Flashcards in Chapter 14 Deck (35):
What is a symptom of bone that has two types, 1. Benign
(Asymptomatic, Grows slowly and by expansion: displaces teeth and expands the cortex, Symmetrical and Does not metastasize) and 2. Malignant (Usually symptomatic. Grows more rapidly, Invades and destroys adjacent structures (cortex), Often asymmetrical, Ragged or poorly defined margins and destroys cortex, Laying down bone outside the cortex, Capable of metastasis)?
What does this look like radiographically?
- Bone Neoplasia (Benign and Malignant)
- Usually has a Corticated rim [white rim] on a radiograph and can be just destroyed bone.
What is the MOST common type of inherited bone disease, Group of heritable disorders, Defect in type I collagen maturation, bone has a Thin cortex, Fine trabeculation and Diffuse osteoporosis. Signs and symptoms are Bone fragility, Blue sclera, Altered teeth, Hearing loss (hypoacusis), Long bone & spine deformities, and Joint hyperextensiblity? What do these look like radiographically? What differentiates the four main types?
- Osteogenesis Imperfecta
- Osteopenia (low bone density) and Bowing bones
- o Type I: Most common, mildest, blue sclera throughout life
o Type II: Not compatible with life
o Type III: Most severe form; 1/3 survive into adulthood
o Type IV: Resembles type I; slightly more severe (more fractures)
What is known as the marble bone disease, Skeletal disorder with a marked increase in bone density, Results from a defect in remodeling caused by a failure of normal osteoclast function? What are the two types and what makes them different? What does it look like radiographically?
- Infantile: Patients with osteopetrosis discovered at birth or early infancy = Malignant Osteopetrosis, Severe disease, Marrow failure, Frequent fractures, Cranial nerve compression, Facial deformities, Delayed tooth eruption, Osteomyelitis post tooth infraction.
- Adult: Discovered later in life and has less severe manifestations, AKA benign osteopetrosis, 40% are asymptomatic, Marrow failure is rare.
- Widespread increase in skeletal density (increased radiopaque) and Roots of teeth are difficult to visualize because of the density of the surrounding bone.
What is a syndrome complex, characterized by dental and clavicle abnormalities, also appears as an individual with a Short stature; big head, Pronounced frontal bossing, Ocular hypertelorism, a Broad base of nose, generalized super numerary teeth (lack of loss of primary teeth, etc.), and higher prevalence of cleft palate?
- Cleidocranial Dysplasia
What is an Area of hematopoietic marrow that produces a radiolucency, May be confused with an intraosseous neoplasm, Area of hematopoietic marrow that produces a radiolucency, May be confused with an intraosseous neoplasm and No jaw expansion?
- Focal Osteoporotic Marrow Defect
What is a Focal area of increased radiodensity that is of unknown cause and cannot be attributed to anything else and in Most cases arise in teenage years and remain static? **(Do not confuse with condensing osteitis, which is associated with an infection. Do not confuse with Focal Cemento-osseous Dysplasia, which will have a radiolucent rim. Do not confuse with Cementoblastoma, which will be fused with the tooth.)
- Idiopathic Osteosclerosis
What is Characterized by spontaneous and progressive destruction of one or more bones (Destroyed bone is initially replaced by a vascular proliferation), Affected area does not regenerate or repair; eventually the site of destruction is filled with a dense fibrous tissue, No known cause, Most patients are children/young adults and Mobile teeth, Pain, Malocclusion and Deviation of the mandible are all seen?
- Massive Osteolysis (AKA 'Gorham disease')
What is Relatively common disease characterized by abnormal resorption and deposition of bone, Results in distortion and weakening of affected bones, Affects more than one bone (polyostotic), Bone pain is a common complaint, Involvement of weight-bearing bones leads to a bowing deformity, resulting in a simian (monkeylike) stance, Patients have high elevations in serum alkaline phosphatase levels with NORMAL calcium and phosphorus levels and Teeth often have hypercementosis with a cotton roll/wool appearance? Severe cases result in what? *(Hat/dentures usually won't fit)
- Paget’s Disease of Bone
- Leontiasis ossea, or lionlike facial deformity
What is Considered a nonneoplastic lesion, Some of which demonstrate aggressive behavior, More common in the anterior jaw; frequently cross the midline, Most are asymptomatic & discovered during routine XRAY or due to painless bone expansion and The histopathology is identical to a brown tumor of hyperparathyroidism (so patients MUST be evaluated for this condition) and lesions of cherubism?
