This document discusses various giant cell lesions of the jaws. It defines giant cells and describes their origin from monocytes/macrophages. Giant cell lesions are classified as inflammatory/reactive, aneurysmal bone cyst, metabolic like hyperparathyroidism, or neoplastic like central giant cell tumor. Central giant cell granuloma is described in detail with regards to etiology, clinical features, radiographic appearance, histology, and treatment involving intralesional steroids, calcitonin or surgery. Other giant cell lesions discussed include peripheral giant cell granuloma, aneurysmal bone cyst, traumatic bone cyst, osteoid osteoma/osteoblastoma, cherubism, and brown tumor of hyperparathyroidism
This document discusses giant cell lesions of the jaws. It begins by defining giant cells and describing their origin from monocytes and macrophages. Giant cell lesions are then classified as inflammatory/reactive, metabolic, or neoplastic. Central giant cell granuloma, aneurysmal bone cyst, and traumatic bone cyst are discussed as examples of inflammatory/reactive lesions. Cherubism and brown tumor of hyperparathyroidism represent metabolic giant cell lesions. Osteoblastoma is provided as an example of a neoplastic giant cell lesion. Clinical, radiographic, histologic, and treatment details are outlined for many of the conditions.
Giant cell lesions can be physiological, occurring normally in tissues like bone marrow and placenta, or pathological. Pathological giant cells are usually formed by the fusion of macrophages and are seen in conditions like granulomas, infections, and foreign body reactions. There are several types of giant cells characterized by their histological appearance and distribution of nuclei, including Langhans', foreign body, and Touton giant cells. Giant cell lesions can also occur in bone and oral mucosa in various inflammatory, infectious, neoplastic, and metabolic conditions. Central giant cell granuloma is a benign bone lesion first described by Jaffe in 1953 as a reparative process consisting of fibrohistocytic proliferation and haemosiderin
Gaint cell lesions of bone/oral surgery courses by indian dental academyIndian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Central Giant Cell Granuloma :
WHO has defined it as an intraosseous lesion consisting of cellular and fibrous tissue that contains multiple foci of hemorrhage, aggregation of multinucleated giant cells and occasionally trabaculae of woven bone
Etiology JAFFE (1953): considered this lesion to be a local reparative reaction of bone, possibly to intramedullary hemorrhage or trauma, hence the term reparative giant cell granuloma was accepted.
Charles A Waldron & W G Shafer (1966) suggested trauma be an important etiological factor in the initiation of the CGCG of the jaws
Thoma K H (1986) suggested that the lesion may be due to capillary injury caused by defective wall due to some type of trauma
J V Soames and J C Southam (1997) suggested that it could be a reaction to some form of hemodynamic disturbance in bone marrow, perhaps associated with trauma and hemorrhage REGEZI AND SCIUBBA(1999) :
Suggested that
Response to previous traumatic or inflammatory episodes.
This lesion is charecterised by proliferation of fibroblasts and multinucleated giant cells, in a densely packed stromaThe CGCG is a benign process that occurs almost exclusively within the jaw bones
CLINICAL PRESENTATION
Found predominantly in children and young adult
It has a female predilection (2:1)
Most commonly affected site is the anterior portion of the jaws, with an increased frequency of occurrence in the mandible
Majority of the CGCG of jaws are painless, expansion of bone is detected on routine examination
Few cases may be associated with pain, paresthesia or perforation of a cortical bone plate, occasionally resulting in the ulceration of the mucosal surface by the underlying lesion
Radiographic featuresCentral giant cell lesions present as radiolucent defects. Which may be unilocular or multilocular.
The defect is usually well delineated
The lesion may vary from a 5×5mm incidental radiographic findings to a destructive lesion greater than 10cm in size.
radiographic findings
A small unilocular lesion may be confused with periapical granuloma or cysts.
multilocular giant cell lesions cannot be radiographically distinguished from ameloblastomas or other multilocular lesions. Based on clinical and radiological features CGCG may be divided into two categories
- Non-aggressive lesion
- Aggressive lesion
The non aggressive lesion makes up most cases and exhibit few or no symptoms, they demonstrate slow growth and do not show cortical perforation or root resorption of teeth involved in the lesion. The aggressive lesions are characterized by pain, rapid growth, cortical perforation and root resorption and show marked tendency to recur when compared with non aggressive typeSoft spongy, brownish to reddish friable tissue of various size.
A specimen is usually coated with fresh or coagulated blood. Giant cell lesions of the jaws show a variety of features. Common to all is the presence of few to many multinucleated
ODONTOGENIC MYXOMA :
Benign mesenchymal lesion that mimics microscopically the dental pulp or follicular connective tissue
Derived from odontogenic ectomesenchymeClinical feature:
Age : 10- 50 yrs with mean age of 30 yrs
No gender predilection
Both mandible and maxilla are equally effectedClinical feature:
Age : 10- 50 yrs with mean age of 30 yrs
No gender predilection
Both mandible and maxilla are equally effectedClinical feature:
Age : 10- 50 yrs with mean age of 30 yrs
No gender predilection
Both mandible and maxilla are equally effected
Radiographic feature :
Radiolucent and it appear as a well circumscribed or diffuse lesion
Often multilocular with honey comb pattern
Cortical plate expansion, root displacement or resorption may be seen Histopathology :
Tumor consist of acellular myxomatous connective tissue.
