simplified charts Flashcards

1
Q
A
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1
Q

Histology

Odontogenic developmental cyst

A

DC. EC/EH. PC. OKC. NBCCS (Gorlin Syndrome). OKOC. LPC. GCA. COC (Gorlin Cyst or Dentinogenic ghost cell tumor). GOD (dialo-odontogenic cyst). Carcinoma arising in odontogenic cysts.

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1
Q

Radiology

Dentigerous cyst.

Eruption cyst.

Paradental cyst. Odontogenic keratocyst.

Nevoid basal cell carcinoma sydrome “Gorlin syndrome.”

ortokeratinized dentinoGENIC cyst.

Lateral periodontal cyst.

Gingival cyst of a newborn.

Gingival cyst of the adult.

califying odontogenic cyst.

glandular odontogenic cyst.

[carcinoma arising in odontogenic cysts]

A

developmental cysts- ~12

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2
Q

Histology

Thin, non-keratinized epithelial lining, multipotential (may have mucous or other cells present), Inflamed cyst=APC histo

A

dentigerous cyst (DC)

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2
Q

Radiology

WD, CB, UL, RL around crown of an unerupted tooth, attached to the CEJ

A

dentigerous cyst (DC)

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3
Q

Histology

Thin layer of keratinized squamous epithelium, may contain blood

A

eruption cyst (eruption hematoma)

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3
Q

Radiology

Soft, translucent swelling in gingival mucosa overlying the crown of an erupting tooth (most commonly 1st perm molars)

A

eruption cyst (eruption hematoma)

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4
Q

Histology

“inflamed dentigerous cyst”, Hx of pericoronitis

A

Paradental cyst

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4
Q

Radiology

Cyst on distal or buccal of partially erupted 3rd molar

A

Paradental cyst

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5
Q

Histology

Small satellite cysts in fibrous wall, uniformly thin epithelium, corrugated parakeratin, palisaded basal layer with hyperchromatic nuclei

A

odontogenic keratocyst (OKC)

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5
Q

Radiology

WD, smooth and CB, UL, RL between teeth. Smetimes ML. resemnbles other cytsts, Rx descriotion not diagnostic

A

odontogenic keratocyst (OKC)

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6
Q

Histology

Multiple basal cell ca’s, multiple OKCs, palmar/plantar pits, calcified cerebri, enlarged head circumference, Rib anomalies, ocular hypertelorism, spina bifida occulta

A

nevoid basal cell carcinoma syndrome “Gorlin syndrome”

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6
Q

Radiology

Jaw cysts present in 75% of patients

A

nevoid basal cell carcinoma syndrome “Gorlin syndrome”

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7
Q

Histology

Orthokeratin WITHOUT nuclei, prominent granular cell layer, basal cell layer NOT PALISADED and less hyperchromatic

A

orthokeratinized odontogenic cyst

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7
Q

Radiology

Posterior mandible, unerupted 3rd molars, UL, RL. Resembles DC

A

orthokeratinized odontogenic cyst

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8
Q

Histology

Focal nodular thickenings (epithelial plaques), lined by uniformly flattened squamous cells, swirl appearance

A

lateral periodontal cyst

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8
Q

Radiology

WD, CB, RL lateral to the roots of VITAL teeth

A

lateral periodontal cyst

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9
Q

Histology

Multiple whitish papules on mucosa overlying alveolar process on a newborn (<3mos). Derived from rests of dental lamina, Keratin-filled cysts lined by parakeratotic stratified squamous epithelium.

A

gingival cyst of the newborn

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9
Q

Radiology

N/A

A

gingival cyst of the newborn

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10
Q

Histology

Fluid-filled swelling of the facial gingiva or alveolar mucosa, blue/gray tint, md premolar/anteriors. Derived from rests of dental lamina, soft tissue counterpart of lateral periodontal cyst, focal nodular thickenings

A

gingival cyst of the adult

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10
Q

Radiology

Usually not seen on radiograph due to soft-tissue nature

A

gingival cyst of the adult

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11
Q

Histology

Ghost cells (outline, but no nuclei), dystrophic calcification of ghost cells (RO’s), ghost cell keratinization, epithelium similar to enamel organ and ameloblastoma, loose stellate/spindle cells, columnar cells

A

calcifying odontogenic cyst (Gorlin cyst or dentinoGENIC ghost cell tumor)

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11
Q

Radiology

WD, UL, RL with or without RO’s or Cal’s.

