Oral Pathology Chapter 14 Flashcards
What disease is also known as “marble bone disease” and is caused by failure of normal osteoclast function?
Osteopetrosis
What two major types of Osteopetrosis are there?
- Infantile and 2. Adult
What type of Osteopetrosis is associated with marrow failure, frequent fractures, cranial nerve compression, facial deformities, delayed tooth eruption and osteomyelitis post tooth infraction?
Infantile Osteopetrosis
What two radiographic signs are present in Infantile Osteopetrosis?
- Widespread increase in skeletal density and 2. Roots of teeth are difficult to make out due to bone density
Which form of Osteopetrosis has less severe manifestations, is 40% asymptomatic and has marrow failure only rarely?
Adult Osteopetrosis (benign osteopetrosis)
What are two significant complications of Osteopetrosis?
- Fracture and 2. Osteomyelitis after tooth extraction
What is the only hope for Infantile Osteopetrosis?
Bone marrow transplant
What disease is associated with dental and clavicle abnormalities?
Cleidocranial Dysplasia
What percentage of the time are the clavicles completely unformed in Cleidocranial Dysplasia?
10%
What four appearance abnormalities are signs of Cleidocranial Dysplasia?
- Short stature/big head, 2. Frontal Bossing, 3. Ocular hypertelorism and 4. Broad base of nose
What two palatal effects does Cleidocranial Dysplasia exhibit?
- High-arched palate and 2. Increased prevalence of cleft palate
What is the name of an area of hematopoietic marrow that produces a radiolucency, may be confused with an intraosseous neoplasm and is NOT a pathology?
Focal Osteoporotic Marrow Defect
How do Focal Osteoporotic Marrow Defects typically present in radiographs?
- Typically asymptomatic, 2. Ill-defined borders with well-defined trabeculations and 3. 75% in adult women, often in the posterior mandible
What pathology is a focal area of increased radiodensity that is of unknown cause and cannot be attributed to anything else?
Idiopathic Osteosclerosis
Where are Idiopathic Osteosclerosis lessons typically located?
Mandible (90%)
What must NOT be present for a diagnosis of Idiopathic Osteosclerosis to be accurate?
A radiolucent rim
What pathology is associated with abnormal resorption and deposition of bone that results in the weakening of affected bones?
Paget’s Disease of Bone
What group is most affected by Paget’s Disease?
Caucasian men
Where does Pagetic bone form?
Near joints
What four bones are the most commonly affected?
- Vertebrae, 2. Pelvis, 3. Skull and 4. Femur
What are the two key dental complaints that someone might have with Paget’s Disease of Bone?
- Hat won’t fit and 2. Dentures no longer fit
What is the name given to the lion-like facial deformity found in Paget’s Disease of Bone?
Leontiasis Ossea
What is the key radiographic appearance of Paget’s Disease?
“Cotton Wool/Roll” appearance
What can often happen to the teeth of patients with Paget’s disease?
Hypercementosis
What blood ions are present in a patient with Paget’s Disease (3)?
- High alkaline Phosphatase levels, 2. Normal Calcium and 3. Normal Phosphorus levels
What three types of drugs are often give to treat patients with Paget’s Disease?
- NSAIDS for pain, 2. Antiresorptive drugs (patients > 50% alkaline phosphatase) and 3. Bisphosphonates
What is a recognized complication of Paget’s Disease?
Development of a malignant osteosarcoma
Where do malignant bone tumors typically form in Paget’s Disease?
Pelvis/Long bones of lower extremities
Which pathology is considered a nonneoplastic lesion that is more common in the anterior jaw and frequently crosses the midline?
Central Giant Cell Granuloma
What other two pathologies are identical histopathologically to Central Giant Cell Granulomas?
- Brown tumor of hyperparathyroidism and 2. Cherubism
Should a Central Giant Cell Granuloma be aggressive (doesn’t occur often), what treatment can be used to slow them?
Injections of Corticosteroids
What pathology is associated with an autosomal dominant inheritance, plump faces and eyes turned heavenward?
