Diseases of bone manifested in the jaws


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Radiology II
Forth Year

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Diseases of bone manifested in the jaws

  1. 1. Diseases of bone manifested in the jaws By Dr. Hassan M Abouelkheir BDS, Msc, Phd.
  2. 2. Bone Dysplasias: • A group of conditions in which normal bone is replaced with fibrous tissue containing abnormal bone or cementum.
  3. 3. Fibrous dysplasia: • It is one type of bone dysplasia where cancellous bone is replaced by fibrous tissue with disoreintation of bone trabeculae • It is either monostatic (solitary) or polystatic (Jafee type)→Café au lait spots, hyperfunction of one of more of endocrine glands.
  4. 4. Clinical features • Monostatic→70% more in old age, no sexual predilection. • More common in jaws, tibia,femer. It may cause unilateral facial deformity or swelling, or may discovered by routine x-rays. • Polystatic→ childern less than 10 years , McCune-Albright syndrome (more in female).
  5. 5. R Fibrous dysplasia: a “ground glass” (“frosted glass”) appearance is typical in extra-oral radiographs. Water’s view showing large lesion of left maxilla. Note lesion is restricted to one bone and does not cross the midline.
  6. 6. Radiographic features: • Location: 2:1 maxilla to mandible • More posteriorly and unilateral. • Periphery:ill defined with gradual blending of normal trabecular bone. • Boundaries may be sharp & corticated • Internal structure: density & trabecular pattern of fibrous dysplasia more pronounced in mandible and more homogeneous in the maxilla.
  7. 7. • Internal aspects ranges from radiolucent, radiopaque to mixed lesion. • Abnormal trabecular pattern →ground-glass appearance, peau d’orange, cotton wool or amorphous dense pattern. • Radiolucent regions resembling cysts may occur in mature lesions of fibrous dysplasia.
  8. 8. Fibrous dysplasia: note enlargement of affected area, buccal expansion of the left mandible with granular opacity. Lesion melds with surrounding bone (PA view).
  9. 9. • Effects on surrounding structures: • Expansion with maintenance of a thinned outer cortex. • Lateral wall of maxillary sinus involvement . • Loss of lamina dura with abnormal bone pattern around teeth & may displace them.
  10. 10. Fibrous dysplasia: note enlargement of affected area, buccal expansion of the maxilla and “orange peel” opacity (topographic occlusal view).
  11. 11. Fibrous dysplasia: Water’s view showing lesion in left maxilla. Note difference in lateral walls of the two maxillary sinuses. R
  12. 12. Fibrous dysplasia: cropped panoramic radiograph showing lesion of the left maxilla. The lesion is radiopaque with some radiolucent mottling. It melds with the surrounding bone. LL
  13. 13. Fibrous dysplasia: note enlargement of affected area, buccal expansion of the mandible and granular opacity (true occlusal view).
  14. 14. Fibrous dysplasia: “orange peel”appearance of fine dense trabeculae seen on intra-oral radiography in late stage.
  15. 15. Fibrous dysplasia: Status X view of unusual bilateralFibrous dysplasia: Status X view of unusual bilateral case in maxilla. Note ground glass appearance.case in maxilla. Note ground glass appearance.
  16. 16. Fibrous dysplasia: Note orange peel appearanceFibrous dysplasia: Note orange peel appearance of trabeculations on intraoral radiography (Caseof trabeculations on intraoral radiography (Case courtesy of Dr. Robert P. Langlais)courtesy of Dr. Robert P. Langlais)
  17. 17. Differential diagnosis • Hyperparathyroidism→ polystatic, bilateral & no bone expansion. • Paget’s disease→ older age, whole mandible is involved. • Periapical cemental dysplasia→epicentral in periapical region, bilateral.
  18. 18. Periapical CementalPeriapical Cemental dysplasia(PCD)dysplasia(PCD) • Definition: • localized change in the normal bone metabolim where cancellous bone is replaced with fibrous tissue or cementum like material.
  19. 19. Clinical features: • Middle age , 9:1 F:M 3:1 black :white. • Teeth are vital most common in lower anterior teeth. • No pain . • Discovered by routine x-ray.
  20. 20. Radiographic features • Location: • At the apex of the tooth or over apical 3rd of the root. • Predilection for mandibular anterior teeth. • Periphery& shape: well defined radiolucent border surrounded by sclerotic bone.
  21. 21. • Internal structure: • It depends on maturity of the lesion. • 11stst stagestage → radiolucency at the apex of the tooth with loss of lamina dura. • 22ndnd stagestage→ mixed lesion , radiopaque tissue in radiolucent structure. • Last stageLast stage → a total radiopaque areas with or without thin rim of radiolucent margin.
  22. 22. Periapical cemental Dysplasia: Stage III: homogeneous opacification - but note that the periodontal ligament spaces are still intact.
  23. 23. Effects on surrounding structures: • Loss of lamina dura . • Widening of PDL space . • Hypercementosis of affected teeth. • Expansion of the bone may occurs. • DD:- rarefying osteitis→ vitality testing. • Bengin cementoblastoma → clinical & radiographic. • Odontoma → tooth-like structure.
  24. 24. Florid Osseous Dysplasia • Synonyms: gigantiform cementoma & familial multiple cementomas. • Definition : FOD is awide spread form of PCD. A cancellous bone is replaced with dense, acellular cemento-osseous tissue in background of fibrous ct. • If PCD is identified in 3 or 4 quadrants →FOD.
  25. 25. Clinical features:Clinical features: • Most common in middle aged females. • Intermittent, poorly localized pain in affected bone. • Bony swelling in extensive lesions. • Radiographic: Periphery:Periphery: • Bilateral in both jaws. • Most common posterior to mandibular cuspid.
