ISSN 2231 2250

International Journal of Oral & Maxillofacial Pathology. 2013;4(3):08-12

Available online at http://www.journalgateway.com or www.ijomp.org

Original Article
Jaw Cysts in Kano: Northern Nigeria
Iyogun CA, Ochicha O, Sule AA, Adebola RA

Abstract
Background and Objective: Jaw cysts are quite common in dental practice, but there has been
no published study from northern Nigeria. We therefore carried out this retrospective study to
document the pattern in Kano. Materials and Method: This was a six year (2006 to 2012)
retrospective study of all cysts of the mandible and maxilla diagnosed at the pathology
department of Aminu Kano Teaching Hospital, Kano. Results: Fifty-four histologically diagnosed
jaw cysts were seen during the six year study period, comprising 32 males and 22 females (M:F =
nd
rd
1.4:1). The age range was 3 to 87 years with highest occurrence in the 2 and 3 decades.
Dentigerous and radicular cysts were the commonest comprising 48.2% and 29.6% respectively.
rd
th
While dentigerous cysts peaked in the 3 , radicular cysts peaked in the 5 decade. Cysts were
more frequent in the mandible than maxilla with a ratio of 1.7:1. Over four-fifth (81%) of
dentigerous cysts were in the mandible while radicular cysts mostly occurred in the maxilla
(62.5%). Other jaw cysts in this series were simple bone cysts (7.4%), aneurysmal bone cysts
(5.5%), odontogenic keratocysts (3.7%), nasopalatine (3.7%) and eruption (1.9%). Conclusion:
With regards to the frequency of different jaw cysts, our findings were broadly consistent with the
few published Nigerian and sub-Sahara Africa reports, but at variance with most studies outside
the continent which documented a preponderance of radicular cysts. However, other parameters
(age, gender and site distribution) largely concur with global trends.
Key words: Jaw cysts; Nonodontogenic Cysts; Odontogenic Cysts; Keratocysts; Root Cysts;
Dental; Nigeria.
Iyogun CA, Ochicha O, Sule AA, Adebola RA. Jaw Cysts in Kano: Northern Nigeria. International Journal of
Oral and Maxillofacial Pathology; 2013:4(3):08-12. International Journal of Oral and Maxillofacial
Pathology. Published by Publishing Division, Celesta Software Private Limited. All Rights Reserved.
Received on: 03/03/2013 Accepted on: 15/09/2013

Introduction
Cysts of the jaws are osteo-destructive
lesions that are quite common in dental
practice. Most of these are derived from
epithelial rests within the jaw bones. Unlike
most other parts of the skeleton, the teeth
are largely derived from odontogenic
epithelium (dental lamina), remnants of
which may persist as epithelial rests that
1
may later give rise to jaw cysts. Other
maxillofacial cysts arise from epithelial
clusters trapped along the fusion lines of
embryologic facial processes. Pseudocysts not lined by epithelium - also occur in the
1
jaws. Collectively, these jaw cysts are
classified into 2 broad groups odontogenic
and non-odontogenic, with the more
common odontogenic group being subdivided into inflammatory, developmental
1,2
and neoplastic . However in common
medical parlance, jaw cysts usually refers to
non-neoplastic cavities within the jaw bones
which is the focus of present study.
The distinction between neoplastic and nonneoplastic jaw cysts is not always clear cut,
as with odontogenic keratocyst which was
previously designated a developmental cyst,

but has recently been reclassified as a

3,4
benign
neoplasm.
Furthermore,
odontogenic cysts have been severally
1,5
documented to give rise to neoplasms.
Here in Kano, the largest city in northern
Nigeria, there has been no formal study of
this common clinical problem. In fact there
are no published reports on jaw cysts from
northern Nigeria. We therefore endeavour to
document and evaluate the pattern in our
locality.
Materials and Methods
This was a six year retrospective study
(2006-2012) of all histologically diagnosed
jaw cysts at the pathology department of
Aminu Kano Teaching Hospital, Kano
(AKTH). The hospital is the only tertiary
health institution offering histopathology
services in Kano state. Biodata (age, sex,
site) were obtained from laboratory records,
and histology slides of all cases were
retrieved and reviewed. All specimens had
been fixed in 10% formal saline, decalcified
with 10% formic acid then routinely
processed for paraffin embedding. Later 5
sections
were
then
stained
with
haematoxylin and eosin. Diagnosis was

2013 International Journal of Oral and Maxillofacial Pathology. Published by Publishing Division, Celesta Software Private Limited. All Rights Reserved

ISSN 2231 2250

Jaw Cysts in Kano: Northern Nigeria... 9

based on WHO classification of jaw cysts.

1,2

2nd and 3rd decades, peaking in the

twenties then gradually declining thereafter.

