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Tim's Cards > Oral Path VI - GMFF > Flashcards

Oral Path VI - GMFF Flashcards

1
Q

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

A

Osteodystrophy

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2
Q

What is the most common inherited bone disease?

A

Osteogenesis Imperfecta

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3
Q

OI is a mutation is what type collagen?

either this gene on this chromosome:

or this gene on this chromosome:

A

Collagen type I

COL1A1, Chromosome 17

COL1A2, Chromosome 7

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4
Q

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

______ teeth if dentinogenesis imperfecta

A

hyperextensibility, hearing, sclera

opalescent

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5
Q

OI type I-IV inherited how?

A

Autosomal Dominant or Recessive

*severity varies

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6
Q

Abnormal collagen in OI results in bone with thin ______

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

A

Cortex

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7
Q

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

A

Bisphosphonates (either IV or oral)

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8
Q

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

A

True

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9
Q

Marble Bone Disease:

A

Osteoporosis

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10
Q

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%)

A

osteoclast

A3

Chloride

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11
Q

Infantile osteoporosis inherited how?

Adult osteoporosis inherited how?

A

Autosomal Recessive

Auto Dominant

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12
Q

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

Adult osteoporosis (AutoDom) is mild and __% asymptomatic

A

Marrow, Facial, Neuro

40%

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13
Q

In osteoporosis bones are more dense, but more fragile

A

True

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14
Q

Osteoporosis dental considerations: 2 complications post extraction?

A

Fracture

Osteomyelitis

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15
Q

Infantile Osteoporosis the prognosis is ______

Adult has ______ prognosis,

Tx (adult) is _______

A

poor

variable

marrow

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16
Q

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

A

osteoblasts

chondrocytes

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17
Q

Defect in osteoblasts and a subset of chondrocytes

A

Cleidocranial Dysplasia

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18
Q

Cleidocranial dysplasia inheritance is:

or:

Specifically a mutation on the _____ gene of chr ____

A

AutoDom

Somatic mutation

RUNX2, 6p21

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19
Q

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

A

Cleidocranial Dysplasia

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20
Q

Cleidocranial Dysplasia - describe 3 aspects affect teeth:

A

Deciduous retention

Delayed eruption permanent teeth

Supernumerary

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21
Q

Prognosis, Cleidocranial dysplasia:

Plan dental Tx on clinical findings

A

good

True

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22
Q

Cherubism inheritance:

chr ______

or…

A

AutoDom

4p16

spontaneous

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23
Q

Cherubism Mn manifestations:

Mx manifestations:

A

bilateral posterior painless swelling

swelling pushes orbits up, rounds face

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24
Q

Avg age Cherubism:

Radiographic

A

7

Mn multilocular, bilateral, posterior lucencies w/ Mx involvement

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25
Q

Cherubism histopathology is a _____ cell lesion

aka…

Post pubertal

A

giant

granuloma

stabilization

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26
Q

Mutations of non-specific alkaline phosphatase:

A

Hypophosphatasia

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27
Q

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 _______

A

variably

ALP (alkaline phosphatase)

phospho-athanolamine

Rickets

Cementum

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28
Q

Vitamin D resistant Rickets, aka

A

Hereditary hypophosphatemia

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29
Q

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 ______

A

X-linked Dominant

PHEX, PO4

Renal Tubules, Calcium

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30
Q

VitaminD-resistant Rickets, manifests as shortened ______

Pulp horns extend into ______

Dentin ____

Periapical ______

A

Lower body

DEJ

cleft

abscess

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31
Q

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

Hyperparathyroidism and _______

A

Osteomalacia

Osteodystrophy

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32
Q

What causes good ol fashioned Rickets?

Causes growth retardation, prominence of _________, and _______ of the legs

A

VitD deficiency during Infancy

costochondra junctions (rachitic rosary), bowing

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33
Q

In adulthood, Vitamin D deficiency (instead of Rickets), causes…

3 manifestations:

A

Osteomalacia

weak bone, fractures, diffuse skeletal pain

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34
Q

Primary Hyperparathyroidism is caused by _______ (80-90%)

or ________ in pts over 60 y/o

more often found in what sex?

