Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Oral Path > Mixed and Radiolucent or Mixed > Flashcards

Mixed and Radiolucent or Mixed Flashcards

1
Q

Mixed lesions always have RO and RL elements. Explain

A

The radiopaque component represents some form of calcification
-bone or cartilage (bone-derived)
-tooth-related material (cementum, dentin and/or enamel)
-dystrophic calcification (pathologic calcification in dead and degenerative tissue or scarred tissue)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

List the Odontogenic mixed lesions. List mixed bone tumors.

A

Odontogenic:
-Cementoblastoma
-Odontoma (compound)
-Odontoma (complex)

Bone Tumor
-Osteoblastoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Cementoblastoma

A

-Rare neoplasm that arises from PDL
-Young adults, posterior mandible, especially 1st permanent molar
-Pain and swelling often presenting features
-Opaque mass fused to root(s), thin lucent rim around mass in mature lesions
-Tx: Conservative excision with either tooth root amputation and endodontic tx, or just extraction. Low recurrence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Cementoblastoma - histology

A

-Cellular cementum with plump cementoblasts
-Often a periphery of radiating columns of calcified material
-May be mistaken for osteosarcoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Odontoma

A

-Most common odontogenic tumor
-Detected before 20yrs, frequently associated with unerupted tooth
-Typically asymptomatic (no pain, swelling)
-Tx: enucleation, no recurrence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

List the types of Odontoma tumors and describe them

A

Compound:
-Anterior jaws; may be associated with unerupted tooth
-Resembles small teeth (toothlets/denticles)

Complex:
-Posterior jaw; dense radiopaque mass surrounded by a radiolucent rim, frequently pericoronal to an impacted tooth
-Contains odontogenic tissues but does not form small tooth-appearing structures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

List the RL or Mixed Benign Tumors/Lesions (similar presentations)

A

-Odontogenic cyst with calcification
-Odontogenic tumor with calcification
-Paget disease of bone
-Fibro-osseous lesions:
1. Fibrous dysplasia
2. Cemento-osseous dysplasia
3. Central ossifying fibroma
-Osteoblastoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

List the RL or Mixed malignant or infectious/inflammatory lesions (different presentation)

A

-Osteosarcoma
-Metastatic tumors
-Osteomyelitis
-Medication-related osteonecrosis of the jaw
-Osteoradionecrosis

*paresthesia = malignant or infectious until proven otherwise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Calcifying Odontogenic Cyst (COC)

A

-Also known as the Gorlin cyst
-Wide age range
-Anterior portions of jaws
-Usually a unilocular radiolucency, but up to 50% can have calcifications (mixed appearance)
-May be associated with an unerupted tooth
-Root resorption and root divergence can be seen
-Tx: enucleation and curettage; unlikely recurrence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Odontogenic Tumors Classification

A
  1. Odontogenic Epithelium
    -Ameloblastoma
    -Adenomatoid Odontogenic Tumor (AOT)*
    -Calcifying Epithelial Odontogeic Tumor    *
  2. Odontogenic Ectomesenchyme
    -Odontogenic Fibroma
    -Odontogenic Myxoma
    -Cementoblastoma***
  3. Mixed (epithelial and ectomes.)
    -Ameloblastic Fibroma
    -Ameloblastic Fibro-odontoma*
    -Compound or Complex Odontoma    *

***Can be RL or mixed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

List the Odontogenic Tumors with Calcification

A
  1. Ameloblastic fibro-odontoma
    -Looks virtually identical to a complex odontoma: always mixed, posterior mandible, ave age 10yrs
  2. Adenomatoid odontogenic tumor (AOT)
    - <20yrs, 80% anterior jaws; unilocular lucency which may develop snowflake/fleck-like radiopacities
    - 75% with unerupted tooth where radiolucency extends beyond CEJ
    -Tx: enucleation
  3. Calcifying epithelial odontogenic tumor (CEOT)
    -posterior jaws, >30 yrs, often with an impacted tooth
    -Tx: conservative resection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Odontogenic Cysts and Tumors: Key Points

A

***All of the benign odontogenic cysts and tumors are asymptomatic or present with a slow growing swelling/expansion with either a unilocular or a multilocular presentation and +/- root divergence and resorption. Unless secondarily infected, pain would only be expected with cementoblastoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Odontogentic Cysts and Tumors - if mixed appearance (have to identify the calcification!)