Results
Fifty four jaw cysts were documented during
the 7 year study period in patients aged from
3 to 61 years. Males were slightly more
preponderant with an overall M:F ratio of
1.4:1. Table 1 shows the relative frequency
and age distribution of different jaw cysts.
Dentigerous and radicular cysts were by far
the commonest comprising 48.2% and
29.6% respectively, distantly followed by
simple bone (7.4%) and aneurysmal bone
cysts (5.5%). In general, cysts most
commonly occurred in young people in the

Table 2 shows the gender and site

distribution of jaw cysts in Kano.
Dentigerous cysts were overwhelmingly
preponderant among males, while radicular
cysts were almost equally distributed among
both sexes. Over four-fifth (81%) of
dentigerous cysts occurred in the mandible
while radicular cysts more frequently
(62.5%) involved the maxilla. Overall cysts
were more common in the mandible than
maxilla with a ratio of 1.7:1.

Type of cyst

No. of
cases

<10
years

10-19
Years

20-29
years

30-39
years

40-49
Years

50-59
Years

>60
years

Dentigerous
Radicular
Simple bone
Aneurysmal bone

26
16
4
3

48.2
29.6
7.4
5.5

2
1
1

7
2
2
-

9
5
1

5
2
-

2
3
1

1
2
-

2
1
-

Odontogenic
keratocyst

3.7

Nasopalatine
2
3.7
1
1
Eruption
1
1.9
1
Total
54
100
5
12
13
8
Table 1: Relative frequency and age distribution of jaw cysts in Kano
Male

Female

Mandible

Maxilla

Dentigerous
Radicular

No. of
cases
26
16

17
9

9
7

21
6

5
10

Simple bone

1
1
1
1
22

3
2
1
34

2
1
20

Type of cyst

Aneurysmal bone
3
2
Odontogenic keratocyst
2
1
Nasopalatine
2
1
Eruption
1
Total
54
32
Table 2: Site and gender distribution of jaw cysts in Kano
Discussion
Only 54 jaw cysts were documented in this
7-year review, which is quite small for the
largest city in northern Nigeria that is also
capital of the most populous state in the
country estimated at 11 million from our
7
2006 national census. Similar paltry figures
were documented in other Nigerian studies.
In Enugu, Oji documented only 20 cases in a
8
10 year study , while a more recent 10 year
study in Ibadan, the second largest city in
9
southern Nigeria documented 92 cases.
Such small sample size undermines the
statistical significance of these Nigerian
studies. Reports from other parts of sub-

Saharan Africa are very scanty. A Kenyan

study spanning two decades reported only
10
194 cases. Studies outside the African
continent document many more cases. A 2
year study in Pakistan documented 100
cases; an 8-year Turkish study documented
459 cases, while 10 year French study
11-14
reported 697 cases.
It is possible that the smaller sample sizes of
Nigerian studies indicate lower incidence,
but it is more likely that jaw cysts are
underreported for a variety of reasons.
Foremost of which is low patronage of
orthodox medical care by our poverty

10 Iyogun CA, et al.

stricken populace who cant be bothered

with expensive maxillofacial surgery they
can ill-afford for benign jaw cysts that are not
life threatening and do not significantly
impair their quality of life. Another
contributory factor to under-reporting of
cases is the proliferation of private dental
clinics which perform jaw cystectomies but
do not bother sending specimens for
histological diagnosis, as the diagnosis is
often obvious with good clinical history and
plain x-ray.
Overall, jaw cysts in this series were slightly
more preponderant among males (M:F =
1.4:1). This is similar to most other published
reports within and outside Nigeria 1.5:1 in
Enugu, 1.3:1 in Libya, 1.7:1 in Pakistan,
1.2:1 in India, 1.1:1 in Ibadan, 1.1:1 in
8,9,11-16
Turkey, 1.1:1 in Chile.
Two studies
from
Kenya
and
France
however
documented
much
higher
male
preponderance, almost twice that of
females;
M:F=1.8:1
and
1.9:1
8,12
respectively . Conversely two Brazillian
studies
reported
slight
female
17,18
preponderance.
Poorer dental hygiene and increased risk of
maxillofacial trauma among men have been
proposed to explain male preponderance,
14
particularly for radicular cysts.
While
increased risk of trauma among men is
understandable, theres no hard evidence
that men indeed have poorer dental hygiene.
More so as the preceding caries would have
occurred; years or decades earlier in
childhood when there is no significant
gender disparity. In this series there was no
significant gender predilection among
patients with radicular cysts, while the
aforementioned Brazillian studies actually
documented
slight
female
17,18
preponderance.
Furthermore, increased
trauma risk and the unproven poor male
dental hygiene hypotheses do not explain
male preponderance documented in other
jaw cysts.
Dentigerous cysts emerged the commonest
jaw cysts in this review accounting for
almost half (48.6%) of all cases. This is
consistent with reports from Enugu in
8
Nigerias south east, but at variance with
Ibadan in our south west where dentigerous
cyst is displaced to distant second (12%) by
9
radicular cysts (50%). In Lagos, also in the
south west, dentigerous (22.2%) and
periapical (21.4%) cysts were almost equal
19
in frequency. With exception of this study,

