Frecuencia de patologias orales y maxilofaciales en pacientes de 0 a 18 anos de la Fundacion Hospital de la Misericordia, Bogota (Colombia), durante el periodo 2006-2014. (2025)

Frequency of Oral and Maxillofacial Pathologies in Patients from 0to 18 Years in the Fundacion Hospital de la Misericordia Bogota(Colombia), during the Period 2006-2014

Introduction

Oral pathologies that occur in children are very diverse, and it isnecessary that odontologists and other health professionals haveextensive knowledge to be able to diagnose them. Lesions can appear inthe mucous membranes and in the soft tissue and bones, with differentcharacteristics and etiologies; this makes the work of the clinicianindispensable for the diagnosis and successful treatment of thesediseases (1,2,3,4).

During dental care, it is very important to have knowledge aboutthe pathologies that may occur in children, as this will be the basisfor early detection and timely referral, in order to provide a bettermanagement and prognosis of these diseases. (5,6).

Lesions in children are different from those in adults; this is whymore studies are necessary, since the most prevalent pathologies inadults should not be generalized as if they were present in the same wayin children (7). Certain oral and maxillofacial diseases occur morefrequently in children, and bring consequences that should be handled ina timely manner (8).

The study conducted by Fattahi et al. (9) on the prevalence of headand neck tumors in children under 12 years of age, showed that most ofthe tumors were benign and located mostly in the neck. Even so, thereare few studies on the prevalence of oral and maxillofacial pathologiesin pediatric patients.

A study conducted in Thailand by Dhanuthai et al. (10), showed thatthe greatest number of lesions in pediatric patients was found in thecystic category, followed by inflammatory and tumor lesions. There werealso differences in the prevalence according to sex: there arepathologies that are reported more in women, such as head and neckbenign tumors, while a higher prevalence of malignant tumors was foundin men. This was concluded in the study by Abdulai et al. (1), on headand neck tumors in Ghanaian children.

In relation to Colombia, a study on the frequency of benignodontogenic tumors was carried out at the Hospital de la Misericordia(HOMI). A nine-year retrospective study conducted by Pena et al. (11),was the first performed in this pediatric institution, and constituted avery important basis for the present research.

There are differences between the different studies; this isbecause the criteria and variables used differ from one study to another(12,13,14). It is necessary that knowledge about oral and maxillofacialpathology be supported on epidemiological bases. For this reason, we setout to describe the frequency of oral and maxillofacial pathologies inpatients aged 0-18 years who attended the Maxillofacial Surgery Serviceof the Fundacion Hospital de la Misericordia during the period2006-2014, and to relate the most frequent oral and maxillofacialpathologies with sociodemographic characteristics.

Methodology-Statistics

The study was descriptive, cross-sectional, with an analysis ofdata collected from the ISIS database. It contained information of 277medical records of the HOMI, of patients aged 0-18 years, attendedbetween 2006 and 2014.

The information in the medical records included the following:female and male patients aged 0-18 years who were arranged into 0-4years, 5-9 years, 10-14 years, 15-18 years age groups, and those whowere diagnosed with some type of oral and maxillofacial pathology,divided as follows: head/neck cystic lesions, temporomandibular joint(TMJ) lesions, infectious lesions, benign head and neck tumor, malignanthead and neck tumor, benign odontogenic tumor, and those admitted to theHOMI in the period between January 2006 and December 2014.

The information of the medical records was organized in a unifiedtable in which the basic data of the medical record, number of therecord, sex, age, histopathological diagnosis, affected area andstructures, presence or not of sensory alterations, pain, were recorded.Exclusion criteria were medical records with incomplete data or reportswith dubious diagnoses.

The sociodemographic characteristics were analyzed as follows: sexand age, and the most frequent oral and maxillofacial pathologies wererelated to each of these characteristics, with the location and thepresence or absence of paresthesia and pain. The statistical analysiswas performed by Pearson and chi2 (p < 0.05) with the SPSS Statisticssoftware.