A

parathyroid adenoma

hyperplasia

female

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35
Q

Secondary Hyperparathyroidism is secondary to chronic _______

which causes malabsorption of ________ and ______

A

Renal disease

Vitamin D by kidney, Calcium in intestine

*increases PTH to get Ca out of bone

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36
Q

Stones, bones, and abdominal groans…

A

Hyperparathyroidism

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37
Q

Hyperparathyroidism, supperiosteal resorption seen where?

Loss of the ______

Trabecular pattern of _______

Brown tumor ________

Renal _______

A

phalanges of fingers

lamina dura

Ground Glass

radiolucency

osteodystrophy (secondary hyperparathyroidism)

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38
Q

Hyperparathyroidism, ulcers seen where?

Histo of brown tumor indistinguishable from what?

Complication of secondary hyperparathyroidism is ESRD

Enlargment seen where?

A

Duodenum

Giant cell granuloma

True

Jaws

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39
Q

Ground Glass Pattern, Fibro-osseous lesions

A

Hyperparathyroidism

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40
Q

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

A

Paget’s disease of bone

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41
Q

Paget’s disease disproportionally affects what population:

Can be bone pain, weakened bone, or asymptomatic

A

white, male, over 40

True

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42
Q

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

A

Paramyxovirus

Genetic

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43
Q

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

Generalized hypercementosis

A

Paget’s

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44
Q

Paget’s Histology depends on the stages

A

True

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45
Q

Dx Pagets, alkaline phosphatase

Calcium

Urinary hydroxyproline

A

increased

same

increased

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46
Q

2 complications of Paget’s

A

fracture

malignant transformation

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47
Q

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?

A

post-zygotic, GNSA1

True

G protein, adenylyl cyclase, cAMP

osteoblasts

Fibrous tissue (immature bone)

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48
Q

% Fibrous Dysplasia involving only 1 bone (monostotic):

Polystotic w/ cafe au lait spots:

Polystotic w/ cafe au lait + endocrinopathy:

A

80-85%

Jaffe-Lichtenstein Syndrome

McCune-Albright Syndrome

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49
Q

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

A

1-2 decades

=

pain/fracture

1/3, Optic Nerve

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50
Q

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

A

Fibrous Dysplasia

clinical diversity

gonads, thyroid

True

1/4

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51
Q

Lesion of of Fibrous Dysplasia described as:

Margins:

Cortical:

Cortical rxn:

A

Ground Glass Opacity

Blend

Expansion

Absent

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52
Q

Chinese script writing bone pattern

A

Fibrous Dysplasia

“fibro-osseous lesion”

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53
Q

Tx Fibrous Dysplasia:

Stabilized with…

If small and localized:

If larger:

If disfiguring:

Bisphosphonates when:

________ Contraindiated

A

individualized

Maturity

Excise

recontour

resect

symptomatic polystotic

Radiation

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54
Q

Use Radiation with Fibrous Dysplasia

A

False

*contraindicated

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55
Q

Giant Cell Granuloma found more often in what sex?

at what age?

characteristic appearance in in Arch?

A

female

prior age 30

Anterior jaws, crosses midline

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56
Q

Giant Cell Granuloma can be aggressive or non-aggressive

*differing symptoms, growth, cortical expansion, root resorption

A

True

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57
Q

Giant Cell Granuloma radiograph:

Margins:

might have cortical perforation/root resporption

A

unilocular/multilocular radiolucency

noncorticated

True

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58
Q

Giant Cell Granuloma Tx:

Recurrence:
(higher w/ aggressive)

Alt Tx:

A

Surgical

15-20%

steroids, calcitonin, interferon

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59
Q

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

A

Aneurysmal bone cyst

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60
Q

Aneurysmal bone cyst most found mostly in what 2 bones?

___% in the jaws

More often at what age?

symptoms:

A

long bones, vertebrae

2%

children/young

rapid swelling/pain

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61
Q

Aneurysmal bone cyst radiograph:

Cortex:

Can aspirate blood from space

Tx is curretage/resection and variable recurrence

A

unilocular/multilocular RL

thin/perforated

True

True

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62
Q

Idiopathic Osteosclerosis increased in what 3 ethnicities:

gender:

90% found where?

80% contact tooth _____

A

Blacks, Chinese, Japs

no preference

Mn1M

Root

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63
Q

Idiopathic Osteosclerosis is very painful

A

False

*no pain, expansion

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64
Q

Idiopathic Osteosclerosis is easily confused w/ what?

