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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
Q

What is an osteoma?

A

Benign- neoplastic
Slow growing
Smaller than 2cm
Central or subperiosteal
Compact or cancellous type

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26
Q

What are the features of Gardner’s syndrome?

A

Multiple intestinal polyps
Multiple osteomas
Epidermoid cysts
Desmoid tumours
Supernumerary
Impacted
Odontomes

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27
Q

What is exostoses?

A

Non-neoplastic bony outgrowth
Slow growth, Compact or cancellous bone

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28
Q

What can an exostoses be due to?

A

Developmental
In response to some stimulus, eg. repeated trauma or free gingival grafts

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29
Q

Give 2 examples of exostoses?

A

Common in alveolar region
Torus palatinus- midline, more common than mandibular
Torus mandibularis- premolar area above mylohyoid line

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30
Q

What is an osteoblastoma?

A

Greater than 2cm
Rare in jaws
More common in tibia and fibula

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31
Q

What is the histology and x ray for osteoblastoma?

A

Looks similar to cementoblastoma, but not associated with roots
Random trabecular woven bone
Lined by osteoblasts and osteoclasts
Many blood vessels

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32
Q

What is osteogenic sarcoma?

A

Most common malignant neoplasm in jaw

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33
Q

What ages does osteogenic sarcoma affect?

A

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
Q

What are the types of osteogenic sarcoma?

A

Intramedullary
Juxtacortical- near periosteum
Juxtacortical has better prognosis than intramedullary

35
Q

What is the prognosis of osteogenic sarcoma?

A

In the jaws they are low grade tumours, that do not metastasise much but they recur
40%= 5 year survival rate

36
Q

What are the symptoms of osteogenic sarcoma?

A

Tooth mobility
Pain
Lip paraesthesia
Swelling

37
Q

What is the histology of osteogenic sarcoma?

A

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
Q

What is chondroma/chondrosarcoma?

A

Occur in posterior mandible and anterior maxilla
May occur in tongue- chondroid metaplasia

39
Q

What do chondromas produce?

A

May produce mature cartilage

40
Q

What is the treatment for chondroma/chondrosarcoma?

A

Wide local excision

41
Q

What is the prognosis for chondroma and chondrosarcoma?

A

Prognosis of malignant cases is poor
Does not metastasise frequently
Local recurrence is common

42
Q

What is the histology of chondrosarcoma?

A

Highly cellular cartilage
Binucleate cells
More than one cell per lacunae
Mitoses

43
Q

What is cemento-ossifying fibroma?

A

Fibrosseous lesion
Mandible-premolar area commonly
Well demarcated
Painless
Sometimes encapsulated
Benign neoplasm

44
Q

What is the radiology of Cemento-ossifying fibroma?

A

Well demarcated
Radiolucent area with variable opacities
Expansion

45
Q

What is the tx for cemento-ossifying fibroma?

A

Enucleation along capsule

46
Q

What is the differential diagnosis for cemento-ossifying fibroma?

A

Fibrous dysplasia but does not blend with the surrounding bone

47
Q

What is the histology for cemento-ossifying fibroma?

A

Fibrous tissue
Woven bone
Spherical deposits
Associated with vital tooth

48
Q

What is another name for giant cell tumour and where does it occur?

A

Osteoclastoma, rare in jaws
20-40 years old
In other bones, it is aggressive and even metastatic

49
Q

What is the osteoclastoma the same entity as?

A

CGCG but it is not as aggressive

50
Q

What is the treatment for GCT and CGCG?

A

CGCG- curettage
GCT- radical/resection

51
Q

What is the histology of CGCG and GCT?

A

Osteoclast like multinucleated giant cells- focal or scattered
Extravasated erythroyctes
Haemosiderin
Small spindle shape cells
Vascular stroma

52
Q

What are the 6 types of giant cell lesions?

A

Browns tumour of hyperparathyroidism
Cherubism
GCT
CGCG
Giant cell epulis
Aneurysmal bone cyst

53
Q

What is myeloma? What are the 2 types?

A

Malignant tumour of plasma cells
Solitary-plasmacytoma
Multifocal
BOTH affect jaws

54
Q

What age does myeloma affect?

