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Oral candidiasis > 15. Diseases of the facial bones > Flashcards

15. Diseases of the facial bones Flashcards

1
Q

What occurs in osteoprosis, eg, what is the bone like?

A

Decreased bone mass/density
Bone is normal structure but less quantity
May be due to less bone apposition, and increased loss

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2
Q

What are the 2 types of osteoprosis?

A
  • Localised
  • Generalised
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3
Q

What are the reasons for generalised osteoporosis?

A

Low calcium and vitamin D diet
Post menopausal- lack of oestrogen accelerates bone loss- 1-2% per year loss

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4
Q

What other diseases is osteoporosis seen in?

A

HPT, Addison’s, Thyrotoxicosis, Multiple myeloma
GI disturbances- malabsorption
Drugs- alcoholism, chemotherapy

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5
Q

What are the symptoms of osteoporosis?

A

Bone is more radiolucent
May predispose to pathological fractures
Might result in disappearance of alveolar bone

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6
Q

What happens to the vertebral bodies in osteoporosis?

A

They become shortened by compression fractures
Loss of horizontal trabeculae
Increased thickening of vertical trabeculae

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7
Q

Who does primary hyperparathyroidism affect most?

A

Middle aged females

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8
Q

What may be the reason for primary hyperparathyroidism?

A

Carcinoma
Adenoma
Hyperplasia of parathyroid gland

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9
Q

What hormonal changes occur in primary hyperparathyroidism?

A

Increase in levels of PTH
Intestinal absorption of Ca
Renal re-absorption of Ca
Osteoclastic resorption
Leading to Hypercalcaemia and hypercalciuria

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10
Q

What can occur in primary hyperparathyroidism in the rest of the body?

A

Kidney stones
Pathological metastatic calcifications that can spread to lungs, kidney and blood vessels

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11
Q

What is the radiology for primary hyperparathyroidism?

A

Radiolucent area

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12
Q

What is the histology for primary hyperparathyroidism?

A

5% develop brown tumours
Multinucleated giant cells, fibroblastic stroma, highly vascular, haemosiderin

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13
Q

What is secondary hyperparathyrodisim?

A

It is in response to hypocalcaemia
Due to chronic renal failure
Prolonged dialysis
Associated to rickets and osteomalacia

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14
Q

What is tertiary hyperparathyrodism?

A

Happens in patients with mild secondary parathyroidism who had a functioning kidney transplant
- Despite calcium and vitamin suppressor therapy, there is still autonomous proliferation with hyperfunction
- Patients continue to have overactive parathyroid glands

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15
Q

What is rickets/osteomalacia due to?

A

Deficiency
Lack of Ca
Resistance to Vit D

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16
Q

What are vit D dependent factors in causing rickets/osteomalacia?

A

Malabsorption
Dietary deficiency
Renal failure
Lack of sunlight exposure

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17
Q

What is inherited vit D resistant rickets/osteomalacia called?

A

Familial hypophosphatemia

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18
Q

What drugs can cause effects in rickets/osteomalacia?

A

Phenyotin- accelerated vitamin D metabolism

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19
Q

What happens to bone in rickets/osteomalacia?

A

Failure of mineralisation of bone
Wide seams of uncalcified osteoid

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20
Q

What can happen dentally in severe cases of rickets/osteomalacia?

A

Enamel hypoplasia
More interglobular dentine
Wide predentine
Delayed eruption

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21
Q

What is acromegaly due to?

A

Increase in secretion of growth hormone
Adenoma of anterior pituitary gland

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22
Q

What is the other type of acromegaly called?

A

Gigantism- before epiphyses fused- localised effects
Acromegaly- after epiphyses fused- generalised effects

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23
Q

What are localised effects of acromegaly?

A

Headaches
Vision field loss- blindness- optic nerve

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24
Q

What are metabolic effects of acromegaly?

