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Oral Path 2 > Non-Odontogenic Poorly Defined Entities > Flashcards

Non-Odontogenic Poorly Defined Entities Flashcards

1
Q

Inflammatory Lesions of Bone - WIDESPREAD

A

Non-Odontogenic Poorly Defined Entities

  • Often (but not always) has poorly defined borders
  • Pain is variable
  • Often, not always surrounded by sclerotic bone
  • May appear “moth eaten”
    • Irregular patches of osteolysis surrounded by denser sclerotic bone
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2
Q

Bone healing

A

Non-Odontogenic Poorly Defined Entities

  • Initial clot replaced by granulation tissue & woven bone
  • Basic multicellular unit (BMU) = Group of osteoclasts, osteoblasts, local vascular supply
    • BMUs perform final remodeling of bone
  • Osteoclasts: Critical for signaling, resorption, and lamellar bone deposition & angiogenesis
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3
Q

Malignant Neoplasms of Bone

A

Non-Odontogenic Poorly Defined Entities

  • Poorly defined; destroys anatomical structures
  • Most common malignant neoplasm of jaw: Metastatic carcinoma
    • Does NOT originate from jaw; Originates from systemic source
    • Most common malignancy of jaw arising from jaw: Osteosarcoma
  • Mainly middle-aged or older pts
  • Lymp nodes if palpable are hard, nontender, fixed
  • May present as toothache
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4
Q

What is the most common malignant neoplasm of the jaw arising from systemic sources?

A

Metastatic carcinoma

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5
Q

What is the most common malignant neoplasm arising from the jaw?

A

Osteosarcoma

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6
Q

What is the most common form of cancer involving the skeleton in general and jaws in particular?

A

Metastatic carcinoma

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7
Q

Osteoradionecrosis

A

Non-Odontogenic Poorly Defined Inflammatory Lesions

  • Chronic infection of bone
  • Follows high dose radiation therapy to bone, usually tx for malignant neoplasms
    • >75 gray - Significant incidence of osteoradionecrosis
    • <60 gray - Minimal risk
  • Characterized by pain, necrosis, sequestration
  • More common in MN bc less vasculature there compared to MX, dentulous pts
  • Often in the first 2yr after radiation therapy
  • Diffuse infection causes necrosis of bone, periosteum, overlying mucosa
  • Long term will develop sequestrum
  • Extremely painful
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8
Q

Osteoradionecrosis: Predisposing factors

A

Non-Odontogenic Poorly Defined Inflammatory Lesions

  • Post-radiation extractions
  • Periodontal disease
  • Irradiation of surgical site before healing has occurred
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9
Q

Osteoradionecrosis: Pathogenesis

A

Non-Odontogenic Poorly Defined Inflammatory Lesions

  • Thickening of BVs
  • Destruction of osteoblasts/osteocytes
  • Absence of bone formation
  • Trauma or infection
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10
Q

Osteoradionecrosis: Prevention

A

Non-Odontogenic Poorly Defined Inflammatory Lesions

  • Prevention is easier than tx
  • Extraction of diseased teeth in tx field prior to radiation
  • Adequate time for surgical site to heal
  • Meticulous OH
  • Fluoride supps
  • Do not construct dental prosthesis immediately after radiation therapy
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11
Q

Osteoradionecrosis: Tx

A

Non-Odontogenic Poorly Defined Inflammatory Lesions

  • Abx
  • Surgical removal of sequestrae
  • Hyperbaric O2
  • Radical surgical resection
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12
Q

Osteoradionecrosis: Complications

A

Non-Odontogenic Poorly Defined Inflammatory Lesions

  • Bone deformity and pathologic fracture
  • Orocutaneous fistulas
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13
Q

Medication-Related Osteonecrosis of Jaws (MRONJ)