  26. 26. Internal structure: • Mixed raiolucent- radiopaque→ complete radiopaque. • Simple bone cyst may developed. • Cotton-wool appearance → largen amorphous calcified areas. Effect on surrounding structure: • Apical displacement of ID canal. • Superior displacement of Max.antrum. • Buccolingual displacement of mandibular bone. • Hypercementosis of involved teeth.
  27. 27. Differential diagnosis: • Paget’s disease→ wool-type radiopaque regions with hypercementosis. • affect the entire jaw While FOD → above ID canal. • Polystatic envolvement. • Chronic sclerosing osteomyelitis. • Management: conservative .
  28. 28. Other lesions of the bone: • 1- Cemento-ossifying fibroma (COF): • it behaves like a benign bone neoplasm. • If calcified part→ ossifying fibroma, if it is cementum→ cementifying fibroma. • Clinical features:Clinical features: young adult females , displacement of teeth is early signs then rapid growth leads to deformity of the jaw.
  29. 29. Radiographic features: • Location: • mandibular Facial bone premolar – molar regions. • In maxilla canine and zygomatic region. • Periphery: well defined radiolucent line (fibrous capsule). • Internal structure:mixed radiolucent- radiopaque density. • Effects on surrounding structures→expansion of outer cortical bone. • Management : surgical enucleation or resection.
  30. 30. 2 –central giant cell granuloma • It is a reactive lesion not neoplastic. • Clinical Features: under 20 years of age. • Painless slowly growing swelling. • Radiographic features: • Location : twice in mand< max. • Anterior to 1st molar. • Periphery → well defined margins.
  31. 31.  Internal structure: granular pattern of calcification with ill defined, wispy septa.  Effect on surrounding structurs:  Displace & resorbe teeth.  Loss of lamina dura.  Management :  Enucleation & curettage.
  32. 32. 3- Aneurysmal bone cyst. • It is considered a reactive bone lesion rather than a cyst or neoplasm. • Clinical features: • Under 30 years and more female predilection. • Rapid bony swelling.
  33. 33. Radiographic features: • Mand. To max. 3:2 at molar & ramus areas. • Periphery : well defined circular or hydraulic. • Internal structure: no structure or multilocular appearance. • Effects on surrounding structure:expansion of outer cortex. • Management : surgical curettage & partial resection. High recurrence rate (19%).
  34. 34. 4- cherubim: • It is inherited developmental abnormality that causes bilateral enlargement of jaws. • Clinical features: • Age 2-years. • Firm painless bilateral enlargement of lower face (chubby) .
  35. 35. Radiographic: • Location: posterior mandible, ramus, tuberosity. • Periphery: well define corticated. • Internal structure: fine granular and multilocular pattern. • Effects on surrounding structures: expansion of the cortical boundaries of the maxilla & mandible. • Management: conservative surgical procedures if required.
  36. 36. 5- Paget’s disease: • It is a condition of abnormal resorption and apposition of osseous tissue in one or more bones. • Clinical features: • Middle & old age (40ys) more in males than females. • Enlaged & deformed bones, bowing of the legs, curvature of the spine & enlargement of the skull.
  37. 37. Radiographic features: • Location: It occurs more often in pelvis, femur, skull and vertebrae and infrequently in jaws. • Maxilla twice than mandible bilateral. • Internal structure: 3 stages: • - early radiolucent resorptive stage. • - ground glass appearing second stage. • - dense radiopaque appositional late stage.
  38. 38. • The trabeculae may be long and align themselves in horizontal linear pattern. • Effects on surrounding structures: • Enlargement of affected bone (prominent pagetoid skull bones three times. • Loss of lamina dura and irrigular hypercementosis. • Management: • Calcitonin for pain and <se Alkaline phosphatase. • Sodium etidronate→ covers bone surfaces and retard bone resorption & formation. • Complications: delayed extraction healing, jaw osteomylitis, 10% of cases → osteogenic sarcoma.
  39. 39. Paget’s disease of bone: early demineralization phase with osteoporosis circumscripta of skull both anteriorly and posteriorly
  40. 40. • generalized • hypercementosis • is a frequently • reported association.
  41. 41. 6- Langerhan’s cell Histocytosis: • It is abnormal proliferation of Langerhan’s cells of histiocytes that normally found on the skin. • It is newly classified into ; • 1- unifocal or multifocal eosinophilic granuloma. • 2- malignant disease→ Letterer- Siwe disease and variants of histiocytic lymphoma.
  42. 42. Clinical features: • Eosinophilic granuloma (EG) affect bony skeleton, in chilern & young adult. • Bony swelling, soft tissue mass, gingivitis, pain and ulceration. • It may be acompained by dibetes insipidus and exophthalmos →Hand- Schϋller-Christian disease.
  43. 43. • Letterer-Siwe disease is a malignant form of LCH in infants under 3 years of age . • Soft tissue and bony granulomatous reactions dissiminated throughout the body, hepatospleenomegaly, anemia, lymphadenopathy, hemorrhge. • Death within several weeks.
  44. 44. Radiographic features: • It is divided into 2 types that occur in alveolar bone and that occur intra- osseous else where in jaws. • Location: alveolar type is multiple while intraosseous type is solatory. • Posterior part of mandible and ramus are more common sites. • Periphery and shape: moderate to well defined without cortication.
  45. 45. • Internal structure: totally radiolucent. • Effect on surrounding structures: alveolar type show scooped-out bone distruction with loss of lamina dura. • Intraosseous type shows periosteal new bone formation and may destroy outer cortex. • Management: surgical curettage or limited radiation therapy.