Benign fibroblast and myofibroblast with some amount of collagen are found in matrix
Bony island representing residual tubeculae
Capillaries are scattered through out the lesion
This document provides an overview of fibro-osseous lesions, which are characterized by the replacement of normal bone by fibrous tissue containing mineralized products. It discusses the definitions, classifications, specific lesions including fibrous dysplasia and cherubism, radiological differential diagnosis, and references various classification systems proposed over time. The classifications discussed include those proposed by Waldron, Malek, Slootweg & Muller, WHO, Brannon & Fowler, Speight & Carlos, and Eversole. Key lesions like fibrous dysplasia, cherubism, ossifying fibroma, cemento-osseous dysplasia are also defined.
Odontogenic keratocyst- A case presentationBinaya Subedi
This case presentation describes a 74-year-old female patient with a swelling in the lower front region of her jaw. Radiographs and biopsy revealed an odontogenic keratocyst. Odontogenic keratocysts are developmental cysts that arise from cell rests of the dental lamina and have a high recurrence rate due to their thin lining. Treatment options considered for this patient's odontogenic keratocyst include curettage with or without peripheral osteotomy or segmental resection of the mandible.
This document provides information about calcifying odontogenic cysts (COCs). It defines COCs and classifies them according to the WHO. COCs are rare jaw lesions characterized by ghost cells and calcifications. They are thought to arise from odontogenic epithelial remnants. Clinically, they typically present in the second decade of life with lesions more common in the maxilla than mandible. Radiographically, COCs appear well-defined with variable calcifications. Histologically, they contain ghost cells and basal cell layer with hyperchromatic nuclei. Prognosis is generally good when treated with surgical removal.
This document discusses giant cell lesions of the jaws. It begins by defining giant cells and describing their origin from monocytes and macrophages. Giant cell lesions are then classified as inflammatory/reactive, metabolic, or neoplastic. Central giant cell granuloma, aneurysmal bone cyst, and traumatic bone cyst are discussed as examples of inflammatory/reactive lesions. Cherubism and brown tumor of hyperparathyroidism represent metabolic giant cell lesions. Osteoblastoma is provided as an example of a neoplastic giant cell lesion. Clinical, radiographic, histologic, and treatment details are outlined for many of the conditions.
Giant cell lesions can be physiological, occurring normally in tissues like bone marrow and placenta, or pathological. Pathological giant cells are usually formed by the fusion of macrophages and are seen in conditions like granulomas, infections, and foreign body reactions. There are several types of giant cells characterized by their histological appearance and distribution of nuclei, including Langhans', foreign body, and Touton giant cells. Giant cell lesions can also occur in bone and oral mucosa in various inflammatory, infectious, neoplastic, and metabolic conditions. Central giant cell granuloma is a benign bone lesion first described by Jaffe in 1953 as a reparative process consisting of fibrohistocytic proliferation and haemosiderin
Gaint cell lesions of bone/oral surgery courses by indian dental academyIndian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Central Giant Cell Granuloma :
WHO has defined it as an intraosseous lesion consisting of cellular and fibrous tissue that contains multiple foci of hemorrhage, aggregation of multinucleated giant cells and occasionally trabaculae of woven bone
Etiology JAFFE (1953): considered this lesion to be a local reparative reaction of bone, possibly to intramedullary hemorrhage or trauma, hence the term reparative giant cell granuloma was accepted.
Charles A Waldron & W G Shafer (1966) suggested trauma be an important etiological factor in the initiation of the CGCG of the jaws
Thoma K H (1986) suggested that the lesion may be due to capillary injury caused by defective wall due to some type of trauma
J V Soames and J C Southam (1997) suggested that it could be a reaction to some form of hemodynamic disturbance in bone marrow, perhaps associated with trauma and hemorrhage REGEZI AND SCIUBBA(1999) :
Suggested that
Response to previous traumatic or inflammatory episodes.
This lesion is charecterised by proliferation of fibroblasts and multinucleated giant cells, in a densely packed stromaThe CGCG is a benign process that occurs almost exclusively within the jaw bones
CLINICAL PRESENTATION
Found predominantly in children and young adult
It has a female predilection (2:1)
Most commonly affected site is the anterior portion of the jaws, with an increased frequency of occurrence in the mandible
Majority of the CGCG of jaws are painless, expansion of bone is detected on routine examination
Few cases may be associated with pain, paresthesia or perforation of a cortical bone plate, occasionally resulting in the ulceration of the mucosal surface by the underlying lesion
Radiographic featuresCentral giant cell lesions present as radiolucent defects. Which may be unilocular or multilocular.
The defect is usually well delineated
The lesion may vary from a 5×5mm incidental radiographic findings to a destructive lesion greater than 10cm in size.
radiographic findings
A small unilocular lesion may be confused with periapical granuloma or cysts.
multilocular giant cell lesions cannot be radiographically distinguished from ameloblastomas or other multilocular lesions. Based on clinical and radiological features CGCG may be divided into two categories
- Non-aggressive lesion
- Aggressive lesion
The non aggressive lesion makes up most cases and exhibit few or no symptoms, they demonstrate slow growth and do not show cortical perforation or root resorption of teeth involved in the lesion. The aggressive lesions are characterized by pain, rapid growth, cortical perforation and root resorption and show marked tendency to recur when compared with non aggressive typeSoft spongy, brownish to reddish friable tissue of various size.