ISSN 2231 - 2250

the authors are not aware of any published

reports on jaw cysts from Northern Nigeria.
Going by the few aforementioned southern
studies, it would appear that there is at
present no discernible consistent pattern
across the nation. Further studies are
therefore required to shed more light on the
issue.
One possible explanation for the apparent
disparities in relative frequencies between
dentigerous and periapical cysts in the
pathology based southern Nigerian studies,
is that both cysts can be histologically
similar. Both are lined by squamous
epithelium, and inflammation is not
uncommon in dentigerous cysts. Thus in the
absence of adequate clinical/radiological
information, and with incomplete fragmented
surgical biopsy specimens, one may be
mistaken for the other. Furthermore, its
been reported that root apex inflammation of
a deciduous tooth can give rise to
dentigerous cyst around an unerupted
20
permanent tooth.
As earlier stated published studies from subSaharan Africa are scanty, however a recent
Kenyan study also documents dentigerous
cysts as their most frequent jaw cyst. In
most other parts of the developed and
developing world radicular cysts were
overwhelmingly preponderant France
(53.5%), UK (52.3%), Germany (56.9%),
Greece (59.6%), Turkey (54.7%), Chile
(65.7%), India (69.3%), Brazil (61.4%),
11-18,21-24
Pakistan (70%), and Libya (68.1%).
.
Radicular cysts were the second most
frequent jaw cyst in Kano, comprising 29.6%
of all cases. As earlier pointed out, this
relative low frequency is at variance with
most other parts of the world where radicular
cysts are more common, but is consistent
with several reports from sub-Saharan Africa
notably Kenya (24%), Lagos (21.4%),
8,10,19
Enugu (15%).
Our lower rates of
radicular cysts can be attributed to lower
rates of dental caries, which often afflicts
more affluent societies with higher
consumption of sugary snacks.
With regards to age distribution, jaw cysts in
our series mostly occurred in the 2nd and
3rd decades, with the more preponderant
dentigerous cyst largely accounting for this
early peak. Radicular cysts on the other
hand peaked later in the 5th decade. This
age profile of dentigerous and other
developmental cysts occurring in younger

ISSN 2231 2250

age group (adolescents, young adults), while

periapical cysts peak later in life, concurs
11-16,21-23
with most other parts of the world.
The differing age distribution reflect the fact
that both dentigerous and radicular cysts are
long term complications of initiating
pathologies beginning several years or
decades earlier one during embryological
development of tooth in intrauterine life, and
the other later in childhood dental caries or
maxillofacial trauma. Over all jaw cysts in
this series were more prevalent in the
mandible than maxilla with a mandiblemaxilla ratio of 1.7:1. Globally there appears
to
be
no
consistent
pattern
of
mandible/maxilla involvement with some
studies documenting more cysts in the
maxilla
(Pakistan,
Chile,
India,
11,13,15,16,
Libya),
while others document more
mandibular
cysts
(France,
Turkey,
9,14,24
Ibadan).
Given the paucity of published reports from
sub-Saharan Africa, it is premature to draw
conclusions as to a general pattern.
Nonetheless, with regards to relative
frequencies of common jaw cysts, our
findings were broadly consistent with the few
available published reports from subSaharan Africa, though at variance with
most other parts of the world where radicular
cysts predominate. Other parameters (age,
gender distribution, jaw distribution) however
largely conform to global trends.
Acknowledgement
I would like to thank the staff members of the
department of oral pathology for their
support and cooperation.
Author Affiliations
1.Dr.Iyogun CA, Department of Oral Pathology,
College of Health Sciences, University of Port
Harcourt, Port Harcourt, 2.Dr.Ochicha O,
3.Dr.Sule
AA,
Pathology
Department,
4.Dr.Adebola RA, Department of Maxillofacial
Surgery, Bayero University, Aminu Kano
Teaching Hospital, Kano, Nigeria.

References
1. Neville BW, Damm DD, Allen CM,
Bouquot JE. Oral and Maxillofacial
rd
Pathology. 3
Ed. St. Louis: WB
Saunders Co; 2009. p 678-9.
2. Larsen
PE,
Hegtvedt
AK.
Odontogenesis and odontogenic cysts
and tumors. In: Cummings CW.
Otolaryngology-Head and Neck Surgery.
rd
3 ed. Mosby; 1998. p 1572-3.
3. Barnes L, Eveson J, Reichart P,
Sidransky D. eds. Pathology and

Jaw Cysts in Kano: Northern Nigeria... 11

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

genetics of head and neck tumours.

