.org/10.1111/j.1600-0714.2006.00451.x] [PMID: 16827841]
, 23Torres-Domingo S, Bagan JV, Jiménez Y, et al. Benign tumors of the oral mucosa: a study of 300 patients Med Oral Patol Oral Cir Bucal 2008; 13(3): E161-6.
[PMID: 18305435]
]. This is probably due to the hormonal changes and stress among females [23Torres-Domingo S, Bagan JV, Jiménez Y, et al. Benign tumors of the oral mucosa: a study of 300 patients Med Oral Patol Oral Cir Bucal 2008; 13(3): E161-6.
[PMID: 18305435]
]. Fibroepithelial polyp is believed to be a non specific focal hyperplasic reaction of the lamina propria in response to chronic irritation. In our study, it accounted for 5.84% of the total biopsies, which is significantly lower than reported by Jones and Franklin and others [12Jones AV, Franklin CD. An analysis of oral and maxillofacial pathology found in adults over a 30-year period J Oral Pathol Med 2006; 35(7): 392-401.
[http://dx.doi.org/10.1111/j.1600-0714.2006.00451.x] [PMID: 16827841]
, 13Al-Khateeb TH. Benign oral masses in a Northern Jordanian population-a retrospective study Open Dent J 2009; 3: 147-53.
[http://dx.doi.org/10.2174/1874210600903010147] [PMID: 19672335]
]. As reported in previous results [12Jones AV, Franklin CD. An analysis of oral and maxillofacial pathology found in adults over a 30-year period J Oral Pathol Med 2006; 35(7): 392-401.
[http://dx.doi.org/10.1111/j.1600-0714.2006.00451.x] [PMID: 16827841]
, 13Al-Khateeb TH. Benign oral masses in a Northern Jordanian population-a retrospective study Open Dent J 2009; 3: 147-53.
[http://dx.doi.org/10.2174/1874210600903010147] [PMID: 19672335]
], fibroepithelial polyps were almost as twice in females as in males.

Gingival and Periodontal Pathology

Within this category, Pyogenic granuloma was the most predominant diagnosis and it amounted to 14.01% of the total. In most western studies, including those from United Kingdom [12Jones AV, Franklin CD. An analysis of oral and maxillofacial pathology found in adults over a 30-year period J Oral Pathol Med 2006; 35(7): 392-401.
[http://dx.doi.org/10.1111/j.1600-0714.2006.00451.x] [PMID: 16827841]
], Singapore [11Tay AB. A 5-year survey of oral biopsies in an oral surgical unit in Singapore: 1993-1997 Ann Acad Med Singapore 1999; 28(5): 665-71.
[PMID: 10597351]
] and Brazil [25Mendez M, Carrard VC, Haas AN, et al. A 10-year study of specimens submitted to oral pathology laboratory analysis: lesion occurrence and demographic features Braz Oral Res 2012; 26(3): 235-41.
[http://dx.doi.org/10.1590/S1806-83242012000300009] [PMID: 22641443]
], it made up only 1.8-2.43% of the overall biopsies. However, our results were similar to biopsied tissues from Jordanian [13Al-Khateeb TH. Benign oral masses in a Northern Jordanian population-a retrospective study Open Dent J 2009; 3: 147-53.
[http://dx.doi.org/10.2174/1874210600903010147] [PMID: 19672335]
] and Yemeni populations [26Daley TD, Wysocki GP, Wysocki PD, Wysocki DM. The major epulides: clinicopathological correlations J Can Dent Assoc 1990; 56(7): 627-30.
[PMID: 2397424]
]. The high female predilection for pyogenic granuloma may reflect the effect of estrogen and progesterone hormones in pregnancy on the pathogenesis of the condition, it was suggested that these hormones make the gingival tissue more susceptible to chronic inflammation caused by plaque and calculus [26Daley TD, Wysocki GP, Wysocki PD, Wysocki DM. The major epulides: clinicopathological correlations J Can Dent Assoc 1990; 56(7): 627-30.
[PMID: 2397424]
]. In the present study, there was high frequency of pyogenic granuloma in females in child bearing age (mean age: 33.93).

