Granulomatus diseases gaint cell lesion fibroosseous lesions

1. Oral Surgery
Mosul university- College of dentistry-oral & maxillofacial surgery department
Dr.Ziad H. Delemi
Assistant prof. B.D.S, F.I.B.M.S (M.F.)
Granulomatus Diseases
Giant Cell Lesions
Fibro Osseous Lesions

2. Mosul university- College of dentistry-oral & maxillofacial surgery department
Granulomatus disease
Group of disease includes:
1- Sarcoidosis
2- Orofacial granulomatosis
3- Wegener granulomatosis
4- Crohns disease

3. Mosul university- College of dentistry-oral & maxillofacial surgery department
Sarcoidosis
Organs affected: skin, salivary gland, eye, oral
mucosa, LN, pulmonary
Clinical features: dry cough, dyspnea, fever, malaise,
weight loss, medistinal LAP, uvitis,
keratocongictivitis, indurated nodules in face,
bilateral diffuse enlarged of parotid glands,
mucosal granularity, erythematus patches ,
granulomatus gingivitis, PD diseases and bone
destruction.submucosal masses, & papules.

4. Mosul university- College of dentistry-oral & maxillofacial surgery department
Sarcoidosis
Diagnosis: CXR, serology, Biopsy, Kvim
test.
Biochemistry: ↑S.alkaline phosphates,
↑S.ACE, ↑ESR, esionophilia, anemia,
leucopenia, thrombocytopenia, ↑S. Ca++
, ↑ U. Ca++,
TTT: self limiting within 2 years systemic
steroids specially for pulmonary cases

5. Sarcoidosis

6. Sarcoidosis

7. Mosul university- College of dentistry-oral & maxillofacial surgery department
Orofacial granulomatosis
Organs affected: skin of the face and oral
mucosa.
Clinical features: chelitis granulomatosa,
linear granulomatus ulcer, linear
hyperplasia, abnormal taste, cobble
stone appearance, granulomatus
gingivitis, Hyposalivation

8. Mosul university- College of dentistry-oral & maxillofacial surgery department
Diagnosis: clinical examination, Biopsy ,
exclusion.
TTT: search for the cause, remove any
infection, intralesional or systemic
steroids, surgical reduction.
Orofacial granulomatosis

9. Mosul university- College of dentistry-oral & maxillofacial surgery department
Orofacial granulomatosis

10. Mosul university- College of dentistry-oral & maxillofacial surgery department
Organs affected: usually systemic
especially upper and lower respiratory
tract in addition to oral cavity and
kidneys.
Clinical features: strawberry gingivitis
palatal ulceration failure of tooth socket
to heal, glomeruolnephritis,
Wegener granulomatosis

11. Mosul university- College of dentistry-oral & maxillofacial surgery department
Diagnosis: Biopsy , serology
Biochemistry: ↑ ESR, markers, ANCA.
TTT: Cycolphosphamide +prednisolone
Wegener granulomatosis

12. Mosul university- College of dentistry-oral & maxillofacial surgery department
Wegener granulomatosis

13. Mosul university- College of dentistry-oral & maxillofacial surgery department
Organs affected: GIT from oral cavity to anus.
Clinical features: chelitis granulomatosa, linear
granulomatus ulcer, linear hyperplasia,
abnormal taste, cobble stone appearance,
granulomatus gingivitis, Hyposalivation,
intestinal cramp, nausea, vomiting, diarrhea,
aphthus ulceration.
Crohns disease

14. Mosul university- College of dentistry-oral & maxillofacial surgery department
Diagnosis: endoscopy & imaging , Biopsy
Biochemistry: ↑ ESR, ↓S.folate, ↓B12,
↓iron (malabsorption)
TTT: Sulphasalazine, Steroids , surgery for
complications.
Crohns disease

