Developmental disturbances of bone 3

1. DEVELOPMENTAL
DISTURBANCES OF
BONE

2. EXOSTOSES

3.  are localized bony protuberances that arise
from the cortical plate.

4.  discovered most often in adults.
 bilateral rows of bony hard nodules along the
facial aspect of the maxillary and/or
mandibular alveolar ridge.
 They usually are asymptomatic, unless the thin
overlying mucosa becomes ulcerated from
trauma.
Buccal exostoses

5. Multiple buccal
exostoses of the
maxillary and
mandibular alveolar
ridges.

6. Palatal exostoses (palatal
tubercles)
develop from the lingual aspect of the maxillary tuberosities.

7. TORUS PALATINUS

8.  a common exostosis.
 bony hard mass that arises along the midline
of the hard palate.
 Mostly are small, measuring < 2cm.
 female-to-male ratio is 2: I

9. TORUS PALATINUS

11. TORUS MANDIBULARIS

12.  is a common exostosis that develops along the
lingual aspect of the mandible.
 presents as a bony protuberance along the lingual
aspect of the mandible in the region of the
premolars.
 bilateral tori may become so large that they almost
meet in the midline.

14.  Torus is causing a
radiopacity that is
superimposed over
the roots of the
mandibular teeth.
 Occlusal radiograph
showing bilateral
mandibular tori.

15.  mass of dense, lamellar, cortical bone with a
small amount of fibrofatty marrow.
Histopathologic Features

16. Treatment
 surgical removal

17. EAGLE SYNDROME

18.  Elongation of the styloid process or mineralization
of the stylohyoid ligament complex.
 symptoms caused by compression of adjacent
nerves or blood vessels.

19. Clinical and Radiographic Features
 Adults.
 women > men.
 facial pain, especially while swallowing, turning
the head, or opening the mouth.
 dysphagia, dysphonia, otalgia, headache, dizziness,
syncope, and transient ischemic attacks.

20. Mineralization of the stylohyoid
ligament

21. Treatment
 In mild cases, no treatment, only Local injection of
corticosteroids sometimes to relief the pain.
 In severe cases, partial surgical excision of the
elongated styloid process or mineralized stylohyoid
ligament

22. FOCAL OSTEOPOROTIC MARROW
DEFECT

23. pathogenesis
 An area of hematopoietic marrow that is sufficient
in size to produce a radiolucency.
 The pathogenesis is unknown, the following
theories have been proposed:
 Aberrant bone regeneration after tooth extraction
 Persistence of fetal marrow
 Marrow hyperplasia in response to increased demand
for erythrocytes

24. Clinical and Radiographic Features
 75% of cases occur in adult females
 70% in the posterior mandible, most often in
edentulous areas.
 asymptomatic and nonexpansile.
 well-circumscribed radiolucency

25. Fairly well-
circumscribe
radiolucency
with fine
central
trabeculation

26. Histopathologic Features
 normal hematopoietic
and/or fatty marrow

27. Treatment
 no treatment is needed.

28. dense bone island
bone scar
focal periapical osteopetrosis.
IDIOPATHIC OSTEOSCLEROSIS

29. Clinical and Radiographic Features
 focally increased bone density of unknown cause.
 arise in the late first or early second decade.
 may remain static or slowly increase in size.
 once the patient reaches full maturity, the sclerotic
area stabilizes. In a smaller percentage, the lesion
diminishes or undergoes complete regression.

30. Clinical and Radiographic Features
 90% mandible, most often in the first molar area.
 well-defined radiopacity without radiolucent rim

31. Treatment
 Follow up until the area stabilizes.
 no treatment is indicated

32. GORHAM DISEASE
GORHAM-STOUT SYNDROME
VANISHING BONE DISEASE
PHANTOM BONE DISEASE
IDIOPATHIC OSTEOLYSIS
MASSIVE OSTEOLYSIS

33.  characterized by spontaneous and usually
progressive destruction of one or more bones.
 The destroyed bone is replaced by a vascular
proliferation and, ultimately, dense fibrous tissue
without bone regeneration.

34. pathogenesis
1) Trauma
2) Increased osteoclastic activity

35. Clinical Features
 children and young adults
 50% of patients recall prior trauma
 extremities, maxillofacial region (mandible), trunk,
and pelvis.
 mobile teeth, pain, and pathologic fracture

36. Radiographic Features
 earliest changes consist of intramedullary
radiolucent foci of varying size with indistinct
margins.
 These foci coalesce, enlarge, and extend to the
cortical bone,destructing large portions of bone

37.  ill-defined
radiolucency
 extensive
bone loss
and a
pathologic
fracture of
the left
mandible.

38. Histopathologic Features
 Vascular proliferation
intermixed with
fibrous connective
tissue and chronic
inflammatory cells

39. Treatment
 surgical resection.
 Surgical reconstruction is advisable to delay until
arrest of the osteolytic disease phase.
 bisphosphonates and/ or alpha-2b interferon lead to
disease stabilization