A

Non-Odontogenic Poorly Defined Inflammatory Lesions

  • Antiresorptive agent
    • Denossumab: Monoclonal ab that prevents osteoclastic maturation
    • Used as anti-neoplastic medication or for osteoporosis
  • Antiangiogenic agents
    • Attempt to decrease blood supply to malignancy
    • Tyrosine kinase inhibitors or vascular endothelial inhibitor
  • ​BRONJ: Bisphosphonate-related osteonecrosis of jaw
    • IV - cancer
      • More likely to cause ONJ
    • PO - osteoporosis
  • ARONJ: Antiresorptive-related osteonecrosis of the jaw
  • MROJ: Medication-related osteonecrosis of the jaw
  • Painful
  • Occurs more often in the MN
    • Lingual side of MN in molar areas
  • Most commonly occurs post-extraction
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14
Q

MRONJ: Rads

A

Non-Odontogenic Poorly Defined Inflammatory Lesions

  • IO shows single or multifocal areas of exposed necrotic bone
  • Rads may show increased RO prior to necrosis
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15
Q

MRONJ: Tx

A

Non-Odontogenic Poorly Defined Inflammatory Lesions

  • Best approach is prevention
  • Improve dental health before future procedures
  • Never take them off bisphosphonates bc they are getting tx’d for cancer or to prevent broken hip and stuff
  • 1/2 life of bisphosphonate is 12yr so even if you take them off, it’s in their system for awhile
  • Eliminate/minimize pain
  • Aggressive removal of necrotic bone results in further necrosis
  • Symptomatic: Systemic abx. chlorhexidine
  • Asymptomatic: Only chlorhexidine
  • Exposed bone smoothed and loose sequestra removed carefully
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16
Q

What else would you include in a differential w/ MRONJ?

A

Non-Odontogenic Poorly Defined Inflammatory Lesions

  • Osteomyelitis
  • Radiation induced osteonecrosis
  • Medication related osteonecrosis of jaw
  • Consider malignancies and metastatic disease
17
Q

Non-Odontogenic Poorly Defined Malignancies, Arise Primary in Jaws

A
  • Osteosarcoma
  • Chondrosarcoma
  • Ewings Sarcoma
  • Multiple myeloma
  • Metastasis to the oral cavity
18
Q

Osteosarcoma

A

Non-Odontogenic Poorly Defined Malignancies, Arise Primary in Jaws

  • Swelling of bone
  • Pain, toothache
  • Paresthesia
  • Loose or displaced teeth
  • Ulceration
  • Increased incidence of osteosarcoma in Paget’s disease of bone
  • Osteoid production by malignant cells
  • Normally older pts
19
Q

Osteosarcoma: Rad

A

Non-Odontogenic Poorly Defined Malignancies, Arise Primary in Jaws

  • RL, RO, or mixed
  • ​Poorly defined margins
  • “Sun Ray”/Sunburst Pattern: Bony trabeculae radiating from periosteum. Present in 25% of cases and NOT unique to osteosarcoma
  • Early feature may be localized symmetrical widening of PDL space or MN canal
  • Periphery of lesion is usually ill-defined
20
Q

Osteosarcoma: Tx

A

Non-Odontogenic Poorly Defined Malignancies, Arise Primary in Jaws

  • Radical surgery, usually supplemented by chemotherapy
  • MN lesions have better px than MX lesions
  • Px is improving but still not good
21
Q

Chondrosarcoma

A

Non-Odontogenic Poorly Defined Malignancies, Arise Primary in Jaws

  • Cancer characterized by formation of cartilage by the tumor
  • About half as common as osteosarcomas
  • Sometimes relatively slowly growing
  • Normally older pts
22
Q

Chondrosarcoma: Microscopic features

A

Non-Odontogenic Poorly Defined Malignancies, Arise Primary in Jaws

  • Abnormal chondroblasts and cartilage
  • May be difficult to distinguish from chondrosarcoma
23
Q