Except that…

A

Condensing Osteitis

Tooth vital

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65
Q

Well defined radiopacity, symmetric

No radiolucent halo but blends

80% contacts tooth root

Occasional root resorption

A

Idiopathic Osteosclerosis

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66
Q

Idiopathic Osteosclerosis study: ___% stable

% smaller

% larger

A

86%

10%

4%

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67
Q

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

A

radiolucent

middle aged females

extraction

Posterior Mn

True

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68
Q

Bone inflammation (strictly)

A

Osteomyeliltis

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69
Q

6 types of clinically distinguishable Osteomyelitis

A

Acute

Chronic

Focal sclerosing (Condensing Osteitis)

Diffuse sclerosing

w/ proliferative periostitis (Garre’s)

Alveolar (Dry socket)

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70
Q

Acute Osteomyelitis duration:

3 systemic symptoms:

_____ drainage may be seen

May cause nerve _______

A

short, less than 1 month

fever, lymph swelling, elevated WBC

Purulent

parasthesia

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71
Q

Acute Osteomyelitis, as infection progresses, radiographically seen as…

primary Tx:

secondary Tx if does not occur spontaneously:

A

asymmetric radiolucency

Abx!!!

Surgical drainage

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72
Q

Long duration, variable pain, not consistently sharp pain

Tooth loss in area of involvement

A

Chronic Osteomyelitis

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73
Q

Chronic Osteomyelitis, Radiographic features:

Tx:

A

Ill-defined, assymetric, radiopacity

Debride, Abx (long duration/IV)

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74
Q

Generally considered rxn of periapical bone to low grade odontogenic infection:

This inflammation (if immune competent) can result in what?

Tooth vital?

A

Chronic Focal Sclerosing Osteomyelitis (Condensing Osteitis)

Sclerosing

Non-vital

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75
Q

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?

A

opacity, blends

RCT/extract

remodels

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76
Q

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

A

Chronic Diffuse Sclerosing Osteomyelitis

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77
Q

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

A

odontogenic infection

trauma/surgery

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78
Q

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?

A

True

Posterior Mn

density

eliminate infection, monitor

hypovascularized sclerotic bone

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79
Q

Chronic Osteomyelitis w/ Proliferative Periostitis, aka…

______ grade osteomyelitis

Immune status?

Age?

Inflammation involves what?

A

Garre’s Osteomyelitis

low

competent

young

periosteum

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80
Q

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…

A

Draining sinus tract

bone production

Mn

bony hard swelling

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81
Q

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

A

immature

onion skin

opaque

occlusal

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82
Q

Chronic Osteomyelitis w/ Proliferative Periostitis Tx:

Abx work?

Remodeling occurs over time so _____ not necessary

A

RCT/Extract

don’t alter process

Surgical recontouring

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83
Q

Dry Socket:

A

Alveolar Osteitis

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84
Q

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…

A

Mn 3M

Females, birth control

clot

3-4 days

dressing

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85
Q

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

A

Osteoclasts

True

True

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86
Q

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

A

Bisphosphonates

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87
Q

BRONJ occurs ____% in pts cancer/IV Tx:

__% cases in pts w/ myeloma/metastatic breast cancer

__% cases in pts on Oral Tx

A

6-10%

85%

4%

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88
Q

The presence of Nitrogen and IV delivery increases chance of BRONJ

A

True

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89
Q

% of BRONJ induced by surgical procedures

Can occur spontaneously, be progressive, difficult to control, or not heal

A

60%

True

90
Q

Tx for BRONJ (aside from prevention)

Wide ____ not recommended

A

Abx mouth rinses, debridement, Hyperbaric Oxygen

excision

91
Q

Cemento-Osseous dysplasias are not 3 things

A

Inflammatory in origin

Neoplastic

Genetic

92
Q

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

A

True

93
Q

3 Cemento-Osseous Dysplasias:

A

Periapical cemento-osseous dysplasia

Florid COD

Focal COD

94
Q

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

A

Periapical

*teeth are vital

95
Q

Periapical Cemento-osseous Dysplasia demographic:

Affects where in the arch?