Results

We analyzed 277 medical records that had been reviewed betweenJanuary 2006 and December 2014. The following results were found:

The most frequent head and neck pathologies that occurred at theHOMI were infectious lesions, a 62.45%, followed by benign odontogenictumors, corresponding to 12.99%, benign head and neck tumors, 10.10%,and malignant head and neck tumors, head and neck cysts, TMJ lesions andskin lesions, which had lower frequency percentages (Table 1).

Regarding sex, in general the male-female relationship was 2:1, menpresented 66.42% of the pathologies evaluated, and women, 33.5%.

According to the report of the Department of Pathology of the HOMI,the age group with the highest frequency of head and neck pathologieswas that of 10-14 years, with 31.05%; followed by patients aged 0-4years, with a frequency of 26.35%; patients aged 5-9 years, with 26.35%;and patients 15-18 years old, with 18.05%.

Regarding the relationships between age and sex, the age group withthe highest frequency of head and neck pathologies in both men and womenwas that of 10-14 years of age. There was no significant differencebetween the age groups regarding the presence of pathologies withrespect to sex (Table 2).

On the other hand, infectious lesions occurred with a frequency of32.8% in women, and of 67.2% in men. In the category of odontogenictumors, the percentage frequency in women was 34.3%, whereas in men itwas 65.7%. These two categories of pathologies were the most frequent inboth women and men (Table 3). With respect to the 28 cases of benignhead and neck tumors, 19 were diagnosed in men and the remaining 9 casesin women.

Regarding head and neck malignant tumors, of the 20 cases, 13occurred in men, 65%; in women, the frequency was 35%. In the categoryof head and neck cystic lesions, 6 of the 11 cases occurred in women,which corresponded to a percentage frequency of 54.5%, whereas in menthere were 5 cases, with a frequency of 45.5%. It is the only categorywhere there were more cases in women than in men (Table 3).

In the category of TMJ lesions, the 5 cases occurred in men. Therewere 4 cases of skin lesions, 2 in men and 2 in women (Table 3). Withregard to the relationship between the pathology and the age groups, ofthe 11 cases of cystic lesion that occurred, 5 were in the 10-14 yearsage group (45.5%), followed by patients aged 0-4 years (27.30%). In the5-9 and 15-18 years age groups there was a lower percentage of cysticlesions (Table 4).

With regard to the 5 cases of TMJ lesions, the age group with thehighest frequency of this pathology was that of 10-14 years, a 60%,followed by the 5-9 and 15-18 years age groups, who each presented onecase (Table 4).

Infectious lesions occurred with an approximately equal frequencyin the 0-4 and 10-14 years age groups, with percentage frequencies of29.30 and 29.9, respectively. 27% corresponded to infectious lesions inpatients aged 5-9 years, whereas in the of 15-18 years age group thepathology occurred less frequently (Table 4).

There were 4 cases of skin lesions. 2 of these were in the 0-4years age group, representing 50% of the frequency (Table 4). There wasa higher frequency of head and neck benign tumors in the 0-4 years agegroup, which represents 32.14%, followed by the 10-14 years age group,in which there were 8 cases (28.60%). Patients aged 15-18 years had thelowest number of cases in this category (Table 4).

Of the 20 cases of head and neck malignant tumor category, 8corresponded to the 10-14 years age group (40%). In the 0-4 and 5-9years age groups there was the same number of cases, 6 in each, totaling60% of the frequency for this pathology. There were no cases in patientsaged 15-18 years (Table 4).

There was a higher frequency of benign odontogenic tumors inpatients aged 15-18 years, with 54.30%, followed by patients aged 10-14years, who had a percentage frequency of 28.60%. In the 0-4 years agegroup only one case occurred, which represented 2.9% (Table 4).

Of the 277 cases, 86 occurred in the 10-14 years age group, whichconstitute 31% of the total sample. Patients aged 0-4 years had thesecond highest percentage frequency (26.5%). The group with the fewestpathologies was the 15-18 years age group (Table 4).

Infectious lesions had the highest percentages in all age groups(Table 4). According to the Pearson chi2 test (0), there is astatistically significant association between the age groups and thepathologies presented.

