What does NIRDS stand for?
- N: Neoplastic
- I: Inflammatory/Infectious/Idiopathic
- R: Reactive
- D: Developmental
- S: Systemic
What are some Neoplastic Benign Pathologies?
- Osteoid Osteoma
- Ossifying Fibroma (BFOL)
- Chondromyxoid Fibroma
- Desmoplastic Fibroma
- Central Hemangioma
What are some Neoplastic Malignant Pathologies?
- Ewing Sarcoma
- Multiple Myeloma
- Langerhands Cell Histiocytosis
- Metastatic Disease
What are some Inflammatory/Infectious/Idiopathic Pathologies?
- Osteoradionecrosis (ORN)
- Osteonecrosis of the jaw (ONJ)
- Paget's Disease
- Idiopathic Osteosclerosis
- Idiopathic Bone Cavity
What are some Reactive Pathologies?
- Central Giant Cell Lesion
- Aneurysmal Bone Cyst
- Cemento-Osseous Dysplasias
What are some Developmental Pathologies?
- Osteogenesis Imperfecta
- Cleidocranial Dysplasia
- Fibrous Dysplasia
What is an example of Systemic Pathology?
What is a Focal Osteoporotic Marrow Defect?
- Not a pathologic Process - etiology unknown
- Area of hematopoietic marrow large enough to note on imagin
- Asymtomatic, incidental finding
- A few millimeters to several centimeters
- Somewhat ill-defined radiolucency containing fine trabeculations
Where are Focal Osteoporotic Marrow Defects usually found?
- >75% female
- 70% posteiror mandible, often edentulous area - may occur elsewhere (skull)
- Histology: Normal Hematopoietic Bone
- Treatment: None necessary, other than possibly incisional biopsy ro rule out pathology
What is a Stafne Defect?
- AKA static bone cyst (not a true cyst)
- Described by Safne in 1942
- Focal concavity on lingual of mandible
- Classically, radiolucency located below mandibular canal, between molars and angle of mandible
- May be located in anterior mandible
- Most patients are male
What is the treatment for Stafne Bone Defect?
- No treatment necessary; biopsy to rule out other pathology
- May exhibit slow growth over time (not necessarily "static")
- Developmental defect, but ot congenital
- Usually seen in middle age to older adults
- Defects usually contains salivary gland tissue (submandibular), but also reports of muscle adipose tissue, vascular tissue, lymphoid tissue, etc
What are the main culprits in the pathology of Osteomyelitis?
- Bacterial Infection most commonly
- Dental Portal
- Mixed flora - Staph aureus, Strep, Actino; also may be mycobacterial, fungal, or viral
- Inflammatory Process
- Medullary &/or cortical bone
- Extends away from initial site of involvement
How do you differentiate between acute and chronic Osteomyelitis?
- Acute (<1 month)
- Chroni (>1 month)
- Diffuse sclerosing
- Focal sclerosing
- Osteomyelitits with proliferative periosititis (Garre's)
- SAPHO syndrome: synovitis, acne, pustulosis, hyperososis, osteitis
What is the treatment for Osteomyelitis?
- Identify cause and treat
- Prevent acute-to-chronic transition
- Culture & antibiotics sensitivity testing (3 culture tubes)
- Gram stain
- Order/set/OMFS/wound culture (1 & 3)
- I & D, surgical debridment
- Antibiotics (oral vs IV)
What is Osteomyelitis with Proliferative Periositits also known as?
- AKA Garre's osteomyelitis - Garre was a German physician who reported on osteomyelitis in 1893. He had no pathologic speciments for microscopic examination and did not mention a periosteal reaction in his original paper. Roentgen did not discover X-rays until 1895
- MEan age of 13 years (children and young aduults)
- Radiopaque laminations (onion-skinning)
- Most cases are due to periapical inflammatory disease
What are Bisphosphonates used to treat?