A

Large hands and feet
Relative microdontia
Macroglossia
Prognathism mandible

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25
What is an osteoma?
Benign- neoplastic Slow growing Smaller than 2cm Central or subperiosteal Compact or cancellous type
26
What are the features of Gardner's syndrome?
Multiple intestinal polyps Multiple osteomas Epidermoid cysts Desmoid tumours Supernumerary Impacted Odontomes
27
What is exostoses?
Non-neoplastic bony outgrowth Slow growth, Compact or cancellous bone
28
What can an exostoses be due to?
Developmental In response to some stimulus, eg. repeated trauma or free gingival grafts
29
Give 2 examples of exostoses?
Common in alveolar region Torus palatinus- midline, more common than mandibular Torus mandibularis- premolar area above mylohyoid line
30
What is an osteoblastoma?
Greater than 2cm Rare in jaws More common in tibia and fibula
31
What is the histology and x ray for osteoblastoma?
Looks similar to cementoblastoma, but not associated with roots Random trabecular woven bone Lined by osteoblasts and osteoclasts Many blood vessels
32
What is osteogenic sarcoma?
Most common malignant neoplasm in jaw
33
What ages does osteogenic sarcoma affect?
People under 25 If occurs elsewhere, normally occurs in jaws 10 years after Can be secondary to Paget's and radiotherapy- then occurs older
34
What are the types of osteogenic sarcoma?
Intramedullary Juxtacortical- near periosteum Juxtacortical has better prognosis than intramedullary
35
What is the prognosis of osteogenic sarcoma?
In the jaws they are low grade tumours, that do not metastasise much but they recur 40%= 5 year survival rate
36
What are the symptoms of osteogenic sarcoma?
Tooth mobility Pain Lip paraesthesia Swelling
37
What is the histology of osteogenic sarcoma?
Sun ray appearance Widening of PDL Mixed, radiolucent or radiopaque Osteoclast like cells Malignant osteoblasts forming osteoid on trabeculae Very pleomorphic Fibrous and chondroid tissue
38
What is chondroma/chondrosarcoma?
Occur in posterior mandible and anterior maxilla May occur in tongue- chondroid metaplasia
39
What do chondromas produce?
May produce mature cartilage
40
What is the treatment for chondroma/chondrosarcoma?
Wide local excision
41
What is the prognosis for chondroma and chondrosarcoma?
Prognosis of malignant cases is poor Does not metastasise frequently Local recurrence is common
42
What is the histology of chondrosarcoma?
Highly cellular cartilage Binucleate cells More than one cell per lacunae Mitoses
43
What is cemento-ossifying fibroma?
Fibrosseous lesion Mandible-premolar area commonly Well demarcated Painless Sometimes encapsulated Benign neoplasm
44
What is the radiology of Cemento-ossifying fibroma?
Well demarcated Radiolucent area with variable opacities Expansion
45
What is the tx for cemento-ossifying fibroma?
Enucleation along capsule
46
What is the differential diagnosis for cemento-ossifying fibroma?
Fibrous dysplasia but does not blend with the surrounding bone
47
What is the histology for cemento-ossifying fibroma?
Fibrous tissue Woven bone Spherical deposits Associated with vital tooth
48
What is another name for giant cell tumour and where does it occur?
Osteoclastoma, rare in jaws 20-40 years old In other bones, it is aggressive and even metastatic
49
What is the osteoclastoma the same entity as?
CGCG but it is not as aggressive
50
What is the treatment for GCT and CGCG?
CGCG- curettage GCT- radical/resection
51
What is the histology of CGCG and GCT?
Osteoclast like multinucleated giant cells- focal or scattered Extravasated erythroyctes Haemosiderin Small spindle shape cells Vascular stroma
52
What are the 6 types of giant cell lesions?
Browns tumour of hyperparathyroidism Cherubism GCT CGCG Giant cell epulis Aneurysmal bone cyst
53
