Surgical Science, 2011, 2, 476-480
doi:10.4236/ss.2011.210104 Published Online December 2011 (http://www.SciRP.org/journal/ss)
An audit of Paediatric Orofacial Lesions at the
Kilimanjaro Christian Medical Centre in Moshi, Tanzania
D. S. Rwakatema1, M. L. Chindia2
1Kilimanjaro Christian Medical College, Tumaini University, Iringa, Tanzania
2School of Dental Sciences, University of Nairobi, Nairobi, Kenya
Received July 20, 2011; revised August 4, 2011; accepted October 17, 2011
Abstract
Objective: To audit and categorize pathological lesions and conditions that occurred in the orofacial region
among children aged up to 15 yrs. Setting: Kilimanjaro Christian Medical Centre, Moshi, Tanzania. Design:
Retrospective cross-sectional audit based on archival records and material between 1985 to 2005. Results:
Biopsy results were generated into 11 categories whence most common lesions encountered were in the ca-
tegories of soft tissue benign neoplasms (35.1%) and soft tissue malignant neoplasms (21.8%). Remarkably,
Burkitt’s lymphoma (BL) in the category of malignant soft tissue neoplasia constituted 11.8% of all the le-
sions biopsied while haemangiomas and tuberculous adenitis comprised 8.1% and 3.8% respectively. The
age groups revealed the highest burden (37.1%) among the 0 to 5-year-olds followed by the 11 to 15-(34.5%)
and 6 to 10-year-olds (28.4%). The orofacial site distribution among the 211 biopsied cases included 62.1%
in the mandibular 29.9% in the maxillary region and 8% in the tongue areas. Malignant neoplasms of the
bone were rare and all were diagnosed in the mandible. Overall, malignant neoplasms of soft tissue were
significantly more in the age group of 6 - 10 years as well as in males than females. On the other hand, sig-
nificantly more benign soft tissue neoplasms occurred in females than in males. Main Outcome Measure:
There is great diversity and preponderance of soft tissue than skeletal orofacial lesions on the present audit.
Significantly, clinicians should maintain high index of suspicion regarding the remarkably high frequency of
diagnosing BL and tuberculous lymphadenitis in such a population in this era of HIV infection/AIDS.
Keywords: Orofacial, Neoplasm, Soft Tissue, Tuberculous Lymphadenitis, Lesion, Children, Burkitt
Lymphoma, Cross-Sectional Study, Tanzania
1. Introduction
Over the past two decades there has been a clear desire,
worldwide, for the development of realistic evidence-
based oral health policies that are integrated in general
health care systems. For this reason, the development of
reporting comparable data on oral diseases is essential
[1]. Notably, prevailing paradigms in health care priori-
tization maintain that oral health has a significant impact
on nutrition and the overall quality of life [2]. In deve-
loping nations such as Tanzania, resources for the provi-
sion of adequate oral health care have remained some-
what strained due to limitations in general economic de-
velopment. It is, therefore, only pertinent that the distri-
bution and optimal utilization of resources in any region
in such a diverse nation is based on meticulous docu-
mentation of diseases and conditions that may be preva-
lent regionally.
Regular laboratory audits of the diverse lesions en-
countered during routine clinical practice could be the
tangible measure of the burden and pattern of diseases
and conditions that may afflict a specific regional popu-
lation. Few studies worldwide have attempted to map
comprehensive paediatric oral neoplasms [3-7]. Studies
of such audits in Tanzania have only been based at the
Muhimbili National Hospital [8]. In this investigation,
therefore, an analysis was performed of all the archival
histopathological reports for orofacial lesions that oc-
curred and had been diagnosed and documented over a
10-year period at the Kilimanjaro Christian Medical Cen-
tre (K.C.M.C.) in Moshi, Northern Tanzania.

D. S. RWAKATEMA ET AL.477
2. Material and Method
2.1. Study Site
Kilimanjaro Christian Medical Centre is one of the four
zonal referral hospitals in Tanzania with a major health-
care facility that serves the vast northern region of Tan-
zania with regard to histopathology analytical services.
2.2. Method
Histology reports that were registered over the period
1985 to 2005 inclusive were analyzed to categorize the
variety of oral lesions that were diagnosed. Ethical clea-
rance was sought from Tumaini University, K.C.M.C.
Ethics Committee. Data extracted included the age of
patients at initial presentation, lesion site, gender, health
centre where biopsy was done and the histopathological
diagnosis. The case definition for this study was any oral
lesion that was diagnosed in the laboratory. Previously
diagnosed cases were excluded. No strict attempt was
made to categorize the registered lesions according to the
International Classification of Diseases. Parameters of
interest were analyzed with the Statistical Package for
Social Sciences (SPSS) version 12.1 and Epidemiology
Information Package (Epilnfo) Chi-square test and Fisher’s
exact tests were used to evaluate any significant diffe-
rences on the occurrence of paediatric orofacial lesions.
A p-value < 0.05 was considered significant.
3. Results
Processed biopsy results were generated into 11 catego-
ries including congenital anomalies, malignant neoplasia
of bone, malignant neoplasia of soft tissue, benign neo-
plasia of soft tissue and dysplastic lesions of bone. Oth-
ers were benign neoplasia of bone, cystic lesions of bone,
cystic lesion of soft tissues, infective lesions of viral ori-
gin, bacteria infective lesions and non-specific lesions.
The distribution of lesion categories according to age
groups revealed the highest burden (36.5%) among the 0
to 5-year-olds followed by the 11 to 15-(33.6%) and 6 to
10-year-olds (29.9%). Significantly more children in the
age group of 6 - 10 and 11 - 15 years were more affli-
cted in the categories of malignant neoplasia of bone and
soft tissue and benign neoplasia of bone than in the age
group of 0 - 5-years. Table 1 summarizes the categories
of lesions and anomalies diagnosed according to the age
groups of children. The site distribution among the 211
biopsied cases included 62.1% in the mandibular, 29.9%
in the maxillary areas and 8% in the tongue. All malig-
nant neoplasms of bone diagnosed were osteosarcoma
and were all located in the mandible. Table 2 summa-
rizes the categories of lesions and anomalies diagnosed
according to the sites biopsied. The most common le-
sions encountered were soft tissue benign neoplasms
(35.1%) and soft tissue malignant neoplasms (21.8%).
Remarkably, Burkitt’s lymphoma (BL) in the category of
malignant soft tissue neoplasia constituted 11.8% of all
the lesions biopsied while haemangiomas comprised
8.1% of the cases. On the other hand the most frequently
diagnosed lesion of bacterial origin was tuberculous lym-
phadenitis (3.8%). Significantly more males than females
were afflicted by malignant neoplasia of the soft tissue.
On the other hand, significantly more benign soft tissue
neoplasms occurred in females than males. Table 3 sum-
marizes the categories of lesions and anomalies diag-
nosed according to gender.
Table 1. A summary of the occurrence of categories of lesions and anomalies diagnosed by biopsy among 211 children ac-
cording to age groups at K.C.M.C. in the period of 1985-2005.