Cystic Lesions

Both odontogenic and non odontogenic cysts were more prevalent among males. Radicular and dentigerous cysts were the most commonly diagnosed lesions in the odontogenic cysts category accounting for 49.17% and 41.37%, respectively. These findings were also reported in other studies from Libya [1Porter SR, Scully C. Early detection of oral cancer in the practice Br Dent J 1998; 185(2): 72-3.
[http://dx.doi.org/10.1038/sj.bdj.4809732] [PMID: 9718803]
], Singapore [27Barnes L, Eveson JW, Reichart P, Sidransky D. World Health Organization classification of tumours: pathology and genetics of head and neck tumours. Lyon: IARC Press 2005.] and Canada

[17Lu Y, Xuan M, Takata T, 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(6): 707-14.
[http://dx.doi.org/10.1016/S1079-2104(98)90208-6] [PMID: 9868729]
]. Radicular cysts comprised 5.84% of all biopsied specimens, ranked the third most common diagnosis. It was ranked the forth most frequent diagnosis (5.3%) in the United Kingdom [12Jones AV, Franklin CD. An analysis of oral and maxillofacial pathology found in adults over a 30-year period J Oral Pathol Med 2006; 35(7): 392-401.
[http://dx.doi.org/10.1111/j.1600-0714.2006.00451.x] [PMID: 16827841]
].

Odontogenic keratocysts including parakeratinized and orthokeratinized types were reclassified as keratocystic odontogenic tumors and jaw cysts with keratinisation according to the new WHO guidelines of 2005 [17Lu Y, Xuan M, Takata T, 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(6): 707-14.
[http://dx.doi.org/10.1016/S1079-2104(98)90208-6] [PMID: 9868729]
]. Keratocystic odontogenic tumors comprised 1.43% of the total submitted specimens, this is substantially lower than the figures found in the United Kingdom [12Jones AV, Franklin CD. An analysis of oral and maxillofacial pathology found in adults over a 30-year period J Oral Pathol Med 2006; 35(7): 392-401.
[http://dx.doi.org/10.1111/j.1600-0714.2006.00451.x] [PMID: 16827841]
], Mexico [28Mosqueda-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(6): 672-5.
[http://dx.doi.org/10.1016/S1079-2104(97)90371-1] [PMID: 9431538]
] and Germany [29Kreidler JF, Raubenheimer EJ, van Heerden WF. A retrospective analysis of 367 cystic lesions of the jaw--the Ulm experience J Craniomaxillofac Surg 1993; 21(8): 339-41.
[http://dx.doi.org/10.1016/S1010-5182(05)80494-9] [PMID: 8113426]
] but similar to those reported in a previous study in Libyan population [30Kamulegeya A, Kalyanyama BM. Oral maxillofacial neoplasms in an East African population a 10 year retrospective study of 1863 cases using histopathological reports BMC Oral Health 2008; 8: 19.
[http://dx.doi.org/10.1186/1472-6831-8-19] [PMID: 18651958]
].