A specimen is usually coated with fresh or coagulated blood. Giant cell lesions of the jaws show a variety of features. Common to all is the presence of few to many multinucleated
ODONTOGENIC MYXOMA :
Benign mesenchymal lesion that mimics microscopically the dental pulp or follicular connective tissue
Derived from odontogenic ectomesenchymeClinical feature:
Age : 10- 50 yrs with mean age of 30 yrs
No gender predilection
Both mandible and maxilla are equally effectedClinical feature:
Age : 10- 50 yrs with mean age of 30 yrs
No gender predilection
Both mandible and maxilla are equally effectedClinical feature:
Age : 10- 50 yrs with mean age of 30 yrs
No gender predilection
Both mandible and maxilla are equally effected
Radiographic feature :
Radiolucent and it appear as a well circumscribed or diffuse lesion
Often multilocular with honey comb pattern
Cortical plate expansion, root displacement or resorption may be seen Histopathology :
Tumor consist of acellular myxomatous connective tissue.
Benign fibroblast and myofibroblast with some amount of collagen are found in matrix
Bony island representing residual tubeculae
Capillaries are scattered through out the lesion
This document provides an overview of fibro-osseous lesions, which are characterized by the replacement of normal bone by fibrous tissue containing mineralized products. It discusses the definitions, classifications, specific lesions including fibrous dysplasia and cherubism, radiological differential diagnosis, and references various classification systems proposed over time. The classifications discussed include those proposed by Waldron, Malek, Slootweg & Muller, WHO, Brannon & Fowler, Speight & Carlos, and Eversole. Key lesions like fibrous dysplasia, cherubism, ossifying fibroma, cemento-osseous dysplasia are also defined.
Odontogenic keratocyst- A case presentationBinaya Subedi
This case presentation describes a 74-year-old female patient with a swelling in the lower front region of her jaw. Radiographs and biopsy revealed an odontogenic keratocyst. Odontogenic keratocysts are developmental cysts that arise from cell rests of the dental lamina and have a high recurrence rate due to their thin lining. Treatment options considered for this patient's odontogenic keratocyst include curettage with or without peripheral osteotomy or segmental resection of the mandible.
This document provides information about calcifying odontogenic cysts (COCs). It defines COCs and classifies them according to the WHO. COCs are rare jaw lesions characterized by ghost cells and calcifications. They are thought to arise from odontogenic epithelial remnants. Clinically, they typically present in the second decade of life with lesions more common in the maxilla than mandible. Radiographically, COCs appear well-defined with variable calcifications. Histologically, they contain ghost cells and basal cell layer with hyperchromatic nuclei. Prognosis is generally good when treated with surgical removal.
Condylar sag is defined as an immediate or late change in the position of the condyle in the glenoid fossa after orthognathic surgery, leading to an undesirable change in occlusion. It can occur after procedures like BSSO, IVRO, and Lefort I osteotomy. Risk factors include incorrect vectoring during condylar positioning and incomplete bone splits. Condylar sag is classified as central or peripheral, and can be diagnosed intraoperatively by examining changes in occlusion. Preventative measures include rigid fixation and intraoperative patient awakening to detect changes.
This document presents a case study of a 30-year-old female patient diagnosed with plexiform ameloblastoma based on a biopsy of her right mandible. It provides background on ameloblastoma, describing it as a benign odontogenic tumor arising from odontogenic epithelium. It discusses the various histological subtypes including follicular, plexiform, unicystic (three groups), peripheral, acanthomatous, granular, basal cell, and desmoplastic. Treatment typically involves radical excision, with curettage having the highest recurrence rates. The case study aims to educate on the clinical, radiographic, and histological features of ameloblastoma.
A 35-year-old female presented with a swelling in her lower right jaw that had been gradually increasing in size over 6 months. Clinical and radiographic examination revealed a cystic lesion associated with missing tooth #45. Histologic examination of the surgically removed cyst confirmed the diagnosis of an odontogenic keratocyst. This type of cyst is known for its high recurrence rate due to the presence of satellite cysts and thin epithelial linings that can be left behind. Close follow-up for at least 5 years is recommended to monitor for recurrence.
This document discusses various types of pseudocysts and true cysts found in the body. It begins by defining the key differences between a true cyst and a pseudocyst. Pseudocysts are lined by granulation and/or fibrous tissue rather than an epithelial cell layer. The document then classifies and describes different types of pseudocysts including traumatic bone cysts, aneurysmal bone cysts, and developmental cysts. It provides details on the etiology, location, patient demographics, clinical presentation, radiographic features, histopathology and treatment for each type.
GIANT CELL LESIONS OF THE JAW
CONTENTS
INTRODUCTION
DEFINITION
CLASSIFICATION
CONCLUSION
REFERENCE
The term Giant cell is derived from a Latin word,” giges; huge and cella; storeroom.
It is defined as an abnormally large tissue cell which often contains more than one nucleus and sometimes may appear as a merger of several normal cells.
CLASSIFICATION OF GIANT CELL LESION
According To Paul Auclair et al
1. Entities in which giant cells are the predominant histologic finding and form the basis of their recognition:
Central giant cell granuloma.
Giant cell tumour of bone.
Aneurismal bone cyst.
Cherubism.
Brown tumour of hyperparathyroidism.
II. Lesions containing giant cells
I. Infectious diseases
Bacterial - Tuberculosis ,Leprosy ,Syphilis ,Actinomycosis ,Cat scratch disease
Viral -Herpes ,Measles
Mycotic -Histoplasmosis ,Blastomycosis
II .Inflammatory diseases of unknown origin
Wegener’s granulomatosis
III. Metabolic
Histiocytosis X
IV. Neoplastic
Benign - Giant cell fibroma ,Osteoblastoma
Malignant - Chondrosarcoma ,Hodgkin’s disease , Burkitt’s lymphoma.