What is myeloma? What are the 2 types?
Malignant tumour of plasma cells Solitary-plasmacytoma Multifocal BOTH affect jaws
54
What age does myeloma affect?
50-70 years
55
How does myeloma occur?
You get DNA damage which produces a damaged white blood cell (B cell) A single clone of cells produces large amounts of immunoglobins in response to foreign antigen- normally IgG.
56
What is the Ig in myeloma called?
In serum or urine it is called M protein, or paraproteins or Bence-Jones protein
57
What is seen systemically in myeloma?
Elevated calcium Renal failure Anaemia/amyloidosis Bone lesions
58
What is the histology of myeloma?
Myeloma cells resemble mature plasma cells Multinucleate forms also seen
59
What is the radiology of myeloma?
Well demarcated appearance with punched out lesions Pepper pot skull
60
What are 2 examples of idiopathic lesions?
Aneursymal bone cyst Giant cell granuloma
61
What is Langerhans cell histiocytosis types?
Solitary- eosinophilic granuloma Disseminated- Lettere-Siwe disease Multifocal EG- Hand-schullter-christian syndrome Collection of histiocytes and eosinophils
62
What occurs to bone in Paget's disease?
Increased bone turnover Disorganised remodelling and formation Osteoblastic and osteoclastic dysfunction Bone deformation
63
What is the reason for Paget's disease?
Idiopathic May be viral Paramyxovirus infection
64
What is the clinical course of Paget's?
1. Primary osteolytic phase 2. Mixed osteolysis and osteogenesis 3. Predominantly osteoblastic (sclerotic) phase
65
What bones do Paget's mostly affect?
Can be single or more rarely disseminated Weight bearing bones
66
What are the symptoms of Paget's?
Wider maxilla, wider skull Deafness, blindness, pain, paraesthesia due to nerve compression Osteosarcoma
67
What is seen in the serum in Paget's?
Increased levels of alkaline phosphatase Normal calcium and phosphate
68
What is the radiology of Paget'?
Radiolucent osteolytic areas with patchy sclerotic areas Cotton woll patchy appearance
69
What is the dental symptoms of Paget's?
Hypercementosis Ankylosis Loss of laminar dura Dentures do not fit Difficult XLA Post op bleeding- ostelytic- lots of BV Occlusion derangament
70
What is the histology of Paget's?
Abnormally large osteoclasts Mosaic pattern Reverse lines where it has gone from bone deposition to bone resoprtion Osteoclastic and osteoblastic activity
71
What are developmental diseases of TMJ?
Aplasia Hypoplasia Hyperplasia
72
What is aplasia TMJ?
Rare Uni or bilateral Often associated with other diseases- hemifacial microsomnia
73
What is hypoplastic TMJ?
Acquired or developmental Trauma Infection during development
74
What is hyperplastic TMJ?
Cause unknown Unilateral-facial asymmetry Self limiting
75
What can inflammatory diseases of the TMJ be split into?
Traumatic Infective Autoimmune Degenerative
76
What can traumatic disease of TMJ be?
Fracture Ankylosis Trauma Dislocation
77
What can infective disease of TMJ be?
Gonococcal Viral Staph Aureus
78
What is degenerative disease of TMJ?
Osteoarthrosis (itis) Rare before 40 Limited opening, deviation on movement, crepitus, pain Vertical splits in cartilage- fibrillation Fragmentation Bone exposure- denudation Thickening- eburnation
79
What are functional diseases of TMJ?
Myofascial pain dysfunction syndrome Trismus
80
What are symptoms of MPDS?
Limited opening Pain Clicking Bruxism- stress- occlusal problems
81
What is trismus?
Limited movement Intra-auricular- dislocation, fracture, trauma, infection, ankylosis Extra-auricular- infection, fracture, haematoma, MPDS, tetanus
82
How does RA affect?
Eroded articular surfaces by vascular pannus Disc destruction Bone resorption Limited opening Fibrous ankylosis- ossifies

Oral candidiasis (18 decks)

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