A

calcifying odontogenic cyst (Gorlin cyst or dentinoGENIC ghost cell tumor)

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12
Q

Histology

Derived from rests of dental lamina, lined by stratified squamous epithelium with cililated columnar shape, small microcysts and clusters of mucous cells in cystic lining

A

Glandular odontogenic cyst (sialo-odontogenic cyst)

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12
Q

Radiology

WD, SB, UL or ML, RL. Anterior mandible

A

Glandular odontogenic cyst (sialo-odontogenic cyst)

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13
Q

Histology

Well-differentiated SCC

A

Carcinoma Arising in odontogenic cysts

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13
Q

Radiology

Irregular and ragged margins of a RL defect

A

Carcinoma Arising in odontogenic cysts

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14
Q

Histology

APC (periapical cyst or radicular cyst). RC. BBC.

A

inflammatory cysts - 3

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14
Q

Radiology

Apical periodontal cyst. Residual cyst. Buccal bifurcation cyst.

A

inflammatory cysts - 3

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15
Q

Histology

NON-VITAL TOOTH. Derived from rests of Malassez, SSEpi exhibiting exocytosis and spongious, may have cholesterol clefts, dystrophic calcifications

A

Apical periodontal cyst (periapical cyst or radicular cyst)

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15
Q

Radiology

WD, CB, UL, RL in periapical area (classical) or interproximal area. May be along lateral aspect of the root

A

Apical periodontal cyst (periapical cyst or radicular cyst)

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16
Q

Histology

Persistent APC after infected tooth has been extracted. Same histo as APC

A

residual cyst

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16
Q

Radiology

WD, CB, RL at extraction site

A

residual cyst

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17
Q

Histology

Buccal of mandibular 1st molars, buccal enamel extension leads to pocket, “Site Specific” paradental cyst

A

buccal bifurcation cyst

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17
Q

Radiology

WD, UL, RL at buccal bifurcation

A

buccal bifurcation cyst

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18
Q

Histology

ABC. FOBMD. STBC. ScC. Idiopathic osteosclerosis. CGCG.osteoma. Chondroma.

A

Non-odontogenic cysts

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18
Q

Radiology

aneurysmal bone cyst. Focal osteoporotic bone marrow defect. Simple traumatic bone cyst. Surgical ciliated cyst. Idiopathic osteosclerosis. Central Giant cell Ganuloma. Osteoma. Chrodroma.

A

Non-odontogenic cysts

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19
Q

Histology

Blood-filled spaces lined by connective tissue septa, multinucleated giant cells

A

aneurysmal bone cyst

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19
Q

Radiology

UL or ML, RL with cortical expansion and thinning

A

aneurysmal bone cyst

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20
Q

Histology

Normal bone marrow, hematopoietic progenitor cells, fat cells. Stimulates an intraosseous neoplasm in an extraction socket

A

focal osteoporotic bone marrow defect

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20
Q

Radiology

RL with fine trabeculations, circumscribed with ill-defined borders

A

focal osteoporotic bone marrow defect

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21
Q

Histology

Thin connective tissue with reactive bone, NO epithelium (NOT a true cyst)

A

simple traumatic bone cyst

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21
Q

Radiology

WD, RL, irregular borders, UL, maybe ML, no tooth displacement or root resorption

A

simple traumatic bone cyst

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22
Q

Histology

Lined by respiratory epithelium, intrabony cyst caused by implantation of sinus epithelium

A

surgical ciliated cyst

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22
Q

Radiology

WD, RL in close proximity, but separate from the maxillary sinus

A

surgical ciliated cyst

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23
Q

Histology

Area of hematopoietic marrow, dense lamellar bone with scant fibro-fatty marrow, NOT pathological

A

idopathic osteosclerosis

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23
Q

Radiology

RL area with fine trabeculations

A

idopathic osteosclerosis

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24
Q

Histology

Multinuclated giant cells with plump proliferating mesenchymal cells, RBC extravasation

A

central giant cell granuloma

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24
Q

Radiology

WD, but NOT corticated, UL or ML, RL defect, anterior mandible

A

central giant cell granuloma

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25
Q

Histology

Associated with Gardner Syndrome, progressive shift in patient occlusion and deviation of midline. Mature compact or cancellous bone