LESIONS CONTAININGMULTINUCLEATED GIANT CELLS
Giant Cell Granuloma
Giant Cell Tumor
Hyperparathyroidism (HPT)
Cherubism
Aneurysmal Bone Cyst.
CENTRAL GIANT CELL GRANULOMA
Benign proliferation of fibroblasts and multinucleated giant cells
Clinical and Radiographic Features
most often found in children and young adults, with up to 75% of cases occurring before 30 years of age.
Females are affected twice as frequently as males.
Lesions are more common in the anterior portions of the jaws, and mandibular lesions frequently cross the midline.
Most giant cell granulomas of the jaws are asymptomatic and first come to attention during a routine radiographic examination or as a result of painless expansion of the affected bone.
A minority of cases, however, may be associated with pain, paresthesia, or perforation of the cortical bone plate, occasionally resulting in ulceration of the mucosal surface by the underlying lesion.
RADIOGRAPHIC FEATURES
appear as radiolucent defects, which may be unilocular or multilocular.
The defect is usually well delineated, but the margins are generally noncorticated .
The lesion may vary from a 5 X 5 mm incidental radiographic finding to a destructive lesion greater than 10 cm in size.
The radiographic findings are not specifically diagnostic.
Small unilocular lesions may be confused with periapical granulomas or cysts.
Multilocular giant cell lesions cannot be distinguished radiographically from ameloblastomas or other multilocular lesions.
Histopathologic Features
presence of few to many multinucleated giant cells in a background of ovoid to spindle shaped mesenchymal cells.
There is evidence that these giant cell s re resent osteoclasts, although others suggest the cells may be aligned more closely with macrophages.
The giant cells may be aggregated focally in the lesional tissue or may be present diffusely throughout the lesion.
This document discusses non-vascularized bone grafts. It notes that autogenous bone grafts are the gold standard for bony reconstruction of the jaws. Costochondral rib harvesting is described as a technique for obtaining bone grafts. The document outlines the advantages of autogenous bone grafts and principles of non-vital grafts, such as needing a blood supply from the recipient site. It provides details on harvesting and using costochondral rib grafts, including preoperative preparation, incision and procedure steps.
This document describes surgical techniques for treating TMJ ankylosis in children, including:
1. Excising the ankylotic mass through a preauricular incision and reconstructing the ramus condyle unit with either a costochondral graft or distraction osteogenesis.
2. Lining the glenoid fossa with a vascularized temporalis fascia flap to prevent reankylosis.
3. An intensive post-operative physical therapy regimen to regain jaw mobility.
Temporomandibular disorders (TMDs) are considered the major cause of orofacial pain. Internal derangement (ID) of the temporomandibular joint (TMJ), which is classified as disc displacement with or without reduction, is one of the disorders of the TMJ that is frequently seen.
Displacement of the articular disc can result in decreased joint space, joint noise (clicking, popping, or crepitation), arthritis, condylar resorption, inflammation, and compression of the bilaminar tissue, all of which can cause various degrees of pain and dysfunction.
Residual Deformity in oral and maxillofacial surgerydr.nikil נαιη
Dr. Nikil Jain discusses nasal deformities resulting from trauma and their surgical correction. Nasal fractures can cause deviations of the nasal bridge and septum. Repositioning requires an intranasal approach to mobilize the septal cartilage and reduce displaced bone through osteotomies and chondrotomies. The nasal skeleton must be precisely realigned and immobilized internally and externally until healing is complete to avoid relapse of the deformity.
This document provides an overview of temporomandibular joint ankylosis. It begins with definitions and historical perspectives on the condition. It then discusses the etiology, pathogenesis, classifications, anatomy, and treatment approaches for TMJ ankylosis. Key points include that ankylosis involves pathologic changes that limit jaw movement, common causes are trauma, infection, inflammation, and it can be classified as true/false, complete/partial, and bony/fibrous. The document provides detailed anatomy of the TMJ and surrounding structures to inform surgical treatment approaches.
This document discusses TMJ ankylosis, including its causes, classification, and management. It begins with an introduction to ankylosis and problems it can cause like limited mouth opening. Surgical management goals are to remove the ankylosed bone, achieve normal opening, and prevent reankylosis. Treatment approaches include gap arthroplasty, interpositional arthroplasty using grafts, and reconstruction using distraction osteogenesis or temporalis flaps. Complications include recurrent ankylosis, malocclusion, and failure to remove all bony disease.
The document discusses odontogenic tumors arising from odontogenic tissues. It defines key terms and provides an overview of the classification of odontogenic tumors. It then focuses on ameloblastoma, the most common odontogenic tumor, describing its pathogenesis, clinical features, subtypes, histopathology, radiographic appearance and treatment. Differential diagnoses are also reviewed.
This document provides information on fibro-osseous lesions, with a focus on fibrous dysplasia. It discusses the classification of fibro-osseous lesions and the importance of radiology in diagnosis. Regarding fibrous dysplasia, it describes the pathogenesis, classification into monostotic and polyostotic forms, and clinical features such as presentations in the jaw, skin pigmentation abnormalities, and craniofacial involvement. Radiographic features include mixed radiolucent-radiopaque appearances and deformities resulting from bone involvement.
The document discusses controversies surrounding odontogenic keratocysts (OKCs). It covers the history and terminology of OKCs, their etiology and pathogenesis, clinical and radiographic features, histopathology, treatment and recurrence rates. There is ongoing debate around whether OKCs should be considered cysts or tumors due to their locally aggressive behavior and high recurrence rates. The document also explores theories on malignant transformation of OKCs and biomarkers that may help predict their biological potential.
