Oral Path VI - GMFF Flashcards by Tim Agee

Term used to describe host of Genetic Diseases including OI, Osteoporosis, Cleidocranial dysplasia, cherubism, hypophosphatasi, vitD resistant Rickets

Metabolic diseases like Rickets, osteomalcia, hyperparathyroidism, renal osteodystrophy

Others: Pagets, fibrous dysplasia, aneurysmal bone cyst, idopathic osteosclerosis, focal osteoprotic bone marrow defect, MRONJ

Osteodystrophy

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What is the most common inherited bone disease?

Osteogenesis Imperfecta

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OI is a mutation is what type collagen?

either this gene on this chromosome:

or this gene on this chromosome:

Collagen type I

COL1A1, Chromosome 17

COL1A2, Chromosome 7

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OI, includes bone fragility/deformity, joint ________, loss of ________, blue _____

______ teeth if dentinogenesis imperfecta

hyperextensibility, hearing, sclera

opalescent

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OI type I-IV inherited how?

Autosomal Dominant or Recessive

*severity varies

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Abnormal collagen in OI results in bone with thin ______

Osteoporosis, soft, prone to fracture, bowing, angulation, deformity

Cortex

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OI Tx: Physiotherapy, Ortho surgery, and what drugs?

Bisphosphonates (either IV or oral)

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Long term use in Bisphosphonates for pedo pts with OI is unknown

True

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Marble Bone Disease:

Osteoporosis

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Osteoporosis (marble bone disease) is a defect in _______ function

Mutation in the _____ subunit of the osteoclast vacuolar proton pump (50-60%)

More severe form is a mutation in the _______ (CLCN7, 10-15%)

osteoclast

Chloride

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Infantile osteoporosis inherited how?

Adult osteoporosis inherited how?

Autosomal Recessive

Auto Dominant

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Infantile Osteoporosis (AutoRecessive) is severe, sclerotic, ______ failure, _____ deformity, and _______ deficit

Adult osteoporosis (AutoDom) is mild and __% asymptomatic

Marrow, Facial, Neuro

40%

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In osteoporosis bones are more dense, but more fragile

True

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Osteoporosis dental considerations: 2 complications post extraction?

Fracture

Osteomyelitis

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Infantile Osteoporosis the prognosis is ______

Adult has ______ prognosis,

Tx (adult) is _______

poor

variable

marrow

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Cleidocranial dysplasia is genetic and a defect in the differentiation of _______ and a subset of _______

osteoblasts

chondrocytes

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Defect in osteoblasts and a subset of chondrocytes

Cleidocranial Dysplasia

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Cleidocranial dysplasia inheritance is:

or:

Specifically a mutation on the _____ gene of chr ____

AutoDom

Somatic mutation

RUNX2, 6p21

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Short stature, frontal bossing, patent fontanels, late closure of cranial sutures, absence/hypoplasia of clavicles:

Cleidocranial Dysplasia

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Cleidocranial Dysplasia - describe 3 aspects affect teeth:

Deciduous retention

Delayed eruption permanent teeth

Supernumerary

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Prognosis, Cleidocranial dysplasia:

Plan dental Tx on clinical findings

good

True

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Cherubism inheritance:

chr ______

or…

AutoDom

4p16

spontaneous

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Cherubism Mn manifestations:

Mx manifestations:

bilateral posterior painless swelling

swelling pushes orbits up, rounds face

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Avg age Cherubism:

Radiographic

Mn multilocular, bilateral, posterior lucencies w/ Mx involvement

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Cherubism histopathology is a _____ cell lesion aka... Post pubertal

giant granuloma stabilization

Mutations of non-specific alkaline phosphatase:

Hypophosphatasia

Hypophosphatasia is _______ expressive (auto dom/rec) Reduced levels of _____ in liver, bone, kidney, intestine, serum Increased levels of blood/urinary _______ Bone abnormalities similar to ________ Premature loss of Teeth due to lack of _______

variably ALP (alkaline phosphatase) phospho-athanolamine Rickets Cementum

Vitamin D resistant Rickets, aka

Hereditary hypophosphatemia

Vitamin D-resistant Rickets (hereditary hypophosphatemia) varies in severity, but is inherited how? Mutation on the ______ gene, which regulated ____ This causes decreased resorption of phosphate from ________ and decreased intestinal absorption of ______

