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BDS5 Radiology OSCE > Bone pathology > Flashcards

Bone pathology Flashcards

1
Q

What is a torus

A
  • exostosis
  • torus palatinus = midline of palate
  • torus mandibularis = in mandible
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2
Q

What is an exostosis

A

defined as an extra growth of bone that extends outward from existing bone

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3
Q

Where is tori mandibularis usually seen

A
  • lingual aspect of mandible
  • premolar region
  • generally unproblematic unless px wants denture
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4
Q

How do osteogenesis imperfecta px present clinically

A

weak bones
multiple fractures
sometimes associated with dentinogenesis imperfecta

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5
Q

What is fibrous dysplasia

A
  • due to gene defect
  • slow growing, asymptomatic bony swelling where bone is replaced by fibrous tissue
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6
Q

How does fibrous dysplasia appear radiographically

A
  • cotton wool appearance
  • ill defined margins which blend into bone
  • bone maintains approximate shape initially
  • becomes more radiopaque as the lesion matures
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7
Q

What is rarefying osteitis

A
  • localised loss of bone in response to inflammation
  • it is a process, not a pathology
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8
Q

What causes rarefying osteitis

A
  • inflammatory factors coming from necrotic pulp and resorb the apex
  • if at the apex of the tooth, consider PA periodontitis, periapical granuloma or periapical abscess
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9
Q

What is sclerosising osteitis

A
  • localised increase in bone density in response to low grade inflammation
  • most common around apex of a tooth with a necrotic pulp
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10
Q

How does sclerosing osteitis present

A
  • periapical radiopacity
  • often poorly defined
  • may eventually lead to external root resorption if chronic
    *also known as condensing osteitis
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11
Q

What is idiopathic osteosclerosis

A
  • localised increase in bone density of unknown cause
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12
Q

Where is idiopathic osteosclerosis most common

A
  • premolar/molar region of mandible
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13
Q

How does idiopathic osteosclerosis present

A
  • always asymptomatic
  • no bony expansion
  • no effect on adj structures
  • similar to sclerosising osteitis - vitality test and look out for symptoms
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14
Q

What is alveolar osteitis aka

A

dry socket
complication of XLA

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15
Q

What is alveolar osteitis due to

A

clot being lost too early
should be recognised as part of healing process
leaves behind bony sequestra

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16
Q

What are risk factors for alveolar osteitis

A
  • smoking
  • OCP
  • difficult XLA
  • mandible
  • posterior
  • rinsing too soon
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17
Q

What is the management of dry socket

A
  • can use medicaments e.g alveogyl however can slow healing
  • best management = encourage healing and allow new clot formation
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18
Q

What is osteomyelitis

A

rare endogenous infection

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19
Q

What is the theory surrounding the cause of osteomyelitis

A
  • compound fracture creation when performing XLA which exposes the fracture to the air
  • can be acute or chronic
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20
Q

What is supparative osteomyelitis

A
  • source of infeciton = teeth e.g abscess
  • anaerobic predominate
  • mandible most ocmmon
  • vascular supply reduced
  • organisms proliferate in the marrow space - acute inflammatory reaction
  • necrosis and suppuration ensue
  • sequestreum may exfoliate or be removed surgically
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21
Q

What are the symptoms of acute osteomyelitis

A

fever
malaise
swelling
pain
trismus

22
Q

What are symptoms of chronic osteomyelitis

A

swelling
pain
chronic suppuration

23
Q

What are other causes of bony necrosis

A

avascular necrosis - reduction of blood supply
irradiation

24
Q

What is brown’s tumour

A
  • focal area of bone resorption results in formation of lesions called browns tumour
  • large number of multinucleate, osteoclast like giant cells are scattered in a highly cellular vascular fibroblastic connective tissue stroma
  • hemosiderin pigment present
25
Q

What is the radiographic appearance of browns tumour

A
  • sharply defined round or oval radioluceny area
  • may appear mutlilocular
  • more common in mandible
26
Q

What are the 2 types of giant cell lesions

A

peripheral giant cell epulis
central giant cell granuloma

27
Q

How does peripheral giant cell epulis present

A

swelling on gingiva
may be a sole lesions
may be a central giant cell granuloma which bursts out of the bone and presents as a peripheral giant cell epulis

28
Q

Which age group is central giant cell granuloma most common in

A

10-25 YO
most common in mandible

29
Q

How does central giant cell granuloma present

A
  • may be multilocular
  • possible swelling of bone
  • tends to grow along length of the jaw so often gets quite large before becoming apparent
  • may thin, expand or perforate the cortex
  • teeth may be displaced and their roots resorbed
30
Q

How does a central giant cell granuloma appear histologically

A
  • multinucleate osteoclast giant cells are present
31
Q

What is the differential diagnosis for giant cell lesions

A
  • browns tumour
  • aneurysmal bone cyst
  • giant cell tumour
32
Q

What is cherubism

A
  • rare condition
  • autosomal dominant inheritance
33
Q

How does cherubism present

A
  • multicystic/multilocular lesions in multiple quadrants
  • painless swelling
  • lesions grow until 7 YO then regress
  • histologically: vascular giant cell lesion
34
Q

What will paget’s present with

A
  • bony swelling - look for changes in facial profile and oclcusion
  • pain
  • nerve compression
  • motor and sensory disturbance if skull involved
35
Q

How does Paget’s present radiographically

A

variable bone pattern
* changes as disease progresses
* osteoporotic/mixed/osteosclerotic
* can have cotton wool appearance
Dental changes
* loss of lamina dura
* hypercementosis
* migration

36
Q

What are reversal lines (Paget’s)

A
  • junctions where there has been reversal of osteoclastic resorption to osteoblastic deposition
37
Q

What are complications of paget’s

A
  • infection
  • MRONJ - px usually on implicated medication
  • tumour - rare complications = osteosarcoma and other bone tumours
38
Q

What is the main benign bone tumour

A

osteoma

39
Q

How does osteoma present

A
  • slow growth
  • excess growth of cortical bone
  • usually solitary but can have multiple
40
Q

What is the main malignant bone tumour

A
  • osteosracoma
41
Q

How does osteosarcoma present

A
  • rare in jaws
  • usually seen in younger px, if elderly, consider pagets
  • usually presents as swelling with pain adn paraesthesia
  • may be a giant osteoid sarcoma
  • often v active growth
42
Q

What is ossifying fibroma

A
  • well demarcated, occasionally encapsulated benign neoplasm
43
Q

What is the clinical presentation of ossifying fibroma

A
  • slow growing
  • wide age range
  • mainly mandible
  • radiologically well defined - may have calcium deposits
44
Q

How does ossifying fibroma present histolofically

A
  • pretty much same as fibrous dysplasia
  • cellular fibrous tissue containing immature bone and acellular calcification
45
Q

What differentiates ossifying fibroma to fibrous dysplasia

A

fibrous dysplasia does not have well defined margins, ossifying fibroma does

46
Q

What are the main 2 cementum lesions

A

cementoblastoma
cemento-osseous dysplasia

47
Q

What is cementoblastoma

A

neoplasm attached to root
histologically same as osteoblastoma

48
Q

What is cementoosseous dysplasia unlikely to be

A

neoplastic

49
Q

What are the 3 types of cemento-osseous dysplasia

A

peripheral
focal
florid

50
Q

What is peripheral COD

A
  • usually lower incisors effected (teeth are vital)
  • starts as well defined radiolucency resembling PA granuloma
51
Q

What is focal COD

A
  • localised
  • no more than 1 in 1 area
52
Q

What is florid COD

A

widespread

BDS5 Radiology OSCE (12 decks)

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