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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 6  |  Issue : 2  |  Page : 60-64

Pattern of histologically diagnosed orofacial tumor and disparity in number managed in a Nigerian University Teaching Hospital: A 5 years review


1 Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Sokoto State, Nigeria
2 Department of Oral and Maxillofacial Surgery and Oral Pathology, Obafemi Awolowo University Teaching Hospitals, Ile-Ife, Osun State, Nigeria
3 Department of Preventive Dentistry, Obafemi Awolowo University Teaching Hospitals, Ile-Ife, Osun State, Nigeria

Date of Web Publication6-Dec-2017

Correspondence Address:
Dr. Ramat Oyebunmi Braimah
Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Sokoto State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-4696.219980

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  Abstract 


Background: Orofacial tumors are tumors that can affect any tissue in the oral and maxillofacial region. They constitute a major health problem in Africa because of late presentation. Aim: This was a retrospective study designed to determine the pattern of histologically diagnosed orofacial tumor and those actually managed. Materials and Methods: The department of Oral and Maxillofacial Surgery and Oral Pathology of a University Teaching Hospital in South West Nigeria. Histological diagnoses file and theater register booklet was retrieved from 2010 to 2014. Age, sex, diagnosis, and occupation of the patients were extracted. Data were analyzed using SPSS version 16 (SPSS 16 Inc., Chicago, IL, USA). Results were presented as descriptive frequencies (%). The value of P < 0.05 was considered statistically significant. Results: Of the 188 data analyzed, 98 (52.1%) were females, whereas 90 (47.9%) were males with male: female ratio 1:1.08. Age groups 21–30 and 31–40 constitute the highest age group with tumor presentation (41 [21.8%]). Most of the patients were traders (62 [33%]). Plexiform ameloblastoma was the most common benign tumor (23 [12.2%]), whereas moderately differentiated squamous cell carcinoma was the most common malignant tumor (9 [4.8%]). Only 58 (30.9%) were treated while 91 (48.4%) were not treated and only 39 (20.7%) were referred. Conclusion: Ameloblastoma was the most common odontogenic tumor while moderately differentiated squamous cell carcinoma was the most common malignant lesion. Most of the diagnosed tumors were not treated and reason is due to low financial status of the patients. Negligence on the part of patient could also be a contributing factor.

Keywords: Ameloblastoma, health care financing, orofacial, squamous cell carcinoma


How to cite this article:
Braimah RO, Soyele OO, Aregbesola SB, Rasheed MA. Pattern of histologically diagnosed orofacial tumor and disparity in number managed in a Nigerian University Teaching Hospital: A 5 years review. J Dent Allied Sci 2017;6:60-4

How to cite this URL:
Braimah RO, Soyele OO, Aregbesola SB, Rasheed MA. Pattern of histologically diagnosed orofacial tumor and disparity in number managed in a Nigerian University Teaching Hospital: A 5 years review. J Dent Allied Sci [serial online] 2017 [cited 2017 Dec 16];6:60-4. Available from: http://www.jdas.in/text.asp?2017/6/2/60/219980




  Introduction Top


Orofacial tumors, which can be benign or malignant depending on their clinical, biologic and histological characteristics, are a group of tumors that can affect various organs or tissues in the maxillofacial region, that is, the jaws, oral lining mucosa, gingival, tongue, lips, oropharynx, maxillary sinus, covering skin of the face and salivary gland. Tumors in this region, with the exception of squamous cell carcinoma, ameloblastoma and Burkitt's lymphoma are believed to be uncommon.[1] However, in Africa, especially Sub-Saharan Africa, they constitute a major health problem because affected patient usually present late in the course of the disease with advanced tumor.[2] This increase the morbidity and mortality. The management of these tumors present a challenge due to their sizes at presentation in the West African sub-region that most of the citizens are in the low socioeconomic class. Despite advances in knowledge about risk factor reduction and improvements in the early detection and management of several cancers, socioeconomic imbalance persist in cancer incidence, morbidity, mortality, and survival.[3],[4],[5]