Cherubism
When does Cherubism typically manifest?
Ages between 2-5
Microscopic findings in Cherubism are identical to those found in what other disease?
Central Giant Cell Granulomas
What is a benign, empty or fluid-filled cavity within the bone called?
Traumatic Bone Cyst
What is thought to cause Traumatic Bone Cysts?
When Bones receive trauma that is insufficient to cause fracture but results in intraosseous hematoma. This hematoma does not undergo organization and repair
What is the most suggestive radiographic sign of Traumatic Bone Cysts?
“Scalloped” Margins
What should be done to rule out thin-walled lesions in Traumatic Bone Cyst cases?
Curettage of the wall of the cavity
What effect do Traumatic Bone Cysts have on the teeth?
None - they stay vital
What is the treatment of Bone Cysts?
Surgical Exploration
What pathology is described as an intraosseous accumulation of blood-filled spaces surrounded by connective tissue?
Aneurysmal Bone Cyst
Where is the most common presentation of an aneurysmal bone cyst in head and neck?
Posterior mandible
What are the two most common symptoms of an aneurysmal bone cyst?
- Pain and 2. Rapidly developing swelling
What surgical appearance does removing an aneurysmal bone cyst resemble?
“Blood-soaked Sponge”
What is the recurrence of the removal of an aneurysmal bone cyst?
10-60%
What tumor-like pathology is defined as replacement of normal bone by fibrous connective tissue intermixed with bone?
Fibrous Dysplasia
What three types of fibrous dysplasia exist?
- Monostotic, 2. Jaffe-Lichtenstein Syndrome (polyostotic) and 3. McCune-Albright Syndrome (polyostotic)
What percentage of fibrous dysplasia cases are monostotic?
80%
What is the key radiographic feature of a monostotic fibrous dysplasia lesion?
“Ground-glass” opacification
Should a case of monostotic fibrous dysplasia occur in the mandible, what would be the result?
Expansion of both the buccal and lingual plates
Should a case of monostotic fibrous dysplasia occur in the maxilla, what would be the result?
Obliteration of the maxillary sinus
Which syndrome has polyostotic fibrous dysplasia and Cafe au lait spots?
Jaffe-Lichenstein Syndrome
Which syndrome has polyostotic fibrous dysplasia and Cafe au lait spots and multiple endocrinopathies?
McCune-Albright Syndrome
What is the most common sign of McCune-Albright Syndrome?
Sexual precocity within the first few years of life
What are two other symptoms of McCune-Albright Syndrome that are less common?
- Pituitary Adenoma and 2. Hyperthyroidism
What is the most common fibro-osseous lesion encountered in clinical practice?
Cemento-Osseous Dysplasias
What are the three types of Cemento-Osseous Dysplasia?
- Focal, 2. Periapical and 3. Florid
What gender bias do Focal Cemento-Osseous Dysplasias have?
90% females
What is the key radiographic finding that designates Focal Cemento-Osseous Dysplasia?
Lesions have a thin radiolucent rim
What two groups are most likely to get Periapical Cemento-Osseous Dysplasia?
- Women (90%) and 2. African Americans (70%)
How does the PDL react to Periapical Cemento-Osseous Dysplasia?
It remains intact - the lesion never fuses with the tooth
Why is biopsy discouraged with Periapical and Florid Cemento-Osseous Dysplasia?
The areas are hypovascularized and biopsy may cause necrosis
What pathology is defined as a true neoplasm that contains a variable mixture of bone and cementum with a significant growth potential?
Ossifying Fibroma
What are the five major x-ray features of an ossifying fibroma?
- Well-defined, 2. Usually unilocular, 3. Completely radiolucent or mixed, 4. Root divergence/resorption and 5. mandibular fibromas create downward bowing of inferior cortex of the mandible
What pathology is just like an ossifying fibroma but differs in age of the patient, common sites of involvement and clinical behavior?
Juvenille (Active) Ossifying Fibroma
What are the two key differences between Ossifying Fibromas and Juvenille Active Ossifying Fibromas?