Regarding the location, there were 11 cases of cystic head and necklesion: 3 located in the TMJ and in the neck, and 3 in the oral cavityand soft tissues, representing a percentage of 27.3 each. Of the 5 casesof TMJ lesions, 60% were located in the TMJ region and the neck.Regarding infectious lesions, the majority were located in the nasalcavity, and the percentage frequency in this area was 64.9%; thefollowing areas where these lesions occurred most frequently were theoral cavity and soft tissues. Regarding skin lesions (nevus), 75% werelocated in the TMJ and the neck. It was also observed that 46.40% of thehead and neck benign tumors were located in the oral cavity, whereasmost of the head and neck malignant tumors were located in the nasalcavity (45%). With regard to benign odontogenic tumors, 42.90% occurredin the posterior mandibular area, and 22.90% were located in theposterior maxillary area (Table 5).

According to the Pearson chi2 test (0), there is a statisticallysignificant association between the patient's pathology and itslocation. However, 18.20% of the patients who presented head and neckcystic lesions reported pain. It can also be seen that the 5 patientswho presented TMJ lesion presented pain (Table 6). 50% of the cases ofinfectious lesions presented pain, and the other 50% did not present.With regard to skin lesions, patients did not present pain (Table 6).

Of the 28 cases of head and neck benign tumors, 39.39% presentedpain. Of the 20 cases of head and neck malignant tumors, 15 reportedpain (75%). There were 35 cases of benign odontogenic tumor, 22 of whichreported pain (Table 6).

Of the 277 patients who presented any of these head and neckpathologies, 142 reported pain (51.30%). However, of the 142 cases, 87presented infectious lesions, which constitutes 61.30% of the patientswith this symptomatology (Table 6). According to the Pearson chi2 test(0.001), there is a statistically significant association between thepatients' pathologies and the presence of pain.

Of the 5 cases of TMJ lesion, 1 had paresthesia, which correspondsto 20%. As for the 174 patients who presented infectious lesions, only 4had paresthesia (2.30%). Of the 28 cases of benign head and neck tumors,only 2 experienced paresthesia, equivalent to 7.10%. On the other hand,of the 20 patients who presented head and neck malignant tumors, 5presented paresthesia, which constitutes a percentage frequency of 25.The frequency of paresthesia in patients with benign odontogenic tumorswas 22, 8% (Table 7).

Of the 277 cases with any of the head and neck pathologies studied,20 presented paresthesia, having a percentage frequency of 7.20. In thepatients who presented paresthesia, the pathology that occurred mostfrequently was benign odontogenic tumors, representing 40% of the total(Table 7). According to the Pearson chi2 test, there is a statisticallysignificant association between the patients' pathologies and thepresence of paresthesia.

Discussion

The most frequent head and neck pathologies occurred in patientstreated at the HOMI were infectious lesions, representing 62.45%. Insecond place were the benign odontogenic tumors, with 12.99%. Benignhead and neck tumors constituted 10.10%, whereas the frequency ofmalignant head and neck tumors of was 7.22%. Regarding head and neckcysts, the prevalence was 3.97%.

The study by Lapthanasupkul et al. (7), conducted in Thailand,showed that the most common oral and maxillofacial pathologies inpediatric patients were odontogenic cysts and tumors (35.5%), followedby inflammatory and reactive lesions (17%). Now, the study by Lei et al.(15), conducted in Taiwan, showed that the highest percentage of the1,023 biopsies analyzed was in the group of inflammatory and reactivelesions (44.10%), followed by groups of tumor lesions (22.45%) andcystic lesions. (19.16%). The study conducted in Thailand by Dhanuthaiet al. (10), showed that the pathologies that occurred most frequentlywere cystic (35.01%), inflammatory reactive (34.77%), and tumor (30.22%)lesions. It can be observed that in the three studies, the most frequentcategories were the inflammatory, tumor and cystic lesions, which issimilar to what was found in the HOMI.

We found in the HOMI that TMJ lesions and skin lesions had a lowerfrequency percentage than the mentioned categories, with frequencies of1.80% and 1.44%, respectively.