This document discusses metastatic tumors of the jaws. It notes that metastases account for 1-1.5% of all malignant tumors, with the most common primary sites being the lungs, breast, kidney, and bone. The Batson's plexus allows tumor cells to bypass the lungs and spread to the head and neck region. Metastases most commonly occur in the mandible and attached gingiva. Clinical features can include pain, swelling, tooth mobility, and pathological fracture. Radiographs may show bone resorption or a moth-eaten appearance. Histopathology is needed for diagnosis, but there can be challenges distinguishing primary from metastatic tumors. Investigations like imaging help determine the primary site and plan treatment.
Arthrocentesis of the temporomandibular jointAhmed Adawy
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Arthrocentesis of the temporomandibular joint refers to lavage of the upper joint space, hydraulic pressure and manipulation to release adhesions of the “anchored disc phenomenon” and improve motion. The technique of arthrocentesis is discussed together with the indications and contraindications of the procedure. Further, the presentation includes modifications of the standard technique.
Cryotherapy and its implications in Oral surgeryShibani Sarangi
Cryosurgery involves applying low temperatures to living tissues in a controlled manner to induce irreversible damage. It has been used for over 100 years to treat skin lesions. The document discusses the history, indications, contraindications, cryogens, and mechanisms of cryosurgery. It describes open systems using liquid nitrogen spray and closed systems using cryoprobes. Cryosurgery can treat premalignant and benign oral lesions using 1-2 minute freeze/thaw cycles and is an effective minimally invasive treatment option in oral and maxillofacial surgery.
This document provides information about genioplasty surgery. It begins with an introduction and overview of genioplasty. It then discusses the history, indications, contraindications, preoperative evaluation including cephalometric and soft tissue analysis, surgical anatomy, classification of chin deformities, and surgical procedure. The surgical procedure section provides a step-by-step explanation of genioplasty surgery from incision and osteotomy to fixation and closure. Key steps include marking reference points, performing the osteotomy, mobilizing and repositioning the chin segment, and securing it with either screws or bone plates. Attention to details like reference marks, osteotomy angle and position, and bone contouring help achieve the planned aesthetic results of
This document classifies and describes different types of maxillectomy defects based on the extent of resection. It discusses four main types of defects:
Type I defects involve limited resection of one or two maxillary walls excluding the palate. Type II defects resect the maxillary arch, palate, and anterior/lateral walls while preserving the orbital floor. Type III defects resect all six maxillary walls, with Type IIIa preserving the orbit and IIIb including orbital exenteration. Type IV defects resect the upper five maxillary walls and orbital contents.
The document outlines reconstruction options for each defect type based on the volume and surface area requirements. Non-vascularized bone grafts or forearm
An overview of various pathological processes affecting the Jaw Bones- Maxilla and Mandible including odontogenic cysts and tumours including their radiological findings!
This document provides information on various types of cysts that can occur in the oral cavity. It defines cysts and discusses their parts and classification. It describes the pathogenesis and factors involved in cyst initiation and enlargement. It then examines several specific cysts in more detail, including their definitions, locations, clinical and radiographic features, pathogenesis and complications. The cysts discussed include dentigerous cysts, odontogenic keratocysts, eruption cysts, calcifying odontogenic cysts, nasopalatine duct cysts and nasolabial cysts. Frequency data on common cyst types is also presented.
Condylar sag is defined as an immediate or late change in the position of the condyle in the glenoid fossa after orthognathic surgery, leading to an undesirable change in occlusion. It can occur after procedures like BSSO, IVRO, and Lefort I osteotomy. Risk factors include incorrect vectoring during condylar positioning and incomplete bone splits. Condylar sag is classified as central or peripheral, and can be diagnosed intraoperatively by examining changes in occlusion. Preventative measures include rigid fixation and intraoperative patient awakening to detect changes.
This document presents a case study of a 30-year-old female patient diagnosed with plexiform ameloblastoma based on a biopsy of her right mandible. It provides background on ameloblastoma, describing it as a benign odontogenic tumor arising from odontogenic epithelium. It discusses the various histological subtypes including follicular, plexiform, unicystic (three groups), peripheral, acanthomatous, granular, basal cell, and desmoplastic. Treatment typically involves radical excision, with curettage having the highest recurrence rates. The case study aims to educate on the clinical, radiographic, and histological features of ameloblastoma.
A 35-year-old female presented with a swelling in her lower right jaw that had been gradually increasing in size over 6 months. Clinical and radiographic examination revealed a cystic lesion associated with missing tooth #45. Histologic examination of the surgically removed cyst confirmed the diagnosis of an odontogenic keratocyst. This type of cyst is known for its high recurrence rate due to the presence of satellite cysts and thin epithelial linings that can be left behind. Close follow-up for at least 5 years is recommended to monitor for recurrence.
This document discusses various types of pseudocysts and true cysts found in the body. It begins by defining the key differences between a true cyst and a pseudocyst. Pseudocysts are lined by granulation and/or fibrous tissue rather than an epithelial cell layer. The document then classifies and describes different types of pseudocysts including traumatic bone cysts, aneurysmal bone cysts, and developmental cysts. It provides details on the etiology, location, patient demographics, clinical presentation, radiographic features, histopathology and treatment for each type.
GIANT CELL LESIONS OF THE JAW
CONTENTS
INTRODUCTION
DEFINITION
CLASSIFICATION
CONCLUSION
REFERENCE
The term Giant cell is derived from a Latin word,” giges; huge and cella; storeroom.
