Bone Pathology III Flashcards
Define Cemento-Osseus Dysplasias
Do not fit easily into a specific etiologic category
- Remodeling effect
- NOT inflammatory or neoplastic
Describe the demographic patterns of Periapical Cemento-osseus Dysplasia
Middle age, average 30-45 yrs
- 70% Blacks
- 90% Females
Clinical presentation of Periapical Cemento-osseus Dysplasia
Anterior mandible affected
Painless, often discovered on routine radiographic study
*TEETH VITAL
Radiographic findings of Periapical Cemento-osseus Dysplasia
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
Treatment of Periapical Cemento-osseus Dysplasia
None!
- Do NOT DO RCT!!!!
Natural history of Periapical Cemento-osseus Dysplasia
Tendency for maturation from lucent to opaque with stabilization
- But lesions can completely regress from any stage
*Demographic pattern of Florid Cemento-Osseous Dysplasia
- Middle age, average 40-45 years
- Blacks
- Females
*Clinical presentation of Florid Cemento-Osseous Dysplasia
*Multiple posterior quadrants affected
- can affect anterior mandible also
Usually painless and often discovered on routine radiographic study
expansion is seen occasionally
Radiographic findings of Florid Cemento-Osseous Dysplasia
Radiolucent to mixed radiolucent-radiopaque to predominantly opaque, often with lucent borders
- borders well-defined to hazy within individual lesions
Treatment of Florid Cemento-Osseous Dysplasia
No treatment
Preventive care to guard against infection
Demographic pattern of Focal Cemento-Osseous Dysplasia
- Different than other two cemento-osseous dysplasias
- Wider age range affected from young to old
- Females still predominate
- **Whites affected more often than blacks!
Clinical presentation of Focal Cemento-Osseous Dysplasia
Mandibular body is primary site
- Premolar/1st molar area commonly
- Commonly in edentulous areas
Usually painless with routine discovery on radiograph
Radiographic findings of Focal Cemento-Osseous Dysplasia
Radiolucent to mixed to opaque
Rounded or lobular architecture
Border varies from well-defined to hazy
Opaque lesions often with a lucent halo
Treatment of Focal Cemento-Osseous Dysplasia
None required, monitor for change
Demographic patterns of Langerhan’s Cell Histiocytosis
Younger patients, rarely seen in older ages
50% are under age 10
What tissues are affected in Langerhan’s Cell Histiocytosis
Bone and soft tissues may be affected
**Classic radiographic features of Langerhan’s Cell Histiocytosis
Jaw lesions
- ***Teeth floating in air
List the spectrum of diseases associated with Langerhan’s Cell Histiocytosis
Letterer-Siwe Disease (Acute disseminated)
Hand-Schuler-Christian Disease
Eosinophilic granuloma
*Describe Letterer-Siwe Disease
Infants under age 2
Involves multiple organs and sites
*Aggressive disease course; invariably fatal
Describe Hand-Schuler-Christian Disease
Also known as Chronic Disseminated Langerhans Cell Histiocytosis
- Children, usually age 3-10
- Multiple sites of involvement
- Slower progression with better prognosis
Describe eosinophilic granuloma
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
Radiographic findings in Langerhan’s Cell Histiocytosis
- Radiolucency May be multiple **Teeth floating in air - Root resorption is not seen - Loss of lamina dura
Treatment of Langerhan’s Cell Histiocytosis
Curettage
Low-dose radiation therapy
A combo of both
Clinical features of Osteoradionecrosis
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
Treatment of Osteoradionecrosis
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
Demographic patterns of Traumatic Bone Cyst (Simple bone cyst)
Young Patients, usually in second decade
History of trauma may or may not be present
*Clinical features of Traumatic Bone Cyst (Simple bone cyst)
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
Surgical findings or treatment of Traumatic Bone Cyst (Simple bone cyst)
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
