15. Diseases of the facial bones Flashcards
What occurs in osteoprosis, eg, what is the bone like?
Decreased bone mass/density
Bone is normal structure but less quantity
May be due to less bone apposition, and increased loss
What are the 2 types of osteoprosis?
- Localised
- Generalised
What are the reasons for generalised osteoporosis?
Low calcium and vitamin D diet
Post menopausal- lack of oestrogen accelerates bone loss- 1-2% per year loss
What other diseases is osteoporosis seen in?
HPT, Addison’s, Thyrotoxicosis, Multiple myeloma
GI disturbances- malabsorption
Drugs- alcoholism, chemotherapy
What are the symptoms of osteoporosis?
Bone is more radiolucent
May predispose to pathological fractures
Might result in disappearance of alveolar bone
What happens to the vertebral bodies in osteoporosis?
They become shortened by compression fractures
Loss of horizontal trabeculae
Increased thickening of vertical trabeculae
Who does primary hyperparathyroidism affect most?
Middle aged females
What may be the reason for primary hyperparathyroidism?
Carcinoma
Adenoma
Hyperplasia of parathyroid gland
What hormonal changes occur in primary hyperparathyroidism?
Increase in levels of PTH
Intestinal absorption of Ca
Renal re-absorption of Ca
Osteoclastic resorption
Leading to Hypercalcaemia and hypercalciuria
What can occur in primary hyperparathyroidism in the rest of the body?
Kidney stones
Pathological metastatic calcifications that can spread to lungs, kidney and blood vessels
What is the radiology for primary hyperparathyroidism?
Radiolucent area
What is the histology for primary hyperparathyroidism?
5% develop brown tumours
Multinucleated giant cells, fibroblastic stroma, highly vascular, haemosiderin
What is secondary hyperparathyrodisim?
It is in response to hypocalcaemia
Due to chronic renal failure
Prolonged dialysis
Associated to rickets and osteomalacia
What is tertiary hyperparathyrodism?
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
What is rickets/osteomalacia due to?
Deficiency
Lack of Ca
Resistance to Vit D
What are vit D dependent factors in causing rickets/osteomalacia?
Malabsorption
Dietary deficiency
Renal failure
Lack of sunlight exposure
What is inherited vit D resistant rickets/osteomalacia called?
Familial hypophosphatemia
What drugs can cause effects in rickets/osteomalacia?
Phenyotin- accelerated vitamin D metabolism
What happens to bone in rickets/osteomalacia?
Failure of mineralisation of bone
Wide seams of uncalcified osteoid
What can happen dentally in severe cases of rickets/osteomalacia?
Enamel hypoplasia
More interglobular dentine
Wide predentine
Delayed eruption
What is acromegaly due to?
Increase in secretion of growth hormone
Adenoma of anterior pituitary gland
What is the other type of acromegaly called?
Gigantism- before epiphyses fused- localised effects
Acromegaly- after epiphyses fused- generalised effects
What are localised effects of acromegaly?
Headaches
Vision field loss- blindness- optic nerve
What are metabolic effects of acromegaly?
Large hands and feet
Relative microdontia
Macroglossia
Prognathism mandible
What is an osteoma?
Benign- neoplastic
Slow growing
Smaller than 2cm
Central or subperiosteal
Compact or cancellous type
What are the features of Gardner’s syndrome?
Multiple intestinal polyps
Multiple osteomas
Epidermoid cysts
Desmoid tumours
Supernumerary
Impacted
Odontomes
What is exostoses?
Non-neoplastic bony outgrowth
Slow growth, Compact or cancellous bone
What can an exostoses be due to?
Developmental
In response to some stimulus, eg. repeated trauma or free gingival grafts
Give 2 examples of exostoses?
Common in alveolar region
Torus palatinus- midline, more common than mandibular
Torus mandibularis- premolar area above mylohyoid line
What is an osteoblastoma?
Greater than 2cm
Rare in jaws
More common in tibia and fibula
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
What is osteogenic sarcoma?
Most common malignant neoplasm in jaw
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
What are the types of osteogenic sarcoma?
Intramedullary
Juxtacortical- near periosteum
Juxtacortical has better prognosis than intramedullary
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
What are the symptoms of osteogenic sarcoma?
Tooth mobility
Pain
Lip paraesthesia
Swelling
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
What is chondroma/chondrosarcoma?
Occur in posterior mandible and anterior maxilla
May occur in tongue- chondroid metaplasia
What do chondromas produce?
