Bone lecture 2 Flashcards
Central giant cell granuloma
Etiology
Etiology uncertain; reactive process vs benign neoplasm
Central giant cell granuloma
Clinical features:
ages and location
60% cases occur before 30 years
70% mandible, anterior MC
Central giant cell granuloma
Nonaggressive lesions:
size?
symptoms?
growth?
Discovered how?
Smaller
Fewer symptoms
Slow growth
Discovered on routine radiographs
MORE COMMON
Central giant cell granuloma
Aggressive lesions:
size?
symptoms?
growth?
effect on teeth?
Cortex?
recurrence potential?
Larger at dx
Pain, paresthesia
Rapid growth
Root resorption, displacement
Cortical perforation
Greater recurrence potential
Central giant cell granuloma
Radiographic findings:
unilocular or multilocular RL, well-defined borders
Central giant cell granuloma histopath
Multinucleated giant cells in a background of mesenchymal cells
which form of CGCG is this? what else could this be?
aggressive CGCG
odontogenic myxoma
glandular odontogenic cyst
OKC
biopsy from ML RL
CGCG, multinucleated giant cells
Central giant cell granuloma
Treatment:
Recurrence rate:
Curettage
Peripheral ostectomy
Intralesional corticosteroids, calcitonin
Recurrence rate: appx 20%
Cherubism
where?
Mutation of?
result?
Appearance reminiscent of?
Developmental jaw disease
Mutation of SH3BP2
Enhanced osteoclastic activity →lytic bone lesions
Appearance reminiscent of cherubs
Cherubism
Clinical features:
First evident 2-5 years, mild cases dx 10-12
Alterations progress until puberty, then slowly regress
Bilateral expansion of the posterior mandible: Angle, rami, coronoid process
Involvement of inferior/lateral orbital wall →“eyes upturned to heaven”
Cherubism
Dental implications:
Tooth displacement
mobility
failure of eruption
impaired mastication
speech difficulties
Cherubism
Radiographic findings:
Bilateral, multilocular, expansile RL
Resorption of adjacent tooth roots
Thinning of cortical bone
Cherubism
Histopathology:
Clinical and RG correlation essential
Multinucleated giant cells, vascular fibrous tissue
biopsy from bilateral mulitlocular lucency, root resorbing
cherubism, multinucleated giant cells with a more pink stroma than CGCG (less RBC)
dif dx?
cherubism
CGCG?
OKC(s)
mild cherubism, may not be symmetrical but both sides involved
Cherubism
Treatment:
Lesions regress after puberty
Facial features appear normal by 4th decade
Conservative therapy (observation)
Surgical intervention for aggressive lesions, marked facial deformity
Fibro-osseous lesions of the jaw
Characterized by?
what is necessary to establish specific diagnosis?
Characterized by replacement of normal bone by fibrous tissue and mineralized product
Clinical, radiographic, and histopathologic correlation necessary to establish specific diagnosis
Fibro-osseous lesions of the jaw
Fibrous dysplasia
Ossifying (cemento-ossifying) fibroma
Cemento-osseous dysplasia
types of Cemento-osseous dysplasia
periapical cemento-osseous dysplasia
focal cemento-osseous dysplasia
florid cemento-osseous dysplasia
Fibrous dysplasia
lesion type?
mutation?
result?
Developmental lesion
GNAS mutation
Replacement of normal bone by cellular fibrous connective tissue with irregular bony trabeculae
Fibrous dysplasia
Monostotic disease clinical features:
% cases? how many bones are involved?
Dx at what age?
preferred jaw locations?
presentation?
Monostotic disease: 80 to 85% of all cases, single bone involved
Dx in 2nd to 3rd decade
Maxilla (posterior) > mandible
Painless unilateral swelling
Fibrous dysplasia
Polyostotic disease Clinical features:
Dx at what age? how many bones involved?
demo?
sigs/symptoms?
Dx in 1st decade, multiple bones involved
Female predilection
Long bone involvement: pain, pathologic fracture, bowing deformity