It is defined as an abnormally large tissue cell which often contains more than one nucleus and sometimes may appear as a merger of several normal cells.
CLASSIFICATION OF GIANT CELL LESION
According To Paul Auclair et al
1. Entities in which giant cells are the predominant histologic finding and form the basis of their recognition:
Central giant cell granuloma.
Giant cell tumour of bone.
Aneurismal bone cyst.
Cherubism.
Brown tumour of hyperparathyroidism.
II. Lesions containing giant cells
I. Infectious diseases
Bacterial - Tuberculosis ,Leprosy ,Syphilis ,Actinomycosis ,Cat scratch disease
Viral -Herpes ,Measles
Mycotic -Histoplasmosis ,Blastomycosis
II .Inflammatory diseases of unknown origin
Wegener’s granulomatosis
III. Metabolic
Histiocytosis X
IV. Neoplastic
Benign - Giant cell fibroma ,Osteoblastoma
Malignant - Chondrosarcoma ,Hodgkin’s disease , Burkitt’s lymphoma.
LESIONS CONTAININGMULTINUCLEATED GIANT CELLS
Giant Cell Granuloma
Giant Cell Tumor
Hyperparathyroidism (HPT)
Cherubism
Aneurysmal Bone Cyst.
CENTRAL GIANT CELL GRANULOMA
Benign proliferation of fibroblasts and multinucleated giant cells
Clinical and Radiographic Features
most often found in children and young adults, with up to 75% of cases occurring before 30 years of age.
Females are affected twice as frequently as males.
Lesions are more common in the anterior portions of the jaws, and mandibular lesions frequently cross the midline.
Most giant cell granulomas of the jaws are asymptomatic and first come to attention during a routine radiographic examination or as a result of painless expansion of the affected bone.
A minority of cases, however, may be associated with pain, paresthesia, or perforation of the cortical bone plate, occasionally resulting in ulceration of the mucosal surface by the underlying lesion.
RADIOGRAPHIC FEATURES
appear as radiolucent defects, which may be unilocular or multilocular.
The defect is usually well delineated, but the margins are generally noncorticated .
The lesion may vary from a 5 X 5 mm incidental radiographic finding to a destructive lesion greater than 10 cm in size.
The radiographic findings are not specifically diagnostic.
Small unilocular lesions may be confused with periapical granulomas or cysts.
Multilocular giant cell lesions cannot be distinguished radiographically from ameloblastomas or other multilocular lesions.
Histopathologic Features
presence of few to many multinucleated giant cells in a background of ovoid to spindle shaped mesenchymal cells.
There is evidence that these giant cell s re resent osteoclasts, although others suggest the cells may be aligned more closely with macrophages.
The giant cells may be aggregated focally in the lesional tissue or may be present diffusely throughout the lesion.
This document discusses non-vascularized bone grafts. It notes that autogenous bone grafts are the gold standard for bony reconstruction of the jaws. Costochondral rib harvesting is described as a technique for obtaining bone grafts. The document outlines the advantages of autogenous bone grafts and principles of non-vital grafts, such as needing a blood supply from the recipient site. It provides details on harvesting and using costochondral rib grafts, including preoperative preparation, incision and procedure steps.
This document describes surgical techniques for treating TMJ ankylosis in children, including:
1. Excising the ankylotic mass through a preauricular incision and reconstructing the ramus condyle unit with either a costochondral graft or distraction osteogenesis.
2. Lining the glenoid fossa with a vascularized temporalis fascia flap to prevent reankylosis.
3. An intensive post-operative physical therapy regimen to regain jaw mobility.
Temporomandibular disorders (TMDs) are considered the major cause of orofacial pain. Internal derangement (ID) of the temporomandibular joint (TMJ), which is classified as disc displacement with or without reduction, is one of the disorders of the TMJ that is frequently seen.
Displacement of the articular disc can result in decreased joint space, joint noise (clicking, popping, or crepitation), arthritis, condylar resorption, inflammation, and compression of the bilaminar tissue, all of which can cause various degrees of pain and dysfunction.
Residual Deformity in oral and maxillofacial surgerydr.nikil נαιη
Dr. Nikil Jain discusses nasal deformities resulting from trauma and their surgical correction. Nasal fractures can cause deviations of the nasal bridge and septum. Repositioning requires an intranasal approach to mobilize the septal cartilage and reduce displaced bone through osteotomies and chondrotomies. The nasal skeleton must be precisely realigned and immobilized internally and externally until healing is complete to avoid relapse of the deformity.
This document provides an overview of temporomandibular joint ankylosis. It begins with definitions and historical perspectives on the condition. It then discusses the etiology, pathogenesis, classifications, anatomy, and treatment approaches for TMJ ankylosis. Key points include that ankylosis involves pathologic changes that limit jaw movement, common causes are trauma, infection, inflammation, and it can be classified as true/false, complete/partial, and bony/fibrous. The document provides detailed anatomy of the TMJ and surrounding structures to inform surgical treatment approaches.
This document discusses TMJ ankylosis, including its causes, classification, and management. It begins with an introduction to ankylosis and problems it can cause like limited mouth opening. Surgical management goals are to remove the ankylosed bone, achieve normal opening, and prevent reankylosis. Treatment approaches include gap arthroplasty, interpositional arthroplasty using grafts, and reconstruction using distraction osteogenesis or temporalis flaps. Complications include recurrent ankylosis, malocclusion, and failure to remove all bony disease.