Benign Tumors

The ratio of benign to malignant tumors is approximately 0.3:1, Fibroma was the most frequent diagnosis in this category, supporting previous findings in the literature [2Melrose RJ, Handlers JP, Kerpel S, Summerlin DJ, Tomich CJ. The use of biopsy in dental practice. The position of the American Academy of Oral and Maxillofacial Pathology Gen Dent 2007; 55(5): 457-61.
[PMID: 17899726]
, 10Sixto-Requeijo R, Diniz-Freitas M, Torreira-Lorenzo JC, García-García A, Gándara-Rey JM. An analysis of oral biopsies extracted from 1995 to 2009, in an oral medicine and surgery unit in Galicia (Spain) Med Oral Patol Oral Cir Bucal 2012; 17(1): e16-22. [Spain].
[http://dx.doi.org/10.4317/medoral.17143] [PMID: 21743423]
, 23Torres-Domingo S, Bagan JV, Jiménez Y, et al. Benign tumors of the oral mucosa: a study of 300 patients Med Oral Patol Oral Cir Bucal 2008; 13(3): E161-6.
[PMID: 18305435]
, 25Mendez M, Carrard VC, Haas AN, et al. A 10-year study of specimens submitted to oral pathology laboratory analysis: lesion occurrence and demographic features Braz Oral Res 2012; 26(3): 235-41.
[http://dx.doi.org/10.1590/S1806-83242012000300009] [PMID: 22641443]
]. In contrast, Jones and Franklin reported high occurrence of squamous cell papilloma and low proportions of fibromas [12Jones AV, Franklin CD. An analysis of oral and maxillofacial pathology found in adults over a 30-year period J Oral Pathol Med 2006; 35(7): 392-401.
[http://dx.doi.org/10.1111/j.1600-0714.2006.00451.x] [PMID: 16827841]
]. The frequency of fibroma was higher in males, a result contrasting with previous studies [2Melrose RJ, Handlers JP, Kerpel S, Summerlin DJ, Tomich CJ. The use of biopsy in dental practice. The position of the American Academy of Oral and Maxillofacial Pathology Gen Dent 2007; 55(5): 457-61.
[PMID: 17899726]
, 25Mendez M, Carrard VC, Haas AN, et al. A 10-year study of specimens submitted to oral pathology laboratory analysis: lesion occurrence and demographic features Braz Oral Res 2012; 26(3): 235-41.
[http://dx.doi.org/10.1590/S1806-83242012000300009] [PMID: 22641443]
, 21Corrêa L, Frigerio ML, Sousa SC, Novelli MD. Oral lesions in elderly population: a biopsy survey using 2250 histopathological records Gerodontology 2006; 23(1): 48-54.
[http://dx.doi.org/10.1111/j.1741-2358.2006.00090.x] [PMID: 16433642]
].

Odontogenic Tumors

Odontogenic tumors accounted for only 3.48% of all submitted specimens; which was similar to findings by Jones and Franklin [12Jones AV, Franklin CD. An analysis of oral and maxillofacial pathology found in adults over a 30-year period J Oral Pathol Med 2006; 35(7): 392-401.
[http://dx.doi.org/10.1111/j.1600-0714.2006.00451.x] [PMID: 16827841]
], Delay [16Daley TD, Wysocki GP, Pringle GA. Relative incidence of odontogenic tumors and oral and jaw cysts in a Canadian population Oral Surg Oral Med Oral Pathol 1994; 77(3): 276-80.
[http://dx.doi.org/10.1016/0030-4220(94)90299-2] [PMID: 8170660]
], Bhaskar [31Bhaskar SN. Oral lesions in the aged population. A survey of 785 cases. Geriatrics 1968; 23: 137-4.] and Regezi [32Bhaskar SN. Oral pathology in the dental office: survey of 20,575 biopsy specimens J Am Dent Assoc 1968; 76(4): 761-6.
[http://dx.doi.org/10.14219/jada.archive.1968.0119] [PMID: 5237768]
] and this tends to confirm that these lesions are rare. Bhaskar [32Bhaskar SN. Oral pathology in the dental office: survey of 20,575 biopsy specimens J Am Dent Assoc 1968; 76(4): 761-6.
[http://dx.doi.org/10.14219/jada.archive.1968.0119] [PMID: 5237768]
] reported a preponderance of odontogenic tumours at 2.37% of all submitted specimens, while Kim and Ellis [33Regezi JA, Kerr DA, Courtney RM. Odontogenic tumors: analysis of 706 cases J Oral Surg 1978; 36(10): 771-8.
[PMID: 280645]
] reported that of 847 cases referred to the Armed Forces Institute of Pathology; only 53.4% (460 cases) were correctly identified as dental follicles and/or dental papillae; common misdiagnosis included odontogenic myxoma and other odontogenic tumours. The study by Kim and Ellis emphasized the importance of referral of such lesions to an oral and maxillofacial pathologist.

