Diseases of Bone Flashcards
(49 cards)
1
Q
4 fibro-osseous lesions of the jaw
A
- Periapical (cemento-) osseous dysplasia
- Florid (cemento-) osseous dysplasia
- Ossifying fibroma
- Fibrous dysplasia
2
Q
8 clinical features of PCD/POD
A
- Very common
- Middle age
- Female/male ratio 9:1
- 3 Black/ 1 Caucasian (also common in SE Asian)
- Affected teeth are vital
- Asymptomatic
- Single or multiple lesions
- No swelling
3
Q
6 radiographic features of early PCD/POD
A
- Purely radiolucent
- Not corticated
- Fairly well-defined
- Loss of lamina dura
- PDL intact
- Diff: rarefying osteitis
4
Q
3 radiographic features of PCD
A
- Mixed radiolucent/radiopaque
- Radiopacities develop within the radiolucency, grow and coalesce
- The radiolucency stops enlarging
5
Q
3 differential diagnoses for PCD
A
- Odontoma
- Cementoblastoma
- OF
6
Q
Radiographic appearance of late stage PCD
A
- Mostly radiopaque
- A radiolucent rim surrounds the lesion but is often incomplete
7
Q
3 differential diagnoses for late stage PCD
A
- Cementoblastoma
- Osteoma
- Idiopathic osteosclerosis
8
Q
Define FOD clinically
A
- Widespread form of PCD
- Multiple lesions
- Lesions are large and often cause swelling
- 4 quadrants can be affected
9
Q
5 ragiographic features of FOD
A
- Similar to PCD
- Cotton-wool appearance
- Granular appearance
- Cortication can be present
- Sometimes associated with simple (traumatic) bone cyst
10
Q
Differential diagnosis for FOD
A
Paget’s disease
11
Q
4 clinical features of oddifying fibroma (OF)
A
- Young adult
- Female > male
- Mandible, molar-premolar region
- Swelling
12
Q
3 radiographic stages of ossifying fibroma
A
Lucent, mixed, opaque
13
Q
7 radiographic features of ossifying fibroma
A
- Radiolucent initially, often round
- Radiopacities develop in the radiolucency, enlarge and coalesce - granular appearance
- Can be very radiopaque
- Well-defined border, hyperostotic sometimes
- Radiolucent rim
- Resorption and/or displacement of roots
- Expansion
14
Q
5 differential diagnoses of ossifying fibroma
A
- AOT
- COC
- CEOT
- PCD
- Ameloblastoma
15
Q
2 types and 2 subtypes of fibrous dysplasia
A
- Monostotic (70%)
- Polyostotic (30%)
- Jaffe’s type
- Albright’s syndrome
16
Q
2 characteristics of Jaffe’s type fibrous dysplasia
A
- Multiple bones affected
- Cafe-au-lait spots
17
Q
3 characteristics of Albright’s syndrome
A
- Multiple bones affected
- Cafe-au-lait spots
- Endocrine abnormalities
- Most common abnormality is precocious sexual development in females
18
Q
5 clinical features of fibrous dysplasia
A
- Children
- Incidental finding in many patients
- Swelling in others
- Stops growing with the end of skeletal growth
- Unilateral in the jaws
19
Q
10 radiographic features of fibrous dysplasia
A
- Diffuse margins
- Blends with normal bone
- Replacement of the normal bone pattern with an abnormal-looking bone
- Alteration in the bone pattern
- Ground glass, orange peel bone patterns
- Expansion - no perforation of cortex
- Unilateral in the jaws
- Can obliterate the maxillary sinus
- Can displace teeth, resorb roots
- Can displace the mandibular canal superiorly (pathognomonic)
NOTE: Radiopacity increases with the stage of the lesion
20
Q
5 differential diagnoses for fibrous dysplasia
A
- CGCG
- OF
- Paget’s
- Osteosarcoma
- Osteomyelitis
21
Q
4 clinical features of central giant cell granuloma (CGCG)
A
- 2nd, 3rd decades
- Mandibleémaxilla 2:1
- Anterior region, regions where deciduous teeth were present
- Swelling
22
Q
7 radiographic features of central giant cell granuloma
A
- Small lesions are radiolucent and unilocular
- Larger lesions are multilocular with fine, wispy trabeculae
- Fairly well-defined but poorly corticated
- Trabeculae at right angle to the buccal cortex on an occlusal radiograph
- Bulging of buccal cortex produces 2 layers of cortex
- Crosses the midline
- Spectacular root displacement and resorption
23
Q
4 differential diagnoses for CGCG
A
- Amelo
- ABC
- OKC
- OF
24
Q
7 clinical characteristics of cherubism
A
- Inherited
- Starts in young children, age 2-6
- Bilateral enlargement of the posterior region of the mandible
- Bilateral enlargement of the posterior maxilla can also be present
- Very rarely unilateral
- Lesions stop growing and even regress during adolescence
- Histology resembling central giant cell granuloma
25
5 radiographic features of cherubism
* Multilocular symmetrical well-defined corticated radiolucencies in the ramus, angle and posterior mandible
* Internal structure similar to CGCG (fine wispy trabeculae giving multilocular appearance)
* Can extend into the condyles posteriorly and anteriorly to the midline in very severe cases
* Expansion of the cortices