No expansion, painless, and the teeth are ______

A

Female, Black, Middle aged (30-45 yrs)

anterior Mn

Vital

96
Q

Periapical Cemento-osseous Dysplasia initial radiographic presentation:

Progress to opacification where?

Late stages are opaque w/ lucent rim and can fuse to ______

A

lucent

central

roots

97
Q

Periapical Cemento-osseous Dysplasia Tx:

A

none

do not RCT

98
Q

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

A

True

99
Q

Florid Cemento-Osseous Dysplasia demographics:

Posteriorly affect where?

Anteriorly where?

A

Middle aged, Black, Female

multiple quadrants

Mn

100
Q

Florid Cemento-Osseous Dysplasia radiographic:

______ architecture

Tx: is preventive against infection, but if infected may need to…

A

lucent/mixed/opaque

rounded/lobular

sequestrate large portions of bone

101
Q

Focal Cemento-Osseous Dysplasia demographics:

Primary site (arch/tooth):

Commonly found in _____ areas

A

Slightly white, female, wide age range

Mn - PM/1M

Edentulous

102
Q

Focal Cemento-Osseous Dysplasia - radiographic:

Architecture:

Generally smaller than ______ form (rarely larger than 1.5cm)

Opaque lesion w/ _____

Tx:

A

lucent/mixed/opaque

rounded/lobular

florid

halo lucency

none (monitor for change)

103
Q

Langerhan’s Cell Histiocytosis, aka…

Rarely seen at what age?

50% pts under ____ y/o

Bone and soft tissues affected

A

Histiocytosis X

older

10

True

104
Q

Langerhan’s Cell Histiocytosis classic radiographic presentation:

Acute Disseminated:

Chronic Disseminated:

Chronic Localized:

A

Teeth floating in air

Letterer-Siwe Disease

Hand-Schuler-Christian

Eosinophilic Granuloma

105
Q

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?

A

Letterer-Siwe

Hand-Schuler-Christian

Eosinophilic granuloma

106
Q

Langerhan’s Cell Histiocytosis presents orally where?

How?

Loss of ______

Dx:

Tx:

A

Jaw

Teeth floating in air

Lamina Dura

biopsy, Langerhan proliferation

Curettage, low dose Radiation

107
Q

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

A

Osteoradionecrosis

108
Q

Osteoradionecrosis will not heal w/o ______ intervention

Tx: (3 steps)

A

surgical

Hyperbaric Oxygen, bone resection, soft tissue closure

109
Q

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

A

lucent, scallops

young (2nd decade)

Mn

True

110
Q

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

A

bleeding

curetted, bleeding

111
Q

4 characteristics of Benign tumors of Bone

A

Asymptomatic

Slowly expands

Displaces teeth (expands cortex)

Symmetrical

112
Q

Malignant neoplasms of bone, 4 characteristics:

A

Symptomatic

Invasive

Asymmetrical

Destroys cortex, ragged borders

113
Q

4 Benign tumors of Bone origin:

A

Exostoses

Osteoma

Osteoid osteoma

Osteoblastoma

114
Q

3 Benign tumors of Cartilaginous origin:

A

Chondroma

Chondromyxoid fibroma

Benign chondroblastoma

115
Q

A benign tumor of Fibrous origin:

A

Desmoplastic fibroma

116
Q

2 malignant tumors of bone origin:

1 cartilaginous origin:

2 marrow in origin:

A

Ostiosarcoma, osteogenic sarcoma

chondrosarcoma

Ewing’s Sarcoma, Multiple Myeloma

117
Q

A localized proliferation of bone that arises from the cortical plate

(minimal/no medullary bone involvement)

A

Exostosis

118
Q

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

A

Torus palatinus

Torus mandibularis

119
Q

An Exostosis is most commonly seen where orally?

Often bilateral, and the this overlying mucosa may ______ easily

A

Buccal of Mx or Mn alveolar ridge

ulcerate

120
Q

Torus Palatinus always located where?

May ulcerate easily, wide variation in size, multifactorial, asymptomatic

A

Midline Hard Palate

True

121
Q

Torus Mandibularis located in the ______ area of the Mn

___% are Bilateral

A

Lingual PM area

90%

122
Q

A localized proliferation of bone

A

Osteoma

123
Q

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

A

Tori

Medullary and Cortical

craniofacial, sinuses

Gardner’s

124
Q

Gardner’s Syndrome inherited how?