Regarding sex, the male-female ratio was 2:1; men presented 66.42%of the pathologies evaluated, and women 33.57%. There was no significantrelationship between sex and the frequency of the pathologies. Thisrelationship was consistent with that of other studies, such as that ofDhanuthai et al. (10) and Lei et al. (15).

Regarding age, the age group that presented the highest frequencyof head and neck pathologies, reported by the Department of Pathology ofthe HOMI, was the 10-14 years age group, with a percentage of 31.05,followed by patients aged 0-4 years, with a frequency of 26.35%. The15-18 years age group had the lowest frequency of pathologies,constituting 18.05%. Although the different studies do not have the samedivision of age groups as the present study, it was observed that mostof the pathologies occurred in patients aged 11-15 years, as shown bythe studies by Lapthanasupkul et al. (7), and by Lei et al. (15). Evenso, there are differences, since studies show that the frequency ofpathologies increases with age (7,10,15,16,17), and from what isreported in the HOMI it can be seen that in the 15-18 years age groupthe frequency was lower than in the other groups. These differences maybe due to the sample size and the age categorization.

Regarding signs and symptoms, in the present study we evaluated thepresence of pain and paresthesia. Of the 277 patients, 142 reported pain(51.30%). However, of these 142 cases, 87 had infectious lesions, whichconstitutes 61.30% of patients with this symptomatology. With regard tothe 277 cases, 20 presented paresthesia (7.20%). As for the patients whopresented paresthesia, the most frequent pathology was that of benignodontogenic tumors, representing 40% of the total. These highpercentages of symptoms may be due to the fact that the health system isnot efficient, and pathologies are diagnosed and treated when theyalready present symptoms and are in more advanced stages.

A statistically significant association was found between thepathologies and their location. It can be observed that of the 11 casesof head and neck cystic lesions, 3 were located in the TMJ and the neck,and 3 in the oral cavity and soft tissues, a percentage of 27.3 foreach. Of the 5 cases of TMJ lesions, 60% were located in the TMJ andneck region. With respect to infectious lesions, the majority waslocated in the nasal cavity (the percentage frequency in this region was64.9). The next area with greater frequency of these lesions was theoral cavity and soft tissues, with 16.10%. 75% of the skin lesions(nevus) were located in the TMJ and neck region. It can also be seenthat 46.40% of the benign head and neck tumors were located in the oralcavity, whereas the head and neck malignant tumors were located in thenasal cavity (45%). With respect to benign odontogenic tumors, 42.90%were located in the posterior mandibular region, followed by thoselocated in the posterior maxilla region, with 22.90%. Thesestatistically significant associations are evidenced in other studies,such as that of Lei et al. (15).

Conclusions

* The most frequent head and neck pathologies that occurred inpatients treated at the HOMI were infectious lesions, followed by benignodontogenic tumors and benign head and neck tumors.

* As for sex, the male-female ratio was 2:1.

* The age group that presented the highest frequency of head andneck pathologies was that of patients aged 10-14 years, followed bypatients aged 0-4 years. The frequency of pathologies diagnoseddecreased in patients aged 15-18 years, with the exception of benignodontogenic tumors, which presented a higher percentage in this agegroup.

* In all age groups, infectious lesions had the highest percentagesof frequency.

* Benign head and neck tumors occurred more frequently in the 0-4years age group, whereas in the category of malignant head and necktumors, the frequency was higher in the 10-14 years age group.

* The most frequent locations of head and neck cystic lesions werethe TMJ and the neck, and the oral cavity and soft tissues. RegardingTMJ lesions, the majority of cases were located in the TMJ and neckregion. With regard to infectious lesions, most were located in thenasal cavity, followed by the oral cavity and soft tissues. Skin lesionswere located in the TMJ and neck region. Benign head and neck tumorswere located in the oral cavity, whereas malignant head and neck tumorswere located mostly in the nasal cavity. With regard to benignodontogenic tumors, they occurred more frequently in the posteriormandibular area, followed by the posterior maxillary area.

There is a statistically significant association between thepathology and the location of the lesions and the signs and symptoms ofpain and paresthesia.

