Bone Lesion - Infective/Neoplastic

Question 1

Gross structure of bone?

Answer 1

Outer layer = cortex

Inner layer = cancellous bone

Question 2

What is immature and mature bone?

Answer 2

Immature = woven
Mature = lamellar

Question 3

How does woven bone appear histology?

Answer 3

Irregular/spikey
Surrounded by fibrous tissue
Cellular

Question 4

What can cause bone remodelling?

Answer 4

Mechanical stimulus - orthi

Systemic hormones - PTH,

Question 5

What are cells which form and resorb bone?

Answer 5

Osteoblast - form bone

Osteoclast - resorb bone

Question 6

What is example developmental exostosis?

Answer 6

Torus

Palatinus or mandibularis

Question 7

What is osteogenesis imperfect?

Answer 7

Type I collagen defect

Question 8

What is osteoporosis?

Answer 8

Lack of osteoclast activity = failure of resoprtion

Question 9

Examples of infection of bone?

Answer 9

Dry socket - localise osteitis
Sclerosing osteitis
Osteomyelitis
Osteoncrosis

Question 10

What is dry socket?

Answer 10

Localised alveolar osteitis - caused by loss of clot/failure clot to develop

Question 11

What site most common see dry socket?

Answer 11

Molars - esp 3rd

Question 12

Why may dry socket occur?

Answer 12

Loss/failure clot

Due: excessive rinsing, fibrolysis of clot, poor blood supply, excessive use vasoconstrictors

Question 13

Pathological process dry socket?

Answer 13

Localised inflammatory reaction bone adjacent socket - becomes necrotic and removed by osteoclasts
Poor healing

Question 14

What is sclerosing osteitis?

Answer 14

Focal bone reaction to low grade inflammation (e.g chronic pulpits)

Question 15

How does scleorising osteitis present radiographically?

Answer 15

Uniform opacity of apex of tooth - often Lucent peripheral

Question 16

Differential sclerosing osteitis?

Answer 16

Hypercementosis
Osteoma
Cementoblastoma

Question 17

Tx of sclerosing osteitis?

Answer 17

Tx of cause inflammation

Question 18

What is osteomyelitis?

Answer 18

Inflammation within marrow cavity of bone - can be acute or chronic

Question 19

Aetiology acute osteomyelitis?

Answer 19

Infectious cause e.g staph/ strep
Caused extension PA abscess
Physical injury/trauma

Question 20

What is response in acute osteomyelitis?

Answer 20

Acute inflammatory response

Question 21

How would pt w/ acute osteomyelitis present?

Answer 21

Pain
Pyrexia
Lympadenopathy
Maliase

Question 22

Aetiology of chronic osteomyelitis?

Answer 22

Low grade inflammatory reaction

Progression acute osteomyelitis

Question 23

What is response is chronic osteomyelitis?

Answer 23

Chronic inflammatory response - bone loss/ seqeustrea

Question 24

Histology of acute osteomyelitis?

Answer 24

Acute inflammatory infiltrate - neutrophils

Bone resorption

Question 25

Histology of chronic osteomyelitis?

Answer 25

Chronic inflammatory cells: lymphoctes/ plasma cells Osteonecrosis Reversal lines?

Question 26

Tx of osteomyelitis?

Answer 26

Remove source infection Remove infected bone Hyperbaric oxygen

Question 27

What is osteonecrosis?

Answer 27

Complication of irradiation to H&N - compromised vasculature

Question 28

What are types osteonecrosis?

Answer 28

MRONJ - medication related | Radioosteonecrosis

Question 29

Management of osteonecrosis?

Answer 29

Prevention: dental assessment, OH, smoking cessation

Question 30

Does management of low and high risk pt of osteonecrosis vary?

Answer 30

Low risk - atrauamtic XLA | High risk - refer OS

Question 31

What makes pt higher risk osteonecrosis?

Answer 31

Malignancy Hx of MRONJ Immunosuppressed

Question 32

Example of bone neoplasms?

Answer 32

Benign: osteoma, osteoblastoma Malignant: osteosarcoma, chondrosarcoma

Question 33

What is osteoma?

Answer 33

Being bone neoplasm

Question 34

How do osteoma present?

Answer 34

Localised bony nodule on maxilla/madnible - continued slow growth

Question 35

How does osteoma present radiographically?

Answer 35

Radiopaque lesion w/ Lucent border

Question 36

Histopathology of osteoma?

Answer 36

Compact bone

Question 37

What is osteosarcoma?

Answer 37

Malignant tumour producing bone

Question 38

Where does osteosarcoma commonly present?

Answer 38

Long bones | 2-10% in jaw

Question 39

Where common site of osteosarcoma in jaw?

Answer 39

Mandible > maxilla

Question 40

How does osteosarcoma present clinically?

Answer 40

Rapidly growing swelling Pain nerve involvement t

Question 41

Radiographic feature osteosarcoma?

Answer 41

Radioluecny w/ bone formation = sun ray appearance Ill-defined expansile lesion w/ calculations Loss lamina dura

Question 42

Management osteosarcoma?

Answer 42

Neo-adjuvant chemotherapy Wide excision Radiotherapy