Clinically, there are multiple _______

In the Jaws, found mainly where?

In the rest of the head, seen where?

A

AutoDom

osteomas

angle

Frontal bone, frontal sinus, ethmoid sinus

125
Q

Gardner’s Syndrome (AutoDom) oral manifests as ______ teeth

Multiple ______ cysts

_____ tumors

What associated sign has a 100% incidence of malignant transformation?

A

Supernumerary

Epidermoid

Desmoid

Adenomatous polyps of Colon/Rectum

126
Q

A True Neoplasm of Bone (there are 2)

A

Osteoid Osteoma

Osteoblastoma

127
Q

Osteoid Osteoma’s are rare, representing less than ___% of all bone tumors

Affect what sex?

What age?

A

1%

2:1 males

less than 30 yrs (85%)

128
Q

Osteoid Osteoma has classic clinical presentation of ______ pain relieved by _______

and radiograph appearance of what?

A

Nocturnal, Aspirin

Target (opaque bullseye, lucent halo, corticated rim)

129
Q

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

A

True

130
Q

Osteoblastomas occur often in the ______ skeleton, and most often in the ______

Age?

Gender?

Size of lesions

A

Craniofacial, Mn

less than 30 y/o (85%)

males, 2:1

usually large, over 2cm

131
Q

2 ways Osteoblastomas differ in clinical presentation from Osteoid Osteoma

A

no nocturnal pain

not relieved by ASA

132
Q

Osteoblastoma has large lesions radiographically (over 2cm) that may produce significant expansion and deformity

May we well/ill defined

A

True

True

133
Q

A benign neoplasm of cartilage origin

A

Chondroma

134
Q

Chondromas occur at what age?

Exceedingly rare in what region?

Most diagnosed as chondroma are in fact low grade chondrosarcomas

A

20-40

Head/Neck

True

135
Q

2 conditions that are exceedingly rare in the jaws:

A

Chondromyxoid Fibroma

Chondroblastoma

136
Q

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

A

Desmoplastic Fibroma

137
Q

Desmoplastic Fibroma, common age

___% in the Mn, often in the ______ Mn and ascending _____

Radiographic _______, unilocular/multilocular, well/ill defined borders

A

children, young adults

85%, Posterior, Ramus

lucency

138
Q

Desmoplastic Fibroma, 2 methods of Tx w/ recurrence rates

A

Curettage, 70% recurrence

Resection, 20% recurrence

139
Q

A malignant neoplasm of osteoblastic cells

A

Osteosarcoma

140
Q

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

A

calcify

radiolucent, mixed, opaque

7%

141
Q

Osteosarcoma age:

site:

Swelling causes pain, loosens teeth, and ______

A

all ages

Mn=Mx

Parasthesia/Anesthesia

142
Q

Osteosarcoma radiographic has a _______ lesion

Esp. worrisome are symmetrical widening of the _____

and the Production of _______

and a ______ appearance

A

ill-defined (blends)

PDL

alveolar bone above normal crest

Suburst (sunray)

143
Q

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

A

25%

Occlusal

144
Q

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

A

Juxtacortical Osteosarcoma

145
Q

Juxtacortical Osteosarcoma prognosis:

2 subtypes:

Tx:

Major problem at Tx site:

A

better

Parosteal, Periosteal

Radical Ablative Surgery

Local recurrence

146
Q

What improves prognosis of Juxtacortical Osteosarcoma

Jaw lesions metastasize less frequently than in ____ bones

Overall survival between __-___%

A

Preoperative chemo

long

30-80%

147
Q

A malignant neoplasm producing cartilage (not bone)

A

Chondrosarcoma

148
Q

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 ________

A

True

Jaws

Ant Mx, Condyles

149
Q

Chondrosarcoma age:

gender:

Swelling loosens teeth, describe pain:

Occurs more often in what arch?

A

wide range, mostly 6-7th decades

Slightly more Males

painless

Mx

150
Q

Radiographically, Chondrosarcoma lucency level?

We’re talking cartilage, so its poorly defined and asymmetric

Tx:

__% metastasize

Challenge is what?

A

lucent/mixed/opaque

True

Radical Surgical Ablation

12%

local recurrence

151
Q

Why is 5 yr survival not a good indicator for Chondrosarcoma?

