Fibro-Osseous Lesions Of The Jaws Flashcards
Definition of fibro-osseous lesion.
Benign pathology wherein fibrous tissue and mineral replaces bony tissue.
Classification of fibro-osseous lesions
Developmental
- Fibrous dysplasia 🍄
- Cemento-osseous dysplasia 🍄
Neoplastic
- Ossifying fibroma 🍄
- Cemento-ossifying fibroma
- Osteoid osteoma / osteoblastoma (nocturnal pain, improved with aspirin)
- Cementoblastoma (attached to roots)
Infective / Inflammatory
- Condensing osteitis —> focal sclerosing osteomyelitis
- Diffuse sclerosing osteomyelitis
- Garre osteomyelitis (looks like FD in children)
- Juvenile sclerosing osteomyelitis (Shand)
Idiopathic
- Idiopathic osteosclerosis / Bone island / Enostosis (cortical change in medullary bone)
- Pagets
Radiopaque lesions
- Pagets
- Osteoma (Gardners)
- MRONJ
- Osteosarcoma
Fibrous dysplasia
- Developmental condition that is characterised by replacement of normal bone by cellular fibrous connective tissue intermixed with irregular bony trabeculae.
- Occurs as a result of mutation of GNAS 1 gene.
- Severity of the disease depends on when the abnormality was developed.
🐳 Variants:
- Monostotic (about 80%; most diagnosed during 2nd decade of life — developmental; painless swelling; slow growing; maxilla involved more frequently)
- Polyostotic (Carniofacial / Other areas such as femur)
- + café au lait (Jaffe Litchenstein)
- + café au lait + endocrine abnormalities (McCune-Albright)
Radiographic features
- Ground-glass opacification 🍄
- Not well demarcated 🍄
- Early lesions may be radiolucent
Treatment
- disease may stabilise and stops enlarging when skeletal maturation is reached
- small legends may be resected
- multidisciplinary approach for large lesions (e.g., large lesion compressing optic nerve)
Cemento-osseous Dysplasia
COD is a spectrum of non-neoplastic fibro-cemento-osseous lesions that are confined to the tooth bearing areas of the jaws or edentulous alveolar bone.
Most common odontogenic tumour / tumour-like lesion.
Classification
- Hereditary (rare)
- Non-hereditary
F:M=26:1 Blacks 78% 50-70
- focal COD 🍄 Do NOT do RCT!
- periapical COD / Multiple
- florid COD
In most instances of florid or periapical cemento-osseous dysplasia, the distinctive clinical and radiographic findings (e.g., a black female patient with multiquadrant involvement or multiple lesions involving vital lower incisor teeth) allow a strong presumptive diagnosis. In contrast, the features of focal cemento-osseous dysplasia tend to be less specific, and biopsy often is needed for diagnosis.
In particular, distinguishing focal cemento-osseous dysplasia from ossifying fibroma can be difficult. However, the findings at surgery may be helpful in discriminating between these two lesions. Before the final sclerotic stage, cemento-osseous dysplasia consists of gritty tissue that the surgeon typically curettes into small fragments during biopsy. In contrast, ossifying fibromas tend to separate cleanly and are removed in one or several large masses (🥔).
Treatment
- non-neoplastic and generally does not require removal
- few problems during radiolucent lesions
- in the sclerotic phase, the lesions tend to be hypovascular and prone to necrosis and secondary infection with minimal provocation
Ossifying fibroma / Cemento-ossifying fibroma
True neoplasm significant growth potential (possibly arises from PDL)
🍄Limited to the tooth-bearing areas of the jaws — posterior mandible*
FD — maxilla*
COD — anterior mandible*
*more frequent
Well-corticated unilocular radiolucency —> variable radiopacity —> when radiopaque shows a radiolucent halo
🐳 Well-corticated suggests slow in expansile (dense white bone — body is trying to trap the lesion), for example: dentigerous cyst; odontogenic keratocyst.
How do you differentiate FD, COD and OF?
They all look the same under the microscope.
History!
FD — young person
COD — young person, periapical looking, infected later on
OF — middle age
Location!
Condensing osteitis
Always associated with a dodgy tooth!
(COD NOT associated a dodgy tooth)
