Other skeletal diseases of the jaw

Question 1

What is Pagets disease and who is it most common in?

Answer 1

Metabolic bone disease characterized by abnormality of bony turnover.
Most common in UK & Australia

Question 2

What are the clinical features of Pagets disease?

Answer 2

• Hypercementosis
• Early stage = bone resorption
• Late stage = bone deposition
• Localised bone pain
• Pathological fracture
• Increasing deafness
• Jaw enlargement
• Tooth migration

Question 3

What are the pathological features of pagets disease?

Answer 3

• Osteoclast resorption is increased
• Marrow becomes fibrous & new bone deposited in later phases of disease
• High rate of bone turnover = high serum alkaline phosphatase

Question 4

What are the radiological features of pagets disease?

Answer 4

• FIRST PHASE: Increased radiolucency and bone expansion as bone is replaced by fibroblasts
• SECOND PHASE: Gradual infilling with new bone showing finely trabeculae bone. This matures into an irregular pattern to give a cotton wool appearance (seen in maxilla of this patient). Maxilla becomes prominent and elongated

Question 5

What are the common features of gardner’s syndrome

Answer 5

• Multiple osteomas in buccal mandible
• Many supernumerary teeth
• Multiple epidermoid cysts
• Fibromatous & other soft tissue tumours

Question 6

What is osteosarcoma? Is it more common in mandible or maxilla?

Answer 6

Primary malignancy of bone
More common in mandible than maxilla.

Question 7

What are the pathological features of osteosarcoma?

Answer 7

Formation of neoplastic bone by malignant osteoblasts.
Osteoblasts have nuclear hyperchromatism and frequent mitoses.
Infiltration of adjacent tissues is common

Question 8

What is a chondrosarcoma and what are the clinical features?

Answer 8

• Benign neoplasm of cartilage
• Rare malignant bone tumour producing cartilaginous matrix
• Painless, enlarging, firm but not bony hard swelling
• Resorption of teeth can occur

Question 9

Which cancers commonly metastasize to the jaw?

Answer 9

• Breast
• Bronchus
• Prostate
• Thyroid
• Kidney

Question 10

What are the pathological features of multiple myeloma?

Answer 10

• Tumour foci destroy teeth, replaced by soft fleshy tissue
• Confluent mass of cells resembling plasma cells
• Cytological features of malignancy
• Monoclonal population: k or l light chain – use staining and in a reactive population we should have an even population of k and l light chains whereas in a neoplastic infiltrate, we have an expression of one or the other