Newer studies show better/worse prognosis than for Osteosarcoma

A

Recurrence can take years

Better

152
Q

A Sarcoma of uncertain cell origin, maybe Neuroectodermal

A

Ewing’s Sarcoma

153
Q

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

A

11 and 22

6-10%

3%

154
Q

Ewing’s Sarcoma, age:

Ethnicity, Gender

Describe pain:

Fever, Leukocytosis, elevated ESR

A

5-30

Caucasion, 3;2 male

intermittent, variable

True

155
Q

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):

A

True

False

Onion Skinning

156
Q

Historically, the prognosis of Ewing’s Sarcoma:

Today, Tx with what?

Survival?

A

Terrible

surgery, radiation, chemo

40-80%

157
Q

There are a lot of non-neoplastic salivary gland conditions

A

True

158
Q

Developmental lingual Mandibular Salivary Gland depression (Static bone cavity)

A

Stafne’s bone cavity

159
Q

Stafne’s bone cavity signs/symptoms:

Radiolucency, often _____, seen where?

Tx:

A

None

corticated, below IA canal angle to midbody

none

160
Q

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

A

Mucocele

161
Q

Mucocele is commonly found where?

Increased for what age group?

Occurs ______, soft and compressible

A

lower lip, lateral tongue, cheek

young

rapidly

162
Q

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

A

Ranula

163
Q

A plunging (cervical) Ranula dissects through what muscle?

Produces swelling where?

A

Mylohyoid

Neck

164
Q

An Antral Pseudocyst is a type of _______.

Shape:

Tx:

A

mucocele

Dome

none

165
Q

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:

A

Mucus Retention Cyst

epithelial

True

Parotid

Excision

166
Q

Calcification in the salivary duct of unknown cause

A

Sialolith

167
Q

Sialolith most often occurs where?

Pain occurs when?

Tx:

A

Submandibular

meal time

massage, fluids, heat, surgery

168
Q

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

A

Sialadenitis

169
Q

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

A

Sialadenitis

170
Q

Mumps is caused by a _____ virus infection of the salivary glands

3 complications: (wouldn’t worry about these)

Dx based on clinical, serologic findings

A

Paramyxovirus

Epidydymoorchitis, Oophoritis, Mastitis

True

171
Q

Self limiting major gland swelling following general anesthesia

A

Anesthesia Mumps

172
Q

Most bacterial Sialadenitis is due to what?

Acute Sialadenitis is often of what gland?

Tumor - chronic inflammation SubMandibular gland:

Rapid onset/young/viral

A

Staph or Strep

Parotid

Kuttner Tumor

Subacute Necrotizing Sialadenitis

173
Q

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

A

Sialadenosis (Sialosis)

174
Q

3 Systemic conditions leading to Sialadenosis:

A

Endocrine

Malnutrition

Drugs

175
Q

Minor Salivary Glands can go through ______ , which is of unknown pathogenesis.

Biopsy rules out neoplasm b/c there _____ of normal gland

A

Adenomatoid Hyperplasia

hypertrophy

176
Q

A locally destructive inflammatory condition of the salivary glands due to infarction (blood flow blockage)

*this can be caused by trauma, injection, etc.

A

Necrotizing Sialometaplasia

177
Q

Necrotizing Sialometaplasia is frequently found unilaterally where?

Ulcer/necrosis sloughs, then heals in ______ weeks

Mimics…

So must ______

A

Palate

5-6 weeks

malignancy

Biopsy

178
Q

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

A

Cheilitis Glandularis

179
Q

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

A

retrograde

sialadenitis

True

180
Q

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

A

Sialorrhea

181
Q

Sialorrhea Tx: (2)

A

Anticholinergics (scopolamine)

Surgery

182
Q

Xerostomia is subjective and reported in ___% of older adults

Prone to what type of caries?

A

25%

Cervical/Root

183
Q

Sarcoidosis, GVHD

A

Xerostomia

184
Q

4 oral lubricants for Xerostomia

A

Xylimelts

Dentiva

Salese

Oramoist

185
Q

Pilocarpine, Cevimeline used for?

A

Xerostomia

186
Q

Non-neoplastic condition of salivary glands producing asymptomatic swelling

A

Lymphoepithelial Sialadenitis

187
Q

Lymphoepithelial Sialadenitis gender ratio

4-7th decade, 90% affect where?