15. Mosul university- College of dentistry-oral & maxillofacial surgery department

16. Mosul university- College of dentistry-oral & maxillofacial surgery department
Crohns disease

17. Mosul university- College of dentistry-oral & maxillofacial surgery department
1-Prepheral giant cell granuloma (GC epulis)
2-Central giant cell granuloma
3-Subperiosteal giant cell granuloma
4-Hyperparathyriodisim (1, 2, 3)
5-Cherobisim
6-Osteoclastoma
Giant Cell Lesions

18. Mosul university- College of dentistry-oral & maxillofacial surgery department
Clinical features: buccal and labial gum or
crest of ridge sessile or pedunculated pain
less red purple mass protruded between
teeth rarely ˃3 cm, rapid ↑ in size, not
encapsulated,
Etiology: proliferative response to injury.
Radiology: pressure resorption of underlying
bone.
Peripheral giant cell granuloma

19. Mosul university- College of dentistry-oral & maxillofacial surgery department
TTT: Excision with few mm of abnormal
tissue , curate bone, scale the tooth or exo.
Exclude hyperparathyroidism , remove the
irritant factor
Tend to recurs.
Peripheral giant cell granuloma

20. Mosul university- College of dentistry-oral & maxillofacial surgery department
Peripheral giant cell
granuloma

21. Mosul university- College of dentistry-oral & maxillofacial surgery department
Peripheral giant cell
granuloma

22. Mosul university- College of dentistry-oral & maxillofacial surgery department
Clinical features: affect young mandible
canine premolar area, painless expansion,
may grow rapidly in young and pregnant
Etiology: dysplasia of the bone resorbing
tissues unknown etiology.
Radiology: unilocular or multilocular
incomplete straight septa with non
corticated border not well circumscribed
Central giant cell granuloma

23. Mosul university- College of dentistry-oral & maxillofacial surgery department
Exclusive in tooth bearing area, equal
vertical and horizontal , root resorption,
may cause teeth displacement but mostly
loops in between teeth.
TTT: Enoculation with skimming of bone
with large bur 0.5 cm to remove hidden
pockets that lead to recurrence. Exclude
osteoclastoma.
Central giant cell granuloma

24. Mosul university- College of dentistry-oral & maxillofacial surgery department
Central giant cell granuloma

25. Mosul university- College of dentistry-oral & maxillofacial surgery department
Central giant cell granuloma

26. Mosul university- College of dentistry-oral & maxillofacial surgery department
Clinical features: at the time of shedding of
primary teeth, dilated small vessels on the
surface.
Etiology: unknown
Radiology: punch out radiolucency (largest bulk
of the mass outside the jaw) subperiosteal mew
bone cover part of lesion lateral spreading bone
defect.
TTT: Enoculation with skimming of bone
Subperiosteal giant cell granuloma

27. Mosul university- College of dentistry-oral & maxillofacial surgery department
Subperiosteal giant cell granuloma

28. Mosul university- College of dentistry-oral & maxillofacial surgery department
Clinical features:
bone pains &pathological fractures (2ry) ,
N&V, peptic ulcer, renal stone, metastatic
calcifications, central or peripheral giant
cell lesion may be presenting sign.
Brown tumor osteitis fibrosa cystica.
Hyperparathyroidism

29. Mosul university- College of dentistry-oral & maxillofacial surgery department
Etiology: Primary: hyperplasia, or adenoma.
Secondary: renal failure or steathorrhea →
phosphorus retention →reciprocal ↓ Ca++
→ stimulation → hyperplasia , if chronic
stimulation (tertiary) autonomous adenoma.
Radiology: well defined uni or bilateral
radiolucency with extensive expansion,
mandible skull ribs.
Hyperparathyroidism

30. Mosul university- College of dentistry-oral & maxillofacial surgery department
Complete or partial loss of lamia dura , ↓
deposition of bone Ground glass ,
generalized osteoporosis.
Biochemistry: ↑S.Ca++, ↓S. phosphorus,
↑ S.alkaline phos. , ↑ U. Ca++.
TTT: primary: surgery
secondary: medical (Ca++, Vit D)
tertiary: surgery.
Hyperparathyroidism

