Bone Pathology III

Question 1

Define Cemento-Osseus Dysplasias

Answer 1

Do not fit easily into a specific etiologic category

• Remodeling effect
• NOT inflammatory or neoplastic

Question 2

Describe the demographic patterns of Periapical Cemento-osseus Dysplasia

Answer 2

Middle age, average 30-45 yrs

• 70% Blacks
• 90% Females

Question 3

Clinical presentation of Periapical Cemento-osseus Dysplasia

Answer 3

Anterior mandible affected
Painless, often discovered on routine radiographic study
*TEETH VITAL

Question 4

Radiographic findings of Periapical Cemento-osseus Dysplasia

Answer 4

Anterior mandibular teeth affected, one or more often multiple

• lesions at apex of teeth
• root tip visible despite presence of the lesion

Variable presentation depending on duration

• Earliest lesions are radiolucent
• Progress to lucency with central opacification
• Late stage lesions are opaque with a thin lucent rim
• Sclerotic lesions can fuse to tooth rooths

Question 5

Treatment of Periapical Cemento-osseus Dysplasia

Answer 5

None!

- Do NOT DO RCT!!!!

Question 6

Natural history of Periapical Cemento-osseus Dysplasia

Answer 6

Tendency for maturation from lucent to opaque with stabilization
- But lesions can completely regress from any stage

Question 7

*Demographic pattern of Florid Cemento-Osseous Dysplasia

Answer 7

1. Middle age, average 40-45 years
2. Blacks
3. Females

Question 8

*Clinical presentation of Florid Cemento-Osseous Dysplasia

Answer 8

*Multiple posterior quadrants affected
- can affect anterior mandible also
Usually painless and often discovered on routine radiographic study
expansion is seen occasionally

Question 9

Radiographic findings of Florid Cemento-Osseous Dysplasia

Answer 9

Radiolucent to mixed radiolucent-radiopaque to predominantly opaque, often with lucent borders
- borders well-defined to hazy within individual lesions

Question 10

Treatment of Florid Cemento-Osseous Dysplasia

Answer 10

No treatment

Preventive care to guard against infection

Question 11

Demographic pattern of Focal Cemento-Osseous Dysplasia

Answer 11

• Different than other two cemento-osseous dysplasias
• Wider age range affected from young to old
• Females still predominate
• **Whites affected more often than blacks!

Question 12

Clinical presentation of Focal Cemento-Osseous Dysplasia

Answer 12

Mandibular body is primary site
- Premolar/1st molar area commonly
- Commonly in edentulous areas
Usually painless with routine discovery on radiograph

Question 13

Radiographic findings of Focal Cemento-Osseous Dysplasia

Answer 13

Radiolucent to mixed to opaque
Rounded or lobular architecture
Border varies from well-defined to hazy
Opaque lesions often with a lucent halo

Question 14

Treatment of Focal Cemento-Osseous Dysplasia

Answer 14

None required, monitor for change

Question 15

Demographic patterns of Langerhan’s Cell Histiocytosis

Answer 15

Younger patients, rarely seen in older ages

50% are under age 10

Question 16

What tissues are affected in Langerhan’s Cell Histiocytosis

Answer 16

Bone and soft tissues may be affected

Question 17

**Classic radiographic features of Langerhan’s Cell Histiocytosis

Answer 17

Jaw lesions

- ***Teeth floating in air

Question 18

List the spectrum of diseases associated with Langerhan’s Cell Histiocytosis

Answer 18

Letterer-Siwe Disease (Acute disseminated)
Hand-Schuler-Christian Disease
Eosinophilic granuloma

Question 19

*Describe Letterer-Siwe Disease

Answer 19

Infants under age 2
Involves multiple organs and sites
*Aggressive disease course; invariably fatal

Question 20

Describe Hand-Schuler-Christian Disease

Answer 20

Also known as Chronic Disseminated Langerhans Cell Histiocytosis

• Children, usually age 3-10
• Multiple sites of involvement
• Slower progression with better prognosis

Question 21

Describe eosinophilic granuloma

Answer 21

Also known as Chronic Localized Langerhans Cell Histiocytosis

• Teenagers and young adults primarily
• Localized disease; bone involvement primarily, single or multiple lesions
• Prognosis is generally good

Question 22

Radiographic findings in Langerhan’s Cell Histiocytosis

Answer 22

- Radiolucency
May be multiple
**Teeth floating in air
- Root resorption is not seen
- Loss of lamina dura

Question 23

Treatment of Langerhan’s Cell Histiocytosis

Answer 23

Curettage
Low-dose radiation therapy
A combo of both

Question 24

Clinical features of Osteoradionecrosis

Answer 24

Always seen in an area of radiation therapy

• Pt. will give history of prior cancer, usually SCC
• Radiation permanently damages bone by destroying blood vessels in the area
  
  • no ability to remodel
  • increases susceptibility to infection
• Will not heal without surgical intervention

Question 25

Treatment of Osteoradionecrosis

Answer 25

Prevention !
- Establish excellent oral hygiene before therapy

Once osteoradionecrosis is present:

• Hyperbaric oxygen regimen often used but efficacy questioned
• Resection of dead bone to viable bleeding bone
• Soft tissue closure over surgical site

Question 26

Demographic patterns of Traumatic Bone Cyst (Simple bone cyst)

Answer 26

Young Patients, usually in second decade

History of trauma may or may not be present

Question 27

*Clinical features of Traumatic Bone Cyst (Simple bone cyst)

Answer 27

Radiolucent lesion, often scallops up between tooth roots

• Asymptomatic, often discovered on routine radiographic exam
• Mandible almost exclusively
• **Scalloping of the lesion up between tooth roots is a classic finding

Question 28

Surgical findings or treatment of Traumatic Bone Cyst (Simple bone cyst)

Answer 28

An empty hole in the bone; little/no tissue recovered, or contains blood tinged fluid
- Entry into the lesion stimulates bleeding or the walls are curetted to produce bleeding which ordinarily results in healing