A

osteoma

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25
Q

Radiology

Slowly growing masses on surface of mandible/maxilla

A

osteoma

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26
Q

Histology

Composed of mature hyaline cartilage, located on short trabecular bones of the hands and feet

A

chrondroma

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26
Q

Radiology

N/A

A

chrondroma

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27
Q

Histology

Ameloblastoma, conventional solid or multicystic ameloblastoma, unicystic ameloblastoma, peripheral ameloblastoma(extraosseaous), malignant ameloblastoma, ameloblastic carinoma, calcifying epithelial odontogenic tumor (pindborg tumor)

A

epithelial odontogenic tumors - 8

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27
Q

Radiology

ameloblastoma. Conventional solid or multicystic ameloblastoma. Unicystic ameloblastoma. Peripheral ameloblastoma (extraosseous). Malignant ameloblastoma. Ameloblastic carcinoma. Adenoatoid odontogenic tumor. Calcifying epithelial odontogenic tumor (pindborg).

A

epithelial odontogenic tumors - 8

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28
Q

Histology

Most common clinically significant odontogenic tumor. Slow growing, locally invasive, usually benign , painless swelling covered by oral mucosa

A

ameloblastoma

28
Q

Radiology

RL, UL early, ML later, expansion, tooth displacement, might resorb roots

A

ameloblastoma

29
Q

Histology

86% of Ameloblastomas. Islands of odontogenic epithelium, core resembles stellage reticulum of enamel organ, peripheral columnar cells with REVERSE POLARITY of nuclei

A

conventional solid or multicystic ameloblastoma

29
Q

Radiology

ML, RL lesion with “soap bubble” or honeycomb appearance, B/L cortical expansion, root resorption of teeth adjacent to the tumor.

A

conventional solid or multicystic ameloblastoma

30
Q

Histology

13% of Ameloblastomas: Luminal: basal layer columnar/cuboidal cells with hyperchromatic nuclei, reverse polarity, basilar cytoplsmic vacuolization. Intraluminal/Plexiform: one or more nodules of ameloblastomas project from cystic lining into lumen. Mural: fibrous wall of the cyst infiltrated by typical follicular or plexiform ameloblastoma

A

unicystic ameloblastoma

30
Q

Radiology

circumscribed RL, may/may not be around the crown. Can resemble DC.

A

unicystic ameloblastoma

31
Q

Histology

1% of Ameloblastomas

A

peripheral ameloblastoma- extraosseous

31
Q

Radiology

na

A

peripheral ameloblastoma- extraosseous

32
Q

Histology

Ameloblastoma in primary tumor and metastatic deposits

A

ameloblastic carcinoma

32
Q

Radiology

na

A

ameloblastic carcinoma

33
Q

Histology

Ameloblastoma that has cytologic features of malignancy in the primary tumor, in a recurrence, or in any metastatic deposit

A

malignant ameloblastoma

33
Q

Radiology

na

A

malignant ameloblastoma

34
Q

Histology

Thick fibrous capsule, duct-like epi structures lined by cuboidal columnar cells, nuclei polarized AWAY from central spaces, all cells are epithelial

A

adenomatoid odontogenic tumor

34
Q

Radiology

WD, CB, UL, RL invoving crown of unerupted tooth (below CEJ), tooth displacement, snowflake cal’s

A

adenomatoid odontogenic tumor

35
Q

Histology

Large cells with nuclei (different from COC), expansile, painless swelling. Congo Red test + for Amyloid proteins . Concentric Liesegang Ring Calcifications

A

califying epithelial odontogenic tumor (pindborg)

35
Q

Radiology

WD or Ill-defined, UL or ML RL with flecks of RO’s, strong tooth displacement, honeycomb appearance

A

califying epithelial odontogenic tumor (pindborg)

36
Q

Histology

Central odontogenic fibroma. Peripheral odontogenic fibroma. Odontogenic myxoma. Cementoblastoma.

A

ectomesenchyme odontogenic tumors

36
Q

Radiology

central odontogenic fibroma. Peripheral odontogenic fibroma. Odontogenic myoma. Cementoblastoma.

A

ectomesenchyme odontogenic tumors

37
Q

Histology

Hyperplastic dental follicle

A

Central odontogenic fibroma

37
Q

Radiology

WD, UL (early)/ML (late), RL associated with periradicular areas of erupted teeth, root resorption

A

Central odontogenic fibroma

38
Q

Histology

Soft tissue counterpart of central odontogenic fibroma.Slow-growing, sessile mass covered by normal mucosa

A

peripheral odontogenic fibroma

38
Q

Radiology

Similar to peripherial ossifying fibroma

A

peripheral odontogenic fibroma

39
Q

Histology

Haphazardly arranged stellate, spindle-shaped and round cells, glycosaminoglycans, no capsule, jelly-like. Locally aggressive, jaw lesion only with painless swelling

A

odontogenic myxoma

39
Q

Radiology

UL or ML, Irregular/scalloped margins, thin, wispy trabeculae of residual bone, “step ladder” pattern, rare root resorption, soap bubble appearance

A

odontogenic myxoma

40
Q

Histology

Slow-growing, dentin-resorbing (not hypercementosis), strongly active osteoblastic activities

A

comentoblastoma

40
Q

Radiology

WD, RO (density of cementum), RL halo, attached to root of affected tooth, resorbed root

A

cementoblastoma

41
Q

Histology

ameloblastic fibroma. Ameloblastic fibrosarcoma. Ameloblastic fibro-odontoma. Compound odontoma. Complex odontoma.

A

Mixed odontogenic tumors (odontogenic epithelium and ecomesenchymal elements)

41
Q

Radiology

ameloblastic fibroma. Ameloblastic fibrosarcoma. Ameloblastic fibro-odontoma. Compound odontoma. Complex odontoma

A

Mixed odontogenic tumors (odontogenic epithelium and ecomesenchymal elements)

42
Q

Histology

Narrow cords of odontogenic epithelium anastomosing, peripheral nuclear palisading columnar cells

A

ameloblastic fibroma

42
Q

Radiology

WD, UL or ML, RL extending from superior part of the tooth follicle (NOT CEJ) of an unerupted tooth

A

ameloblastic fibroma

43
Q

Histology

Malignant counterpart of ameloblastic fibroma

A

ameloblastic fibrosarcoma

44
Q

Histology

Disorganized tooth structure, same histo as ameloblastic fibroma,

A

ameloblastic fibro-odontoma

44
Q

Radiology

WD, CB, RL defect with variable amt of calcified material with the radiodensity of tooth structure

A

ameloblastic fibro-odontoma

45
Q

Histology

Multiple tooth-like structures, anterior maxilla

A

compound odontoma

45
Q

Radiology

Collection of ROs (tooth-like structures) surrounded by a narrow RL zone

A

compound odontoma

46
Q

Histology

Conglomerate mass of enamel and dentin, NO resemblance to a tooth, may cause impaction

A

complex odontoma

46
Q

Radiology

Calcified mass with radiodensity of tooth structure surrounded by RL halo

A

complex odontoma

47
Q

Radiology

fibrous dysplasia. Reactive/dysplastic lesions in alveolous (tooth bearing areas of the jaw) or? Cemento-osseous dysplasia. Fibro-osseous neoplasms.

A

Three categories of fibro-osseous lesions in the jaw (normal bone replaced with excessive proliferation of fcellular fibrous CT)

48
Q

Histology

Monostotic fibrous dysplasia of the jaw. Polyostotic dysplasia of the jaw. Focal-cemento-osseous dysplasia. Periapical cemento-posseous dysplasia. Florid cemento-osseous dysplasia. Ossifying/cementifying fibroma. Osteoblastoma (and osteoid osteoma)

A

name 7 fibro-osseous lesions of the jaw

48
Q

Radiology

FIBROUS DYSPLASIA: monostatic fibrous dysplasia of the jaws. Polyostotic fibrous dysplasia of the jaws. REACTIVE/DYSPLASTIC LESION OF THE ALVEOLOUS AND CEMENTO-OSSEOUS DYSPLASIA: Focal cemento-osseous dysplasia (FCOD). Periapical cemento-osseous dysplasia (PCOD). Florid cemento-osseous dysplasia (FOD, FLCOD). FIBRO-OSSEOUS NEOPLASMS (2): Ossifying/cementifying fibroma. osteoblastoma and osteoid osteoma.