The document discusses odontogenic tumors arising from odontogenic tissues. It defines key terms and provides an overview of the classification of odontogenic tumors. It then focuses on ameloblastoma, the most common odontogenic tumor, describing its pathogenesis, clinical features, subtypes, histopathology, radiographic appearance and treatment. Differential diagnoses are also reviewed.
This document provides information on fibro-osseous lesions, with a focus on fibrous dysplasia. It discusses the classification of fibro-osseous lesions and the importance of radiology in diagnosis. Regarding fibrous dysplasia, it describes the pathogenesis, classification into monostotic and polyostotic forms, and clinical features such as presentations in the jaw, skin pigmentation abnormalities, and craniofacial involvement. Radiographic features include mixed radiolucent-radiopaque appearances and deformities resulting from bone involvement.
The document discusses controversies surrounding odontogenic keratocysts (OKCs). It covers the history and terminology of OKCs, their etiology and pathogenesis, clinical and radiographic features, histopathology, treatment and recurrence rates. There is ongoing debate around whether OKCs should be considered cysts or tumors due to their locally aggressive behavior and high recurrence rates. The document also explores theories on malignant transformation of OKCs and biomarkers that may help predict their biological potential.
This document discusses metastatic tumors of the jaws. It notes that metastases account for 1-1.5% of all malignant tumors, with the most common primary sites being the lungs, breast, kidney, and bone. The Batson's plexus allows tumor cells to bypass the lungs and spread to the head and neck region. Metastases most commonly occur in the mandible and attached gingiva. Clinical features can include pain, swelling, tooth mobility, and pathological fracture. Radiographs may show bone resorption or a moth-eaten appearance. Histopathology is needed for diagnosis, but there can be challenges distinguishing primary from metastatic tumors. Investigations like imaging help determine the primary site and plan treatment.
Arthrocentesis of the temporomandibular jointAhmed Adawy
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Arthrocentesis of the temporomandibular joint refers to lavage of the upper joint space, hydraulic pressure and manipulation to release adhesions of the “anchored disc phenomenon” and improve motion. The technique of arthrocentesis is discussed together with the indications and contraindications of the procedure. Further, the presentation includes modifications of the standard technique.
Cryotherapy and its implications in Oral surgeryShibani Sarangi
Cryosurgery involves applying low temperatures to living tissues in a controlled manner to induce irreversible damage. It has been used for over 100 years to treat skin lesions. The document discusses the history, indications, contraindications, cryogens, and mechanisms of cryosurgery. It describes open systems using liquid nitrogen spray and closed systems using cryoprobes. Cryosurgery can treat premalignant and benign oral lesions using 1-2 minute freeze/thaw cycles and is an effective minimally invasive treatment option in oral and maxillofacial surgery.
This document provides information about genioplasty surgery. It begins with an introduction and overview of genioplasty. It then discusses the history, indications, contraindications, preoperative evaluation including cephalometric and soft tissue analysis, surgical anatomy, classification of chin deformities, and surgical procedure. The surgical procedure section provides a step-by-step explanation of genioplasty surgery from incision and osteotomy to fixation and closure. Key steps include marking reference points, performing the osteotomy, mobilizing and repositioning the chin segment, and securing it with either screws or bone plates. Attention to details like reference marks, osteotomy angle and position, and bone contouring help achieve the planned aesthetic results of
This document classifies and describes different types of maxillectomy defects based on the extent of resection. It discusses four main types of defects:
Type I defects involve limited resection of one or two maxillary walls excluding the palate. Type II defects resect the maxillary arch, palate, and anterior/lateral walls while preserving the orbital floor. Type III defects resect all six maxillary walls, with Type IIIa preserving the orbit and IIIb including orbital exenteration. Type IV defects resect the upper five maxillary walls and orbital contents.
The document outlines reconstruction options for each defect type based on the volume and surface area requirements. Non-vascularized bone grafts or forearm
An overview of various pathological processes affecting the Jaw Bones- Maxilla and Mandible including odontogenic cysts and tumours including their radiological findings!
This document provides information on various types of cysts that can occur in the oral cavity. It defines cysts and discusses their parts and classification. It describes the pathogenesis and factors involved in cyst initiation and enlargement. It then examines several specific cysts in more detail, including their definitions, locations, clinical and radiographic features, pathogenesis and complications. The cysts discussed include dentigerous cysts, odontogenic keratocysts, eruption cysts, calcifying odontogenic cysts, nasopalatine duct cysts and nasolabial cysts. Frequency data on common cyst types is also presented.
This document discusses several tumor-like bone lesions including solitary bone cyst, aneurysmal bone cyst, and fibrous dysplasia. It describes the typical clinical features, gross appearance, microscopic findings, and differential diagnosis for each lesion. Solitary bone cysts commonly occur in long bones of males under 20 and contain fluid-filled cysts. Aneurysmal bone cysts typically involve the metaphysis of long bones and contain blood-filled cysts separated by fibrous septa. Fibrous dysplasia is a non-neoplastic condition involving abnormal bone formation that can be monostotic or polyostotic.
This document discusses several benign bone lesions that can mimic malignant tumors based on their appearance. It provides details on the classification, characteristics, pathogenesis, clinical features, imaging appearance and histology of solitary bone cysts, aneurysmal bone cysts, fibrous dysplasia, osteofibrous dysplasia and myositis ossificans. Key information includes that solitary bone cysts commonly affect long bones in males under 20 and have a fluid-filled cyst wall containing fibroblasts. Aneurysmal bone cysts contain blood-filled spaces separated by fibrous septa and can arise de novo or in association with other bone tumors. Fibrous dysplasia is a non-neoplastic fibro-osseous lesion involving
Bone tumour seminar ,ewing sarcoma, chordoma,Narmada Tiwari
1. Giant cell tumor is an epiphyseal neoplasm composed of stromal cells and giant cells, most commonly affecting people over 20 years old in the lower femur, radius, and upper tibia. Microscopically it shows giant cells with similar nuclei to mononuclear stromal cells.
