Oral Path: Bone Lesions Flashcards
Central Giant Cell Granuloma (CGCG)
Anterior Mandible mostly
Composed of:
* Fibroblasts
* Multinucleated Giant cells
Types:
Central (CGCG):
* Bone
* RL w/thin wipsy septations
Peripheral:
* Soft tissue
* Red-purple gingival Mass
Tx: Excision
Aneurysmal Bone Cyst
Pseudocyst w/ blood-filled spaces
Posterior Mandible
* Multilocular Radiolucency:
* Expansile
Tx: Fine Needle Aspiration 1st (Blood=Confirms Dx)
* Excision
Hyperparathyroidism
Multiple bone lesions that look like CGCG’s
* due to Excessive PTH Levels
Brown Tumor:
* Excess osteoclast activity–> Elevated Alkaline Phosphate
Cherubism
Clinical: Symmetrical Bilateral Swelling
Radiographically:
* expansile bilateral multilocular RL
Stops growing after puberty
Langerhans Cell Disease
Aka Idiopathic Histiocytosis
Rare Cancer
Langerhan cells (Histiocytes):
* normally found in skin as antigen-presenting cells
* Cause damage if buildup in body
Punched out “Ice cream scoop” radiolucencies
* lead to floating teeth
Paget’s Disease
Progressive Metabolic Disturbance of many bones (Spine, femur, skull, jaws)
* Causes symmetric enlargement
Cotton Wool Appearance
Adults > 50
* Increased Bone Breakdown=Elevated alkaline phosphate
* Denture & hats become too tight
Associated with:** hypercementosis**
Tx: Bisphosphonates & Calcitonin
Central Ossifying Fibroma
Fibroblastic Stroma: form foci of mineralized products
* Similar in appearance & Behaviour to cementifying fibroma (Odontogenic tumor)
3 types:
Central:
* Bone
* Well circumscribed RL w/ossificaotin product in center
Peripheral:
* Soft tissue
* no RL
Juvenile:
* Aggressive variant
* rapid growth
* younger pts
Fibrous Dysplasia
Ground Glass Appearance
* Fiberglass–> Fibrous Glass
Stops growing after puberty
Periapical Cemento-Osseous Dysplasia (PCOD)
Reactive Process
* Unknown Origin
Most common:
* apices of mandibular anteriors
* Middled aged black females
* Vital Teeth
Starts RL–>progress to RO (w/RL halo) as it matures
Osteoblastoma
Circumscribed opaque mass of bone & Osteoblasts
Acute Osteomyelitis
Cause:
* Odontogenic Infection
* Trauma
Infection/inflammation:
* Starts in the medullary space involving cancellous bone
* spreads to cortical bone, periosteum, soft tissues
Symptoms:
* Deep intense pain
* high or intermittent fever
* Paresthesia or anesthesia of IAN
* Tooth is not loose (This is caused by periodontitis)
Tx: Antibiotics
Cardinal Signs of Systemic Infection
FML!
Fever
Malaise
Lymphadenopathy
Chronic Osteomyelitis
Diffuse Mottled Radiolucency
Garre’s Osteomyelitis:
* Chronic Osteomyelitis w/proliferative periosteitis (onion skin)
Tx: ANtibiotics & debridement of infected area
Focal Sclerosing Osteomyelitis
Aka Condensing Osteitis
Bone sclerosis
*resulting from low-grade inflammation (like chronic pulpitis)
Tx: None, address cause of inflammation
Diffuse Sclerosing Osteomyelitis
Same as Focal, BUT wider scale
* may lead to Jaw fracture
Bone Sclerosis:
* resulting from low-grade inflammation (like chronic pulpitis)
Osteosarcoma
Sarcoma of the jaw
* new bone is produced by tumor cells
Sunburst Pattern of radiopacity
Tx: Resection & Chemo
Bisphosphonate Related Osteonecrosis of the Jaws (BRONJ)
Greater risk w/IV Bisphosphonates than oral
5 yr survival rate: 25-40% (Pretty deadly)
Jaw Pain
* exposed necrotic bone
Tx: CHX rinse, antibiotics, conservative sx
Chondrosarcoma
Sarcoma of the jaws
* New CARTILAGE is produced by tumor cells
* Same presentation & Tx as osteosarcoma
COndyle
*. Due to cartilage origin
Ewing’s Sarcoma
Sarcoma of Long bones involving “Round cells”
Children
* rarely affects the jaw
* swelling
Moth Eaten or Onion skinning
Metastatic Carcinoma
Breast > Lung > Kidney > Kidney > Prostate