A

-Compound, complex odontoma and ameloblastic fibro-odontoma - clear cut features
-All of the other lesions where you see calcification in the tooth-bearing portions of the jaws or in association with an unerupted/impacted tooth since they can’t clearly be separated by presentation, you can simplify the diff. dx.: “benign odontogenic cyst or tumor with calcification” (COC, AOT, CEOT –> will only ask to differentiate for extra credit purposes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Paget Disease of Bone

A

-“osteitis deformans”
-Pathogenesis: increased/uncontrolled bone remodeling resulting in thickened but distorted and weakened bones
-Unknown etiology; >40yrs
-May have bone pain and possible fractures
-Most cases are polyostotic affecting pelvis, femur, lumbar vertebrae, skull (hat doesn’t fit) and tibia most commonly
-When jaws affected, more often Mx causing symmetric enlargement (“dentures don’t fit”), spaces develop between teeth
-Deafness and blindness (narrowing of ostea)
-Markedly elevated total serum alkaline phosphatase (marker of osteoblastic activity)
-Chronic progression from vascular (lytic) phase to late lesions that show patchy sclerosis (“Cotton-wool”) appearance with thickened cortices. This is the classic appearance!
-Often extensive hypercementosis of teeth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Paget Disease Tx

A

-NSAIDs for mild pain
-Bisphosphonates - help slow bone turnover
-Monitor patients as they can develop bone tumors (ex. osteosarcoma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Paget Disease dental considerations

A

-Difficult extractions due to hypercementosis and ankylosis
-Place of implants with caution
-Surgical bleeding risk during vascular lytic phase
-Poor wound healing with risk for osteomyelitis during sclerotic phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Fibro-osseous Lesions

A

-Non-specific term that describes a group of processes, with different pathogeneses, where normal bone is replaced by fibrous tissue with a newly formed mineralized product
-Accurate diagnosis requires correlation of the clinical and radiographic features with the microscopic features because they can look very similar microscopically.

**Focus on how you can distinguish these from one another

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

List the Fibro-osseous Lesions of the Jaw

A

-Fibrous Dysplasia
-Cemento-osseous Dysplasia (focal, periapical and florid variants)
-Ossifying fibroma

19
Q

Fibrous Dysplasia

A

-Developmental, tumor-like lesion due to a stimulatory G protein mutation
-Usually presents in the second or third decade
-Usually monostotic (only one bone); jaws are commonly affected. When polystotic, can also see cafe au lait pigmentation and endocrine problems
-Slowly growing, painless swelling
-Maxillary lesions that involve adjacent facial bones can cause facial deformity (called “craniofacial fibrous dysplasia)

20
Q

Fibrous Dysplasia Radiographically

A

Early Lesion - radiolucent or mottled followed by classic “ground glass” pattern with blending margins (why? abnormal bone fuses to adjacent normal bone - no capsule)

21
Q

Fibrous Dysplasia Tx

A

Growth often stabilizes upon skeletal maturation so conservative management advised. Surgical reduction only if significant cosmetic or function deformity (up to 50% can show regrowth)

22
Q

Central Ossifying Fibroma (COF)

A

-Benign neoplasm considered by most to be derived by bone, though often also has cementum-like material in it
-Mandible far more than max., especially posterior region
-Asymptomatic when small; large lesions show a painless swelling

23
Q

Central Ossifying Fibroma (COF) Radiographically

A

-Well-demarcated, unilocular, expansile radiolucent or mixed lesion (varying degrees of central radiopacity with a radiolucent periphery)
-May cause divergence or resorption of tooth roots
-At surgical exploration, the lesion tends to shell out as one potato-like mass
-Fibro-osseous lesion comprised of a cellular fibrous connective tissue with interspersed trabeculae or spherules of mineralized tissue that resembles bone and/or cementum. Need radiographs and hx to diagnose this!

24
Q

Central Ossifying Fibroma (COF) Tx

A

Enucleation, recurrences are uncommon

25
Q

Cemento-osseous Dysplasia General Features

A

-Strong predilection for middle-aged (>30yrs) females, mostly often in blacks
-Painless, typically no expansion, around tooth roots/apices (teeth are vital!)
-Well-defined but irregular borders, unilocular radiolucency that slowly develops central radiopacity
-Lesional tissue appears as easily fragmented, gritty, red/brown tissue early on and denser as it matures

26
Q

Cemento-osseous Dysplasia Tx

A

Vitality testing in early lesions to prevent doing RCT; always take pano to check for multiple lesions and PAs of individual lesions; radiographic follow-up is all that is needed

27
Q

Cemento-osseous Dysplasia Variants

A
  1. Focal: solitary lesion, posterior mandible, may mimic COF requiring biopsy
  2. Periapical: Mandibular anterior predominantly, often with multiple lesions
  3. Florid: Bilateral mandible (anterior and posterior) and can affect all 4 quadrants (Mx. and Md.); dense radiopacities that can fuse to roots, bone exposure can cause secondary infection and sequestration
28
Q

Osteoblastoma

A

-Histologically identical to cementoblastoma but not fused to a tooth root
-Most pts are <30yrs
- 2-4cm up to 10cm
-Dull pain and expansion are common
-Well/ill-defined RL with patchy to diffuse mineralization
-TX: local excision or curettage
-Good prognosis with low recurrence rate

29
Q

Osteosarcoma - Jaws

A

-Malignancy showing malignant mesenchymal cells producing osteoid
-Most common primary (originating within) bone malignancy - twice as common as chondrosarcoma
-Typically a fast-growing mass around knees in children and young adults (mean age = 18yrs). Only 6% of these affect the jaws - mean age ~33yrs
-Some cases arise in Paget’s disease of bone or radiated bone

