| dc.description.abstract | Burkitt's lymphoma (BL) accounts for 40-50%o of all childhood malignancies in Malawi. It is a highly
aggressive, fast growing, mature B-cell non-Hodgkin's Lymphoma (NHL). It has one of the highest proliferation rates of any human tumour, with a doubling time of 24-48 hours making it the fastest growing human tumour. There are three forms of BL: endemic or the African form (eBL), sporadic or non-endemic form (sBL) and the immunodeficiency-associated form in HIV-AIDS. The African form most often involves the maxilla or mandible. The survival rate of a child with BL is dependent upon rapid diagnosis and treatment.
The purpose of this study was to determine the orofacial manifestations in children with BL in Malawi. It was anticipated that the findings may assist in the education of oral and other health care workers in the early recognition of BL for prompt referral. Oral health workers are a critical component of the referral chain since these lesions can be life threatening. The present study was done in two parts: the first was a retrospective record-based study from 2005 to 2007 consisting of a sample of 661 cases suspected of BL and the second, a prospective study from June 2008 to October 2009 documenting 19 cases of suspected and confirmed cases of BL. A structured data capture sheet was used for data collection and a data capture sheet together with a short questionnaire collected information for the prospective study. In the retrospective study, two thirds presented with BL at various sites of which the abdomen was the most common site. The 5 to 9 year age $oup predominated with an average peak incidence of 7 years and accounting for 60.0% of all the cases. The maxilla was the most common site for orofacial BL accounting for 13.7%o followed by the mandible (7.2%), cheeks (5.7%), maxilla and mandible @5%) and cervical lymph nodes (4.1%). Of the 397 with BL, 4l.4yo were tested for HIV and 37 .97o/o were HIV-negative while 5oZ were HIV-positive. There was a male preponderance with a ratio of male to female of 1.6 to1.
In the prospective study, females predominated with a male to female ratio of I to I . I and the mandible was the most common site accounting for 19.04o/o. The age group 5-9 years predominated with 68.4Yo relative frequency. In both studies, Lilongwe predominated with orofacial BL cases. Initial findings at presentation were intraosseous mass, mobile or loose teeth, displaced teeth, cervical and/or submandibular lymphadenopathy, intraoral swelling, trismus, jaw deviation, Bell's palsy, salivation, gingival enlargement, bleeding tumour, ulceration, bony or soft tissue deformity, infected tumour causing halitosis and gingival growths. Difficulties with breathing, speech and eating was largely due to bilateral swelling of both the maxilla and mandible and in other cases unilateral swelling involving both maxilla and mandible.
Generally, the trend of BL had decreased from 2005 to 2007 possibly due to better access to health services, increased use of bed-treated mosquito nets for malaria prevention and knowledgeable healthcare workers. This study therefore re-iterates the need for all oral healthcare workers and other healthcare workers to be educated on the orofacial manifestations of BL for prompt referral, management. This would result in a better prognosis since BL is curable as it responds favourably to chemotherapy. The community also needs to be educated on the early signs and symptoms of BL and the importance of visiting a hospital as soon as possible. | en_US |