X-linked Dominant PHEX, PO4 Renal Tubules, Calcium

VitaminD-resistant Rickets, manifests as shortened ______ Pulp horns extend into ______ Dentin ____ Periapical ______

Lower body DEJ cleft abscess

Metabolic diseases associated w/ VitaminD-resistant Rickets: Rickets and _______ Hyperparathyroidism and _______

Osteomalacia Osteodystrophy

What causes good ol fashioned Rickets? Causes growth retardation, prominence of _________, and _______ of the legs

VitD deficiency during Infancy costochondra junctions (rachitic rosary), bowing

In adulthood, Vitamin D deficiency (instead of Rickets), causes... 3 manifestations:

Osteomalacia weak bone, fractures, diffuse skeletal pain

Primary Hyperparathyroidism is caused by _______ (80-90%) or ________ in pts over 60 y/o more often found in what sex?

parathyroid adenoma hyperplasia female

Secondary Hyperparathyroidism is secondary to chronic _______ which causes malabsorption of ________ and ______

Renal disease Vitamin D by kidney, Calcium in intestine *increases PTH to get Ca out of bone

Stones, bones, and abdominal groans...

Hyperparathyroidism

Hyperparathyroidism, supperiosteal resorption seen where? Loss of the ______ Trabecular pattern of _______ Brown tumor ________ Renal _______

phalanges of fingers lamina dura Ground Glass radiolucency osteodystrophy (secondary hyperparathyroidism)

Hyperparathyroidism, ulcers seen where? Histo of brown tumor indistinguishable from what? Complication of secondary hyperparathyroidism is ESRD Enlargment seen where?

Duodenum Giant cell granuloma True Jaws

Ground Glass Pattern, Fibro-osseous lesions

Hyperparathyroidism

Accelerated resorption and deposition of bone. Osteoblasts win and bones become sclerotic, large, and brittle

Paget's disease of bone

Paget's disease disproportionally affects what population: Can be bone pain, weakened bone, or asymptomatic

white, male, over 40 True

Paget's is caused by a ______ infection and a predisposing _____ factor

Paramyxovirus Genetic

Well defined Radiolucency, mixed lucency/opacity, cotton wool-like radiolucency Generalized hypercementosis

Paget's

Paget's Histology depends on the stages

True

Dx Pagets, alkaline phosphatase Calcium Urinary hydroxyproline

increased same increased

2 complications of Paget's

fracture malignant transformation

Fibrous Dysplasia is a ____ zygotic mutation of _______ gene 20q13.2 guanine nucleotide-binding protein, alpha stimulating activity polypeptide This encodes for the _______ subunit that activates _______ and ______ Affects the differentiation of pre________ Bones replaced with what?

post-zygotic, GNSA1 True G protein, adenylyl cyclase, cAMP osteoblasts Fibrous tissue (immature bone)

% Fibrous Dysplasia involving only 1 bone (monostotic): Polystotic w/ cafe au lait spots: Polystotic w/ cafe au lait + endocrinopathy:

80-85% Jaffe-Lichtenstein Syndrome McCune-Albright Syndrome

Fibrous dysplasia usually seen at what age? Males or Females? Long bone problem: Craniofacial involved in _____ and may compress vital structures like the ______ nerve and result in Blindness

1-2 decades = pain/fracture 1/3, Optic Nerve

McCune-Albright Syndrome is a type of what? Somatic mosaicism accounts for ______ Increases endocrine function in what 2 places? Sexually precocious girls, cafe au lait w/in 1st 2 yrs Craniofacially involved in _____ , morbidity associated w/ GH

Fibrous Dysplasia clinical diversity gonads, thyroid True 1/4

Lesion of of Fibrous Dysplasia described as: Margins: Cortical: Cortical rxn:

Ground Glass Opacity Blend Expansion Absent

Chinese script writing bone pattern

Fibrous Dysplasia "fibro-osseous lesion"

Tx Fibrous Dysplasia: Stabilized with... If small and localized: If larger: If disfiguring: Bisphosphonates when: ________ Contraindiated

individualized Maturity Excise recontour resect symptomatic polystotic Radiation

Use Radiation with Fibrous Dysplasia

False *contraindicated

Giant Cell Granuloma found more often in what sex? at what age? characteristic appearance in in Arch?