30
Q

Osteosarcoma - Jaws - Signs/Symptoms

A

-Initial complaint is often pain, followed by swelling, loose teeth or paresthesia
-Mixed radiopaque/radiolucent lesion with ill-defined borders
-Symmetrically widened PDL of teeth in the area may be seen
-Growth of bone above the crestal height
-“sun-burst” pattern is uncommon in jaws

31
Q

Osteosarcoma - Jaws - Tx

A

-Tx is wide surgical resection with initial complete removal being the most important prognostic factor
-Metastasizes to lung and brain
-Death is usually due to uncontrolled local disease, tumor infiltrates beyond radiographic margins

32
Q

Metastatic Disease

A

-Metastatic carcinoma is the most common cancer involving bone
-Jaws (mostly posterior mandible) are occasionally affected
-Metastatic deposits from malignancies below the neck may affect the jaws through Batson’s paravertebral plexus of veins - no valves
-Over half of affected pts are over 50yrs
-Mandible = 61% of cases
-Maxilla = 24% of cases
-Soft tissue = 15% of cases (most commonly gingiva, resembles a pyogenic granuloma)

33
Q

Metastatic Disease Signs/Symptoms

A

-Pain
-Paresthesia
-Tooth mobility (mimicking periodontal disease) with PDL widening.
-Radiographically: poorly defined, “moth eaten” radiolucency; less commonly, radiopacity
-Swelling
-Hemorrhage
-Pathologic fracture
-Trismus

34
Q

Describe the common primary tumors that metastasize to the jaw

A
  • 22% of jaw mestastases represent the initial manifestation of the malignant process
    -Most common primary tumors that metastasize to the jaw are:
    1. breast or prostate (these may be radiopaque)
    2. lung, kidney, thyroid, colon
    -In soft tissue: most often see primary tumors from lung, breast, kidney, melanoma
35
Q

Metastatic Disease histology

A

Looks like tissue of origin, may show diffuse infiltration or scattered tumor cells (“seeded” effect)

36
Q

With lack of healing of a tooth socket, clinically consider:

A

-Granulation tissue
-Lymphoma
-Metastatic disease

37
Q

Metastatic Disease Tx and Prognosis

A

-Typically widely disseminated disease (stage IV) once it appears in the oral cavity
-Tx: palliation, usually with radiation therapy. Bisphosphonates slow progression of bone mets and decrease bone pain and fracture risk
Prognosis: very poor; most patients die within one year of the diagnosis

38
Q

Osteomyelitis

A

Acute or Chronic inflammatory process in the medullary space or cortical surface of bone that extends away from initial site

39
Q

What are the 2 main types of Osteomyelitis?

A

-Most often caused by bacterial infection (“suppurative osteomyelitis”) causing expanding lytic destruction with suppuration and sequestra formation
1. Arises after odontogenic infection or jaw fracture
2. Occurs more in setting of immune suppression or diseases that decrease bone vascularity
-2nd pattern: idiopathic inflammation of bone without suppuration or sequestra; non-responsive to antibiotics; leads to bone sclerosis so called “diffuse sclerosing osteomyelitis”

40
Q

Acute Suppurative Osteomyelitis

A

-Acute: spreads rapidly before body can react to the inflammatory infiltrate. Typically S/S (fever, leukocytosis, LAD, pain and soft tissue swelling) for <1 month
-Can cause paresthesia of lower lip mimicking malignancy
-Ill-defined radiolucency; drainage or separation and exfoliation of necrotic bone (sequestrum). Necrotic bone can be surrounded by new vital bone (involucrum)

41
Q

Acute Suppurative Osteomyelitis Tx

A

-Resolve source of infection
-Establish drainage
-Remove infected bone
-Empiric use of antibiotics (PCN with metronidazole or clindamycin) while awaiting culture and antibiotic sensitivity results
-Multiple procedures may be required over days to weeks to eliminate infection and reconstruct the defect

42
Q

Chronic Suppurative Osteomyelitis

A

-Defensive response produces granulation tissue that remodels into dense scar tissue attempting to wall off the infected area. This dead space harbors bacteria and antibiotics have difficulty reaching the area which can lead to a smoldering process with periodic acute exacerbations
-Can arise de novo or from unresolved acute osteomyelitis
-Swelling, pain, sinus formation, purulent discharge, sequestrum formation, tooth loss or pathologic fracture
-Patchy, ragged, ill-defined radiolucency +/- central radiopaque sequestra (typically mixed appearance)

43
Q

Chronic Suppurative Osteomyelitis Tx

A

-IV antibiotics to get high dose to dead spaces
-Removal of all infected material down to good bleeding bone is mandatory (ranges from curettage to resection)
-Hyperbaric oxygen use in refractory cases or for disease arising in hypovascularized bone

Oral Path (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions