Mixed/Radiopaque Non-Odontogenic Lesions Flashcards
Benign fibro-osseous lesions
Mixed/Radiopaque Non-Odontogenic Lesions
- Group of benign neoplasms & non-neoplastic lesions of bone w/ similar microscopic features; growth is altered, bone gets taken up and replaced w/ fibrous tissue and makes its own bone
- Cemento-osseous dysplasia: Not a neoplasm
- Ossifying (cementifying) fibroma: Neoplasm
- Fibrous dysplasia: Not a neoplasm
Cemento-Osseous Dysplasia
Mixed Non-Odontogenic Lesions
- Develop in areas of teeth but may represent benign fibro-osseous lesions
- Not neoplasms - Benign self-limiting growth disturbances of bone
- Asymptomatic
- Do not cause enlargement, rarely tooth resorption
- Replacement of normal bone w/ cellular fibrous CT, then replacing w/ disorganized bone/cementum
- 90% in middle aged females 30-50yo
- Cellular fibrous tissue w/ formation of cementum & bone
What are the three types of Cemento-Osseous Dysplasia?
Mixed Non-Odontogenic Lesions
- Periapical Cemento-Osseous Dysplasia
- Focal Cemento-Osseous Dysplasia
- Florid Cemento-Osseous Dysplasia
Periapical Cemento-Osseous Dysplasia
Mixed Non-Odontogenic Lesions
One of the types of Cemento-Osseous Dysplasia
- Multiple PA lesions involving MN anteriors
- More common in AAs
- May produce mineralized pdt
- Surrounded by thin RL line
Of the three types of Cemento-Osseous Dysplasia, which is the most common?
Mixed Non-Odontogenic Lesions
Focal Cemento-Osseous Dysplasia
Focal Cemento-Osseous Dysplasia
Mixed Non-Odontogenic Lesions
One of the Cemento-Osseous Dysplasias
- Same features as PCOD (mutliple PA lesions involving MN ant)
- May produce mineralized pdt
- Surrounded by thin RL line
- Occurs in only 1 location other than MN ant
- Most common
- Usually in posterior MN
- More common in Caucasians
Florid Cemento-Osseous Dysplasia
Mixed Non-Odontogenic Lesions
One of the Cemento-Osseous Dysplasias
- Same features as PCOD
- Occurs in 2+ quadrants
- More common in AAs
- Multiple, bilateral RL-RO lesions throughout the jaws
- Multiple PA RL areas w/ formation of mineralized pdt
Cemento-Osseous Dysplasia: Tx
Mixed Non-Odontogenic Lesions
- After dx, no additional tx - for all Cemento-Osseous Dysplasia types
Central Ossifying Fibroma
Mixed Non-Odontogenic Lesions
- True neoplasm of bone ⇒ persistent & progressive growth; must be removed
- Grows slowly; can cause bony expansion and displacement of teeth
- Growth of bone PLUS fibrous tissue
- Appears at wide age range
Central Ossifying Fibroma: Rad
Mixed Non-Odontogenic Lesions
- Well-defined borders and RO foci
- Causes expansion and slowly growing
What other two conditions are difficult to differentiate microscopically from Central Ossifying Fibroma?