female prior age 30 Anterior jaws, crosses midline

Giant Cell Granuloma can be aggressive or non-aggressive *differing symptoms, growth, cortical expansion, root resorption

True

Giant Cell Granuloma radiograph: Margins: might have cortical perforation/root resporption

unilocular/multilocular radiolucency noncorticated True

Giant Cell Granuloma Tx: Recurrence: (higher w/ aggressive) Alt Tx:

Surgical 15-20% steroids, calcitonin, interferon

Intraosseous accumulation of variable sized, blood-filled spaced surrounded by Fibrous Tissue and Giant Cells

Aneurysmal bone cyst

Aneurysmal bone cyst most found mostly in what 2 bones? ___% in the jaws More often at what age? symptoms:

long bones, vertebrae 2% children/young rapid swelling/pain

Aneurysmal bone cyst radiograph: Cortex: Can aspirate blood from space Tx is curretage/resection and variable recurrence

unilocular/multilocular RL thin/perforated True True

Idiopathic Osteosclerosis increased in what 3 ethnicities: gender: 90% found where? 80% contact tooth _____

Blacks, Chinese, Japs no preference Mn1M Root

Idiopathic Osteosclerosis is very painful

False *no pain, expansion

Idiopathic Osteosclerosis is easily confused w/ what? Except that...

Condensing Osteitis Tooth vital

Well defined radiopacity, symmetric No radiolucent halo but blends 80% contacts tooth root Occasional root resorption

Idiopathic Osteosclerosis

Idiopathic Osteosclerosis study: ___% stable % smaller % larger

86% 10% 4%

Focal Ostoporotic Bone Marrow Defect: an asymptomatic ________ lesion w/ internal trabeculation commonly found in what demographic? Orally, Often found at site of previous ______ 70% found where? After Dx by incisional biopsy, no Tx

radiolucent middle aged females extraction Posterior Mn True

Bone inflammation (strictly)

Osteomyeliltis

6 types of clinically distinguishable Osteomyelitis

Acute Chronic Focal sclerosing (Condensing Osteitis) Diffuse sclerosing w/ proliferative periostitis (Garre's) Alveolar (Dry socket)

Acute Osteomyelitis duration: 3 systemic symptoms: _____ drainage may be seen May cause nerve _______

short, less than 1 month fever, lymph swelling, elevated WBC Purulent parasthesia

Acute Osteomyelitis, as infection progresses, radiographically seen as... primary Tx: secondary Tx if does not occur spontaneously:

asymmetric radiolucency Abx!!! Surgical drainage

Long duration, variable pain, not consistently sharp pain Tooth loss in area of involvement

Chronic Osteomyelitis

Chronic Osteomyelitis, Radiographic features: Tx:

Ill-defined, assymetric, radiopacity Debride, Abx (long duration/IV)

Generally considered rxn of periapical bone to low grade odontogenic infection: This inflammation (if immune competent) can result in what? Tooth vital?

Chronic Focal Sclerosing Osteomyelitis (Condensing Osteitis) Sclerosing Non-vital

Chronic Focal Sclerosing Osteomyelitis (Condensing Osteitis): radiographically it is irregular _______, asymmetric and often ______ with surrounding bone Tx: 85% of the area (after odontogenic infection addressed) does what?

opacity, blends RCT/extract remodels

Controversial bony condition often confused w/ other pathologic conditions, particularly cemto-osseous dysplasia which frequently becomes secondarily infected

Chronic Diffuse Sclerosing Osteomyelitis

Chronic Diffuse Sclerosing Osteomyelitis is considered a rxn to low grade _______, often following _______

odontogenic infection trauma/surgery

Chronic Diffuse Sclerosing Osteomyelitis is like focal but affects large area of bone in one quadrant Characteristically affects where? Diffuse radiopacity of varying _______ Tx: Abx not effective why?

True Posterior Mn density eliminate infection, monitor hypovascularized sclerotic bone

Chronic Osteomyelitis w/ Proliferative Periostitis, aka... ______ grade osteomyelitis Immune status? Age? Inflammation involves what?

