Generalized Radiopacities Flashcards
1
Q
What is the disease mechanism for fibrous dysplasia (polyostotic)?
A
- Is a localized change in normal bone metabolism that results in the replacement of all the components of cancellous bone by fibrous tissue containing varying amounts of abnormal-appearing bone.
- Affects more than one bone
- Usually found in children younger than 10 years of age
2
Q
What is the jaffe-lichtenstein syndrome of Jaffe type of fibrous dysplasia?
A
- Polyostotic FD with cutaneous pigmentation (café au lait spots)
3
Q
What is the McCune-Albright syndrome of fibrous dysplasia?
A
- Polyostotic FD with cutaneous pigmentation (café au lait spots) and endocrinopathies
- Affects almost exclusively women
4
Q
What is the disease mechanism for florid cemento-osseous dysplasia?
A
- FCOD is a widespread form of Periapical cementoosseous dysplasia (PCOD)
— If PCOD is identified in three or four quadrants or is extensive throughout one jaw, it usually is FCOD - Normal cancellous bone is replaced with dense acellular amorphous bone in a background of fibrous connective tissue
- Poor vascular supply (susceptibility to infection)
5
Q
A
florid cemento-osseous dysplasia
6
Q
What are the clinical features of florid cemento-osseous dysplasia?
A
- Most patients are female and middle-aged, although the age range is broad
- Predilection for African Americans and Asians
- Often FOD produces no symptoms (incidental finding)
- 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
7
Q
What are the imaging features of florid cemento-osseous dysplasia?
A
- Can vary from radiolucent - mixed - almost totally radiopaque.
- The radiopaque regions can vary from small oval and circular regions to large, irregular and amorphous.
8
Q
What effects on surrounding tissue does florid cemento-osseous dysplasia have?
A
- 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
9
Q
What is the differential diagnosis for florid cemento-osseous dysplasia?
A
- Osteomyelitis (may appear similar to the sequestrum seen in osteomyelitis): This is not to be confused with a situation where FOD has become secondarily infected, resulting in osteomyelitis. The foci of amorphous bone that are secondarily infected have a wider and more profound radiolucent border.
10
Q
How do you manage florid cemento-osseous dysplasia?
A
- 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.
11
Q
What is the disease mechanism for paget’s disease (osteitis deformans)?
A
- Is a skeletal disorder involving osteoclasts resulting in abnormal resorption and apposition of poorquality bone in one or more bones
- May involve many bones, but it 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 activity starts
12
Q
What are the clinical features of paget’s disease?
A
- 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 approximately twice that of women.
- Affected bone is enlarged and commonly deformed because of the poor quality of bone formation, resulting in bowing of the legs, curvature of the spine, and enlargement of the skull. The jaws also enlarge when affected.
- Separation and movement of teeth may occur, causing malocclusion. Dentures may fit poorly.
- Jaw pain is uncommon.
- Patients 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
13
Q
Where is paget’s disease often located?
A
- Often in the pelvis, femur, skull, and vertebrae and infrequently in the jaws
- It affects the maxilla about twice as often as the mandible.
- Although this disease is bilateral, occasionally it affects only one maxilla, or the involvement may be significantly greater on one side.
14
Q
What is the internal structure of paget’s disease?
A
- Generally, the appearance of the internal structure depends on the developmental stage of the disease: three radiographic
stages although these often overlap in the clinical setting: - Early radiolucent resorptive stage.
- A granular or ground-glass appearance.
- A denser, more radiopaque appositional late stage.
15
Q
What is the radiographic pattern of paget’s disease?
A
- Linear: The trabeculae may be long and may align themselves in a linear pattern, which is more common in the mandible.
- Granular: Similar to that of fibrous dysplasia.
- Cotton-wool appearance
16
Q
What are the effects of paget’s disease on surrounding structures?
A
- 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 altered into the abnormal bone pattern
- Exuberant and irregular hypercementosis
- The teeth may become spaced or displaced in the enlarging jaw
17
Q
What is the managment of paget’s disease?
A
- Usually managed medically (bisphosphonates).
- Surgery may be required to correct deformities
- Extraction sites heal slowly.
- Higher incidence of osteomyelitis
- 10% of cases develop osteosarcomas