Most pts with what syndrome have this?

A

3:1 female

Parotid

Sjogrens

188
Q

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

A

Immune

189
Q

Sjogren’s is a ______ disease of salivery/lacrimal glands

80-90%

Primary vs Secondary

A

autoimmune

female

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

190
Q

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

A

Dx Sjogren’s

191
Q

Dx Sjogren’s must have 4/6 criteria but one of the following two

Amer. College or Rheumatology is anti SSA/SSB and

A

Oral labial Biopsy, SS-A, SS-B

Focal lymphocytic sialadenitis (>1/4mm foci)

192
Q

Sjogren’s must be monitored for what?

B/c there is a _____x increased risk

A

Lymphoma

40x

193
Q

Multi-system granlulomatous disorder of unknown cause

A

Sarcoidosis

194
Q

Sarcoidosis demographics:

Affects lungs, nodes, skin, eyes, and _____ glands

___% asymptomatic

Dx based on clinical findings, _____ radiographs, biopsy, serum ACE

A

20-40, african american

salivary

20%

chest

195
Q

2 Syndromes related to Sarcoidosis

A

Lofgren’s (erythema nodosum)

Heerfordt (Parotid enlargement)

196
Q

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

A

Frey Syndrome (auricolotemporal syndrome(

197
Q

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

A

40%

198
Q

% of Salivary tumors in Major glands:

Parotid:

SubM

SubL

A

79%

69%

9%

1%

199
Q

% Salivary tumors in Minor glands:

Palate:

A

21%

10%

200
Q

2:1 salivary tumors are benign

This is inverted for what gland?

A

True

SubL

201
Q

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

A

Gingiva

Ant. Dorsal Tongue

202
Q

Salivary neoplasms more common in which glands?

Minor glands found where?

Most common neoplasm:

Most common malignant neoplasm:

A

Major glands

Post/Lat hard palate

pleomorphic adenoma

mucoepidermoid carcinoma

203
Q

2 types of Benign neoplasms of the oral cavity

includes…

A

Adenomas

Papillomas

Oncocytoma (an adenoma)

204
Q

Carcinomas are…

A

malignant

205
Q

Adenomas are asymptomatic, benign, _____ lesions

Usually grow w/o ulceration

Usually encapsulated, freely movable

A

submucosal mass

True

True

206
Q

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

A

Salivary

Parotid, SubM

Palate

True

207
Q

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

A

Canilicular Adenoma

208
Q

Canilicular Adenoma found where?

age?

A

Upper lip

Older adults

209
Q

Oncocytoma is a type of _______

Older adults, major glands, benign tumor of ______

Eosinophilic/glassy b/c of ischemia

Hyperplasia occurs

A

Adenoma

oncocytes

True

True

210
Q

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

may occur bilaterally

A

Warthin Tumor

papillary cystadenoma lymphomatosum

211
Q

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

A

EBV

212
Q

Tx Adenomas:

A

Excision

  • enucleated if encapsulated
  • prognosis good, recurrence low
213
Q

Exophytic and papillary proliferation from orifice of duct, similar to papillomas

All papillomas, including this one, are

A

Sialadenoma papilliferum

Benign

214
Q

Adenocarcinomas may grow fast, ulcerate, produce pain.

There are not many clinical features to distinguish between types

Cystic spaces/Blue masses may indicate:

A

True

True

Mucoeps

215
Q

Tumor of mucus cells + epidermoid cells

A

Mucoepidermoid Carcinoma

216
Q

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

A

Mucoepidermoid Carcinoma

217
Q

Mucoepidermoid Carcinoma affects what gland most?

Occurs centrally in ______

A

Parotid

bone

218
Q

Notorious perineural invasion growing away from main tumor mass.

Much recurrence

Good short term prognosis, bad long term

A

Adenoid Cystic Carcinoma

219
Q

2nd most common intraoral malignant salivary gland tumor

good prognosis

A

Polymorphous Low Grade Adenocarcinoma

220
Q

Low grade tumor

Primarily in Parotid

Tumor of Acinar Cells, usually serous

A

Acinic Cell Carcinoma

221
Q

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

A

Malignant Mixed Tumor

Tim's Cards (140 decks)

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