Disease of the Bone - Tumour-Like and Neoplastic Flashcards
What is a torus?
Tumour like mass of bone occurring in precise anatomical locations in the jaw
Describe the classification of torus
- Torus palatinus (hard palate)
2. Torus mandibularis (mandible)
Describe the general features of tori
- Relatively common
- Appears in young adult life
- Both sexes affected
Describe the clinical features of torus palatinus
- Bony hard swelling in bilaterally in the vault of hard palate in the midline, may be lobulated
- Normal overlying mucosa present
Describe the clinical features of torus mandibularis
- Bony hard swelling bilaterally in premolar region of mandible on lingual aspect, may be lobulated
- Normal overlying mucosa present
Describe the radiographic features of tori
- Non-specific
- Facial views may show radiodense mass in characteristic location
Describe the pathology of tori
- Mass of dense sclerotic lamellar bone
- May have trabecular arrangement with fibrous intertrabecular tissue
- Not normally biopsied
Describe the treatment of tori
- Usually unnecessary
- Reassure the patient
- Surgical reduction may be required to allow fit of dentures
What is fibrous dysplasia?
A benign condition, presumably developmental in nature, characterised by presence of fibrous connective tissue with irregular trabeculae of bone
Describe 3 classifications of fibrous dysplasia
- Monostotic (one bone - 75%)
- Polyostotic (many bones - 25%)
- Albright’s Syndrome (rare)
Describe the general features of fibrous dysplasia
- Young patients, childhood or adolescence
- 3F : M
- Any bone, frequently maxilla
Describe HPC of fibrous dysplasia
- May be incidental
- Slow progressive enlargement of bone with deformity
Describe clinical features of fibrous dysplasia
- Painless swelling of bone with deformity
- May cause malocclusion, spacing of teeth or nerve or ocular compression
Describe the radiographic appearance of fibrous dysplasia in terms of extent, quality, margins and adjacent anatomy
Extent: Usually large area or all of bone
Quality: Variable, “ground glass” or “cystic” appearance
Margins: Ill-defined
Adjacent Anatomy: May obliterate antrum, compress nerve, separate teeth
Describe the pathology of fibrous dysplasia
- Variable pathology
- Fibro-osseous
- Irregular short trabecular of bone, often woven bone, in a vascular fibrous stroma
Describe the treatment of fibrous dysplasia
- None usually
- Surgery may be required
- Regrowth can occur
- Bisphosphonates
- May regress as the patient reaches adulthood
Describe the prognosis of a patient suffering from fibrous dysplasia
- Persistent residual deformity common
- Sarcomas recorded usually following radiotherapy
What is Paget’s disease?
A progressive disorder representing a disturbance of the “coupling” off synthesis and resorption of bone
What is another name for Paget’s disease?
Osteitis deformans
Describe the classification of Paget’s disease
- Monostotic (15%)
2. Polyostotic (85%)
Describe the general features of Paget’s disease
- 4% over 40 years, becoming commoner with age
- 2M:F
- Any bone, frequently jaws and usually maxilla
Describe the HPC of Paget’s disease
- May be incidental
- Slow progressive enlargement of bone with deformity, occasionally painful
Describe the clinical features of Paget’s disease
- Enlargement of skull and jaws
- Swelling with deformity, weight bearing, bowing of legs and spinal curvature
- Red and warm skin
- Usually maxilla (80% bilateral)
- Neurological effects if skull base affected
Describe the radiographic features of Paget’s disease in terms of extent, quality, margins and adjacent anatomy
Extent: Usually large area or all of bone
Quality: Variable, initially radiolucent then radiopaque (cotton wool)
Margins: Ill-defined
Adjacent Anatomy: Teeth displaced, resorbed, ankylosed
Describe the pathology of Paget’s disease
- Variable
- Fibro-osseous
- Irregular masses of lamellar bone with prominent reversal lines, giving mosaic pattern
- Fibrous stroma
- Osteoblastic and osteoclastic activity
Describe the pathology in teeth of Paget’s disease
- Resorption, hypercementosis and ankylosis may affect roots in adjacent teeth
Describe 4 treatments for Paget’s disease
- Specialist referral
- Analgesia
- Calcitonin
- Bisphosphonates
Describe 4 complications of Paget’s disease
- Difficult extraction
- Pathological fracture
- Infection and osteomyelitis
- Sarcoma
Give an overview of neoplasms of the bone
- Neoplasms off the bone are uncommon
- Classification and nomenclature are complex
- Diagnosis based on careful correlation of clinical, radiology and histopathology
Describe the classification of neoplasms of the bone
- Benign
2. Malignant - Primary, Haemopoietic and Secondary
Describe 4 general features of neoplasms of the bone
- Rare in jaw bones
- Wide age range with both sexes affected
- May present with non-specific symptoms apparently related to odontogenic apparatus
- Requires specialist referral for investigation and management
Describe the clinical features of neoplasms of the bone
- Variable
- Bone pain and swelling
- Tooth mobility
- Pathological fracture
- Paraesthesia
Describe the radiographic features of the neoplasms of the bone
- Variable
- Radiolucency
- Speckled radiolucency
- Radiodensity
- Changes in associated anatomical markings or structures
Describe the pathology of neoplasms of the bone
- Bone / Cartilage / Fibrous tissue
- Haemopoietic elements
- Osteoclastic giant cells
- Decalcification of specimen required before examination of sections
