Bone Lesions

Question 1

occurring between the premolar and molar regions of the mandible, this lesion is composed of fibroblastic stroma (CT) in which foci of mineralized products are formed

Answer 1

central ossifying fibroma

Question 2

3 forms of central ossifying fibroma:

Answer 2

Central- lesion occurs in bone, and has well-circumscribed radiolucency with ossification product in center –> looks similar to cementifying fibroma

Peripheral- lesion occurs in gum with no radiolucency or radiopacity

Also has a juvenile variant with aggressive and rapid growth

Question 3

tx of central ossifying fibroma

Answer 3

surgical excision

Question 4

condition in which scar-like fibrous tissue grows in place of normal bone, and usually does not stop growing until puberty

Answer 4

fibrous dysplasia

Question 5

radiographically, this has a ground-glass appearance with soft RO areas throughout the lesion

Answer 5

fibrous dysplasia

Question 6

syndrome characterized by polyostic fibrous dysplasia (affecting multiple bones), as well as cutaneous cafe au lait spots, and endocrine abnormalities (such as precocious puberty)

Answer 6

McCune-Albright syndrome (MAS)

Question 7

tx of fibrous dysplasia

Answer 7

surgical re-contouring, preferably after puberty when the lesion stops growing

Question 8

a circumscribed RO mass of osteoblasts and bone

Answer 8

osteoblastoma

Question 9

tx of osteoblastoma

Answer 9

surgical excision

Question 10

this reactive process with unknown origin is characterized by fibrous tissue replacing normal bone tissue, commonly at the apices of mandibular anterior teeth

Answer 10

periapical cemento-osseous dysplasia

Question 11

While the pulps may radiographically look necrotic, the affected teeth are vital.

Answer 11

periapical cemento-osseous dysplasia

Question 12

PCOD: Are teeth vital or non-vital?

Answer 12

vital

While the pulps may radiographically look necrotic, the affected teeth are vital.

Question 13

This is more prevalent in middle-aged black females.

Answer 13

PCOD

Question 14

This condition starts out looking RL, but transitions to having a more RO border.

Answer 14

PCOD

Question 15

tx of PCOD

Answer 15

none

Question 16

a benign blood-filled pseudocyst that tends to expand or grow, this lesion has a multilocular radiolucency and is commonly found in the posterior mandible

Answer 16

aneurysmal bone cyst

Question 17

first step of diagnosing a condition like aneurysmal bone cyst

Answer 17

an aspiration biopsy to determine if it in fact a vascular bone cavity filled with blood

Question 18

tx of an aneurysmal bone cyst

Answer 18

surgical excision

Question 19

an osteolytic neoplasm composed of fibroblasts and multinucleated giant cells

Answer 19

central giant cell granuloma

Question 20

common location of central giant cell granulomas

Answer 20

anterior mandible

Question 21

Two forms of central giant cell granulomas:

Answer 21

Central: occurs in bone, and has radiolucency with thin wispy separations

Peripheral: occurs in gum, and presents as red/purple gingival mass

Question 22

tx of central giant cell granuloma

Answer 22

surgical excision

Question 23

an autosomal dominant disorder characterized by enlargement and prominence of the mandible and maxilla as bone is replaced by a fibrous granuloma that contains multinucleated giant cells

Answer 23

cherubism

Question 24

this condition has symmetrical bilateral swelling, and expansile bilateral multilocular radiolucencies that stop growing after puberty (unlike fibrous dysplasia that has unilateral swelling)

Answer 24

cherubism

Question 25

excessive levels of PTH result in multiple bone lesions that look similar to CGCGs

Answer 25

hyperparathyroidism

Question 26

name of the lesion associated with hyperparathyroidism, which forms due to excess osteoclast activity

Answer 26

Brown tumor

Question 27

What is elevated with a Brown tumor? Why?

Answer 27

alkaline phosphatase levels due to excess osteoclast activity

Question 28

Brown tumor can lead to...?

