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Oral pathology > OP15 diseases of facial bones and joints II > Flashcards

OP15 diseases of facial bones and joints II Flashcards

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1
Q

What are the metabolic/endocrine diseases of facial bones and joints?

A

Osteoporosis, hyperparathyroidism, Rickets/osteomalacia, acromegaly

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2
Q

What is osteoporosis?

A

When the bone has normal structure, but less in quantity.
Diminished bone mass and density.

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3
Q

What can cause osteoporosis?

A

Excessive loss or reduced apposition of bone

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4
Q

What can cause localised osteoporosis?

A

Seen with immobilisation, lack of exercise

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5
Q

What can cause generalised osteoporosis?

A

Low Ca or Vit-D diet
Menopausal women (lack of oestrogen)
Diseases (endocrine - HPT, thyrotoxicosis, Addisons, multiple myeloma; GI disturbances - malabsorption; Drugs - alcoholism, chemotherapy)

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6
Q

What happens to the bone in osteoporosis?

A

It is more radiolucent
Shortened by compression fractures
Loss of horizontal trabeculae and thickened vertical trabeculae

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7
Q

What is primary hyperparathyroidism and what can cause it?

A

Increase in parathyroid hormone levels (adenoma, carcinoma or idiopathic hyperplasia of parathyroid gland)

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8
Q

What does parathyroid hormone usually cause?

A

Intestinal absorption of Ca, renal reabsorption of Ca and osteoclastic resorption leading to hypercalcaemia and hypercalciuria

AKA PTH retains calcium/increases its levels

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9
Q

What might hyperparathyroidism cause?

A

Development of kidney stones, pathological metastatic calcifications (blood vessels, lung, kidney)

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10
Q

What do 5% of people with hyperparathyroidism develop?

A

Brown tumours (brown to haemosiderin) - very similar to giant cell epulis and other giant cell lesions

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11
Q

What is secondary hyperparathyroidism?

A

In response to chronic hypocalcaemia:
- Due to chronic renal failure
- Prolonged dialysis
- In association to Rickets and osteomalacia

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12
Q

What is Rickets/Osteomalacia and what causes it?

A

Rickets (in children) and osteomalacia (in adults) due to a deficiency or resistance to vitamin D or lack of Ca

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13
Q

What things can cause deficiency or resistance to vitamin D or lack of Ca?

A

Lack of sunlight exposure
Dietary deficiency
Malabsorption
Renal failure
Vitamin D resistant
Accelerated vitamin D metabolism (phenytoin)

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14
Q

What happens to the bone in rickets/osteomalacia?

A

Failure of mineralisation of bone (wide seams of uncalcified osteoid)

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15
Q

What can happen to the teeth in severe rickets/osteomalacia?

A

Enamel hypoplasia (thus caries), wide predentine, more interglobular dentine, delayed eruption

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16
Q

What is acromegaly?

A

Excessive secretion of growth hormone (adenoma of anterior pituitary gland)
(after epiphyses have fused)

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17
Q

What is excessive growth hormone called when it occurs before the epiphyses have fused?

A

Gigantism

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18
Q

What are the local features of acromegaly?

A

Temporal headaches
Visual field loss - blindness (optic nerve constriction)

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19
Q

What are the metabolic features of acromegaly?

A

Hands and feet enlarged
Lips and nose thickened
Enlarged tongue (macroglossia), mandible prognatism (class III)
Relative microdontia/spacing

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20
Q

What are some exostoses of bone?

A

Torus palatinus, torus mandibularis

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21
Q

What is an exostoses?

A

Non-neoplastic bony outgrowths (distinction between osteoma is difficult)
Develops in response to some stimulus, eg repeated trauma, grafts
Some are symmetrical, in alveolar region

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22
Q

What are tori and where are they found?

A

Slow growth - cancellous or compact bone
Torus palatinus - common in midline of palate
Torus mandibularis - premolar area above mylohyoid line

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23
Q

What are the neoplastic bone diseases, benign and malignant?

A

Benign - osteoma, osteochrondroma, osteoid osteoma, osteoblastoma, cemento-ossifiying fibroma, giant cell tumour (osteoclastoma), chondroma, haemangioma

Malignant - osteogenic sarcoma, juxtacortical osteosarcoma, Erwin’s tumour, myeloma, chondrosarcoma, metastatic tumours

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24
Q

What is osteoma?

A

A benign (<2cm), slow growing growth that can be central (inside bone) or subperiosteal (on bone surface)