Lyon France IARC press; WHO
classification of tumours. 2005.
MacDonald-Jankowski DS. Keratocystic
odontogenic tumour: systematic review.
Dentomaxillofac Radiol 2011;40:1-23.
Moosvi Z, Tayaar SA, Kumat GS.
Neoplastic potential of odontogenic
cysts. Contemp Clin Dent 2011;2:1069.
Stafne
EC.
Epithelial
tumours
associated with developmental cysts of
maxilla. Oral Surg 1948;1:88794.
Nigeria Population Census. 2006.
Available
at:
www.population.gov.ng/index.php/statepopulation
Oji CH. Statistical observations on jaw
cysts in Enugu, Nigeria 1987-96. Odo
Stomat Tropi 1999;85:33-6.
Lawal AO, Adisa AO, Sigbeku OF. Cysts
of the oro-facial region: A Nigerian
experience. J Oral Maxillofac Pathol
2012;16:167-71.
Butt FM, Ogengo J, Bahra J, Chindia
ML. Pattern of odontogenic and nonodontogenic cysts. J Craniofac Surg
2011;22:2160-2.
Ansari SR, Rehman AU, Rehman B.
Frequency
and
demography
of
commonly occurring odontogenic cysts
in Khyber pakhtunkhwa, Pakistan.
Pakistan Oral Dent J 2010;30:41-6.
Aikgz A, Uzun-Bulut E, zden B,
Gndz K. Prevalence and distribution
of odontogenic and non-odontogenic
cysts in a Turkish population. Med Oral
Pathol Oral Cir Buccal 2002;17:e108-15.
Ochsenius G, Escobar E, Godoy L,
Peafel C. Odontogenic cysts: Analysis
of 2944 cases in Chile. Med Oral Pathol
Oral Cir Buccal 2007;12:E85-91.
Meningaud J, Oprean N, Pitak-Arnop P,
Betrand J. Odontogenic cysts: A clinical
study of 695 cases. J Oral Sci
2006;48:59-62.
Selvamani M, Donoghue M, Basandi
PS. Analysis of 153 cases of
odontogenic cysts in a south Indian
population. Br Oral Res 2012;26:330-4.
El Gehani R, Krishnan B, Orafi H. The
prevalence
of
inflammatory
and
developmental cysts in a Libyan
population. Libyan J Med 2008;3:75-7.
De Souza L, Gordon-Nunez M, Nonaka
C, De Medeiros M, Torres T, Emiliano
G. Odontogenic cysts: Demographic
profile in a Brazillian population. Med
Oral
Pathol
Oral
Cir
Buccal
2010;15:e583-90.

ISSN 2231 - 2250

12 Iyogun CA, et al.

18. Prockt AP, Schebela CR, Maito FDM,

Sant Ana-Filho M, Rados PV.
Odontogenic cysts: Analysis of 680
cases in Brazil. Head Neck Pathol
2008;2:150-6.
19. Ogunlewe MO, Odukoya O, Akinwande
JA. Epithelial jaw cysts: analysis of 126
Nigerian cases. Afr Dent J 1996;10:1-9.
20. Narang RS, Manchanda AS, Arora P,
Randhawa K. Dentigerous cyst of
inflammatory origin a diagnostic
delimma. Ann Diagn Pathol 2012;2:11923.
21. Jones AV, Craig GT, Franklin CD.
Range
and
demographics
of
odontogenic cysts diagnosed in a UK
population.
J
Oral
Pathol
Med
2006;35:500-7.

22. Kriedler JF, Raubenheimer EJ, VanHeerden WF. A retrospective analysis of

367 cystic lesions of the jaw. J
CranioMax Surg 1993;21:339-41.
23. Ioannidou F, Mustafa B, SeferiadouMavropoulo T. Odontogenic cysts of the
jaws. A Clinicopathologic study. Rev
Med Inst Mex Seguro Soc 2009;5:493-6.
24. Koseglu BG, Atalay B, Erdem MA.
Odontogenic cysts: a case study of 90
cases. J Oral Sci 2004;4:253-7.
Corresponding Author
Dr.O.Ochicha
Pathology Department
Aminu Kano Teaching Hospital
Kano, Nigeria
E-mail: ochicha@gmail.com

Source of Support: Nil, Conflict of Interest: None Declared.

Copyright of International Journal of Oral & Maxillofacial Pathology is the property of

Celesta Software Private Limited and its content may not be copied or emailed to multiple
sites or posted to a listserv without the copyright holder's express written permission.
However, users may print, download, or email articles for individual use.