May produce mature cartilage
What is the treatment for chondroma/chondrosarcoma?
Wide local excision
What is the prognosis for chondroma and chondrosarcoma?
Prognosis of malignant cases is poor
Does not metastasise frequently
Local recurrence is common
What is the histology of chondrosarcoma?
Highly cellular cartilage
Binucleate cells
More than one cell per lacunae
Mitoses
What is cemento-ossifying fibroma?
Fibrosseous lesion
Mandible-premolar area commonly
Well demarcated
Painless
Sometimes encapsulated
Benign neoplasm
What is the radiology of Cemento-ossifying fibroma?
Well demarcated
Radiolucent area with variable opacities
Expansion
What is the tx for cemento-ossifying fibroma?
Enucleation along capsule
What is the differential diagnosis for cemento-ossifying fibroma?
Fibrous dysplasia but does not blend with the surrounding bone
What is the histology for cemento-ossifying fibroma?
Fibrous tissue
Woven bone
Spherical deposits
Associated with vital tooth
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
What is the osteoclastoma the same entity as?
CGCG but it is not as aggressive
What is the treatment for GCT and CGCG?
CGCG- curettage
GCT- radical/resection
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
What are the 6 types of giant cell lesions?
Browns tumour of hyperparathyroidism
Cherubism
GCT
CGCG
Giant cell epulis
Aneurysmal bone cyst
What is myeloma? What are the 2 types?
Malignant tumour of plasma cells
Solitary-plasmacytoma
Multifocal
BOTH affect jaws
What age does myeloma affect?
50-70 years
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.
What is the Ig in myeloma called?
In serum or urine it is called M protein, or paraproteins or Bence-Jones protein
What is seen systemically in myeloma?
Elevated calcium
Renal failure
Anaemia/amyloidosis
Bone lesions
What is the histology of myeloma?
Myeloma cells resemble mature plasma cells
Multinucleate forms also seen
What is the radiology of myeloma?
Well demarcated appearance with punched out lesions
Pepper pot skull
What are 2 examples of idiopathic lesions?
Aneursymal bone cyst
Giant cell granuloma
What is Langerhans cell histiocytosis types?
Solitary- eosinophilic granuloma
Disseminated- Lettere-Siwe disease
Multifocal EG- Hand-schullter-christian syndrome
Collection of histiocytes and eosinophils
What occurs to bone in Paget’s disease?
Increased bone turnover
Disorganised remodelling and formation
Osteoblastic and osteoclastic dysfunction
Bone deformation
What is the reason for Paget’s disease?
Idiopathic
May be viral
Paramyxovirus infection
What is the clinical course of Paget’s?
- Primary osteolytic phase
- Mixed osteolysis and osteogenesis
- Predominantly osteoblastic (sclerotic) phase
What bones do Paget’s mostly affect?
Can be single or more rarely disseminated
Weight bearing bones
What are the symptoms of Paget’s?
Wider maxilla, wider skull
Deafness, blindness, pain, paraesthesia due to nerve compression
Osteosarcoma
What is seen in the serum in Paget’s?
Increased levels of alkaline phosphatase
Normal calcium and phosphate
What is the radiology of Paget’?
Radiolucent osteolytic areas with patchy sclerotic areas
Cotton woll patchy appearance
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
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
What are developmental diseases of TMJ?
Aplasia
Hypoplasia
Hyperplasia
What is aplasia TMJ?
Rare
Uni or bilateral
Often associated with other diseases- hemifacial microsomnia
What is hypoplastic TMJ?
Acquired or developmental
Trauma
Infection during development
What is hyperplastic TMJ?
Cause unknown
Unilateral-facial asymmetry
Self limiting
What can inflammatory diseases of the TMJ be split into?
Traumatic
Infective
Autoimmune
Degenerative
What can traumatic disease of TMJ be?
Fracture
Ankylosis
Trauma
Dislocation
What can infective disease of TMJ be?
Gonococcal
Viral
Staph Aureus
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
What are functional diseases of TMJ?
Myofascial pain dysfunction syndrome
Trismus
What are symptoms of MPDS?
Limited opening
Pain
Clicking
Bruxism- stress- occlusal problems
What is trismus?
Limited movement
Intra-auricular- dislocation, fracture, trauma, infection, ankylosis
Extra-auricular- infection, fracture, haematoma, MPDS, tetanus
How does RA affect?
Eroded articular surfaces by vascular pannus
Disc destruction
Bone resorption
Limited opening
Fibrous ankylosis- ossifies
