LO 9

Question 1

Describe Nonneoplastic Diseases of Bone

Answer 1

1. These diseases fall into various categories, and several are discussed in other chapters
2. Inherited diseases affecting bone
3. Benign and malignant neoplasms

Question 2

Describe dysplasia in the context of this learning outcome

Answer 2

1. In this chapter, dysplasia refers to the abnormal and disordered production of cementum and bone
2. Should not be confused with dysplasia in the context of epithelial dysplasia

Question 3

List the common

Answer 3

1. Periapical cemento-osseous dysplasia
2. Focal cemento-osseous dysplasia
3. Florid cemento-osseous dysplasia
4. Fibrous dysplasia

Question 4

Describe Periapical Cemento-Osseous Dysplasia

Answer 4

1. Relatively common disease of unknown cause that affects periapical bone
2. Occurs most commonly in the anterior mandible of patients older than 30
3. More common in women than men- hormonal link
4. Early lesions are well circumscribed and radiolucent; with time, they become increasingly calcified
5. Teeth in the affected area are vital
6. A biopsy may be necessary when characteristic radiographic features are not evident
7. No treatment

Question 5

Describe Florid Cemento-Osseous Dysplasia

Answer 5

1. A condition of disordered cementum and bone development
2. Best diagnosed on the basis of its characteristic patient history, clinical presentation, and radiographic appearance
3. Asymptomatic florid cemento-osseous dysplasia does not require treatment
4. Clinical and radiographic features - Typically affects more than one quadrant
5. Masses of irregular opacification are noted that are composed of dense sclerotic bone, cementum, or both

Question 6

Describe Focal Cemento-Osseous Dysplasia

Answer 6

1. An asymptomatic fibro-osseous lesion
2. Occurs in women between 30 and 50 years of age
3. Isolated, well-delineated radiolucent-to-radiopaque lesion
4. Less than 1.5 cm in size

Question 7

Describe diagnosis and treatment of Focal Cemento-Osseous Dysplasia

Answer 7

1. Biopsy and histologic examination are usually necessary to establish a diagnosis
2. Composed of numerous gritty pieces of soft and hard tissue: Fibrous connective tissue interspersed with bone trabeculae and cementum-like material

Question 8

Describe Fibrous Dysplasia

Answer 8

1. Characterized by replacement of bone with abnormal fibrous connective tissue interspersed with varying amounts of calcification
2. Histologically, it is a benign fibro-osseous lesion, with vascularized, cellular fibrous connective tissue interspersed with irregular trabeculae of bone

Question 9

Polyostotic fibrous dysplasia is a type of _________

Answer 9

Fibrous Dysplasia

Question 10

Describe Polyostotic Fibrous Dysplasia

Answer 10

1. Characterized by involvement of more than one bone
2. Typically occurs in children, with a female predilection
3. When long bones are involved, they may exhibit bowing and an associated dull aching pain
4. Patients may have skin lesions appearing as light-brown macules called café au lait spots

Question 11

What are the 3 types of Polyostotic Fibrous Dysplasia

Answer 11

1. Craniofacial fibrous dysplasia - Involves the maxilla with extension into the sinuses and adjacent zygoma, sphenoid, and occipital bones
2. Jaffe type - Involves multiple bones along with café au lait macules on the skin
3. Albright syndrome - Characterized by endocrine abnormalities, precocious puberty in females, stunting or deformity of skeletal growth in both sexes as a result of premature closing of the epiphyseal plates, café au lait spots

Question 12

Describe Polyostotic Fibrous Dysplasia

Answer 12

1. Typically a painless, progressive, unilateral enlargement of the mandible or maxilla
2. The classic radiographic appearance is a diffuse radiopacity looking like “ground glass”
3. Characterized by cellular fibrous connective tissue interspersed with irregularly shaped bony trabeculae
4. Treatment - Surgical recontouring of bone for cosmetic reasons

Question 13

Describe Paget Disease of Bone

Answer 13

1. A chronic metabolic bone disease
2. Characterized by resorption, osteoblastic repair, and remineralization of involved bone
3. Unknown cause: May be due to a virus
4. Most commonly occurs in men over age 50 years
5. The maxilla is more commonly affected than the mandible
6. Enlargement of affected bone
7. Patient often complains of pain
8. Spaces may increase between teeth as jaw bone enlarges
9. Radiographic - A patchy radiolucency and radiopacity, “cotton wool”; Hypercementosis, loss of lamina dura, and obliteration of the periodontal ligament may occur

Question 14

Describe Central Giant Cell Granuloma
(Central Giant Cell Lesion)

Answer 14

1. Composed of well-vascularized connective tissue containing many multinucleated giant cells
2. Occurs in both peripheral (tissue) and central (bone) locations
3. Often related to chronic infection
4. May experience pain; not common
5. Slow-growing lesion
6. Destructive
7. Unilocular or multilocular radiolucency
8. Ill-defined borders
9. Divergence of roots
10. Treatment - Surgical excision

Question 15

Aneurysmal Bone Cyst

Answer 15

1. Pseudocyst
2. Consists of blood-filled spaces surrounded by multinucleated giant cells and fibrous connective tissue
3. Radiographic: “Honeycomb” or “soap bubbles”
4. Often related to a trauma
5. Treatment - Surgical excision