generalized opacities

Question 1

generalized opacities we discuss

Answer 1

1. Fibrous dysplasia – Polyostotic
2. Florid cemento-osseous dysplasia
3. Paget’s disease
4. Osteopetrosis

Question 2

polyostotic FD dx mechanism

Answer 2

• Is a localized change in normal bone metabolism that
  results in the replacement of all the components of
  cancellous bone by fibrous tissue containing varying
  amounts of abnormal-appearing bone.
  ▪ Affects more than one bon

Question 3

polyostotic FD usually found in what demo?

Answer 3

Usually found in children younger than 10

Question 4

polyostotic FD associated syndromes

Answer 4

Jaffe-Lichtenstein Syndrome or Jaffe type
McCune-Albright Syndrome

Question 5

Jaffe-Lichtenstein Syndrome or Jaffe type

Answer 5

• Polyostotic FD with cutaneous pigmentation (café au lait spots)

Question 6

McCune-Albright Syndrome

Answer 6

• Polyostotic FD with cutaneous pigmentation (café au lait spots) and endocrinopathies
• Affects almost exclusively women

Question 7

what structure could be compressed in poly FD? implication?

Answer 7

pterygomax fissure= nn symptoms

Question 8

florid COD dx mech

Answer 8

• FCOD is a widespread form of Periapical cemento- osseous dysplasia (PCOD)
• If PCOD is identified in three or four quadrants or is
  extensive throughout one jaw, it usually is FCOD.
• Normal cancellous bone is replaced with dense,
  acellular amorphous bone in a background of fibrous connective tissue.

Question 9

FCOD vascularity?

Answer 9

Poor vascular supply (susceptibility to infection and poor healing)

Question 10

likely?

Answer 10

FCOD could also argue multiple osteomas/DBI

Question 11

what can be seen with FCOD radio images periphery?

Answer 11

RL rim, similar to COD

Question 12

FCOD clinical features
* Demo?
* Predilection for?
* symptoms?
* Extensive lesions often have?
* infection?
* Teeth vitality?

Answer 12

• Most patients are female and middle-aged, although the age range is broad.
• Predilection for African Americans and Asians.
• Often FOD produces no symptoms (incidental finding).
• Extensive lesions often have an associated bony swelling.
• If the lesions become secondarily infected, features of osteomyelitis may develop
• Teeth in the involved bone are vital.

Question 13

Answer 13

FCOD

Question 14

FCOD imaging features:
internal structure

Answer 14

• Can vary from radiolucent - mixed - almost totally radiopaque.
• The radiopaque regions can vary from small oval and circular regions to large, irregular and amorphous

Question 15

does FCOD need teeth?

Answer 15

no

Question 16

what is likely? dif?

Answer 16

FCOD
dif: osteomas, DBIs, osteoblastoma

Question 17

FCOD effects on surr strucutres
Large lesions displacement of?
* The roots of associated teeth?

Answer 17

Large lesions can displace the inferior IAC inferiorly, the floor of the maxillary sinus superiorly and enlarge the alveolar bone.
* The roots of associated teeth may have hypercementosis.

Question 18

dif dx of FCOD?

Answer 18

• Osteomyelitis (may appear similar to the sequestrum seen in osteomyelitis): This is not to be confused with a situation where FOD has become secondarily infected, resulting in osteomyelitis. The foci of amorphous bone that are secondarily infected have a wider and more profound radiolucent border.

Question 19

FCOD management

Answer 19

• Under normal circumstances, FOD does not require treatment.
• No age limit is apparent for the cessation of growth of FOD.
• Because of the propensity to develop secondary infections in FOD, oral hygiene is important in order to avoid odontogenic infections.

Question 20

pagest dx mechanism

Answer 20

• Is a skeletal disorder involving osteoclasts resulting
  in abnormal resorption and apposition of poor- quality bone in one or more bones.
• May involve many bones, but it is not a generalized
  skeletal disease.
• It is initiated by an intense wave of osteoclastic activity, with resorption of normal bone resulting in
  irregularly shaped resorption cavities. After a period of time, osteoblastic activity startsv

Question 21

Answer 21

pagets

Question 22

pagets clinical features
* Affects what ages?
* At age 65 years, gender?
* Affected bones app?
* teeth affected?
* Jaw pain?
* nn symptoms?
* Patients have severely elevated levels of ?

Answer 22

• Affects later middle and old age (3.5% of individuals older than 40 years of age)
• At age 65 years, the incidence of involvement in men is approximately twice that
  of women.
• Affected bone is enlarged and commonly deformed because of the poor quality of bone formation, resulting in bowing of the legs, curvature of the spine, and enlargement of the skull. The jaws also enlarge when affected.
• Separation and movement of teeth may occur, causing malocclusion. Dentures may fit poorly.
• Jaw pain is uncommon.
• Patients may also have ill-defined neurologic pain as the result of bone impingement on foramina and nerve canals.
• Patients have severely elevated levels of serum alkaline phosphatase

Question 23

Answer 23

pagets

Question 24

pagets imaging features:
location
* Often in what bones?
* jaw? which arch more common?

