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Benign Pediatric Jaw Lesions at Massachusetts General Hospital Over 13 Years
Youbai Chen1, Jie Zhang2, Yan Han3
1Attending and Instructor, Department of Plastic and Reconstructive Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China; and Fellow, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Insights
Pediatric jaw lesions, classified using the 2017 WHO guidelines, show varied recurrence rates. Aggressive tumors like central giant cell tumors and odontogenic keratocysts have high recurrence, suggesting tailored treatment is key.
Area of Science:
- Oral and Maxillofacial Pathology
- Pediatric Oncology
- Head and Neck Surgery
Background:
- Pediatric jaw lesions are rare but require accurate classification.
- The 2017 World Health Organization (WHO) classification provides a standardized approach to head and neck tumors.
- Previous studies have not extensively reported pediatric jaw lesions based on the latest WHO classification.
Purpose of the Study:
- To review the spectrum of benign pediatric jaw lesions treated at Massachusetts General Hospital.
- To classify these lesions according to the 2017 WHO classification of head and neck tumors.
- To analyze recurrence rates and influencing factors in pediatric jaw lesions.
Main Methods:
- Retrospective cohort study of patients under 18 years with benign bony jaw lesions.
- Histopathologic diagnosis grouped into odontogenic tumors (OTs), non-OTs, and odontogenic cysts.
- Analysis of recurrence incidence, interval to recurrence, symptoms, radiographic findings, and treatment modalities using descriptive statistics, Kaplan-Meier, and Cox regression.
Main Results:
- 131 patients with 14 diagnoses were analyzed, grouped into non-OTs (n=67), OTs (n=36), and odontogenic cysts (n=28).
- Odontogenic cysts presented as radiolucent, unilocular, well-circumscribed lesions compared to OTs and non-OTs.
- Overall recurrence was 0.77/100 person-years; aggressive central giant cell tumors (39.1%) and odontogenic keratocysts (40%) showed high recurrence rates.
Conclusions:
- Swelling in pediatric patients may indicate jaw lesions requiring panoramic examination.
- Management should consider lesion behavior, maxillofacial development, and growth.
- Enucleation with pharmacologic therapy shows promise for aggressive central giant cell tumors in children.
Purpose:
To the best of our knowledge, no study has reported pediatric jaw lesions according to the latest World Health Organization (WHO) classification of head and neck tumors. We reviewed the spectrum of benign pediatric jaw lesions treated at the Massachusetts General Hospital during a 13-year period according to the 2017 WHO classification.
Patients And Methods:
We implemented a retrospective cohort study of patients younger than 18 years old with benign bony lesions. The primary predictor variable was the histopathologic diagnosis, grouped into odontogenic tumors (OTs), non-OTs, and odontogenic cysts. The primary outcome variables were the incidence of recurrence and the interval to recurrence. Other outcome variables included symptoms, radiographic findings, and treatment modalities. Descriptive statistics were computed. Kaplan-Meier analyses and Cox regressions were performed.
Results:
The sample included 131 patients (58 males and 73 females; mean age, 12.6 ± 3.7 years) with 14 pathologic diagnoses. These were grouped as follows: non-OTs (n = 67), OTs (n = 36), and odontogenic cysts (n = 28). Odontogenic cysts were predominantly radiolucent, unilocular, and well-circumscribed cysts compared with the OTs and non-OTs (P < .05). Enucleation was the most commonly performed surgical procedure (72.5%). Adjuvant nonoperative procedures included cryotherapy for 10 patients, interferon therapy for 9 patients, and chemotherapy with denosumab for 3 patients to treat aggressive tumors. The overall incidence of recurrence was 0.77/100 person-years. The Cox hazard ratio of non-OTs/OTs was 3.1 (P = .13) and cysts/OTs was 4.3 (P = .075). Neither the incidence of recurrence nor the interval to recurrence among the 3 groups showed significant differences. A high incidence of recurrence was noted for aggressive central giant cell tumors (39.1%) and odontogenic keratocysts (40%) during a median follow-up of 3 years.
Conclusions:
Although pediatric jaw lesions are uncommon, symptoms such as swelling could indicate potential pathologic findings and require panoramic examination. Management of pediatric jaw lesions should consider the biologic behavior of the lesion, maxillofacial development, and growth. Enucleation combined with pharmacologic therapy is a promising strategy for the management of aggressive central giant cell tumors in children.
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