The funding of health care in Sub-Saharan Africa, especially Nigeria has often been described as grossly inadequate with budgetary provision to health hardly exceeding 3% of the nation's total budgetary provisions.[6],[7] Health care spending in Nigeria is segmented into private and public spending. Public health expenditures in Nigeria account for just 20%–30% of total health expenditures, private expenditures accounts for 70%–80% of total health expenditure. The dominant private expenditure is through out-of-pocket (OOP), which accounts for more than 90% of private health expenditures.[8],[9]

In most developed countries, health care is paid for largely by the government or an organization associated with it, using taxes collected from citizens. The United Kingdom, for example, has a “single-payer” system in which the government pays directly for care; in France and Germany, the government collects taxes to fund part of the government health care system, and employers and individuals pay for the remainder of the costs directly.[10] In other countries, such as the USA, a portion of the health care system is market based, which is, paid for by private entities such as employers and individuals. Even in market based systems, the government may provide health care to vulnerable people. For instance, in the USA, federal funds support Medicare, which covers the elderly and disabled, and state and federal funds support Medicaid, which covers low-income people.[11] Further recognition of the importance of universal coverage and equity in health services provision led WHO to propose at the 2010 World Health Assembly issues that will address financing of health that will ensure universal coverage.[12]

The main aim of this study is to determine the pattern of histologically diagnosed orofacial tumor and those actually managed from 2010 to 2014 in a Nigerian University Teaching Hospital. The specific objectives were; to highlight histological types of orofacial tumors, to determine how many of the orofacial tumors diagnosed were treated and to determine reasons for not seeking treatment.


  Materials and Methods Top


This was a retrospective study designed to determine the pattern of histologically diagnosed orofacial tumor and those actually managed in a Nigerian University Teaching Hospital. Histological diagnoses file and operation register was retrieved from 2010 to 2014. Age, sex, diagnosis, and occupation of the patients were retrieved, recorded, and stored. Data were analyzed using SPSS version 16 (SPSS 16 Inc., Chicago, IL, USA). Results were presented as simple frequencies (%). The value of P < 0.05 was considered statistically significant.


  Results Top


Out of the 188 data retrieved and analyzed most of the patients were females 98 (52.1%), while males are 90 (47.9%). Male: female ratio was 1:1.1 [Table 1]. Age groups 21–30 and 31–40 constitute the highest age group with tumor presentation (41 [21.8%]) while age group 91–100 was the least age group with tumor [Table 2]. With respect to age group presentation and type of tumor, benign tumors are most common in the age group 31–40 closely followed by age group 21–30 while malignant tumor are more common in age group 51–60 followed by age groups 21–30 [Table 2]. Most of the study population were traders 62 (33%), others are shown in [Table 3].
Table 1: Sex distribution of patient

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Table 2: Distribution of age group and diagnosis

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Table 3: Distribution of occupation of patients

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[Table 4] shows histological distribution of tumors. Plexiform ameloblastoma constitute the highest frequency of the benign tumors (23 [12.2%]), while moderately differentiated squamous cell carcinoma constitute the highest frequency of the malignant tumors (9 [4.8%]).
Table 4: Histological distribution of orofacial tumours

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Out of the 188 samples retrieved, 58 (30.9%) was treated while 91 (48.4%) were not treated and only 39 (20.7%) were referred to other centers for management [Table 5]. Out of the 39 cases that were referred 7 (17.9%) were benign tumors while 32 (82.1%) were malignant tumors [P < 0.001, [Table 5].
Table 5: Distribution of type of tumor and treatment

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Considering patient occupation and whether treatment was given or not, 31 (34.0%) patients out of the 91 that were not treated are traders, while 23 (25.3%) students and Artisans each were also not treated [Table 6].
Table 6: Distribution of type of treatment and patient's occupation

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  Discussion Top


Most of the patients during the study were females 98 (52.1%), whereas there were 90 (47.9%) males, with male: female ratio of 1:1.1. This finding agrees with some studies.[13],[14],[15],[16],[17],[18] However, differ to others[18],[19],[20],[21],[22] where a male predilection was reported. In general, female gender are known to have good health seeking behavior therefore will present more in the hospital than males. Most of the lesion diagnosed was seen in the second and third decades of life (21.8%). Santos et al., has reported similar findings.[13] Of all the malignant lesions seen, 11 cases were seen in the sixth decade of life whereas nine cases were seen in the second decade of life. It is known that one of the risk factors for malignancy is increase in age; however, from this study, malignant lesions were also seen in the younger age group.