- Central Giant Cell Granuloma
What is a Developmental jaw condition; with AD inheritance, the facial appearance is similar to that of plump-cheeked little angels, arises from bilateral involvement of the posterior mandible that produces chubby cheeks, There is an “eyes upturned to heaven” appearance due to a wide rim of exposed sclera noted below the iris, Disease occurs between the ages of 2-5, Clinical alterations progress until puberty, then stabilize & slowly regress, Mandibular lesions are painless, bilateral, posterior, and expansile, Causes marked widening and distortion of the alveolar ridges, May lead to failure of tooth eruption amongst other things, and Radiation therapy is contraindicated due to risk of post-irradiation sarcoma?
What is a Benign, empty or fluid filled cavity within bone, where "Cyst” is a misnomer because the lesion does not have an epithelial lining, Trauma to the bone which is insufficient to cause a fracture results in intraosseous hematoma, If the hematoma does not undergo organization & repair, it may liquefy and result in a defect, usually found in long bones, in a radiograph when several teeth are involved, the defect shows domelike projections that scallop between the roots; this feature is highly suggestive?
- Traumatic Bone cyst (simple bone cyst ) **Teeth are left alone, cyst goes around teeth/roots. (Scalloping)
What is an Intraosseous accumulation of blood-filled spaces surrounded by connective tissue, NOT a true cyst; no epithelial lining, Typically seen in long bones, Most common clinical manifestation is a swelling that has developed rapidly, Pain is often reported, radiographically described is a “blow-out” or ballooning distention of the contour of the affected bone, The appearance is like a “blood-soaked sponge”?
- Aneurysmal bone Cyst
What is a Diverse group of processes characterized by replacement of normal bone by fibrous tissue containing a mineralized product, Microscopic lesions are very similar amongst different types of fibre-osseous lesions, and Therefore, clinical and radiographic finding are necessary to establish diagnosis? What are examples of benign forms of this?
- Fibro-Osseous Lesions
- Examples of BFOLs (benign fibro-osseous lesions):
o Fibrous dysplasia
o Cemento-osseous dysplasia
o Ossifying fibroma
What is a Tumor-like condition that is Characterized by replacement of normal bone by fibrous connective tissue intermixed with bone, Sporadic condition resulting from a post zygotic mutation, and Therefore, depending on when the mutation takes place, the process may involve: One bone (monostotic), Multiple bones (polyostotic), Skin, Endocrine system? There are two types of this dysplasia, what are they?
- Fibrous Dysplasia
- Monostotic and Polyostotic
There are two types of Fibrous Dysplasia, which one:
• Accounts for 80% of all cases, Jaws are among the most commonly affected sites, Usually diagnosed in teenage years, Painless, slowly-growing swelling of the affected area is the most common feature, Chief radiographic feature is a fine “ground-glass” opacification, Results from superimposition of poorly calcified bone in a disorganized fashion.PA radiographs may show narrowing of PDL with an ill-defined lamina dura, Involvement of the mandible leads to expansion of both buccal and lingual plates and Maxilla involvement leads to obliteration of the maxillary sinus?
• Involvement of two or more bones; can involve up to 75% of skeleton, If jaw is involved, facial asymmetry may result, Disease tends to stabilize and stop growing at skeletal maturity, May reduce surgically; up to 50% recur, Radiation therapy is contraindicated? What two syndromes are associated with this form of dysplasia and what makes them different?
- Monostotic Fibrous Dysplasia
- Polyostotic Fibrous Dysplasia:
• Jaffe-Lichtenstein syndrome:
o Polyostotic fibrous dysplasia
o Café au lait spots (coast of Maine)
• McCune-Albright Syndrome:
o Polyostotic fibrous dysplasia
o Café au lait spots (coast of Maine)
o Multiple endocrinopathies
- Sexual precocity, pituitary adenoma, and/or hyperthyroidism.