Garre's Osteomyelitis low competent young periosteum

Chronic Osteomyelitis w/ Proliferative Periostitis occurs near cortical surface and there is presence of what? Periosteal inflammation stimulates what? What arch most affected? Clinically presents as...

Draining sinus tract bone production Mn bony hard swelling

Chronic Osteomyelitis w/ Proliferative Periostitis: lays down ______ bone (inflammatory rxn) Thin cortical layering produces what pattern? Layered bone is weakly ______ (less dense than cortical) Often requires ______ films to visualize

immature onion skin opaque occlusal

Chronic Osteomyelitis w/ Proliferative Periostitis Tx: Abx work? Remodeling occurs over time so _____ not necessary

RCT/Extract don't alter process Surgical recontouring

Dry Socket:

Alveolar Osteitis

Alveolar Osteitis (Dry Socket) is a post extraction complication usually found in what tooth? Increases chance for infection, more common in ______, associated with ______ pills Caused by a breakdown of the ______ in the socket Occurs _____ days following extraction Produces pain/odor, Tx by packing socket w/ protective...

Mn 3M Females, birth control clot 3-4 days dressing

BRONJ (MRONJ, etc) cause is drugs like Denosumab inhibiting the action of what cell? Half life is 12 yrs or greater Also affects angiogenesis/osteoblasts

Osteoclasts True True

Drug to Tx malignancy, hypercalcemia, multiple myeloma, metastatic disease (breast/prostate), Paget's

Bisphosphonates

BRONJ occurs ____% in pts cancer/IV Tx: __% cases in pts w/ myeloma/metastatic breast cancer __% cases in pts on Oral Tx

6-10% 85% 4%

The presence of Nitrogen and IV delivery increases chance of BRONJ

True

% of BRONJ induced by surgical procedures Can occur spontaneously, be progressive, difficult to control, or not heal

60% True

Tx for BRONJ (aside from prevention) Wide ____ not recommended

Abx mouth rinses, debridement, Hyperbaric Oxygen excision

Cemento-Osseous dysplasias are not 3 things

Inflammatory in origin Neoplastic Genetic

Cemeto-Osseous Dysplasias might be PDL progenitor cell defect that causes changes to remodel bone/cementum

True

3 Cemento-Osseous Dysplasias:

Periapical cemento-osseous dysplasia Florid COD Focal COD

Which Cemento-osseous dysplasio do you NOT do RCT on?

Periapical *teeth are vital

Periapical Cemento-osseous Dysplasia demographic: Affects where in the arch? No expansion, painless, and the teeth are ______

Female, Black, Middle aged (30-45 yrs) anterior Mn Vital

Periapical Cemento-osseous Dysplasia initial radiographic presentation: Progress to opacification where? Late stages are opaque w/ lucent rim and can fuse to ______

lucent central roots

Periapical Cemento-osseous Dysplasia Tx:

none do not RCT

Periapical Cemento-osseous Dysplasia can mature from lucent to opaque w/ stabilization and can regress at any state

True

Florid Cemento-Osseous Dysplasia demographics: Posteriorly affect where? Anteriorly where?

Middle aged, Black, Female multiple quadrants Mn

Florid Cemento-Osseous Dysplasia radiographic: ______ architecture Tx: is preventive against infection, but if infected may need to...

lucent/mixed/opaque rounded/lobular sequestrate large portions of bone

Focal Cemento-Osseous Dysplasia demographics: Primary site (arch/tooth): Commonly found in _____ areas

Slightly white, female, wide age range Mn - PM/1M Edentulous

Focal Cemento-Osseous Dysplasia - radiographic: Architecture: Generally smaller than ______ form (rarely larger than 1.5cm) Opaque lesion w/ _____ Tx:

lucent/mixed/opaque rounded/lobular florid halo lucency none (monitor for change)

Langerhan's Cell Histiocytosis, aka... Rarely seen at what age? 50% pts under ____ y/o Bone and soft tissues affected

Histiocytosis X older 10 True

Langerhan's Cell Histiocytosis classic radiographic presentation: Acute Disseminated: Chronic Disseminated: Chronic Localized:

Teeth floating in air Letterer-Siwe Disease Hand-Schuler-Christian Eosinophilic Granuloma

Which form of Langerhan's Cell Histiocytosis is found in infants (under 2) and always fatal? Which has slower progression (age 3-10) and better prognosis? Which affects teens/young adults with good prognosis?