Recommendations

It is necessary to make a meaningful comparison and unify themethodological criteria; it is also necessary to categorize thepathology with more specific groups, and to limit the age variable sothat all studies manage a population with similar ages.

It is important to adapt ourselves to the ICD-10 codes, to bespecific in the head and neck tumor pathology diagnoses.

In order to provide a national epidemiological benchmark, it isimportant to conduct similar studies in hospitals that treat this typeof pathologies, and thus have beneficial tools to assess the behavior ofthese pathologies in the pediatric population of the country. Thepresent study can be a benchmark in Colombia, and serve as a guide forsimilar studies in healthcare institutions.

Acknowledgements

We wish to express our thanks to the Scientific Direction of theHOMI and to the Oral and Maxillofacial Surgery Service.

References

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Erika Alexandra Parra Sanabria (a) [emailprotected]

Universidad Nacional de Colombia, Colombia

Claudia Patricia Pena Vega [1]

Universidad Nacional de Colombia, Colombia

Author notes

(a) Correspondence: [emailprotected]

[1] Odontologist, Pontificia Universidad Javeriana, Bogota,Colombia. Oral and Maxillofacial Surgeon, Universidad Nacional deColombia. Oral Pathologist, Pontificia Universidad Javeriana. AssociateProfessor, School of Dentistry, Universidad Nacional de Colombia

