Bone Pathology 1 Flashcards
Focal Osteoporotic Defect
(2)
Area of hematopoietic marrow which produces a defect
75% adult females
Focal Osteoporotic Defect
Possible pathogenesis:
(3)
Aberrant bone regeneration after tooth extraction
Persistence of fetal marrow
Marrow hyperplasia in response to increased demand for erythrocytes
Focal Osteoporotic Defect
Clinical and Radiographic features:
(3)
70% posterior mandible, MC in edentulous areas
Asymptomatic, nonexpansile
Well-defined or ill-defined radiolucency
Focal Osteoporotic Defect
Histopathologic features:
(1)
Cellular hematopoietic/fatty marrow
Focal Osteoporotic Defect
Treatment:
(2)
Incisional biopsy indicated to establish diagnosis
No further treatment needed after diagnosis established
Traumatic bone cyst - Simple bone cyst
(4)
Bone cavity that is empty or fluid-filled
NOT a true cyst – no epithelial lining
Etiology uncertain: Trauma-hemorrhage theory
Reported in most bones of the body
Traumatic bone cyst
Clinical features:
where
who
infrequent (2)
may exhibit
MC in mandible
MC in young patients, peak in the second decade
Pain and paresthesia infrequent
May exhibit painless jaw swelling
Traumatic bone cyst
Radiographic features:
(5)
Well-defined, unilocular RL
Occasionally ill-defined, multi-locular
Range from 1-10 cm
RL defect often scallops upward between roots of teeth
Root resorption, cortical expansion infrequent
Traumatic bone cyst
Treatment:
(4)
Surgical exploration and biopsy
Cavity often empty, may contain serosanguinous fluid
New bone formation, resolve after 1-2 years
Low recurrence
Idiopathic osteosclerosis
Dense bone island, Bone scar
(2)
Focally increased bone density of unknown cause
Most arise in late 1st decade or early 2nd decade
Idiopathic osteosclerosis
Clinical features:
(3)
May remain static or slowly increase in size
Asymptomatic and nonexpansile
90% occur in mandible, 1st molar MC
Idiopathic osteosclerosis
Radiographic features:
(2)
Well-defined radiopacity, 0.2 cm to 2.0 cm
Nonexpansile
Idiopathic osteosclerosis
Diagnosis:
(2)
History, clinical features and radiographic findings
Lack of cortical expansion and continued growth rule against a neoplastic
process
Idiopathic osteosclerosis
Treatment:
(1)
Periodic radiographs during adolescence
Osteogenesis imperfecta
“— bone disease”
Group of heritable disorders characterized by (2)
Worldwide prevalence of
Brittle
osteopenia and bone fragility
6-7 per 100,000 population
Osteogenesis Imperfecta
–% AD inheritance pattern
Type I collagen gene mutations: (2)
Type I collagen: (5)
Mutations result in abnormal
Disease characterized as
90
COL1A1 and COL1A2
bone, dentin, sclerae, ligaments, skin
type I collagen, low tensile strength
mild, moderate, severe
Osteogenesis Imperfecta
Clinical Findings:
(6)
Bone fractures
Long bone, spine deformity
Growth impairment
Blue sclerae
Hearing loss
Joint hyperextensibility or contractures
Osteogenesis Imperfecta
Radiographic findings:
(4)
Osteopenia
Bowing deformity of long bones
Multiple fractures
Wormian bones (skull)
- Small sutural bones arranged in a mosaic pattern
Osteogenesis Imperfecta
Dental alterations
(5)
Clinically and radiographically identical to dentinogenesis imperfecta
Blue, yellow, brown translucence (primary and permanent)
Severe attrition, loss of VDO
Tooth roots narrow
Class III malocclusion due to maxillary hypoplasia, crossbite, open bite
Osteogenesis Imperfecta
Diagnosis requires correlation of the
Treatment:
clinical features, radiographic and/or
prenatal ultrasound findings, family hx
physiotherapy, rehabilitation, orthopedic surgery, IV
bisphosphonates
Osteopetrosis
Markedly increased