Chondrosarcoma: Rad

A

Non-Odontogenic Poorly Defined Malignancies, Arise Primary in Jaws

  • RL, RO, mixed
  • Poorly defined margins
24
Q

Chondrosarcoma: Tx

A

Non-Odontogenic Poorly Defined Malignancies, Arise Primary in Jaws

  • Radical surgery
  • Less likely to metastasize compared to osteosarcoma
25
Q

Ewing Sarcoma

A

Non-Odontogenic Poorly Defined Malignancies, Arise Primary in Jaws

  • Malignant tumor of bone
  • Cells of neuroectodermal origin
  • 3rd most common osseous malignant tumor
  • 80-95% of cases - 11;22 translocation
  • Mainly in children and young adults
    • ​Always <20yo - peak age 10-20yo
  • Early s/s: Pain & swelling
26
Q

Ewing Sarcoma: Rad

A

Non-Odontogenic Poorly Defined Malignancies, Arise Primary in Jaws

  • Diffuse poorly defined RL lesion
  • “Onion peel” appearance: May stimulate periosteum to produced layers of new bone; seen in numerous malignant and inflammatory diseases
27
Q

Ewing Sarcoma: Tx

A

Non-Odontogenic Poorly Defined Malignancies, Arise Primary in Jaws

  • 40-80% survival rates
  • Metastasis is frequent
28
Q

Multiple Myeloma

A

Non-Odontogenic Poorly Defined Malignancies, Arise Primary in Jaws

  • Characterized by multiple tumors of plasma cells scattered throughout skeleton and sometimes ST
  • Lesions most common in axial skeleton: Vertebrae, ribs, skull, pelvis
  • Rare before 40yo​
    • Does NOT occur before 40yo
  • Bone pain, esp in back, is most common presenting manifestation
  • Pathological fractures
  • Fatigue (anemia)
  • Fever (neutropenia)
  • Neoplastic plasma cells produce high levels of monoclonal Igs in immunoelectrophoresis
  • Hypercalcemia and renal disease might occur
  • M-protein (Bence Jones protein) may be deposited in tongue, gingiva, salivary glands, skin
29
Q

Multiple Myeloma: Rad

A

Non-Odontogenic Poorly Defined Malignancies, Arise Primary in Jaws

  • Multiple punched out RL lesions w/o corticated borders, most commonly in jaws, skulls, vertebrae
30
Q

Multiple Myeloma: Tx

A

Non-Odontogenic Poorly Defined Malignancies, Arise Primary in Jaws

  • Chemotherapy is used for management
  • Poor px
31
Q

Metastasis to the Oral Cavity

A

Non-Odontogenic Poorly Defined Malignancies, Arise Primary in Jaws

  • Only 1% of all oral ST and jaw cancers
  • Malignant neoplasms metastasize to bone more often than ST
  • Metastatic neoplasms are the most common malignant tumors IN the jaw
  • 5th-7th decades of life
  • MN more common than MX
  • Molar area of MN is most common site
  • Early manifestation:
    • May be asymptomatic and detected upon routine rad exam
  • Swelling, expansion, perforation of cortical plate
  • Pain, paresthesia
  • Tootache, increased tooth mobility
  • Failure of extraction site to heal = worrisome
32
Q

What is the most common malingant tumor IN the jaw?

A

Metastatic neoplasms

33
Q

Metastasis to the Oral Cavity: Rad

A

Non-Odontogenic Poorly Defined Malignancies, Arise Primary in Jaws

  • May be localized but w/o corticated borders
  • Poorly defined w/ irregular margins
  • Multiple, separate foci
  • Occasionally RO: breast, prostate
34
Q

Most common locations for metastasis to oral cavity

A

Non-Odontogenic Poorly Defined Malignancies, Arise Primary in Jaws

  • Gingiva & tongue
  • Early lesions can look benign
  • Later lesions can look clinically aggressive
  • ST tumors of gingiva may be arising from underlying bone
35
Q

Non-Odontogenic Poorly Defined Inflammatory Lesions

A
  • Osteoradionecrosis
  • Medication Related Osteonecrosis of the Jaw
36
Q

What are Non-Odontogenic Poorly Defined Malignancies that arise Primary in the jaws?

A
  • Osteosarcoma
  • Chondrosarcoma
  • Ewings Sarcoma
  • Multiple Myeloma
  • Metastasis to the Oral Cavity

Oral Path 2 (11 decks)

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