Letterer-Siwe Hand-Schuler-Christian Eosinophilic granuloma

Langerhan's Cell Histiocytosis presents orally where? How? Loss of ______ Dx: Tx:

Jaw Teeth floating in air Lamina Dura biopsy, Langerhan proliferation Curettage, low dose Radiation

Prior cancer (usually SCC), radiation permanently damages bone by destroying BV, severe pain

Osteoradionecrosis

Osteoradionecrosis will not heal w/o ______ intervention Tx: (3 steps)

surgical Hyperbaric Oxygen, bone resection, soft tissue closure

Traumatic Bone Cyst (simple bone cyst): radio_____ w/ ______ btwn roots (which is a classic finding) Age affected: Asymptomatic, non-expansile, found in what arch? Hx of trauma may or may not be present

lucent, scallops young (2nd decade) Mn True

Traumatic Bone Cyst surgical finding is an empty hole in the bone with tinged fluid, entry stimulates ______ walls are ______ to produce ______ which results in healing

bleeding curetted, bleeding

4 characteristics of Benign tumors of Bone

Asymptomatic Slowly expands Displaces teeth (expands cortex) Symmetrical

Malignant neoplasms of bone, 4 characteristics:

Symptomatic Invasive Asymmetrical Destroys cortex, ragged borders

4 Benign tumors of Bone origin:

Exostoses Osteoma Osteoid osteoma Osteoblastoma

3 Benign tumors of Cartilaginous origin:

Chondroma Chondromyxoid fibroma Benign chondroblastoma

A benign tumor of Fibrous origin:

Desmoplastic fibroma

2 malignant tumors of bone origin: 1 cartilaginous origin: 2 marrow in origin:

Ostiosarcoma, osteogenic sarcoma chondrosarcoma Ewing's Sarcoma, Multiple Myeloma

A localized proliferation of bone that arises from the cortical plate (minimal/no medullary bone involvement)

Exostosis

Exostosis (cortical benign bone tumor) can be single or multiple, have sporadic sites, or what 2 specific oral locations?

Torus palatinus Torus mandibularis

An Exostosis is most commonly seen where orally? Often bilateral, and the this overlying mucosa may ______ easily

Buccal of Mx or Mn alveolar ridge ulcerate

Torus Palatinus always located where? May ulcerate easily, wide variation in size, multifactorial, asymptomatic

Midline Hard Palate True

Torus Mandibularis located in the ______ area of the Mn ___% are Bilateral

Lingual PM area 90%

A localized proliferation of bone

Osteoma

Osteoma may be indistinguishable from what? Involves what type of bone? Almost exclusively found in the ______ skeleton, with a predilection for the ______ May be a manifestation of _______ Syndrome

Tori Medullary and Cortical craniofacial, sinuses Gardner's

Gardner's Syndrome inherited how? Clinically, there are multiple _______ In the Jaws, found mainly where? In the rest of the head, seen where?

AutoDom osteomas angle Frontal bone, frontal sinus, ethmoid sinus

Gardner's Syndrome (AutoDom) oral manifests as ______ teeth Multiple ______ cysts _____ tumors What associated sign has a 100% incidence of malignant transformation?

Supernumerary Epidermoid Desmoid Adenomatous polyps of Colon/Rectum

A True Neoplasm of Bone (there are 2)

Osteoid Osteoma Osteoblastoma

Osteoid Osteoma's are rare, representing less than ___% of all bone tumors Affect what sex? What age?

1% 2:1 males less than 30 yrs (85%)

Osteoid Osteoma has classic clinical presentation of ______ pain relieved by _______ and radiograph appearance of what?