Mixed Non-Odontogenic Lesions
- Cemento-Osseous Dysplasia
- Fibrous Dysplasia
- Central Ossifying Fibroma
Central Ossifying Fibroma: Tx
Mixed Non-Odontogenic Lesions
- Enucleation or curettage
- Usually slow growing but can become large if untx’d
- Low recurrence rate
Radiopaque Non-Odontogenic Lesions
- Fibrous Dysplasia
- Idiopathic Osteosclerosis
- Osteoma
- Mucositis
- Sinusitis
- Mucous Retention Pseudocyst
Fibrous Dysplasia
Radiopaque Non-Odontogenic Lesions
- Non-neoplastic developmental disturbance of bone growth
- Bone ⇒ Fibrous tissue
- GNAS gene
- Severity of disease depends on stage of development that mutation occurred
-
Mutation happening later but before 20yo = monostotic b/c only one bone is affected genetically
- Most common
-
Mutation happening earlier in life = polyostotic b/c many bones are affected
- Skin and bone
-
Mutation happening later but before 20yo = monostotic b/c only one bone is affected genetically
- Stops growing when bones do and then we can recontour back to normal
Two types of Fibrous Dysplasia
Radiopaque Non-Odontogenic Lesions
-
Monostotic: Only one bone
- Begins in 1st & 2nd decades of life - always before 20yo
- More common than PFD
- Involvement of MN leads to expanion of both buccal & lingual plates
-
Polyostotic: Multiple bones
- Begins early in life
- Systemic features
- Very rare
-
Jaffe Syndrome
- Involves fewer bones
- Cafe-au-lait melanotic macules
-
McCune-Albright Syndrome
- Involves most of the skeleton
- Endocrine abnormalities; precocious puberty in females
- Cafe-au-lait macules
Fibrous Dysplasia: Microscopic Features
Radiopaque Non-Odontogenic Lesions
- Features of fibro-osseous lesion: Fibrous CT and trabeculae of bone
- Can’t be separated from Ossifying (Cementifying) Fibroma on basis of microscopic features
Fibrous Dysplasia: Tx
Radiopaque Non-Odontogenic Lesions
- Dx requires clinical & radiographic information
- Bony contouring after lesion stops growing - if it is a cosmetic problem
- Usually stops growing when bones stop growing
- Good px
- Lesions should NOT be irradiated bc it might cause malignant transformation
Idiopathic Osteosclerosis
Radiopaque Non-Odontogenic Lesions
- AKA Dense Bone Island, Enostosis, Bone Whorl
- Intraosseous counterpart to exostosis/tori
- Focal area of increased radiodensity
- Bone thicker and denser and we don’t know why
- Very common
Other names for Idiopathic Osteosclerosis
Radiopaque Non-Odontogenic Lesions
- Dense Bone Island
- Bone Whorl
- Enostosis
Idiopathic Osteosclerosis: Dx
Radiopaque Non-Odontogenic Lesions
- Dx can be made w/ rads alone
- Biopsy considered only if there are symptoms, continued growth or cortical expansion
Osteoma
Radiopaque Non-Odontogenic Lesions
-
Benign tumor of bone restricted to craniofacial skeleton
- Composed of mature compact or cancellous bone
- Tori and exostoses are not considered osteomas
- Periosteal: Surface of bone
- Endosteal: Medullary bone
- Osteoma cutis: W/in muscle or dermis
-
Condyle: Osteomas of condyle can lead to a shift in the pt’s occlusion
- Deviation from midline and x-bite
- Youn pts
Osteoma: Rad
Radiopaque Non-Odontogenic Lesions
- Well-circumscribed
- Not really corticated bc so RO
What lesions may small osteomas appear very similar to?
Condensing osteitis
Idiopathic osteosclerosis
Osteoma: Tx
Radiopaque Non-Odontogenic Lesions
- Observe (small & asymptomatic)
- Surgery (symptomatic & deforming)
- Lesions causing symptoms or deformities are conservatively excised
- Small lesions can be observed periodically
- Lesions in condyle usually require removal
- Paranasal lesions may req excision if symptomatic
- Entirely benign
Mucositis/Sinusitis
Radiopaque Non-Odontogenic Lesions
- Inflammatory disease of the sinus
- Epithelium thickens bc it is inflamed and then we can see it radiographically
- Generally follows contour of the floor
-
Mucositis: Regional; Focal in one sinus
- Inflammation of the sinus lining
- Allergy, irritation, foreign body, trauma
- Typically asymptomatic
- Well defined, non-corticated, RO band of increased radiopacity paralleling the bony wall of the MX sinus
-
Sinusitis: Generalized in both sinuses
- Allergen, bacteria, or virus
- Pain, pressure, swelling over area of sinuses
- May manifest as tooth pain
- May have associated discharge
Mucositis/Sinusitis: Tx
Radiopaque Non-Odontogenic Lesions
- Mucositis: No tx needed
- Sinusitis: Control infection, relieve pain, surgery
Mucous Retention Pseudocyst
Radiopaque Non-Odontogenic Lesions
- Blockage of seromucous glands in sinus mucosa
- Submucosal accumulation of secretions = dome-shaped swelling
- Well-defined, corticated, smooth, dome-shaped, sessile RO mass
- Asymptomatic
- No tx necessary
What are Mixed Non-Odontogenic Lesions?
- Cemento-osseous Dysplasia
- Central Ossifying Fibroma
What are RO Non-Odontogenic Lesions?
- Fibrous Dysplasia
- Idiopathic Osteosclerosis
- Osteoma
- Mucositis/Sinusitis
- Mucous Retention Pseudocyst