Answer 28

Von Recklinghausen's disease of bone

Question 29

this rare type of cancer involves the abnormal buildup of Langerhans cells (histiocytes) in certain parts of the body

Answer 29

Langerhans cell disease (aka idiopathic histiocytosis)

Question 30

this condition has discrete punched/scooped out radiolucencies that cause a floating teeth appearance

Answer 30

Langerhans cell disease

Question 31

another name for Langerhans cell disease

Answer 31

idiopathic histiocytosis

Question 32

tx of Langerhans cells disease

Answer 32

surgical excision, radiation, and chemotherapy

Question 33

a progressive metabolic disturbance of different bones (skull, jaw, spine, femur) resulting in symmetrical enlargement with a cotton wool appearance

Answer 33

Paget's disease

Question 34

similar to hyperparathyroidism, elevated alkaline phosphatase levels are observed due to increased breakdown of bone

Answer 34

Paget's disease

Question 35

Because of enlargement, dentures or even hats become too tight.

Answer 35

Paget's disease

Question 36

tx of Paget's disease

Answer 36

bisphosphonates, calcitonin

Question 37

a clinical term for a new infection in bone

Answer 37

acute osteomyelitis

Question 38

MC causes of acute osteomyelitis (2)

Answer 38

odontogenic infection and trauma

Question 39

progression of acute osteomyelitis

Answer 39

Infection and inflammation first start in the medullary space, involving cancellous (spongey) bone. To observe radiolucency, the infection needs to have spread to cortical bone, periosteum, and soft tissues. Otherwise, we won't see much radiographically.

Question 40

noteworthy symptoms include pain, high or intermittent fever, and paresthesia or anesthesia of IAN (teeth do NOT become loose --> this is caused by periodontitis)

Answer 40

acute osteomyelitis

Question 41

tx of acute osteomyelitis

Answer 41

antibiotics and drainage

Question 42

current or previous treatment of bisphosphonates that leads to exposed bone that does not heal quickly

Answer 42

bisphosphonate-related osteonecrosis of the jaws (BRONJ)

Question 43

puts pt at a higher risk of developing BRONJ

Answer 43

IV administered bisphosphonates (drugs that end in -dronate)

Question 44

tx of BRONJ

Answer 44

CHX rinse, antibiotics, conservative surgery

Question 45

a bone infection that doesn't go away despite treatments, resulting in recurring drainage and intense pain, has diffuse mottled radiolucency since it has now been able to impact cortical bone

Answer 45

chronic osteomyelitis

Question 46

condition that involves chronic osteomyelitis and proliferative periostitis as the body tries to heal

Answer 46

Garre's osteomyelitis

Question 47

tx of chronic osteomyelitis

Answer 47

antibiotics and debridement

Question 48

a periapical lesion resulting from low-grade inflammation such as chronic pulpitis, a wall of diffuse dense bone forms to "wall off" the infection

Answer 48

focal sclerosing osteomyelitis (condensing osteitis)

Question 49

tx of focal sclerosing osteomyelitis (condensing osteitis)

Answer 49

none, other than addressing the cause of infection (such as performing a root canal)

Question 50

similar to condensing osteitis, but on a wider scale, this condition may lead to jaw fracture and osteomyelitis

Answer 50

diffuse sclerosing osteomyelitis

Question 51

tx of diffuse sclerosing osteomyelitis

Answer 51

none, other than addressing the cause of infection

Question 52

most common symptom of bone malignant lesions

Answer 52

paresthesia

Question 53

sarcoma of the jaws when tumor cells produce new cartilage, commonly involves the condyle due to its cartilaginous origin

Answer 53

chondrosarcoma

Question 54

has a sunburst pattern radiographically

Answer 54

chondrosarcoma

Question 55

sarcoma of long bones involving round cells, or undifferentiated mesenchymal cells

Answer 55

Ewing's sarcoma

Question 56

rarely affects the jaws, most commonly affects children with intense swelling as the primary symptom

Answer 56

Ewing's sarcoma

Question 57

- orally, this condition involves pain, swelling, and most importantly paresthesia (lip numbness) - diffuse and ill-defined changes such as eroding bone are observed radiographically

Answer 57

metastatic carcinoma

Question 58

Rank from most to least likely the places of origin of metastatic carcinoma:

Answer 58

breast > lung > kidney > colon > prostate

Question 59

sarcoma of the jaws when tumor cells produce new bone

Answer 59

osteosarcoma

Question 60

the deposition of new bone creates a sunburst pattern radiopacity

Answer 60

osteosarcoma

Question 61

tx of osteosarcoma

Answer 61

resection and chemotherapy