Our results showed that ameloblastoma was the most predominant odontogenic tumor, which is similar to that found by Tay [16Daley TD, Wysocki GP, Pringle GA. Relative incidence of odontogenic tumors and oral and jaw cysts in a Canadian population Oral Surg Oral Med Oral Pathol 1994; 77(3): 276-80.
[http://dx.doi.org/10.1016/0030-4220(94)90299-2] [PMID: 8170660]
] and Jones and Franklin [12Jones AV, Franklin CD. An analysis of oral and maxillofacial pathology found in adults over a 30-year period J Oral Pathol Med 2006; 35(7): 392-401.
[http://dx.doi.org/10.1111/j.1600-0714.2006.00451.x] [PMID: 16827841]
] but differs from other studies. For example, ameloblastoma are more common in the African [17Lu Y, Xuan M, Takata T, 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(6): 707-14.
[http://dx.doi.org/10.1016/S1079-2104(98)90208-6] [PMID: 9868729]
] and Chinese [18Ladeinde AL, Ajayi OF, Ogunlewe MO, 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(2): 191-5.
[http://dx.doi.org/10.1016/j.tripleo.2004.08.031] [PMID: 15660091]
] whereas odontomas appear to be more common in Canada [16Daley TD, Wysocki GP, Pringle GA. Relative incidence of odontogenic tumors and oral and jaw cysts in a Canadian population Oral Surg Oral Med Oral Pathol 1994; 77(3): 276-80.
[http://dx.doi.org/10.1016/0030-4220(94)90299-2] [PMID: 8170660]
] and Mexico [28Mosqueda-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(6): 672-5.
[http://dx.doi.org/10.1016/S1079-2104(97)90371-1] [PMID: 9431538]
].

Salivary Gland Pathology and Benign Tumors

Mucocele, chronic sialadenitis and ranula were the most predominant diseases; similar results were reported by Jones and Franklin [12Jones AV, Franklin CD. An analysis of oral and maxillofacial pathology found in adults over a 30-year period J Oral Pathol Med 2006; 35(7): 392-401.
[http://dx.doi.org/10.1111/j.1600-0714.2006.00451.x] [PMID: 16827841]
]. Mucocele made up 3.38% of the total specimens, compared with 3.4%, 4.3% and 11.6% from other findings in the literature [12Jones AV, Franklin CD. An analysis of oral and maxillofacial pathology found in adults over a 30-year period J Oral Pathol Med 2006; 35(7): 392-401.
[http://dx.doi.org/10.1111/j.1600-0714.2006.00451.x] [PMID: 16827841]
, 34Das S, Das AK. A review of pediatric oral biopsies from a surgical pathology service in a dental school Pediatr Dent 1993; 15(3): 208-11.
[PMID: 8378160]
], it was found to be the most frequent salivary gland lesion with predominance in children and young adults.