Age group in years
Total 0 - 5 (n = 77) 6 - 10 (n = 63) 11 - 15 (n = 71)
Diagnosed lesions
No (5%) No (%) No (%) No (%) p-Value
Congenital anomalies 5 (2.4) 2 (2.6) 3 (4.8) 0 (0) 0.19
Malignant neoplasia of bone 2 (0.9) 0 (0.0) 0 (0.0) 2 (2.8) 0.00
Malignant neoplasia of soft tissue 46 (21.8) 19 (24.7) 19 (30.2) 8 (11.3) 0.02
Benign neoplasia of bone 15 (7.1) 2 (2.6) 3 (4.8) 10 (14.1) 0.02
Benign neoplasia of soft tissue 74 (35.1) 28 (36.4) 20 (31.7) 26 (36.6) 0.80
Dysplastic lesions of bone 3 (1.4) 0 (0.0) 1 (1.6) 2 (2.8) 0.35
Cystic lesions of bone 5 (2.4) 0 (0.0) 1 (1.6) 4 (5.6) 0.07
Cystic lesions of soft tissues 12 (5.7) 7 (9.1) 3 (4.8) 2 (2.8) 0.24
Infective lesions of viral origin 2 (0.9) 0 (0.0) 1 (1.6) 1 (1.4) 0.57
Bacterial infective lesions 9 (4.3) 2 (2.6) 3 (4.8) 4 (5.6) 0.64
Non specific lesions 38 (18.0) 17 (22.1) 9 (14.3) 12 (16.9) 0.47

D. S. RWAKATEMA ET AL. 478
Table 2. A summary of the occurrence of categories of lesions and anomalies diagnosed by biopsy among 211 children ac-
cording to the sites biopsied at K.C.M.C. in the period of 1985-2005.
Diagnosed lesions Sites biopsied
Maxillary areas Mandibular areas Tongue
Total (n = 63) (n = 131) (n = 17)
No (%) No (%) No (%) No (%) P-value
Congenital anomalies 5 (2.4) 1 (1.6) 3 (2.3) 1 (5.9) 0.58
Malignant neoplasia of bone 2 (0.9) 0 (0.0) 2 (1.5) 0 (0.0) 0.00
Malignant neoplasia of soft tissue 46 (21.8) 15 (23.8) 28 (21.4) 3 (17.6) 0.85
Benign neoplasia of bone 15 (7.1) 6 (9.5) 9 (6.9) 0 (0.0) 0.39
Benign neoplasia of soft tissue 74 (35.1) 28 (44.4) 37 (28.2) 9 (52.9) 0.11
Dysplastic lesions of bone 3 (1.4) 2 (3.2) 1 (0.8) 0 (0.0) 0.36
Cystic lesions of bone 5 (2.4) 2 (3.2) 3 (2.3) 0 (0.0) 0.74
Cystic lesions of soft tissues 12 (5.7) 2 3.2) 9 (6.9) 1 (5.9) 0.58
Infective lesions of viral origin 2 (0.9) 0 (0.0) 2 (1.5) 0 (0.0) 0.54
Bacterial infective lesions 9 (4.3) 1 (0.6) 8 (6.1) 0 (0.0) 0.23
Non specific lesions 38 (18.0) 6 (9.5) 29 (22.1) 3 (17.6) 0.10
Table 3. A summary of the occurrence of categories of lesions and anomalies diagnosed by biopsy among 211 children ac-
cording to gender at K.C.M.C. in the period of 1985-2005.
Diagnosed lesions Gender of patient
Male Female
Total (n = 110) (n = 101)
No (%) No (%) No (%) P-value
Congenital anomalies 5 (2.4) 3 (2.7) 2 (2.0) 1.00
Malignant neoplasia of bone 2 (0.9) 1 (0.9) 1 (1.0) 1.00
Malignant neoplasia of soft tissue 46 (21.8) 30 (27.3) 16 (15.8) 0.05
Benign neoplasia of bone 15 (7.1) 8 (7.3) 7 (6.9) 0.86
Benign neoplasia of soft tissue 74 (35.1) 29 (26.4) 45 (44.6) 0.01
Dysplastic lesions of bone 3 (1.4) 1 (0.9) 2 (2.0) 0.61
Cystic lesions of bone 5 (2.4) 3 (2.7) 2 (2.0) 1.00
Cystic lesions of soft tissues 12 (5.7) 6 (5.5) 6 (5.9) 0.88
Infective lesions of viral origin 2 (0.9) 1 (0.9) 1 (1.0) 1.00
Bacterial infective lesions 9 (4.3) 5 (4.5) 4 (4.0) 1.00
Non specific lesions 38 (18.0) 23 (20.9) 15 (14.9) 0.33
4. Discussions
The regional population health profiles in a country such
as Tanzania have to be, largely, heterogeneous across the
expansive provinces. Knowledge of the pattern and bur-
den of diseases and conditions that may be prevalent
among regional populations should constitute the logical
benchmark upon which healthcare delivery could be
more efficiently implemented. While the most reliable
measures of any relevant healthcare needs may best be
achieved through population-based surveys, they are
often resource-intensive and would require prolonged pe-
riods to collate. On the other hand laboratory-based au-
dits at major regional health facilities should offer tangi-
ble information, albeit restrictive, on the pattern of and
gravity of diseases and conditions that may be prevalent
across the region. In the present investigation, the occur-
rence of BL was relatively low compared to the one re-
ported in Dar-Es Salaam among Tanzanian children [8].