Failure of
Decreased
bone density
osteoclast function or differentiation
bone resorption →sclerotic bone
Osteopetrosis
AD Adult Osteopetrosis:
MC type, — severe manifestations
Sclerosis affects
— frequent
Increased risk of
less
axial skeleton, minimal involvement in long bones
Bone pain
fracture and osteomyelitis following tooth extraction
Osteopetrosis
AD Adult Osteopetrosis
Radiographic findings:
Diffuse radiopacity of medullary bone
Osteopetrosis
Treatment:
Adult osteopetrosis:
Infantile osteopetrosis:
management of disease complications
Poor prognosis
- Most patients die during 1st decade
Cleidocranial Dysplasia
Mutations in — gene
Worldwide prevalence:
Bone disorder, dental and clavicular abnormalities
RUNX2
1:1,000,000
Mutations in RUNX2 gene
(2)
Osteoblastic differentiation, chondrocyte maturation
May also have role in odontogenesis
Cleidocranial Dysplasia
Clinical Features:
(5)
Clavicles: hypoplastic, 10% cases absent
- Approximate shoulders anteriorly
Short stature
Enlarged skull
Ocular hypertelorism
Broad-based nose
Cleidocranial Dysplasia
Radiographic features
Skull radiographs:
(2)
sutures and fontanels show delayed closure
Wormian bones
Cleidocranial Dysplasia
Dental
(2)
Over-retained deciduous teeth
Numerous unerupted permanent and supernumerary teeth
Cleidocranial Dysplasia
Treatment
(2)
Removal of primary and supernumerary teeth
Orthognathic surgery
Paget disease of bone
(4)
Abnormal, anarchic resorption and deposition of bone
Skeletal weakening
Anglo-Saxon ancestry, highest rates in UK
Genetic and environmental factors involved
Paget disease of bone
Clinical features:
(5)
Older patients, rare in patients <40 years
Male predilection
40% present with bone pain
Arises in one or more bones simultaneously
Pelvis, femur, lumbar vertebrae, skull and tibia
Paget disease of bone
Clinical features:
Affected bones:
Deformity:
Skull involvement:
thickened, enlarged, weakened →increased risk of fracture
Bowing
progressive increase in head circumference
Paget disease of bone
Clinical features:
involvement
where
special fact
Jaw involvement (17% patients)
Maxilla: mandible (2:1)
Alveolar ridges grossly enlarged: spacing between teeth
Paget disease of bone
Alveolar ridges grossly enlarged: spacing between teeth
Denture too —!
small
Paget disease of bone
Maxilla: mandible (2:1)
(3)
Enlargement of middle third of face
Nasal obstruction, obliterated sinuses
Severe cases: leontiasis ossea
Paget disease of bone
Radiographic findings:
Early stages:
Later stages:
Generalized — may be observed
decreased radiodensity, course trabecular pattern
patchy areas of bone sclerosis
“cotton wool” appearance
hypercementosis
Paget disease of bone
Diagnosis:
(2)
Correlation of clinical and radiographic findings
Lab testing: elevated serum alkaline phosphatase increased levels
Paget disease of bone
Dental complications:
(4)
Difficult extractions (hypercementosis/ankylosis)
Extensive hemorrhage –vascular lytic phase
Poor wound healing, osteomyelitis – avascular sclerotic phase
Edentulous patients- provide new dentures periodically
Paget disease of bone
Disease is
Malignant transformation:
chronic and slowly progressive
osteosarcoma <1%
Paget disease of bone
Treatment:
(2)
Bisphosphonate therapy – reduce bone turnover, decrease bone pain
Orthotics, canes, orthopedic surgery
Antral Pseudocyst
Common finding on
Develops due to
Results in a
panoramic
an accumulation of inflammatory exudate
sessile elevation
Antral Pseudocyst
Radiographic findings:
Uniform, dome shaped faintly opaque lesion
Antral Pseudocyst
Treatment:
(2)
No treatment if asymptomatic
Symptomatic cases – endoscopic surgery