A

name 7 fibro-osseous lesions of the jaw

49
Q

Histology

single bone, max>mandib, young F, poorly calcified bone trabeculae arranged in a disorganized pattern

A

FD: monostotic fibrous dysplasia of the jaw

49
Q

Radiology

Fine “ground glass” opacification, not well-demarcated

A

FD: monostotic fibrous dysplasia of the jaw

50
Q

Histology

two or more bones, café au lait spots, jaffe-lichtenstein syndrome, McCume-albright syndrome (sexual precosity)

A

FD: polyostotic fibrous displasia of the jaw

50
Q

Radiology

Early: RL, WD, UL. Late: ROs take on numerous shapes and sizes, borders blend with bone. Bone exp, tooth displacement, root resorption, obliteration of max sinus.

A

FD: polyostotic fibrous displasia of the jaw

51
Q

Histology

anywhere in jaw, singl-site involved, asymptomatic, small

A

R/DL, COD: focal cemento-osseous dysplasia (FCOD)

51
Q

Radiology

Mixed RL/RO, thin RL rim

A

R/DL, COD: focal cemento-osseous dysplasia (FCOD)

52
Q

Histology

VITAL TEETH, asymptomatic pt, scpecules of bone and some cementum-like hard tissues

A

R/DL, COD: periapical cemento-osseous dysplasia (PCOD)

52
Q

Radiology

Uncircumscribed zones of RL involving periapical region of anterior mandible.

A

R/DL, COD: periapical cemento-osseous dysplasia (PCOD)

53
Q

Histology

VITAL TEETH, multifocal involvement, not limited to anterior mandible, bilateral symmetry involvement, simple bone cyst may be present, osteomyolitis due to reduced valscularity

A

R/DL, COD: florid cemento-osseous dysplsia (PLCOD, FOD)

53
Q

Radiology

Multiple, WD, lobular, <3m, RL with some ROs, bilateral and symmetric, no tooth resorption, hypercementosis, increased bone density

A

R/DL, COD: florid cemento-osseous dysplsia (PLCOD, FOD)

54
Q

Histology

painless swelling with obvious facial asmmatry, jaw expansion, tooth displacement, asymmtomatic

A

FON: ossifying/cementifying fibroma

54
Q

Radiology

WD, UL w/varying levels of RO (RL, Mixed or RO), CB (diff from later stage fibrous dysplasia), root resorption

A

FON: ossifying/cementifying fibroma

55
Q

Histology

benign bone tumors occasionally seen in the haw, histo identical to OSTEOBLASTOMA

A

FON: obsteoblastoma and osteoid osteoma

55
Q

Radiology

N/A

A

FON: obsteoblastoma and osteoid osteoma

56
Q

Histology

Osteosarcoma. Chondrosarcoma. Metatstatic tumors of the jaw.

A

Malignant bone tumors- 3

56
Q

Radiology

osteosarcoma. Chondrosarcoma. Metastatic tumors of the jaws.

A

Malignant bone tumors- 3

57
Q

Histology

redness and bleeding of gingiva. Persistent, non-healing ulcers

A

clinical findings of bone malignancies (2)

57
Q

Radiology

clinical findings of bone malignancies: 1. redness and bleeding of gingiva. 2. persistent, non-healing ulcer.

A

clinical findings of bone malignancies (2)

58
Q

Histology

superficial horizontal resorption. Erosion of bony SF. RL with ill-defined bornders and ragged Ros. Pathologival fractures. Opacification of sinus. Destruction of sinus walls. Floating teeth. Root resorption.

A

general RG findings of bone malignancies (8)

58
Q

Radiology

general RG findings of bone malignancies: 1. superficial horizontal resorption. 2. erosion of bony SF. 3. RL with ill-defined borders and ragged Ros. 4. pathological fractures. 5. opacification of the sinus. 6. destruction of the sinus walls/floor. 7. floating teeth. 8. root resorption.

A

general RG findings of bone malignancies (8)

59
Q

Histology

leukemia. Burkitt’s lymphoma. Multiple myeloma.

A

other malignancies of the jaws and O.C. (3)

59
Q

Radiology

leukemia. Burkitt’s lymphoma. Multiple myeloma.