Benign tumors of salivary glands included pleomorphic adenoma and warthin tumor. Pleomorphic adenoma, a benign tumor of epithelial origin, made 4.6% of the total specimens. This was a relatively higher percentage than the figures reported by Jones and Franklin, and others [10Sixto-Requeijo R, Diniz-Freitas M, Torreira-Lorenzo JC, García-García A, Gándara-Rey JM. An analysis of oral biopsies extracted from 1995 to 2009, in an oral medicine and surgery unit in Galicia (Spain) Med Oral Patol Oral Cir Bucal 2012; 17(1): e16-22. [Spain].
[http://dx.doi.org/10.4317/medoral.17143] [PMID: 21743423]
, 21Corrêa L, Frigerio ML, Sousa SC, Novelli MD. Oral lesions in elderly population: a biopsy survey using 2250 histopathological records Gerodontology 2006; 23(1): 48-54.
[http://dx.doi.org/10.1111/j.1741-2358.2006.00090.x] [PMID: 16433642]
]. It was found to be the most predominant benign tumor in major and minor salivary glands [10Sixto-Requeijo R, Diniz-Freitas M, Torreira-Lorenzo JC, García-García A, Gándara-Rey JM. An analysis of oral biopsies extracted from 1995 to 2009, in an oral medicine and surgery unit in Galicia (Spain) Med Oral Patol Oral Cir Bucal 2012; 17(1): e16-22. [Spain].
[http://dx.doi.org/10.4317/medoral.17143] [PMID: 21743423]
, 12Jones AV, Franklin CD. An analysis of oral and maxillofacial pathology found in adults over a 30-year period J Oral Pathol Med 2006; 35(7): 392-401.
[http://dx.doi.org/10.1111/j.1600-0714.2006.00451.x] [PMID: 16827841]
, 21Corrêa L, Frigerio ML, Sousa SC, Novelli MD. Oral lesions in elderly population: a biopsy survey using 2250 histopathological records Gerodontology 2006; 23(1): 48-54.
[http://dx.doi.org/10.1111/j.1741-2358.2006.00090.x] [PMID: 16433642]
, 35Jaber MA. Intraoral minor salivary gland tumors: a review of 75 cases in a Libyan population Int J Oral Maxillofac Surg 2006; 35(2): 150-4.
[http://dx.doi.org/10.1016/j.ijom.2005.07.006] [PMID: 16181771]
].

Bone Pathology

Central giant cell granuloma and ossifying fibroma were the most predominant diagnoses in this group, both of which showed female predilection. These results were similar to studies from eastern Libya [4El-Gehani R, Orafi M, Elarbi M, Subhashraj K. Benign tumours of orofacial region at Benghazi, Libya: a study of 405 cases J Craniomaxillofac Surg 2009; 37(7): 370-5.
[http://dx.doi.org/10.1016/j.jcms.2009.02.003] [PMID: 19362008]
] and Kuwait [14Ali MA. Biopsied jaw lesions in Kuwait: a six-year retrospective analysis Med Princ Pract 2011; 20(6): 550-5.
[http://dx.doi.org/10.1159/000330023] [PMID: 21986014]
]. Other studies [10Sixto-Requeijo R, Diniz-Freitas M, Torreira-Lorenzo JC, García-García A, Gándara-Rey JM. An analysis of oral biopsies extracted from 1995 to 2009, in an oral medicine and surgery unit in Galicia (Spain) Med Oral Patol Oral Cir Bucal 2012; 17(1): e16-22. [Spain].
[http://dx.doi.org/10.4317/medoral.17143] [PMID: 21743423]
, 12Jones AV, Franklin CD. An analysis of oral and maxillofacial pathology found in adults over a 30-year period J Oral Pathol Med 2006; 35(7): 392-401.
[http://dx.doi.org/10.1111/j.1600-0714.2006.00451.x] [PMID: 16827841]
] showed lower frequencies of these lesions and higher prevalence of other pathologies like osteoarthrosis, exostosis and BRONJ.

It has been demonstrated that factors such as smoking, alcohol consumption, socioeconomic status and prosthetic use can be associated with the occurrence of oral lesions [36Carrard V, Haas A, Rados P, et al. Prevalence and risk indicators of oral mucosal lesions in an urban population from South Brazil Oral Dis 2011; 17(2): 171-9.
[http://dx.doi.org/10.1111/j.1601-0825.2010.01712.x] [PMID: 20659262]
]. Unfortunately, these factors are not often considered when histopathological evaluation is required. Since this information was not recorded in our laboratory reports, we were unable to evaluate its effect on the pathogenesis of benign oral lesion.

CONCLUSION

The number of investigated benign orofacial specimens reported at Tripoli Medical Centre over 17 years period was 975. Pyogenic granuloma, lichen planus, fibroepithelial polyp and radicular cyst were the most frequent diagnoses. The relative frequencies reported in our results were comparable to similar studies in the literature and to those reported from eastern part of Libya. These results can be used as a baseline for further nationwide population-based surveys of orofacial diseases in Libyan population.

CONFLICT OF INTEREST

The authors confirm that this article content has no conflict of interest.

ACKNOWLEDGEMENTS

None declared.

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