• Sexual precocity is the most common
o Menstrual bleeding, breast development, and pubic hair appear in females within first few years of life.
What Occurs in tooth-bearing areas of the jaws, is the MOST common fibro-osseous lesion encountered in clinical practice and do NOT need biopsy? What are the three types?
- Cemento-Osseous Dysplasia
- Focal, Periapical and Florid
What Involves the periapical region of the anterior mandible, Multiple foci are usually present, Teeth are invariably vital, is Asymptomatic and discovered when XRAYs are taken for other reasons, Early lesions are circumscribed areas of RL involving the apex of a tooth – this lesion looks identical to that of a periapical granuloma or cyst, Lesions “mature” over time to have a mixed RL-RO appearance, End-stage lesions are densely RO with a RL rim, and The PDL will be intact; the lesion will NOT fuse to the tooth?
- Periapical Cemento-osseous Dysplasia **(Don't treat)
What are Multiple focal involvement not limited to the anterior mandible, Pts may just have lesions in the post. jaws, but many patients have lesions throughout, Marked tendency to be bilateral and symmetrical, May be completely asymptomatic, Via XRAY, lesions demonstrate an identical pattern of maturation noted in the other two forms:, Initially, lesions are predominantly radiolucent Over time become mixed RL-RO, End-stage lesions are predominantly radiopaque with a thin peripheral RL rim and Involvement is unrelated to presence or absence of teeth?
- Florid Cemento-Osseous Dysplasia **(Don't treat)
What Exhibits a single sight of involvement, 90% occur in females. On your boards, this is more common in Caucasians. However, for your professional life, realize that is due to a population bias of the survey; it is actually more common in African Americans. Most common place is posterior mandible, Asymptomatic, Vary from completely radiolucent to densely radiopaque, Lesions will have a thin radiolucent rim (Differentiates from idiopathic osteosclerosis & condensing osteitis), Most commonly, there is a mixed RL-RO pattern and Lesion is usually well defined?
- Focal Cemento-Osseous Dysplasia **(Should do a biopsy)
What is a True neoplasm with significant growth potential, a Neoplasm composed of fibrous tissue that contains a variable mixture of bone & cementum, symptoms are detected via XRAY, Large tumors result in a painless swelling, Can be completely radiolucent or, more commonly, mixed RL-RO, and Large ossifying fibromas of the MANDIBLE demonstrate a characteristic downward bowing of the inferior cortex of the mandible and more common in FEMALES?
- Ossifying Fibroma
This is something that is Distinguished from ossifying fibroma on basis of: Age of patient, Most common sites of involvement is the MAXILLA, Clinical behavior. Rapidly-growing, Well-circumscribed, Lesions are typically RL with central RO Both psammomatoid & trabecular, more common in MALES (opposite of ossifying fibroma), As a general rule, the younger the patient is, the more aggressive the tumor? What are the two different neoplasms have been reported under this term?
- Juvenile (Active) Ossifying Fibroma
- o Psammomatoid Neoplasm (4x more common)
o Trabecular Neoplasm
What are Benign tumors of mature bone, Restricted to the craniofacial skeleton, Arise on the surface of bone or within medullary bone, Found in young adults as asymptomatic, solitary lesions, Paranasal sinus lesions are more common than gnathic lesions, May cause pain, swelling, sinusitis, or nasal discharge and will exhibit continued growth? What disease is this associated with?
- Gardner Syndrome
What is A symptom complex characterized by: Colonic Bowel polyps, adenocarcinoma (WILL transform into adenocarcinoma), Skeletal abnormalities (Osteomas are most common), Dental abnormalities (Supernumerary teeth), Epidermoid cysts, Dermoid tumors, Thyroid carcinoma, Pigmented lesions of the ocular fundus and odontomas?
- Gardner Syndrome
What is Closely related, benign bone tumors, Arise from osteoblasts, Histopathologic features are identical, Osteoid osteoma produces prostaglandins; Distinction usually depends on the size of the lesion? What makes the two different?