31. Mosul university- College of dentistry-oral & maxillofacial surgery department
Hyperparathyroidism

32. Mosul university- College of dentistry-oral & maxillofacial surgery department
Clinical features: starts at 2 y bilateral symmetric firm
swelling may involve all quadrents till 7 y then slow
growth till puberty then regression , exposed sclera.
Etiology: autosomal dominant there is spontaneous
mutation
Radiology: multilocular radiolucency with unerupted teeth.
TTT: wait till growth completed then correct deformity in
extreme cases.
Cherobisim

33. Mosul university- College of dentistry-oral & maxillofacial surgery department
Cherobisim

34. Mosul university- College of dentistry-oral & maxillofacial surgery department
Clinical features: aggressive rapid growth
pain paraesthesia ulceration after cortical
perforation , tendency for recurrence,
Etiology: unknown, malignant neoplasm of
giant cell lesions.
Radiology: root resorption ill defined border
TTT: radical surgery margin of normal tissue
should seen
Osteoclastoma

35. Mosul university- College of dentistry-oral & maxillofacial surgery department
Osteoclastoma

36. Mosul university- College of dentistry-oral & maxillofacial surgery department

37. Mosul university- College of dentistry-oral & maxillofacial surgery department
CGCG

38. Mosul university- College of dentistry-oral & maxillofacial surgery department
CGCG

39. Mosul university- College of dentistry-oral & maxillofacial surgery department
CGCG

40. Mosul university- College of dentistry-oral & maxillofacial surgery department
CGCG

41. Mosul university- College of dentistry-oral & maxillofacial surgery department
CGCG

42. Mosul university- College of dentistry-oral & maxillofacial surgery department
Pyogenic granuloma

43. Mosul university- College of dentistry-oral & maxillofacial surgery department
Pyogenic granuloma

44. Mosul university- College of dentistry-oral & maxillofacial surgery department
Pyogenic granuloma

45. Mosul university- College of dentistry-oral & maxillofacial surgery department
I. Fibrous dysplasia
A. Monostotic
B. Craniofacial
C. Polyostotic
D. McCune-Albright syndrome
II. Ossifying fibroma and juvenile ossifying fibroma
III. Osseous dysplasia
A. Periapical
B. Focal
C. Florid
D. Familial gigantiform cementoma
Benign Fibro-osseous Diseases

46. Mosul university- College of dentistry-oral & maxillofacial surgery department
I. Fibrous dysplasia
Developmental tumour like lesions 80-85%
monostotic (limited to single bone) polyostotic
involve several bones relatively uncommon
and called Jaffe disease. 3%of polyostotic have
cutaneous pigmentation hyperfunction of one
or more endocrine gland known as McCune
Albright syndrome.
Benign Fibro-osseous Diseases

47. Mosul university- College of dentistry-oral & maxillofacial surgery department
Clinical and radiographic features:
More in 1st &2nd decade slowly growing teeth
displaced painless , more vascular than normal
bone the mature with time.
Takes 3 stages radiolucent, mixed, radioopaqe
, loss lamina dura.
Fibrous dysplasia
Treatment:
Better to wait till complete skeletal growth the
reduction only. So not remove all lesion .

48. Mosul university- College of dentistry-oral & maxillofacial surgery department
Ossifying fibroma and juvenile
ossifying fibroma

49. Mosul university- College of dentistry-oral & maxillofacial surgery department
Ossifying fibroma and juvenile
ossifying fibroma

50. Mosul university- College of dentistry-oral & maxillofacial surgery department
Cemento osseous dysplasia
Periapical : affect lower ant. Teeth, no expansion self
limiting, teeth are vital, well defined unilocular with
radiolucent rim , TTT: observation.
Focal: affect mandible post. Even edentulous
unrelated to teeth. no expansion self limiting, teeth
are vital, well defined unilocular with radiolucent rim
, TTT: observation.
Florid: bilateral symmetrical may be 4 quadrant
unrelated to teeth, also need observation but some
times cause low grade osteomyelitis (need
saucerization).

51. Mosul university- College of dentistry-oral & maxillofacial surgery department
Osseous dysplasia
Familial gigantiform cementoma