Pontificia Universidad Javeriana, Colombia

Received: February, 05, 2018

Accepted: July, 24, 2018

DOI: https://doi.org/ 10.11144/Javeriana.umed59-4.fpom

Redalyc: http://www.redalyc.org/ articulo.oa?id=231056644015

Table 1Frequency of head and neck pathologies at the HOMI, 2006-2014Global histopathological diagnosis Frequency PercentageHead-Neck Cysts 11 3.97TMJ lesions 5 1.80Infectious lesions 173 62.45Skin lesions 4 1.44Head and neck benign tumors 28 10.10Head and neck malignant tumors 20 7.22Benign odontogenic tumors 36 12.99Total 277 100.00Table 2Age groups and sex of patients with head andneck pathologies, 2006-2014Sex Age Groups Total 0-4 5-9 10-14 15-18Male 48 46 58 32 184 26.09 25 31.52 17.39 100Female 25 22 28 18 93 26.88 23.66 30.11 19.35 100Total 73 68 86 50 277 26.35 24.55 31.05 18.05 100Table 3Relationship between sex and diagnoses ofhead and neck pathologies, 2006-2014Pathology Sex Total F MHead and neck cystic lesion n 6 5 11 % 54.5 45.5 100TMJ lesion n 0 5 5 % 0 100 100Infectious lesion n 57 117 174 % 38.2 67.2 100Skin lesion n 2 2 4 % 50 50 100Head and neck benign tumor n 9 19 28 % 32 68 100Head and neck malignant tumor n 7 13 20 % 35 65 100Benign odontogenic tumor n 12 23 35 % 34.3 65.7 10Total n 93 184 277 % 33.57 66.42 100Table 4Relationship between age with diagnoses of head and neckpathology, 2006-2014Pathology Age Group 0-4 5-9Head and neck Count 0 3 2 cystic lesion % within the illness 0.00 27.30 18.20TMJ lesion Count 0 0 1 % within the illness 0.00 0.00 20.00Infectious Count 0 52 47 lesion % within the illness 0.00 29.90 27.00Skin lesion Count 0 2 1 % within the illness 0.00 50.00 25.00Head and neck Count 1 S 6 benign tumor % within the illness 3.60 28.60 21.40Head and neck Count 0 6 6 malignant tumor % within the illness 0.00 30.00 30.00Benign odontogenic Count 0 1 5 tumor % within the illness 0.00 2.90 14.30Benign tumor Count 1 72 68 % within the illness 0.40 26.00 24.50Total % within the illness 100.00 100.00 100.00 % of the total 0.40 26.00 24.50Pathology Age Group Total 10-14 15-1SHead and neck Count 5 1 11 cystic lesion % within the illness 45.50 9.10 100.00TMJ lesion Count 3 1 5 % within the illness 60.00 20.00 100.00Infectious Count 51 24 174 lesion % within the illness 29.30 13.80 100.00Skin lesion Count 1 0 4 % within the illness 25.00 0.00 100.00Head and neck Count 8 5 28 benign tumor % within the illness 28.60 17.90 100.00Head and neck Count 8 0 20 malignant tumor % within the illness 40.00 0.00 100.00Benign odontogenic Count 10 19 35 tumor % within the illness 28.60 54.30 100.00Benign tumor Count 86 50 277 % within the illness 31.00 18.10 100.00Total % within the illness 100.00 100.00 100.00 % of the total 31.00 18.10 100.00Table 5Relationship between the disease and its anatomical locationPathology Location TMJ Nasal Oral cavity Face and and cavity and soft skull bones neck tissuesHead and neck n 3 1 3 1cystic lesion % 27.30 9.10 27.30 9.10TMJ lesion n 3 0 1 0 % 60.00 0 20.00 0Infectios lesion n 14 113 28 5 % 2.90Skin lesion n 3 1 0 0 % 75.00 25.00 0 0.00Head and neck n 1 S 13 2benign tumor % 3.60 23.6-0 46 40 7.10Head and neck n 2 9 5 0malignant tumor % 10.00 45.00 25.00 0.00Benign odontogenic n 1 1 5 0tumor %Total n 27 133 55 8 % 9.7 48.0 19.9 2.9Pathology Location Anterior Posterior Anterior Posterior mandible mandible masilla maxillaHead and neck n 0 1 1 1cystic lesion % 0 9.1 9.1 9.1TMJ lesion n 0 1 0 0 % 0 20 0 0Infectios lesion n 0 12 2 %Skin lesion n 0 0 0 % 0 0 0 0Head and neck n 1 2 0benign tumor % 3.60 7.10 3.60 0Head and neck n 0 4 0malignant tumor % 0 20 0 0Benign odontogenic n 1 15 4 8tumor % 42.90Total n 2 35 6 11 % 0.7 12.60 2.20 4.0Pathology Location TotalHead and neck n 11cystic lesion % 100TMJ lesion n 5 % 100Infectios lesion n 174 %Skin lesion n 4 % 100Head and neck n 28benign tumor % 100Head and neck n 20malignant tumor % 100Benign odontogenic n 35tumor %Total n 277 % 100Table 6Relationship between disease and presence of painPathology Pain Total No YesHead and neck Count 9 2 11cystic lesion % within the illness 81.80 18.20 100.00TMJ lesion Count 0 5 5 % within the illness 0.00 100.00 100.00Infectious lesion Count 87 87 174 % within the illness 50.00 50.00 100.00Skin lesion Count 4 0 4 % within the illness 100.00 0.00 100.00Head and neck Count 17 11 28benign tumor % within the illness 60.70 39.30 100.00Head and neck Count 5 15 20malignant tumor % within the illness 25.00 75.00 100.00Benign odontogenic Count 13 22 35tumor % within the illness 37.10 62.90 100.00Total Count 135 142 277 % within the illness 48.70 51.30 100.00 % within pain 100.00 100.00 100.00 % of the total 48.70 51.30 100.00Table 7Relationship between the disease and the presence of paresthesiaPathology Paresthesia Total No YesHead and neck Count 11 0 11cystic lesion % within the illness 100.00 0.00 100.00TMJ lesion Count 4 1 5 % within the illness 80.00 20.00 100.00Infectious lesion Count 170 4 174 % within the illness 97.70 2.30 100.00Skin lesion Count 4 0 4 % within the illness 100.00 0.00 100.00Head and neck Count 26 2 28benign tumor % within the illness 92.90 7.10 100.00Head and neck Count 15 5 20malignant tumor % within the illness 75.00 25.00 100.00Benign odontogenic Count 27 8 35tumor % within the illness 77.10 22.90 100.00Total Count 257 20 277 % within the illness 92.80 7.20 100.00 % within paresthesia 100.00 100.00 100.00 % of the total 92.80 7.20 100.00