Generalized Radiopacities Flashcards
what are the generalized radiopacities
- fibrous dysplasia- polyostotic
- florid cemento-osseous dysplasia
- Paget’s disease
- osteopetrosis
what is the disease mechanism of fibrous dysplasia- polyostotic
a localized change in normal bone metabolism that results in the replacement of all components of cancellous bone by fibrous tissue containing varying amounts of abnormal appearing bone
polyostotic fibrous dysplasia affects:
more than one bone
polyostotic fibrous dysplasia is usually found in:
children younger than 10 years old
what are the types of polyostotic fibrous dysplasia
- Jaffe- Lichetenstein Syndrome or Jaffe type
- Mccune Albright Syndrome
describe Jaffe type
polyostotic FD with cutaneous pigmentation
- cafe au lait spots
describe mccune albright syndrome
- polyostotic FD with cutaneous pigmentation - cafe au lait spots and endocrinopathies
- affects almost exclusively women
what is the disease mechanism of florid cemento osseous dysplasia
- a widespread form of periapical cemento osseous dysplasia
- normal cancellous bone is replaced with dense acellular amorphous bone in a background of fibroud CT
- poor vascular supply- susceptibility to infection
If PCOD is identified in_________ it is usually FCOD
three or four quandrants or extensive throughout one jaw
what are the clinical features of florid cemento osseous dysplasia
- most patients are female and middle aged, although the age range is broad
- predilection for african americans and asians
- often FOD produced no symptoms
- extensive lesions often have an associated bony swelling
- if the lesions become secondarily infected, features of osteomyelitis may develop
- teeth in the involved bone are vital
what is the internal structure/imaging features of florid cemento osseous dysplasia
- can vary from RL - mix to almost totally radiopaque
- the RO regions can vary from small oval and cricular regions to large, irregular and amorphous
what are the effects on surrounding structures in florid cemento osseous dysplasia
- large lesions can displace the inferior IAC inferiorly, the floor of the maxillary sinus superiorly and enlarge the alveolar bone
- the roots of associated teeth may have hypercementosis
what is the DDX for florid cemento osseous dysplasia
osteomyelitis
what is the difference between osteomyelitis and secondary osteomyelitis from FOD infection
the foci of amorphous bone that are secondarily infected have a wider and more profound radiolucent border
what is the managemnt for florid cemento osseous dysplasia
- under normal circumstances, FOD requires monitoring
- no age limit is apparent for the cessation of growth of FOD
- because of the propensity to develop secondary infections in FOD, oral hygiene is important in order to avoid odontogenic infections
what is the disease mechanism in paget’s disease
- a skeletal disorder involving osteoclasts resulting in abnormal resorption and apposition of poor quality bone in one or more bones
- may involve many bones but is not a generalized skeletal disease
- it is initiated by an intense wave of osteoclastic activity, with resorption of normal bone resulting in irregularly shaped resorption cavities. after a period of time, osteoblastic acitivity starts
what is another name for paget’s disease
osteitis deformans
what are the clinical features of paget’s disease
- affects later middle and old age - 3.5% of individuals older than 40 years of age
- at age 65 years, the incidence of involvement in men is twice that of women
- affected bone is enlarged and commonly deformed because of the poor quality of bone formation resulting in bowing of legs, curvature of spine, and enlargement of skull, the jaws also enlarge when affected
- separation and movement of teeth may occur causing malocclusion. dentures may fit poorly
- jaw pain is uncommon
- paitnets may also have ill defined neurologic pain as the result of bone impingement on foramina and nerve canals
- patients have severely elevated levels of serum alkaline phosphatase
what is the location of paget’s disease
- often in the pelvis, femur, skull and vertebrae and infrequently in the jaws
- it affects the maxilla about tiwce as often as the mandible
- although this disease is bilateral, occassionally it affects only one maxilla or the involvement may be significantly greater on one side
describe the internal structure in paget’s disease
- the appearance of the internal structure depends on the developmental stage of the disease. there are 3 radiographic stages
- early radiolucent resorptive stage
- a granular or ground glass appearance
- a denser, more RO appositional stage
the stages in Pagets disease are less apparent in:
the jaws
what are the radiographic patterns seen in pagets disease
- linear
- granular
- cotton wool appearance
describe the linear radiographic pattern in pagets disease
the trabeculae may be long and may align themselves in a linear pattern which is more common in the mandible
describe the granular pattern in pagets disease
similar to that of fibroud dysplasia
what are the effects on surrounding structures in paget’s disease
- always enlarges an affected bone (3x.4x)
- the outer cortex may be thinned but remains intact
- the lamina dura may become less evident and may be altereed into the abnormal bone pattern
- exuberant and irregular hypercementosis
- the teeth may become spaced or displaced in the enlarging jaw
what is the mangement of Paget’s disease
- usually managed medically with bisphosphonates
- surgery may be required to correct derfomities
- extraction sites heal slowly
- higher incidence of osteomyelitis
- 10% cases develop osteosarcomas
what are the other names for osteopetrosis
marble bone disease or Albers- Schoenberg Disease
what is the disease mechanism of osteopetrosis and the prevalance
- an inherited disorder of bone that results from a defect in the differentiation and function of osteoclasts -> abnormal formation of bone and abnormal bone turnover thereafter
- the failure of bone to remodel causes the bones to become densely mineralized, fragile and susceptible to fracture and infection
- hematopoiesis is retarded and cranial nerves may be compressed
- prevalanece is 1 in 100,000 to 500,000
what are the 3 clinical forms of osteopetrosis
- infantile malignant
- intermediate
- benign or adult type
describe the infantile type of osteopetrosis
- autosomal recessive
- apparent short after borth
- fatal within the first few years of life
- progressive deposition of bone results in narrowing of bony canals and foramina -> sensorineural and sensorimotor deficits including hydrocephalus, blindness, deafness, vestibular nerve dysfunction and facial nerve paralysis
- diminished marrow spaces -> affects hematopoietic development of blood cells
- delayed dental eruption
describe the adult form of osteopetrosis
- may be entirely asymptomatic or have mild signs and symptoms
- it may be discovered at any time from childhood into adulthood as an incidental finding or it may manifest as a bone fracture
- diminsihed marrow spaces secondary to the deposition of bone -> affects hematopoietic development of blood cells -> anemia, leukopenia, and thrombocytopenia
- the increased bone density and relative poor vascularity increases the risk of osteomyelitis
what is osteopetrosis’ affect on teeth and jaws
- because this condition is systemic, the changes affect all bones - it is bilateral and symmetrical
- the bone may be so dense that teeth roots and other structures within the bone may not be apparent
- the lamina dura and cortical boundaries are thickened or blended into the surrounding dense bone
what are the effects on teeth in osteopetrosis
- missing teeth
- malformed roots and crowns
- poorly calcified teeth
- delayed eruption as a result of the increased bone density
what is the management for osteopetrosis
- bone marrow transplantation to attempt to stimulate the formation of functional osteoclasts
- when osteomyelitis develops it is difficult to treat, and a combination of antibiotics and hyperbaric oxygen therapy is used. prevention of odontogenic inflammatory disease is key