Answer 24

• Often in the pelvis, femur, skull, and vertebrae and infrequently in the jaws.
• It affects the maxilla about twice as often as the mandible.
• Although this disease is bilateral, occasionally it affects only one maxilla, or the involvement may be significantly greater on one side

Question 25

what can happen to roots with pagets

Answer 25

generalized hypercementosis

Question 26

Answer 26

pagets

Question 27

pagets dx int structure

Answer 27

* Generally, the appearance of the internal structure depends on the developmental stage of the disease: three radiographic stages although these often overlap in the clinical setting: 1. Early radiolucent resorptive stage. 2. A granular or ground-glass appearance. 3. A denser, more radiopaque appositional late stage. These stages are less apparent in the jaws

Question 28

pagets dx possible radiographic patterns of int structure

Answer 28

* Linear: The trabeculae may be long and may align themselves in a linear pattern, which is more common in the mandible. * Granular: Similar to that of fibrous dysplasia. * Cotton-wool appearance.

Question 29

pagets dx effects on surr structures: * affected bone? * The outer cortex? * The lamina dura? * roots? * The teeth?

Answer 29

* Always enlarges an affected bone (3x, 4x) * The outer cortex may be thinned but remains intact. * The lamina dura may become less evident and may be altered into the abnormal bone pattern. * Exuberant and irregular hypercementosis * The teeth may become spaced or displaced in the enlarging jaw

Question 30

pagets dx management * Usually managed how? * correct deformities? * Extraction sites? * Higher incidence of? * % of cases develop osteosarcoma?

Answer 30

* Usually managed medically (bisphosphonates). * Surgery may be required to correct deformities * Extraction sites heal slowly. * Higher incidence of osteomyelitis * 10% of cases develop osteosarcomas

Question 31

Answer 31

pagets

Question 32

what is likely?

Answer 32

pagets

Question 33

osteopetrosis dx mechanism

Answer 33

▪ Is an inherited disorder of bone that results from a defect in the differentiation and function of osteoclasts → Abnormal formation of bone and abnormal bone turnover thereafter. ▪ The failure of bone to remodel causes the bones to become densely mineralized, fragile, and susceptible to fracture and infection

Question 34

osteopetrosis cranial nn's/ hematopoesis

Answer 34

Hematopoiesis is retarded and cranial nerves may be compressed

Question 35

osteopetrosis vs paget's

Answer 35

petrosis is generalized

Question 36

clinical forms osteopetrosis ▪ Infantile malignant: ▪ Intermediate: ▪ Benign or Adult type:

Answer 36

▪ Infantile malignant: Autosomal recessive. Apparent short after birth. Fatal within the first few years of life ▪ Intermediate: Autosomal recessive or dominant. Occurs in the first decades of life and can allow a normal life expectancy. Severity is variable ▪ Benign or Adult type: Autosomal dominant. Full life expectancy. Mild symptoms in late childhood to adulthood.

Question 37

infantile osteopetrosis ▪ foramina? ▪ marrow? ▪ dental eruption?

Answer 37

▪ Progressive deposition of bone results in narrowing of bony canals and foramina → sensorineural and sensorimotor deficits including hydrocephalus, blindness, deafness, vestibular nerve dysfunction, and facial nerve paralysis, etc ▪ Diminished marrow spaces→ Affects hematopoietic development of blood cells ▪ Delayed dental eruption

Question 38

▪ Adult osteopetrosis ▪ May be entirely? ▪ It may be discovered when? ▪ marrow spaces? ▪ higher risk of?

Answer 38

▪ May be entirely asymptomatic or have mild signs and symptoms. ▪ It may be discovered at any time from childhood into adulthood as an incidental finding, or it may manifest as a bone fracture. ▪ Diminished marrow spaces secondary to the deposition of bone → Affects hematopoietic development of blood cells → anemia, leukopenia, and thrombocytopenia. ▪ The increased bone density and relatively poor vascularity: Higher risk of osteomyelit

Question 39

osteopetrosis imaging features: Effects on the teeth and jaws.

Answer 39

▪ Because this condition is systemic, the changes affect all bones (it is bilateral and symmetrical) ▪ The bone may be so dense that teeth roots and other structures within the bone may not be apparent ▪ The lamina dura and cortical boundaries are thickened or blended into the surrounding dense bone ▪ Effects on teeth: missing teeth, malformed roots and crowns, poorly calcified teeth and delayed eruption as a result of the increased bone density.

Question 40

osteopetrosis management ▪ Bone marrow transplantation? ▪ When osteomyelitis develops?

Answer 40

▪ Bone marrow transplantation to attempt to stimulate the formation of functional osteoclasts. ▪ When osteomyelitis develops it is difficult to treat, and a combination of antibiotics and hyperbaric oxygen therapy is used. Prevention of odontogenic inflammatory disease is key.

Question 41

this is seen bilaterally

Answer 41

osteopetrosis