- Males more likely to get Juvenille and 2. Maxilla more common than mandible (for Juvenille - opposite would be true of Ossifying)
What is the recurrence rate of a Juvenille Active Ossifying Fibroma?
30-60%
What pathology is a benign tumor of mature bone that is restricted to the craniofacial skeleton?
Osteoma
Where is the most common location of an Osteoma?
Paranasal Sinuses
How do osteomas differ depending on the type of bone they form in?
Compact bone for radio opaque lesions while cancellous bone produces mixed lesions
What pathology is associated with colon polyps/adenocarcinomas, skeletal abnormalities and dental abnormalities?
Gardner Syndrome
What procedure is usually performed prophylactically in patients with Gardner’s Syndrome?
Colonectomy
What is the first sign typically presented in Gardner’s Syndrome?
Multiple Osteomas
What dental abnormalities are present in Gardner’s Syndrome (3)?
- Supernumerary teeth, 2. Impacted teeth and 3. Odontomas
What two pathologies are closely related, involve bone tumors and have identical histopathologic features?
Osteoblastoma and Osteoid Osteoma
What two ways exist to differentiate Osteoid osteomas from Osteoblastomas?
- Osteoid osteomas have pain relieved by asprin and 2. Osteoid Osteomas are smaller than 2 cm
Which lesion can a small radio opaque nidus be seen resulting in a target-like appearance?
Osteoid Osteoma
Besides being relieved by asprin, what other fact about pain points to an osteoid osteoma?
Nocturnal pain
What pathology can be described as Odontogenic neoplasm of cementoblasts?
Cementoblastoma
What three radiographic features are suggestive of Cementoblastomas?
- Radio opaque mass that is fused to one or more teeth, 2. Outline of the roots is often obscured and 3. Surrounded by a thin Radiolucent rim
What is the treatment of a cementoblastoma?
Extraction of the tooth and mass
What pathology is a mesenchymal malignancy where cells produce immature bone and is the most common malignancy to originate within bone (besides hematopoietic neoplasms)?
Osteosarcoma
What age distrubution is affected by Osteosarcomas?
Bimodal - 10-20 most common with a group after 50
Where are the two most common sites of development for osteosarcomas?
- Distal femur and 2. Proximal Tibia
When osteosarcomas develop in the jaw, what is the average age?
33
Where are osteosarcomas likely to develop in the facial area?
Mandibular and Maxillary Osteosarcomas are each equally likely
Mandibular osteosarcomas often present where?
Posterior Jaw
Maxillary Osteosarcomas are likely to present in which three locations?
- Alveolar ridge, 2. Sinus floor and 3. Palate
Should a maxillary Osteosarcoma present superiorly, where would it likely be (2)?
- Zygoma or 2. Orbital rim
Should root resorption occur in an Osteosarcoma, what is the name of the special tapering of the root called?
Spiking resorption
What is the classic radiographic presentation of an osteosarcoma?
Sunburst appearance
What x-ray should be used to see osteosarcomas?
Occlusal
What is the name of the triangular elevation of periosteum in osteosarcomas?
Codman’s Triangle
What occurs in the PDL in Osteosarcomas (and other malignancies)?
It widens due to tumor infiltration
What is the most important prognostic indicator for osteosarcomas?
The ability to achieve an initial complete surgical removal
What is the most common form of cancer involving bone?
Metastatic Carcinoma
What are the five most common sites of origin when cancer metastasizes from the jaw?
- Breast, 2. Lung, 3. Thyroid, 4. Prostate and 5. Kidney
What are the four most common metastatic tumors that go to the jaws?
- Vertebrae, 2. Ribs, 3. Pelvis and 4. Skull
Where do the majority of jaw metastasis occur?
Mandible
What term is employed when metastasis to the mandible involves the inferior alveolar nerve and produces a distinct pattern of anesthesia?
Numb-Chin Syndrome
What are the three radiographic characteristics of metastatic tumors to the jaws?
- Moth-eaten ill-defined borders, 2. Widening of PDL and 3. May stimulate bone formation to create a mixed RL-RO lesion