A

50-70 years

55
Q

How does myeloma occur?

A

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
Q

What is the Ig in myeloma called?

A

In serum or urine it is called M protein, or paraproteins or Bence-Jones protein

57
Q

What is seen systemically in myeloma?

A

Elevated calcium
Renal failure
Anaemia/amyloidosis
Bone lesions

58
Q

What is the histology of myeloma?

A

Myeloma cells resemble mature plasma cells
Multinucleate forms also seen

59
Q

What is the radiology of myeloma?

A

Well demarcated appearance with punched out lesions
Pepper pot skull

60
Q

What are 2 examples of idiopathic lesions?

A

Aneursymal bone cyst
Giant cell granuloma

61
Q

What is Langerhans cell histiocytosis types?

A

Solitary- eosinophilic granuloma
Disseminated- Lettere-Siwe disease
Multifocal EG- Hand-schullter-christian syndrome
Collection of histiocytes and eosinophils

62
Q

What occurs to bone in Paget’s disease?

A

Increased bone turnover
Disorganised remodelling and formation
Osteoblastic and osteoclastic dysfunction
Bone deformation

63
Q

What is the reason for Paget’s disease?

A

Idiopathic
May be viral
Paramyxovirus infection

64
Q

What is the clinical course of Paget’s?

A
  1. Primary osteolytic phase
  2. Mixed osteolysis and osteogenesis
  3. Predominantly osteoblastic (sclerotic) phase
65
Q

What bones do Paget’s mostly affect?

A

Can be single or more rarely disseminated
Weight bearing bones

66
Q

What are the symptoms of Paget’s?

A

Wider maxilla, wider skull
Deafness, blindness, pain, paraesthesia due to nerve compression
Osteosarcoma

67
Q

What is seen in the serum in Paget’s?

A

Increased levels of alkaline phosphatase
Normal calcium and phosphate

68
Q

What is the radiology of Paget’?

A

Radiolucent osteolytic areas with patchy sclerotic areas
Cotton woll patchy appearance

69
Q

What is the dental symptoms of Paget’s?

A

Hypercementosis
Ankylosis
Loss of laminar dura
Dentures do not fit
Difficult XLA
Post op bleeding- ostelytic- lots of BV
Occlusion derangament

70
Q

What is the histology of Paget’s?

A

Abnormally large osteoclasts
Mosaic pattern
Reverse lines where it has gone from bone deposition to bone resoprtion
Osteoclastic and osteoblastic activity

71
Q

What are developmental diseases of TMJ?

A

Aplasia
Hypoplasia
Hyperplasia

72
Q

What is aplasia TMJ?

A

Rare
Uni or bilateral
Often associated with other diseases- hemifacial microsomnia

73
Q

What is hypoplastic TMJ?

A

Acquired or developmental
Trauma
Infection during development

74
Q

What is hyperplastic TMJ?

A

Cause unknown
Unilateral-facial asymmetry
Self limiting

75
Q

What can inflammatory diseases of the TMJ be split into?

A

Traumatic
Infective
Autoimmune
Degenerative

76
Q

What can traumatic disease of TMJ be?

A

Fracture
Ankylosis
Trauma
Dislocation

77
Q

What can infective disease of TMJ be?

A

Gonococcal
Viral
Staph Aureus

78
Q

What is degenerative disease of TMJ?

A

Osteoarthrosis (itis)
Rare before 40
Limited opening, deviation on movement, crepitus, pain
Vertical splits in cartilage- fibrillation
Fragmentation
Bone exposure- denudation
Thickening- eburnation

79
Q

What are functional diseases of TMJ?

A

Myofascial pain dysfunction syndrome
Trismus

80
Q

What are symptoms of MPDS?

A

Limited opening
Pain
Clicking
Bruxism- stress- occlusal problems

81
Q

What is trismus?

A

Limited movement
Intra-auricular- dislocation, fracture, trauma, infection, ankylosis
Extra-auricular- infection, fracture, haematoma, MPDS, tetanus

82
Q

How does RA affect?

A

Eroded articular surfaces by vascular pannus
Disc destruction
Bone resorption
Limited opening
Fibrous ankylosis- ossifies

Oral candidiasis (18 decks)

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