Oral Path VI - GMFF Flashcards
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
What is the most common inherited bone disease?
Osteogenesis Imperfecta
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
OI, includes bone fragility/deformity, joint ________, loss of ________, blue _____
______ teeth if dentinogenesis imperfecta
hyperextensibility, hearing, sclera
opalescent
OI type I-IV inherited how?
Autosomal Dominant or Recessive
*severity varies
Abnormal collagen in OI results in bone with thin ______
Osteoporosis, soft, prone to fracture, bowing, angulation, deformity
Cortex
OI Tx: Physiotherapy, Ortho surgery, and what drugs?
Bisphosphonates (either IV or oral)
Long term use in Bisphosphonates for pedo pts with OI is unknown
True
Marble Bone Disease:
Osteoporosis
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
A3
Chloride
Infantile osteoporosis inherited how?
Adult osteoporosis inherited how?
Autosomal Recessive
Auto Dominant
Infantile Osteoporosis (AutoRecessive) is severe, sclerotic, ______ failure, _____ deformity, and _______ deficit
Adult osteoporosis (AutoDom) is mild and __% asymptomatic
Marrow, Facial, Neuro
40%
In osteoporosis bones are more dense, but more fragile
True
Osteoporosis dental considerations: 2 complications post extraction?
Fracture
Osteomyelitis
Infantile Osteoporosis the prognosis is ______
Adult has ______ prognosis,
Tx (adult) is _______
poor
variable
marrow
Cleidocranial dysplasia is genetic and a defect in the differentiation of _______ and a subset of _______
osteoblasts
chondrocytes
Defect in osteoblasts and a subset of chondrocytes
Cleidocranial Dysplasia
Cleidocranial dysplasia inheritance is:
or:
Specifically a mutation on the _____ gene of chr ____
AutoDom
Somatic mutation
RUNX2, 6p21
Short stature, frontal bossing, patent fontanels, late closure of cranial sutures, absence/hypoplasia of clavicles:
Cleidocranial Dysplasia
Cleidocranial Dysplasia - describe 3 aspects affect teeth:
Deciduous retention
Delayed eruption permanent teeth
Supernumerary
Prognosis, Cleidocranial dysplasia:
Plan dental Tx on clinical findings
good
True
Cherubism inheritance:
chr ______
or…
AutoDom
4p16
spontaneous
Cherubism Mn manifestations:
Mx manifestations:
bilateral posterior painless swelling
swelling pushes orbits up, rounds face
Avg age Cherubism:
Radiographic
7
Mn multilocular, bilateral, posterior lucencies w/ Mx involvement
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