A

other malignancies of the jaws and O.C. (3)

60
Q

Histology

malignancy of mesenchymal cells, central lesion. “bad cells, bad bone” malignant cartilage and bone

A

osteosarcoma

60
Q

Radiology

Ill-defined and indistinct peripheral border, classic sunburst appearance (periosteal reaction), widening of PDL, elevation of bone height ABOVE CEJ, perforation, exp of cortical margins

A

osteosarcoma

61
Q

Histology

maignancy Chx by formation of cartilage and no bone

A

chomdrosarcoma

61
Q

Radiology

RL process with poorly defined borders

A

chomdrosarcoma

62
Q

Histology

MOST COMMON malignancy of the jaw, from BREAST, PROSTATE, LUNG, KIDNEY carcinomas

A

metastatic tumors of the jaws

62
Q

Radiology

Ill-defined, “moth eaten”, destructive margins, irregular shape, destruction of lamina dura, tooth mobility, “floating teeth,” RL defects

A

metastatic tumors of the jaws

63
Q

Histology

acute (50-60yo), gingival infiltration, swelling, perio disease

A

leukemia

63
Q

Radiology

Destruction of alveolar bone, loss of lamina dura, loosening of teeth, ill-defined RLs

A

leukemia

64
Q

Histology

african form has jaw involvement, 5-12yo, loosening, displacement, premature eruption

A

burkitt’s lymphoma

64
Q

Radiology

Jaw expansion, single or multiple RL foci in molar region, ill-defined borders, perforation, destruction, displacement of B/L corticies

A

burkitt’s lymphoma

65
Q

Histology

weakness and pain, pathologic fractures, multiple bone involved (%14 JAWS), mobility and migration of teeth, bence-jones protein urine

A

multiple myeloma

65
Q

Radiology

Multiple, small, WD, non-corticated RLs, uni- or bilateral, skull often involved, “punched-out”

A

multiple myeloma

66
Q

Unilocular Radiolucencies
Well-defined

A

_Unilocular Radiolucencies
Well-defined
_

  • Odontgenic cysts
  • Fissural cysts
  • Cementoma (early)
  • Odontogenic tumors
  • Neural tumors
  • Salivary gland depressions
67
Q

_Unilocular Radiolucencies
Poorly-defined
_

A

_Unilocular Radiolucencies
Poorly-defined
_

  • Odontogenic cysts
  • Fissural cysts
  • Cementoma
  • Odontogenic tumors
  • Metastatic tumors
  • Histiocytosis X
  • Osteoporotic bone marrow defect
68
Q

_Multilocular Radiolucencies
Well-defined
_

A

Multilocular Radiolucencies
Well-defined

  • Odontogenic keratocyst
  • Odontogenic tumors
  • Giant cell lesions
  • Fibro-osseous lesions
  • Hemangioma
69
Q

_Multilocular Radiolucencies
Poorly-defined
_

A

_Multilocular Radiolucencies
Poorly-defined
_
Osteomyelitis
Fibro-osseous lesions
Sarcomas
Metastatic tumors

70
Q

_Radiopacities
Discrete lesions
_

A

_Radiopacities
Discrete lesions
_

  • Cementoma (mature)
  • Osteoma / osteoblastoma
  • Sclerosing osteitis / bone scar
  • Foreign bodies
71
Q

_Radiopacities
Multiple or diffuse lesions
_

A

_Radiopacities
Multiple or diffuse lesions
_
Osteomyelitis
Florid osseous dysplasia
Paget’s disease
Blastic metastases
Osteosarcoma

72
Q

Mixed lucencies/opacities

A

Mixed lucencies/opacities

  • Fibro-osseous disease
  • Ossifying tumors
  • Odontomas
  • Cementoma (intermediate)
  • Paget’s disease
  • Chronic osteomyelitis
  • Blastic metastases
  • Sarcomas
73
Q

Condylar lesions

A
74
Q

indications for marsupialization …

A

indications for marsupialization …

  • To prevent injury to adjacent structures
  • To prevent devitalization of teeth
  • To assist in the eruption of teeth
  • Where there is difficult surgical access
  • Where there is a risk of pathologic fracture
  • In the medically compromised patient
    • Short surgical procedure
    • Local anesthesia
  1. Decreased risk of fracture No risk to the IA nerve
  2. Useful teeth can erupt
75
Q

a benign reactive lesion that is caused by altered hemodynamics and cause an accumulation of blood in the bone with out a detectable bruit. what two interaosseous lesions can occur in combination with this lesion?

A
  1. aneurysmal bone cyst
  2. fibro-osseous lesions
  3. giant cell granuloma