Nocturnal, Aspirin Target (opaque bullseye, lucent halo, corticated rim)

Osteoid Osteomas and Osteoblastomas are both rare and less than 1% of all bone tumors

True

Osteoblastomas occur often in the ______ skeleton, and most often in the ______ Age? Gender? Size of lesions

Craniofacial, Mn less than 30 y/o (85%) males, 2:1 usually large, over 2cm

2 ways Osteoblastomas differ in clinical presentation from Osteoid Osteoma

no nocturnal pain not relieved by ASA

Osteoblastoma has large lesions radiographically (over 2cm) that may produce significant expansion and deformity May we well/ill defined

True True

A benign neoplasm of cartilage origin

Chondroma

Chondromas occur at what age? Exceedingly rare in what region? Most diagnosed as chondroma are in fact low grade chondrosarcomas

20-40 Head/Neck True

2 conditions that are exceedingly rare in the jaws:

Chondromyxoid Fibroma Chondroblastoma

Benign locally aggressive fibrous bony neoplasm, bone equivalent of soft tissue fibromatosis (desmoid tumors)

Desmoplastic Fibroma

Desmoplastic Fibroma, common age ___% in the Mn, often in the ______ Mn and ascending _____ Radiographic _______, unilocular/multilocular, well/ill defined borders

children, young adults 85%, Posterior, Ramus lucency

Desmoplastic Fibroma, 2 methods of Tx w/ recurrence rates

Curettage, 70% recurrence Resection, 20% recurrence

A malignant neoplasm of osteoblastic cells

Osteosarcoma

Osteosarcoma produces an osteoid matrix that may or may not _______ The lesions are entirely _______, ______, or ______ This is the most common primary malignancy of bone, ___% occurring in the Jaws

calcify radiolucent, mixed, opaque 7%

Osteosarcoma age: site: Swelling causes pain, loosens teeth, and ______

all ages Mn=Mx Parasthesia/Anesthesia

Osteosarcoma radiographic has a _______ lesion Esp. worrisome are symmetrical widening of the _____ and the Production of _______ and a ______ appearance

ill-defined (blends) PDL alveolar bone above normal crest Suburst (sunray)

A Sunburst appearance is seen in ____% of Osteosarcoma and can only be seen on _____ radiographs

25% Occlusal

An Osteosarcoma arising on the cortical surface rather than in an intramedullary location

Juxtacortical Osteosarcoma

Juxtacortical Osteosarcoma prognosis: 2 subtypes: Tx: Major problem at Tx site:

better Parosteal, Periosteal Radical Ablative Surgery Local recurrence

What improves prognosis of Juxtacortical Osteosarcoma Jaw lesions metastasize less frequently than in ____ bones Overall survival between __-___%

Preoperative chemo long 30-80%

A malignant neoplasm producing cartilage (not bone)

Chondrosarcoma

Chondrosarcoma matrix may show dystrophic maturation/calcification to bone, therefore lesions lucent/mixed/opaque Normal cartilage isn't found in the ______ vestigial remnant found in the ________ and ________

True Jaws Ant Mx, Condyles

Chondrosarcoma age: gender: Swelling loosens teeth, describe pain: Occurs more often in what arch?

wide range, mostly 6-7th decades Slightly more Males painless Mx

Radiographically, Chondrosarcoma lucency level? We're talking cartilage, so its poorly defined and asymmetric Tx: __% metastasize Challenge is what?

lucent/mixed/opaque True Radical Surgical Ablation 12% local recurrence

Why is 5 yr survival not a good indicator for Chondrosarcoma? Newer studies show better/worse prognosis than for Osteosarcoma

Recurrence can take years Better

A Sarcoma of uncertain cell origin, maybe Neuroectodermal

Ewing's Sarcoma

Ewing's Sarcoma, consistent genetic defect is Translocation of ______ Results in ____% of all primary bone tumors over 50% are in the pelvic bones/femur, < ___% occurs in the Jaws

11 and 22 6-10% 3%

Ewing's Sarcoma, age: Ethnicity, Gender Describe pain: Fever, Leukocytosis, elevated ESR

5-30 Caucasion, 3;2 male intermittent, variable True

Radiographically, Ewing's Sarcoma is irregular, asymmetric radiolucency w/ ill-defined borders Typically involves the Cortical bone Characteristic pattern in long bone lesions (not in jaws):

True False Onion Skinning

Historically, the prognosis of Ewing's Sarcoma: Today, Tx with what? Survival?

