DISCUSSION Sorafenib B-Raf AOT occurs mainly in the second decade of life, and is uncommon in patients older than 30 years of age. Females are more commonly affected than males with a ratio of 2:1, but it was not so in our analysis.[3,7] This female predilection is even more marked in Asian populations, the highest female incidence being observed in Sri Lanka (3.2:1) and Japan (3:1). The maxillary arch is the predominant site of occurrence, being almost twice as frequent as that of the mandible, and the anterior part of the jaw is more frequently involved than the posterior part.[5] Giansanti et al. (1970) reported that 65% AOTs were seen in the maxilla and 35% in the mandible. Of the maxillary lesions, 80% occurred in the anterior region, 14% in the premolar region, and few in the molar area.

Of the mandibular lesions, 69% were found in the anterior region, 27% in the premolar region, and a few in the molar region.[8] It is pertinent to note that all our four cases had AOT in the anterior as well as posterior part of the mandible. AOT is frequently associated with an impacted tooth, a canine in more than 60% of the cases.[4] Permanent incisors, premolars, molars, and deciduous teeth are rarely involved. But more than one tooth may also be related with AOT as noticed in our case analysis wherein permanent incisors, canines, and premolars were involved with the lesion. AOTs are relatively small in size. Usually, they do not exceed 1-3 cm in diameter.[9] However, some large tumors have been reported, and all our present cases had unusually large dimensions, that is, more than 3 cm.

The continuous slow growth of the lesion may cause cortical plate expansion leading to a painless hard swelling, asymmetry of the face, and displacement of the teeth, as was evident in our case analysis. As the growth is only within the confinement of the jaw bone, there is no invasion in the soft tissue. The slow-growing nature of the lesion may cause the patients to tolerate the swelling for years until it produces an obvious deformity. Delayed eruption of a permanent tooth or a regional swelling of the jaws may be the first symptom. Pain or other neurologic signs are not characteristic. Clinically, Ajagbe et al. (1985) found that a few lesions on palpation were soft and spongy like cysts, whereas many lesions were firm and bony hard, like fibro-osseous lesions.

[10] Generally, AOT occurs intraosseously, but can also occur rarely in peripheral locations. There are three variants of AOT: Follicular, extrafollicular, and peripheral. The follicular Anacetrapib type (pericoronal) is a central intrabony lesion associated with an unerupted tooth, which accounts for about 70% of all cases. The extrafollicular type (extracoronal) is also an intraosseous lesion, but unrelated to an unerupted tooth, and represents 25% of all AOTs. The peripheral type (extra osseous) is a rare form that arises in the gingival tissue, and accounts for 5% of all AOTs.