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25
What type of bone is osteoma?
Compact and cancellous
26
What is the difference between compact and cancellous bone?
Compact = all lamina bone, solid Cancellous = has trabecular bone inside with bone marrow spaces
27
Do people usually present with one or multiple osteomas?
Usually solitary, but multiple in Gardner's syndrome.
28
What is osteoblastoma?
>2cm, benign bony growth made of random trabecular woven bone, rimmed by osteoblasts and osteoclasts, many blood vessels Not related to dental roots Rare in jaws, common in tibia/fibula
29
What is osteogenic sarcoma?
Malignant tumour of bone (rare in jaws)
30
What are the subtypes of osteogenic sarcoma?
Intramedullary or juxtacortical (near periosteum, better prognosis than central type)
31
What is osteogenic sarcoma associated with?
Paget's disease, radiotherapy
32
Although rare in the jaws, what type of tumours are osteogenic sarcomas of the jaw?
Low grade tumours that recur but metastasise less often
33
How does osteogenic sarcoma present clinically?
Swelling, pain, lip paraesthesia, tooth mobility
34
How does osteogenic sarcoma present on x-ray?
Radiolucenct, radiopaque or mixed, widening of PDL, 'sun-ray' appearance
35
What is histology of osteogenic sarcoma?
Osteoid formation by malignant osteoblasts on trabeculae, osteoclast-like cells, also fibrous and chondroid tissue. Very pleomorphic.
36
Where do chondromas and chondrosarcoma's occur?
Rare but in the anterior maxilla and posterior mandible
37
What do chondromas do?
Produce mature cartilage Sometimes ossification takes place - osteochondromas May happen in the soft tissues
38
What is the prognosis like of chondrosarcomas?
Prognosis is poor, infrequent metastases, but local recurrence is common
39
What is tx for chondromas and chondrosarcomas?
Wide local excision
40
What is histology of chondrosarcomas?
Highly cellular cartilage, binucleated cells, more than one cell per lacunae
41
What are the types of fibroosseous lesions?
Cemento-ossifying fibroma COF Ossifiying fibroma OF Fibrous dysplasia FD Cemento-ossifying dysplasia COD
42
Where do fibroosseous lesions arise from?
The PDL
43
What are cemento-ossifying fibromas?
Painless, well demarcated, sometimes encapsulated, benign neoplasm, mainly in mandible of adults
44
How does cemento-ossifying fibroma present on a radiograph?
Well defined radiolucent areas, with variable opacities. Can expand the jaw bones.
45
What is the histology of cemento-ossifying lesions?
Cellular fibrous connective tissue, bone trabeculae and spherical deposits of calcified material resembling cementum DD from fibrous dysplasia: age and encapsulation
46
What is treatment for giant cell tumour GCT vs central giant cell granuloma CGCG?
Curretage for CGCG Radical treatment (resection) for GCT
47
What is histology of GCT and CGCG?
Osteoclast-like multinucleated giant cells (focal or scattered) in a vascular stroma, rich in small spindle shape cells, extravasated erythrocytes and haemosiderin.
48
Which giant cell lesions all have similar histological features?
CGCG, GCT, giant cell epulis, brown tumour of hyperparathyroidism, cherubism, aneurysmal bone cyst
49
What is a myeloma?
Malignant tumour of plasma cells
50
What are the types of myeloma?
Multifocal (vertebrae, ribs, pelvis, skull, mandible) Or solitary (plasmacytoma)
51
Can myeloma affect the jaws?
Yes, painfully
52
What is the mechanism of myeloma?
A single clone of cells produce large amounts of immunoglobulins (usually IgG). In serum or urine, the Ig (or its components) are known as paraproteins, M.
53
What is CRAB, the symptoms of myeloma?
Calcium elevated Renal failure Anaemia/amyloidosis Bone lesions
54
What is histology of myeloma?
Myeloma cells resemble mature plasma cells, bi-/multinucleated forms are also seen.
55
How does myeloma present radiographically?
Well demarcated lesions with 'punched out' appearance.
56
What idiopathic conditions of the facial bones and joints are there?
Giant cell granuloma, Pagets disease, fibroosseous lesions, histiocytosis, aneurysmal bone cyst
57
What is Langerhans cell histiocytosis?
Histologically characterised by collection of histiocytes and eosinophils
58
What are histiocytes?
Macrophages of the connective tissue
59
What does Paget's disease of bone cause?
Increased bone turnover, disorganised formation and remodelling of bone, osteoclastic/blastic dysfunction leading to bone deformation
60
What is the clinical course of Paget's disease?
Initial osteolytic phase (bone resorbed due to OC's) Mixed osteolysis and osteogenesis Predominantly osteoblastic phase
61
What are the clinical features of Paget's?
- Single or more rarely disseminated: weight bearing bones (simian posture), skull (hate size), maxilla (denture do not fit) - Sensory disturbances (pain, deafness, blindness, paralysis due to nerve compression) - Osteosarcoma - Serum: Ca & P within normal limits, increased alkaline phosphatase
62
What does Paget's disease present like radiographically?
Osteolytic, radiolucent areas, patchy area, 'cotton wool' appearance
63
What are the dental manifestations of Paget's disease?
Hypercementosis, ankylosis , loss of lamina dura, occlusal derangement, dentures do not fit
64
What is the histology of Paget's disease?
Osteoclastic and osteoblastic activity (depending on the phase) Reversal lines 'mosaic pattern' or 'jigsaw' of lamellar bone
65
What are the diseases of the TMJ?
Developmental - aplasia, hypoplasia, hyperplasia of the condyle Inflammatory (arthritis) Functional - myofascial pain dysfunction syndrome, trismus
66
What are the developmental diseases of the TMJ?
Aplasia of the condyle Hypoplasia of the condyle Hyperplasia of the condyle
67
What inflammatory diseases of the TMJ are there?
Traumatic arthritis - fractures, dislocation, severe trauma may cause ankylosis Infective arthritis - Staph. aureus Autoimmune - RA - TMJ affected by eroded articular surfaces, bone resorption, disc destruction, limited opening, ankylosis Degenerative - crepitus, limited opening, deviation on movement, vertical splits in cartilage, fragmentation, bone exposure and thickening
68
What is myofascial pain-dysfunction syndrome?
Painful TMJ-muscles, clicking, limited movement Associated with emotional stress, bruxism
69
What is trismus?
Limited movement
70
What are the 2 types of trismus?
Intra-articular: dislocation, fracture, infection, trauma, ankylosis Extra-articular: inflammation, fracture, haematoma, MPDS, tetanus

Oral pathology (27 decks)

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