Probably this may be consistent with what has been
stated in other studies that most biopsies in some centres
with regard to BL may relate to geographical clinical pre-
sentation thus affecting clinicians to decisions biopsy [9,
10]. It is worthy of note, in this study, that about 21.8%

D. S. RWAKATEMA ET AL.479
of the diagnosed lesions were malignant neoplasms of
the soft tissues which was half the number of malignant
neoplasm findings at Muhimbili National Hospital in
Tanzanian children of a similar age group [8]. Since BL
was categorized into malignant neoplasm of the soft tis-
sues its occurrence took a larger portion in this category.
The same trend was also observed in other studies in this
region [6,8,11]. In healthcare, the desirable resources to
optimally manage malignant diseases can be elaborate
and expensive. The present findings should, therefore,
provide useful guidelines for health planners and mana-
gers as to how to logically and proportionately utilize
available resources.
With the present findings and others available else-
where in the region [1,8], sufficient information should
evolve to facilitate the possibilities of mapping out the
pattern and gravity of diseases and conditions that may
be prevalent in children across the East African region.
This may give the region the capacity of comparing in-
formation regarding these lesions with other countries
worldwide. For instance the present investigation has
highlighted the dissimilarities of the occurrence of malig-
nant neoplasms as compared to a similar report in South
American children [3].
In addition to, the essence of highlighting the pattern
and burden of malignant disease in a population cohort
such as the present one, it is also important to note the
significant burden of benign neoplasms. Early in life be-
nign neoplasms if not timely diagnosed and treated, are
often most debilitating and difficult to manage. In the
present investigation, as in several other studies [4,7,12]
the haemangioma was the most commonly diagnosed
neoplasm. This lesion and pleomorphic adenoma de-
pending on their location and extent, pose significant
challenges in terms of definitive management not only in
the professional context but also the man-hours and
school-hours that may be lost while seeking treatment for
these minors. The occurrence of 3.8% of cases of tuber-
culous lymphadenitis in this study was quite alarming
and probably was an indicator of the HIV infection/
AIDS burden in this population [13].
Although they occurred rarely, malignant and benign
neoplasms of bone were significantly higher at the age
group of 11 - 15 years than at the other two age groups.
This is the age of accelerated growth especially in the
bone. Higher chances of bone neoplastic changes are
likely to occur in this period of growth. Overall, the pre-
sent investigation has yielded useful baseline information
that is certainly most pertinent for those in clinical prac-
tice who must maintain logical indices of diagnosing
diverse lesions in the orofacial region. In the absence of
analytical population-based studies, laboratory-based au-
dits shall remain relevant and should be encouraged.
5. Conclusions
Evidently, there is a considerable diversity and prepon-
derance of soft tissue than skeletal oral lesions based on
the present audit. Remarkably, clinicians should maintain
a high index of suspicion regarding the high frequency of
diagnosing BL in such a population.
6. Acknowledgements
The authors are grateful to the authorities of Kilimanjaro
Christian Medical Centre Histopathology Department for
allowing retrieval of biopsy reports of this study. The
authors appreciate the help from Miss Sally Musinde of
the Department of Oral and Maxillofacial Surgery, Sch-
ool of Dental Sciences, University of Nairobi, Kenya for
her involvement in the preparation of the manuscript.
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