Terrible surgery, radiation, chemo 40-80%

There are a lot of non-neoplastic salivary gland conditions

True

Developmental lingual Mandibular Salivary Gland depression (Static bone cavity)

Stafne's bone cavity

Stafne's bone cavity signs/symptoms: Radiolucency, often _____, seen where? Tx:

None corticated, below IA canal angle to midbody none

Mucous extravasation phenomenon (traumatic severance of salivary duct, not epithelially lined):

Mucocele

Mucocele is commonly found where? Increased for what age group? Occurs ______, soft and compressible

lower lip, lateral tongue, cheek young rapidly

A mucocele in the floor of the mouth, usually lateral to the midline

Ranula

A plunging (cervical) Ranula dissects through what muscle? Produces swelling where?

Mylohyoid Neck

An Antral Pseudocyst is a type of _______. Shape: Tx:

mucocele Dome none

Salivary Duct Cyst, aka... This is a true ______ lined cyst from a salivary duct Occurs in major/minor glands, can be multiple Most often found in what gland? Bluish or normal - What Tx:

Mucus Retention Cyst epithelial True Parotid Excision

Calcification in the salivary duct of unknown cause

Sialolith

Sialolith most often occurs where? Pain occurs when? Tx:

Submandibular meal time massage, fluids, heat, surgery

Infection of the salivary duct caused by Mumps, etc. but also non-infectious causes like Sjogren's (radiation, etc)

Sialadenitis

Mumps, Obstruction, Sjogrens, Sarcoidosis, Radiation, Anesthesia, allergy can cause what to salivary ducts?

Sialadenitis

Mumps is caused by a _____ virus infection of the salivary glands 3 complications: (wouldn't worry about these) Dx based on clinical, serologic findings

Paramyxovirus Epidydymoorchitis, Oophoritis, Mastitis True

Self limiting major gland swelling following general anesthesia

Anesthesia Mumps

Most bacterial Sialadenitis is due to what? Acute Sialadenitis is often of what gland? Tumor - chronic inflammation SubMandibular gland: Rapid onset/young/viral

Staph or Strep Parotid Kuttner Tumor Subacute Necrotizing Sialadenitis

Non-inflammatory asymptomatic salivary gland enlargement, mainly of the Parotid

Sialadenosis (Sialosis)

3 Systemic conditions leading to Sialadenosis:

Endocrine Malnutrition Drugs

Minor Salivary Glands can go through ______ , which is of unknown pathogenesis. Biopsy rules out neoplasm b/c there _____ of normal gland

Adenomatoid Hyperplasia hypertrophy

A locally destructive inflammatory condition of the salivary glands due to infarction (blood flow blockage) *this can be caused by trauma, injection, etc.

Necrotizing Sialometaplasia

Necrotizing Sialometaplasia is frequently found unilaterally where? Ulcer/necrosis sloughs, then heals in ______ weeks Mimics... So must ______

Palate 5-6 weeks malignancy Biopsy

Swelling and eversion of the lower lip as a result of hypertrophy and inflammation of the minor salivary glands Symptoms vary from slight to massive pain/suppuration

Cheilitis Glandularis

Cheilitis Glandularis cause is most likely sun damage and ______ infection This is a chronic _______ and ductal dilation *most likely not premalignant, sun predisposes to both

retrograde sialadenitis True

Aphthous, GERD, rabies, heavy metals, lithium, cholinergic agonist, Down's, Cerebral Palsy

Sialorrhea

Sialorrhea Tx: (2)

Anticholinergics (scopolamine) Surgery

Xerostomia is subjective and reported in ___% of older adults Prone to what type of caries?

25% Cervical/Root

Sarcoidosis, GVHD

Xerostomia

4 oral lubricants for Xerostomia

Xylimelts Dentiva Salese Oramoist

Pilocarpine, Cevimeline used for?

Xerostomia

Non-neoplastic condition of salivary glands producing asymptomatic swelling

Lymphoepithelial Sialadenitis

Lymphoepithelial Sialadenitis gender ratio 4-7th decade, 90% affect where? Most pts with what syndrome have this?