Plexiform ameloblastoma was the most common histologically diagnosed benign orofacial tumor (12.2% of all the tumors), while moderately differentiated squamous cell carcinoma is the most common malignant orofacial tumor seen during the study period. This finding is in agreement with other studies from Nigeria where ameloblastoma was the most common odontogenic tumor.[2],[21],[23],[24] This was, however, in disagreement to non-African studies were odontoma was reported as the commonest odontogenic tumor.[13],[16],[22] This has been possibly attributed to difference in genetic factors.[20] Odontoma from the present study was 0.5%. With regard to diagnosis and those cases that were actually treated, 58 (30.9%) where treated while 91 (48.4%) were not treated and 39 (20.7%) were referred. Most of the referred cases were malignant tumors. The reason being that there is no facility for radiotherapy in our center, hence their referral to centers with this facility where surgery and radiotherapy could be offered. From this study, we speculate that the reason for delay or no treatment was the majorly as a result of low financial status of these patients. Most of the patients were petty traders and artisans in the low socioeconomic class (62 [33%] being petty traders and 53 [28.2%] artisans). Amanda et al. concluded from their study that low socioeconomic status individuals report higher levels of several modifiable cancer risk factors, including obesity and physical inactivity.[25] They are also almost 2.5 times more likely to be current smokers compared to higher socioeconomic status individuals, and report lower rates of screening for cancer.[25] Furthermore, the fact that low socioeconomic status individuals are less likely to have health insurance and/or a personal care provider than higher socioeconomic status individuals may contribute to and compound these cancer risks.[25] Similarly, Clegg et al. in 2009 reported that socioeconomic patterns in incidence vary for specific cancers and such patterns were mostly associated with lower socioeconomic status.[26] How societies pay for health care, and how many resources they devote to health, affects both the care people can get and its quality. In Nigeria, the major sources of health financing include; (i) the tax-based public sector that comprises Local, State, and Federal Governments (ii) the private sector (including the not-for-profit sector) financing which is done, directly or indirectly through health insurance of their employees (iii) households, through OOP expenditures, including user fees paid in public facilities; (iv) other insurance-social and community-based; and (v) external financing (through grants and loans) from donor organizations.[27] Nigeria's health financial arrangement has moved from health provisioning by government to a competitive market where greater proportion of health services are provided by ability to pay through out of pocket expenses (often referred to as user fee).[28] Furthermore, this excessive dependence on the ability to pay through OOP payment reduces health care consumption, exacerbates the already inequitable access to quality care, and exposes households to the financial risk of expensive illness in low income settings.[29] Where the present study was carried out is a semi-urban area with low income population and majority are petty traders and artisans. This low income community have made treatment of complex surgical cases a mirage. It could then be argued that the system of health care financing in Nigeria is disproportionate, such that, it pushes the burden and risk of obtaining quality health services to the poor.[27]

Other possible factors for treatment delay or no treatment could not be deduced because this was a retrospective study with limitations of data. Despite this shortcoming, this study has shown that most of the diagnosed orofacial tumors were not actually treated. In conclusion, ameloblastoma still remain the most common odontogenic tumor in our environment while moderately differentiated squamous cell carcinoma was the commonest histologically diagnosed malignant lesion. Most of the diagnosed tumors were actually not treated and reason for this may be due to low financial status of these patients. It is, therefore, important for governments in Sub-Saharan Africans to make adequate budgetary allocations to the health sector for adequate universal health coverage for its citizenry. Although, low socioeconomic status and lack of radiotherapy machine has been highlighted from the study as reasons for referrals and lack of treatment, we opined that ignorance and negligence on the part of the patient could also be a contributing factor, however, this was not observed from the current review probably due to the retrospective nature of the study.


  Conclusion Top


Ameloblastoma was the most common odontogenic tumor while moderately differentiated squamous cell carcinoma was the most common malignant lesion. Most of the diagnosed tumors were not treated and reason from this study is due to low financial status of the patients. We also opined that ignorance on the part of the patient could also be a reason for the lack of treatment.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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