Bone Diseases 2

Question 1

_____ is a cyst-like lesion present in the max sinus with serum inflammatory exudate

• No biopsy needed
• No epithelial lining

Answer 1

Psuedocyst of max sinus

Antral pseudocyst

Question 2

 Lingual developmental mandibular salivary gland depression
 Developmental defect – lobe of submandibular gland fills defect
 Well-defined radiolucent area
 Between mandibular canal and inferior border
 No treatment required

Answer 2

SUBMANDIBULAR SALIVARY

GLAND DEFECT

Question 3

Empty cavity - not a true cyst
Trauma-hemorrhage theory of origin
Male (2:1)
Teenagers – young adults
Mandible
Lucency
Scalloped border frequent
Asymptomatic
Expansion rare (20%)
Vital teeth
Biopsy initiates healing

Answer 3

Traumatic bone cyst

Question 4

What does the traumatic bone cyst look like in relation to teeth?

Answer 4

Scalloped border

Question 5

 Young individuals < 20 years
 Rapidly growing, may blow out the cortex, painful
 Mandible most commonly
 Lucency, frequently multilocular

Answer 5

ANEURYSMAL BONE CYST

Question 6

 Ballooning dilation of bone
 Blood welling up from within the cavity, like a blood-
soaked sponge
 Fleshy aggregates of tumor surrounding cystic spaces
filled with blood
 Hemosiderin pigmentation (RBCs breaking down)

Answer 6

ANEURYSMAL BONE CYST

Question 7

What is the ANEURYSMAL BONE CYST HISTOLOGY?

Answer 7

 Not a true cyst
 Cyst-like cavities, filled with blood
 Multinucleated giant cells

Question 8

 Autosomal  dominant, many cases 
are new mutations
 Intestinal polyposis with 100% 
malignant  transformation
 Osteomas and jaw bone densities
 Supernumerary  teeth

Answer 8

Gardner syndrome

Question 9

Besides Gardner syndrome, what other disorder has supernumerary teeth?

Answer 9

CCD

Question 10

What other disorder besides Gardner presents with intestinal polyps?

Answer 10

Puetz Jehger

Question 11

 A group of diseases involving defective synthesis of type I
collagen, the most widely distributed collagen in the body (bone,
joints, eye, teeth)
 The skeletal manifestations, consisting of extreme bone fragility,
are the most prominent clinical findings
 Four types that may be inherited in an autosomal dominant or
recessive manner

Answer 11

OSTEOGENESIS IMPERFECTA:
BRITTLE BONE DISEASE
LOBSTEIN DISEASE

Question 12

Too little bone
Cortical thinning
Attenuated trabeculae
Skeletal fragility, deformity, short stature
Blue sclera
Joint laxity
Dentinogenesis imperfecta

Answer 12

OSTEOGENESIS IMPERFECTA:

Question 13

What is the medication used for OI?

Answer 13

Bisphosphonates

Question 14

A group of rare genetic diseases in which bone
density is increased
Reduced osteoclast bone resorption resulting in
diffuse, symmetric skeletal sclerosis
Progressive obliteration of the marrow cavity

Answer 14

OSTEOPETROSIS:
MARBLE BONE DISEASE
ALBERS SCHONBERG DISEASE

Question 15

 Osteoclasts are multinucleated cells located in resorption pits
(Howship lacunae)
 Osteoclasts acidify the local environment to dissolve mineral
and release enzymes to degrade bone matrix proteins
 In _______, enzyme defects interfere with acidification of the
resorption pit and prevent bone removal

Answer 15

osteopetrosis

Question 16

Continued osteoblastic apposition in the absence of
osteoclastic resorption leads to increased density of
both cortical and cancellous bone

Answer 16

Osteopetrosis

Question 17

__________ osteopetrosis – most

severe – becomes evident in utero or soon after birth

Answer 17

Autosomal recessive infantile “malignant”

Question 18

_________ osteopetrosis – least severe –

may not present until adulthood

Answer 18

 Autosomal dominant adult “benign”

Question 19

Complications of \_\_\_\_\_\_\_\_
 Dense, but abnormally brittle bones that 
fracture easily
 Bone marrow failure
 Neutropenia
 Normocytic anemia
 Extramedullary hematopoiesis 
 Narrowing of scull foramina
 Blindness
 Deafness
 Facial nerve paralysis
 Impaired venous drainage
 Jawbones
 Delayed tooth eruption
 Osteomyelitis

Answer 19

Complications of Osteopetrosis

Question 20

 Excessive and abnormal remodeling of bone caused by osteoclast dysfunction
 Mutations in genes involved in osteoclast activation via NF-kB transcription signaling pathway.
 Possibility of a viral infection by a slow virus or paramyxovirus, (measles virus or respiratory syncytial virus)
 A focal, localized process that may present as a solitary lesion (monostotic) or may occur at multiple sites (polyostotic) with marked variation at each location
 Initial lytic stage
 Mixed lytic-sclerotic stage
 Late sclerotic stage

Answer 20

PAGET DISEASE OF BONE:

OSTEITIS DEFORMANS

Question 21

 Older individuals - affects 3% of population over 40 in some
countries (geographic variation)
 Produces enlargement of affected bones, impinging on cranial
foramina
 Monostotic or polyostotic
-Pain, headache, deafness, visual disturbances
 Change in hat size, denture fit

Answer 21

PAGET DISEASE OF BONE:

OSTEITIS DEFORMANS

Question 22

 Vascular phase - lucency
 Sclerotic phase - increased opacity, cotton wool bone
 Generalized hypercementosis

Answer 22

PAGET DISEASE OF BONE:

OSTEITIS DEFORMANS

Question 23

What lab values are elevated in PAGET DISEASE OF BONE:

OSTEITIS DEFORMANS?

Answer 23

Serum alkaline phosphatase

Question 24

_____ complications:
 Bowing, deformity, pathologic fracture
 High output cardiac failure in vascular phase
 Infection in sclerotic phase
 Bone neoplasia

Answer 24

PAGET DISEASE OF BONE:

COMPLICATIONS

Question 25

_______ is the most common sarcoma complicating Paget

disease

Answer 25

Osteosarcoma