* Displacement of erupted teeth, displacement of unerupted teeth anteriorly. Some tooth buds can be missing
26
4 differential diagnoses for cherubism
* CGCG
* Fibrous dysplasia
* Gorlin-Goltz syndrome (multiple keratocysts)
* Histiocytosis X
27
How to differentiate cherubism from CGCG and fibrous dysplasia
Cherubism is bilateral while the other two are unilateral
28
How to differentiate cherubism from Gorlin-Goltz syndrome
Gorlin-Goltz is usually not as symmetrical as cherubism and there is not as much anterior displacement of the teeth
29
Treatment of cherubism
Cosmetic surgery at the end of skeletal growth
30
3 clinical forms of idiopathic histiocytosis
* Eosinophilic granuloma
* Hand-Shuller Christian
* Letterer-Siwe
31
3 clinical features of idiopathic histiocytosis
* Age related
* 10% of patients have oral lesions
* Most lesions are in the mandible
32
Radiographic appearance of idiopathic histoicytosis skull lesions
Geographic skull
33
Radiographic appearance of idiopathic histiocytosis jaw lesions
* Central lesions
* Ill-defined
* Solitary
* Periosteal reaction
* Alveolar bone lesions
* Multiple
* Well-defined
* Scooped-out effect
* Teeth floating in air
34
4 differential diagnoses for idiopathic histiocytosis
* Perio
* Leukemia
* Cyclic neutropenia
* Lymphoma
35
6 clinical features of Paget`s disease
* Older adults
* Male \> Female
* Many bones can be affected, particularly the skull
* Entire bone is affected, so it is bilateral in the jaws (to differentiate from FD)
* Bone pain, swelling, bowing of legs, curvature of spine, large head, diastemas, denture/hat too tight, deafness...
* Serum alkaline phosphatase elevated
36
2 treatments for Paget's disease
Calcitonin or bisphosphonate
37
3 radiographic stages of Paget's disease
Radiolucent, mixed and radiopaque
38
6 radiographic features of Paget's disease
* Alteration of the bone pattern, ground glass, thumb print, cotton wool appearance, linearity in mandible
* Severe expansion of the bone
* Reduction in size of maxillary sinus
* Generalized hypercementosis
* Diastemas
* Increase in density of bone (i.e. in mandible and skull)
39
2 conditions for which the incidence is inreased in Paget's disease
* Osteogenic sarcoma (~10%)
* Osteomyelitis in dense bone
40
3 differential diagnoses for Paget's disease
* Fibrous dysplasia
* Osteomyelitis
* Metastases
NOTE: FD and osteomyelitis are unilateral while Paget's is bilateral
41
3 clinical features of hypeparathyroidism
* Increased PTH parathyroid hormone by the parathyroid glands
* Primary hyperparathyroidism
* Benign tumor of a parathyroid gland
* 2-3 females: 1 male
* Secondary hyperparathyroidism
* In response to hypocalcemia
42
5 radiographic features of hyperparathyroidism
* Generalized increased radiolucency due to a demineralization of the jaws
* Granular appearance of the bone pattern - ground glass
* Thinning of cotices including inferior cortex and lamina dura of teeth
* Partial or complete loss of lamina dura
* Teeth stand out because the adjacent bone is so radiolucent
* Roots of teeth have a tapered appearance
* Brown tumors histologically identical to CGCG can develop. Radiolucent and can have ill-defined borders
43
5 clinical features of osteoporosis
* Reduction in bone mass
* Older adults
* Female\>male
* Post-menopausal women
* Fracture
44
4 radiographic features of osteoporosis
* Generalized increased radiolucency of the jaws
* Reduction in the number of trabeculae
* Thinning of cortices including inferior cortex and lamina dura of teeth
* Teeth appear to stand out because the adjacent bone is so radiolucent
45
Define osteopetrosis
Defect of osteoclasts --\> increase in bone mass
May be asymptomatic
46
3 complications of osteopetrosis
* Fracture
* Cranial nerve palsies
* Osteomyelitis
47
5 radiographic features of osteopetrosis
* Generalized increased radiopacity of the jaws and all bones of the skeleton
* Increased density can result in disappearance of the trabecular bone pattern
* Mild expansion can be present
* Cortices are less apparent because the adjacent bone is so dense
* Teeth are less apparent because the adjacent bone is so dense
* Malformed roots, missing teeth, delayed eruption often present
48
7 clinical features of progressive systemic sclerosis
* Chronic autoimmune disease of connective tissue
* 4th, 5th, 6th decades
* 3 females : 1 male
* Hardened, thickened skin
* Limitation of opening
* Xerostomia
* Severity of involvement variable
49
2 radiographic features of progressive systemic sclerosis
* Generalized widening of the periodontal ligament space
* Bilateral and symmetrical erosions at the site of attachment of muscles
* Coronoid process
* Condylar head
* Angle of mandible
* Digastric region