3:1 female Parotid Sjogrens

Lymphoepithelial Sialadenitis shown ______ infiltrates that replace salivary acini and residual ducts showing squamous metaplasia

Immune

Sjogren's is a ______ disease of salivery/lacrimal glands 80-90% Primary vs Secondary

autoimmune female only autoimmune disease/other autoimmune diseases (SLE, etc)

SS-A, SS-B, Biopsy, Schimer test, rose bengal test, etc

Dx Sjogren's

Dx Sjogren's must have 4/6 criteria but one of the following two Amer. College or Rheumatology is anti SSA/SSB and

Oral labial Biopsy, SS-A, SS-B Focal lymphocytic sialadenitis (>1/4mm foci)

Sjogren's must be monitored for what? B/c there is a _____x increased risk

Lymphoma 40x

Multi-system granlulomatous disorder of unknown cause

Sarcoidosis

Sarcoidosis demographics: Affects lungs, nodes, skin, eyes, and _____ glands ___% asymptomatic Dx based on clinical findings, _____ radiographs, biopsy, serum ACE

20-40, african american salivary 20% chest

2 Syndromes related to Sarcoidosis

Lofgren's (erythema nodosum) Heerfordt (Parotid enlargement)

Flushing, sweating, warmth in preauricular/temporal skin during chewing

Frey Syndrome (auricolotemporal syndrome(

Frey (auriculotemporal) Syndrome occurs in ___% of pts w/ parotidectomies

40%

% of Salivary tumors in Major glands: Parotid: SubM SubL

79% 69% 9% 1%

% Salivary tumors in Minor glands: Palate:

21% 10%

2:1 salivary tumors are benign This is inverted for what gland?

True SubL

Patients can't get salivary gland tumors in what 2 places b/c there are no salivary glands present?

Gingiva Ant. Dorsal Tongue

Salivary neoplasms more common in which glands? Minor glands found where? Most common neoplasm: Most common malignant neoplasm:

Major glands Post/Lat hard palate pleomorphic adenoma mucoepidermoid carcinoma

2 types of Benign neoplasms of the oral cavity includes...

Adenomas Papillomas Oncocytoma (an adenoma)

Carcinomas are...

malignant

Adenomas are asymptomatic, benign, _____ lesions Usually grow w/o ulceration Usually encapsulated, freely movable

submucosal mass True True

Pleomorphic Adenoma (Benign mixed tumor) is the most common _____ neoplasm Most occur where? followed closely by? If minor gland, where? Ductal, myoepithelial, cartilage, bone myxoid

Salivary Parotid, SubM Palate True

A type of monomorphic Adenoma, slow growing, painless, blue, multifocal

Canilicular Adenoma

Canilicular Adenoma found where? age?

Upper lip Older adults

Oncocytoma is a type of _______ Older adults, major glands, benign tumor of ______ Eosinophilic/glassy b/c of ischemia Hyperplasia occurs

Adenoma oncocytes True True

Tumor almost exclusively in the Parotid Gland, second most common benign parotid tumor may occur bilaterally

Warthin Tumor | papillary cystadenoma lymphomatosum

Warthin Tumor is found in older adults and may be associated w/ smoking and _____ virus

EBV

Tx Adenomas:

Excision * enucleated if encapsulated * prognosis good, recurrence low

Exophytic and papillary proliferation from orifice of duct, similar to papillomas All papillomas, including this one, are

Sialadenoma papilliferum Benign

Adenocarcinomas may grow fast, ulcerate, produce pain. There are not many clinical features to distinguish between types Cystic spaces/Blue masses may indicate:

True True Mucoeps

Tumor of mucus cells + epidermoid cells

Mucoepidermoid Carcinoma

The most common malignant salivary gland tumor (in children, men, women - more women)

Mucoepidermoid Carcinoma

Mucoepidermoid Carcinoma affects what gland most? Occurs centrally in ______

Parotid bone

Notorious perineural invasion growing away from main tumor mass. Much recurrence Good short term prognosis, bad long term

Adenoid Cystic Carcinoma

2nd most common intraoral malignant salivary gland tumor good prognosis

Polymorphous Low Grade Adenocarcinoma

Low grade tumor Primarily in Parotid Tumor of Acinar Cells, usually serous

Acinic Cell Carcinoma

Rarely pleomorphic adenomas become malignant But when they do, there is rapid growth in a slowly glowing long standing tumor that could be malignantly transformed pelomorphic adenoma

Malignant Mixed Tumor