- Osteoblastoma & Osteoid Osteoma
- Osteoblastomas are larger and do NOT respond to NSAIDs. Osteoid osteomas are SMALLER than 2 cm, respond to NSAIDs and have nocturnal pain.
What is rare, especially in jaws, 85% occur before age 30, are between 2-4 cm, and the radiograph appears as Well-defined or ill-defined and Radiolucent with varying degrees of central RO?
What is Very rare in the jaws, Pain is common (especially Nocturnal and is Relieved by aspirin), in a radiograph will appear as a Well-circumscribed, Radiolucent defect, Usually less than 1 cm (remember, less than 2 cm still indicates lesion is OO), Small RO nidus may be present, resulting in a “target-like” appearance?
- Osteoid Osteoma (OO)
What is an Odontogenic neoplasm of cementoblasts, 75% arise in the mandible, almost always in the molar/premolar region, Typically only affect permanent teeth, 75% occur before age 30, Pain and swelling are present in 2/3, radiographically is a RO mass that is fused to one or more tooth roots, Outline of the root or roots is usually obscured, Surrounded by a thin RL rim?
What is a Benign tumor of cartilage, Common bone tumors but usually found in the hands and feet, Diagnosis in the jaws should be viewed with skepticism, they likely arise from cartilaginous rests (Anterior maxilla, Symphysis, Coronoid process, Condyle), Most examples are found in the condyle or anterior maxilla and is Painless and slowly-growing?
What is Rare, benign, nonneoplastic, is the Development of cartilaginous nodules within the synovial membrane, Unknown cause, Most commonly affects large joints, but can affect TMJ. Swelling, pain, crepitus, and limitation of motion are common features. And via radiograph, loose bodies are seen (Irregularly shaped, variably sized RO structures, Sometimes called JOINT MICE)?
- Synovial Chondromatosis
What has a Parosteal type (which has o Lobulated nodule attached to the cortex by a short stalk, o No elevation of periosteum, o No peripheral periosteal reaction, o Better prognosis than both intramedullary and periosteal osteosarcomas) and a Periosteal type (o Sessile lesion arising from within the cortex, o Elevates the periosteum, which provokes peripheral periosteal reaction, o Better prognosis than intramedullary osteosarcomas; worse than parosteal)?
- Juxtacortical Osteosarcoma
• Parosteal type:
• Periosteal type:
What is a Sarcoma arising in a bone that has been previously subjected to radiation therapy is a well-recognized phenomenon, Postirradiation sarcomas may develop 3 years after radiation, but the average is 15 years after therapy, Osteosarcoma is the most common type (50%), Fibrosarcoma composes 40%, and Almost all the rest are chondrosarcomas?
Postirradiation Bone Sarcoma
What is a Primary malignant tumor of bone, 3rd MOST common osseous neoplasm (after osteosarc & chondrosarc), 80% of patients are younger than 20, Jaws are only involved 2% of the time, Pain with associated swelling and is the most common symptom, If jaws are involved, paresthesia & loosening of the teeth are common findings, and radiographically looks like Irregular RL with ill-defined margins and Characteristic “onionskin” periosteal reaction? What gene is this involved with?
- Ewing Sarcoma
- T11 to T22
What are a Mesenchymal malignancy, Cells have the ability to produce osteoid or immature bone. Excluding hematopoietic neoplasms, it is the most common (2nd most common) type of malignancy to originate within bone, 7% occur in the jaw, Swelling and pain are common symptoms. Root resorption can occur, which is termed Spiking Resorption or tapered narrowing of root, has Classic is Sunburst appearance – found only in 25% and due to bony projections on the surface of the lesion, has a A triangular elevation of periosteum termed Codman’s Triangle can occur, and PDL widening is due to tumor infiltration?
What are Malignant bone tumor of cartilage, Up to 3% arise in the head and neck, In the extragnathic bones, it is a tumor of adulthood, almost all patients are older than 50, Painless mass or swelling is the most common presenting sign, which may be associated with separation or loosening of teeth?