Fibro-Osseous and Giant Cell Lesions

Question 1

What is a fibrous-osseous lesion?

Answer 1

Lesion where normal bone is replaced by fibrous tissue in which abnormal bone is laid down

Question 2

What are the stages radiographically in fibro-osseous lesion?

Answer 2

Initially will be radiolucent lesion as bone is lost

Then will become classic mixed lesion as abnormal bone is laid down

Question 3

What is classic radiographic appearance of fibre-osseous lesion?

Answer 3

Mixed radiopaque and Lucent lesion

Question 4

What are 4 types of fibro-osseous lesions?

Answer 4

RIDN

Reactive
Idopathic
Developmental
Neoplastic

Question 5

Give example of reactive fibro-osseous lesion?

Answer 5

Cemento osseous dysplasia

Question 6

Give example of idiopathic fibro-osseous lesion?

Answer 6

Paget’s

Question 7

Give example of developmental fibro-osseous lesion?

Answer 7

Fibrous dysplasia

Question 8

Give example of neoplastic fibro-osseous lesion?

Answer 8

Ossifying fibroma

Question 9

What is ossifying fibroma?

Answer 9

Benign neoplastic fibro-osseous lesion

Question 10

What is ossifying fibroma composed of?

Answer 10

Benign neoplasm composed of fibrous tissue w/ spicules/ islands or cementicles of bone

Question 11

Who does ossifying fibroma affect?

Answer 11

Average 35yrs - 20-50yrs

Females > males

Question 12

Where does ossifying fibroma affect?

Answer 12

Mandible most common site

Often premolar/ molar region

Question 13

What would you expect to see from the histology of ossifying fibroma?

Answer 13

Lesion have well-defined margin and be separate from cortical plate
Fibrous tissue
Pattern of bone and cellularity will be variable

Question 14

Pt management of those with ossifying fibroma?

Answer 14

Conservative enulceation

Resection

Question 15

Will ossifying fibroma recur?

Answer 15

Low recurrence rate

Question 16

What is fibrous dysplasia?

Answer 16

Developmental disorder of the bone

Question 17

How is fibrous dysplasia caused?

Answer 17

Mutation GNAS1 - not inherited

Question 18

What is the frequency of fibrous dysplasia affecting H&N?

Answer 18

25%

Question 19

Who does fibrous dysplasia affect?

Answer 19

15-30yrs

Males = females

Question 20

What see in fibrous dysplasia?

Answer 20

Painless smooth enlargement/ swelling

Question 21

Where is most common to see fibrous dysplasia in H&N?

Answer 21

Maxilla

Question 22

What see radiograph of fibrous dysplasia?

Answer 22

Poorly demarcated radiopacity

Strippled ‘orange peel’ - bone look granular which merges w/ bone

Question 23

What see in histology of fibrous dysplasia?

Answer 23

Irregular strands of bone interconnecting

Large amount fibrous tissue

Question 24

What are the clinical variants of fibrous dysplasia?

Answer 24

Monostotic - one bone involved

Polyostotic - multiple bones involved

Question 25

Most common sites for monostotic F.D?

Answer 25

Ribs and femur

Question 26

What proportion of those w/ monostotic F.D will have H&N lesions?

Answer 26

25%

Question 27

What proportion of those w/ polyostotic F.D will have H&N lesions?

Answer 27

50%

Question 28

What gender is more likely to have polyostotic F.D?

Answer 28

75% female

Question 29

What syndrome can polyostotic F.D be related to?

Answer 29

McCune-Albright

Question 30

How manage patients with fibrous dysplasia?

Answer 30

Growth will stabilise w/ skeletal maturity Can debulk/ contour bone - will recur if during growth phase/ pregnancy Surgical removal May need orthodontics

Question 31

Can fibrous dysplasia become malignant?

Answer 31

Small risk of malignant transformation

Question 32

How differentiate ossifying fibroma and fibrous dysplasia?

