Bone disease

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The term ‘Fibro-Osseous Lesion’ is a generic
designation of a group of bone disorders characterized
by the replacement of bone by a benign connective
tissue matrix that displays varying degrees of
mineralization in the form of woven bone or
cementum.

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 Fibro-osseous lesion of medullary bone origin
 Fibrous dysplasia
 Fibro-osteoma
 Cherubism
 Juvenile ossifying fibroma
 Giant cell tumor
 Jaw lesion in hyperparathyroidism
 Paget’s disease.

4.  Fibro-osseous lesions of periodontal origin
 Periapical cemental dysplasia
 Florid osseous dysplasia
 Cemento-ossifying fibroma
 Cementifying fibroma
 Ossifying fibroma
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6.  It is a disease of Bone Maturation & Remodeling
in which the normal medullary bone & cortices are
replaced by a disorganized fibrous woven bone.
 It was originally described by Lich ten stein in
1938 & Lich ten stein- Jaffe in 1942
 Caused by deletion of a bone maturation protein
during embryogenesis.
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 Basically 2 types:
 Monostotic
 Polyostotic
 Polyostotic may be divided into 3 subtypes
• Craniofacial FD
• Lich ten stein-Jaffe type
• Albright syndrome

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Monostotic Fibrous Dysplasia-
 Limited to single bone.
 80 to 85% of all cases (jaws being most common).
 Diagnosed mostly in 2nd decade of life.
 Male: female ratio about equal.
 Painless swelling of the affected side is most
common feature
 Maxilla involved more than mandible.

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16 year old female pts. of MONOSTOTIC
FIBROUS DYSPLASIA.

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Polyostotic Fibrous Dysplasia:
 Craniofacial:-
 Peculiar form affecting skull bones
 Not restricted to single bone, but confined to
single anatomic site.
 Primarily affect maxilla, but may cross sutures
into sphenoid, zygoma, front-nasal bones and base
of skull.

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Photograph showing frontal and parietal involvement
& Postoperative appearance after recontouring

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 Lich ten stein- jaffe’s Type-
 Multiple bone (skeleton including craniofacial & jaw
bones).
 Female: Male 3:1
 Recurrent bone pain, spontaneous #
 Skeletal lesion became static with growth but
proliferation continue.
 Most common site is neck of the femur(disease 1st
seen).
 Café au lait (coffee with milk) pigmentation.

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 Albright’s syndrome-
 Most severe & least frequent.
 Females mostly affected.
 Endocrinopathies.
 Café au lait pigmentation (larger & irregular).
 Bone expansion causes disfigurement.
 Pathological # cause deformities.

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Café-au-lait skin pigmentation

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Before and after surgery photographs of 14-year-old pts. The
polyostic fibrous dysplasia associated with McCune-Albright
syndrome.

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A) Ground Glass opacification in the mandible, (b)Ground glass in the maxilla,
(c). Clinical photograph demonstrating cortical expansion, (d). Diffuse unilateral
opacification of the maxillary sinus

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Expansion of the right maxillary bone with the
inferior displacement of the teeth and alveolar ridge
and the superior displacement of the orbit.

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 Ossifying Fibroma,
 Cemento Osseous Dysplasia,
 Paget's Disease,
 Cementoma,
 Cherubism,
 Hyperparathyroidism,
 Chronic Sclerosing Osteomyelitis,

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 Surgical removal of the lesion.
 Osseous contouring.

22. CENTRAL GIANT
CELL
GRANULOMA

23. CENTRAL GIANT CELL GRANULOMA
 Benign hyperplastic lesion of unknown aetiology.
 More common in young females over a wide age
range.(60% in younger than 20yrs & 74% in younger than
30yrs)
 Mandible is twice frequently involved than
maxilla,anterior region most commonly affected crossing
the midline.
 The earliest sign of the lesion may be expansion of bone
with premature loosening & shedding of deciduous
teeth,usually painless.
 Later,very expansile,may be destructive & penetrate cortical
bone & periosteum.

24. Radiological Features
 Solitary or multilocular cyst like radiolucency.
 May occupy whole mandible body.
 Borders may be smooth,moderately well defined &
moderately well corticated.
 Sometimes may show honeycomb appearance owing to
to the delicate, mild wavy & wispy trabeculation of bone.
 Adjacent teeth often displaced,sometimes resorbed.
 Surrounding buccal lingual bone expansion unevenly
producing the scalloped border.

28. LABORATORY FINDINGS
 No change in blood chemistry.
 Biopsy shows loose fibrillar connective tissue stroma
with many interspersed proliferating fibroblasts &
small capillaries.
 Multinucleated giant cells are prominent.

29. MANAGEMENT
 Thorough curettage.
 Weekly inj of corticosteroids directly into tumour
with triamcinolone acetonide.
 Salmon Calcitonin intradermal inj daily for 12 months
or as Nasal spray.
 Interferon alfa also given in some cases.
 Partial surgical resection indicated in aggressive
tumour.

30. CHERUBISM

31. CHERUBISM
 Cherubism:it gives the pt. a cherub,i.e angel like
appearance.
 Inherited as autosomal dominant trait.

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1st begins 2.5yr to 5yrs of age
 Male more than female
 Associated with regional lymphadenopathy.
 if maxilla is involved nasal obstruction seen.
 Nasal obstruction causes enlargement of middle
concha.

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35. RADIOLOGICAL FEATURES
 Appears as large bilateral,multilocular,expansile
lesion.
 The interior of lesion shows fine granular wispy
trabeculae.
 Tooth buds may be destroyed or characteristically
displaced anteriorly.
 The lesions may show signs of regression & by late
adulthood,the bone may appear to be completely
normal.

36. Multilocular radiolucencies
Absence of solid bone
structure and enlarged jaw
region
.

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Radiographic appearance of Cherubism similar to
giant cell granuloma,
Multiple odontogenic keratocyst in basal cell
nevus syndrome.

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 No active treatment.
 Extraction of teeth in involved area,
 Surgical contouring of expanded lesion & complete
curettage.
 radiation therapy is contraindicated leads to post
irradiation sarcoma.