Benign Pediatric Jaw Lesions at Massachusetts General Hospital Over 13 Years

Abstract

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.