Answer 32

O.F - well defined margins which are clear, F>M, often mandible F.D - poorly defined margins, M=F, maxilla

Question 33

Who does cemento-osseous dysplasia affect?

Answer 33

Those 30-50yrs | Often females

Question 34

What see in cemento-sseous dysplasia radiographically?

Answer 34

Multiple opacities in tooth bearing areas of jaw

Question 35

What see in cements-osseous dysplasia?

Answer 35

Irregular trabeculae of woven bone and cementum in fibrous stroma

Question 36

What are the classifications of cements-osseous dysplasia?

Answer 36

FPF Florid Periapical Focal

Question 37

What is florid cemento-osseous dysplasia?

Answer 37

Multiple lesions

Question 38

What is focal cemento-osseous dysplasia?

Answer 38

Single lesion

Question 39

What is periapical cemento-osseous dysplasia?

Answer 39

Multiple lesions at apex teeth

Question 40

What is familial gigantiform cementoma?

Answer 40

Variant florid OD

Question 41

What see in histology of cements-osseous dysplasia?

Answer 41

Can see osteoclast Evidence haemorrhage More blue bone/ cementum appearance

Question 42

What can cemento-osseous dysplasia look similar to histologically?

Answer 42

Ossifying fibroma - irregular bony fragments in fibrous tissue

Question 43

What is Paget disease?

Answer 43

Rare bone disorder affecting all bones

Question 44

What happens in Paget's disease?

Answer 44

Increased bone turnover

Question 45

What are the early stages of Paget's and what is risk?

Answer 45

Bones become very vascular | Increased risk of heart failure

Question 46

What are the late stages of Paget's and what would you see?

Answer 46

Bones become sclerotic | can see reversal and resting lines

Question 47

What clinical features might you see in Paget's?

Answer 47

Legs become bowed | Enlargement of skull - contrition of foramen (death)

Question 48

What is feature of Paget's you might see in dental setting?

Answer 48

Enlargement of jaw - tooth become spaced/ dentures don't fit

Question 49

Dental implications of Paget's?

Answer 49

Bone scerosis - diff XLA, infection | Hypercementosis - diff XLA

Question 50

What are those with Paget's at risk of?

Answer 50

Osteosarcoma/ bone malignancy

Question 51

What medication should you be aware of in those with Paget's?

Answer 51

Bisphosphonates

Question 52

What characterises a giant cell lesion?

Answer 52

The replacement of bone by fibrous tissue which contains numerous multi-ncuelate cells

Question 53

What is example of multi-nucleate cell?

Answer 53

Osteoclast

Question 54

What examples of giant cell lesions?

Answer 54

Cherubism Central giant granuloma Hyperparathyroidism

Question 55

What is cherubism?

Answer 55

Developmental condition - autosomal dominant inheritance

Question 56

Clinical features of cherubism?

Answer 56

Bilateral expansion of posterior mandible

Question 57

What see radiographically in cherubism?

Answer 57

Large multilocular radiolucent lesion at angle of mandible

Question 58

What are giant cell lesions?

Answer 58

Benign giant cell lesion which can be reactive or hyper plastic

Question 59

Who is most likely to be affected by giant cell lesion?

Answer 59

Age 10-60 | F>M

Question 60

Where see giant cell lesions?

Answer 60

In mandible

Question 61

What is classic radiographic appearance giant cell lesions?

Answer 61

Well demarcated radiolucency | May see destruction

Question 62

How manage pt with giant cell lesions?

Answer 62

Blood biochemistry - serum calcium initally Currettage Resection

Question 63

Example of primary hyperparathyroidism lesion?

Answer 63

Parathyroid adenoma

Question 64

What is often caused by hyperparathyroidism?

Answer 64

Renal failure and malabsorption

Question 65

What see in blood chemistry of those with hyperparathyroidism?

Answer 65

Increased alkaline phosphates Parathyroid hormone Calcium phosphate

Question 66

Management of those w/ hyperparathyroidism?

Answer 66

Treat hyperparathyroidism