2. Ewing's sarcoma is a malignant undifferentiated sarcoma most common in children ages 5-20 that typically involves long bones, pelvis and ribs. Microscopically it shows a diffuse growth pattern with monotonous cytology.
3. Fibrous dysplasia is a benign bone tumor resulting from local developmental arrest, seen as abnormal bone formation with tra
This document discusses various types of soft tissue calcification that can occur in the oral and facial regions. It describes dystrophic calcification, idiopathic calcification, and metastatic calcification. Specific examples covered include general dystrophic calcification, calcified lymph nodes, tonsilloliths, cysticercosis, and arterial calcification. The clinical features, radiographic appearance, and management are summarized for each condition.
Peripheral and central giant cell granulomaRijuwana77
This document discusses two types of non-epithelial tumours of the oral cavity: peripheral giant cell granuloma and central giant cell granuloma. Peripheral giant cell granuloma originates from the periodontal membrane or alveolar bone and presents as a soft tissue nodule composed of multinucleated giant cells. Central giant cell granuloma is a rare, benign, intraosseous lesion most commonly found in the mandible of young people that causes expansion of the bone and resorption of tooth roots. Both lesions contain proliferation of multinucleated giant cells and other cells and may require surgical excision, with central giant cell granuloma having a higher rate of recurrence.
This document summarizes various cartilage forming tumors including:
1. Chondrosarcoma, which is the third most common malignant bone tumor arising in adults. The main subtypes are conventional, dedifferentiated, clear cell, and mesenchymal chondrosarcoma.
2. Osteochondroma, which is a benign cartilage-capped outgrowth most commonly affecting adolescents and young adults.
3. Chondroma, which is a benign tumor composed of hyaline cartilage that can occur intraosseously as enchondromas or juxtacortically.
4. Other rare tumors discussed include chondroblastoma and chondromyxoid fibroma.
benign and malignant tumors of connective tissue originmadhusudhan reddy
This document discusses various connective tissue tumors that can occur in the oral cavity. It describes benign fibrous lesions like fibroma and giant cell fibroma. It also discusses benign adipose tissue lesions like lipoma. Various benign vascular lesions are described, including hemangiomas and lymphangiomas. Finally, it summarizes benign bone tissue tumors like osteoma and osteoid osteoma. For each lesion, the clinical features, histopathology, radiographic appearance, and treatment are summarized.
The document summarizes the cytology of various bone lesions. It describes the cytological features of inflammatory conditions including osteomyelitis. It also discusses osteoblastic lesions such as osteoblastoma and osteosarcoma. Regarding cartilaginous tumors, it provides details on chondroma, chondrosarcoma and other lesions. Giant cell-containing lesions such as giant cell tumor are also summarized. The document aims to help in diagnosis of bone lesions based on cytological examination.
This document discusses pediatric neoplasms affecting the oral cavity. It begins by defining pediatrics and discussing risk factors for pediatric neoplasms such as radiation exposure and Down syndrome. It then classifies and describes several benign and malignant pediatric neoplasms that can affect the head and neck region, including congenital granular cell tumor, hemangioma, lymphangioma, juvenile ossifying fibroma, ameloblastoma, adenomatoid odontogenic tumor, odontoma, leukemia, lymphoma, and mucoepidermoid carcinoma. For each neoplasm, the document discusses etiology, clinical features, histopathology, differential diagnosis, immunohistochemistry, imaging features, and treatment approaches.
The document discusses various giant cell lesions of bone, including their pathogenesis, classification, clinical features, radiological appearance, histopathological characteristics, differential diagnosis, and key distinguishing features. Reactive and benign giant cell lesions are covered such as giant cell tumor, aneurysmal bone cyst, giant cell reparative granuloma, brown tumor, and chondroblastoma. Differential diagnoses and distinguishing characteristics of different lesions are also provided.
Giant cell lesions of bone include both reactive and neoplastic conditions characterized by the presence of multinucleated giant cells. Reactive giant cell lesions include giant cell reparative granuloma and brown tumor of hyperparathyroidism. Benign neoplastic giant cell lesions include giant cell tumor and aneurysmal bone cyst. Giant cell tumor is the most common, occurring most frequently in long bones of the extremities in young and middle aged adults. Histologically it is characterized by uniformly distributed osteoclast-like giant cells and mononuclear stromal cells that express RANKL.
This document discusses cysts of the jaw, including definitions, types, pathogenesis, diagnosis, and treatment. It describes the two main types of cysts as true cysts lined by epithelium and pseudo cysts not lined by epithelium. Common jaw cysts discussed include dentigerous cysts, odontogenic keratocysts, and radicular cysts. The pathogenesis and theories of cyst enlargement are explained. Diagnostic methods like radiography, FNAC, and biopsy are outlined. Surgical treatment options for cyst removal include marsupialization, enucleation, enucleation with chemical cauterization, and resection.
This document discusses several types of primary bone tumors. It begins with an introduction to the classification of bone tumors based on histologic criteria. It then discusses several benign bone tumors in more detail, including chondroma, osteoma, osteoid osteoma, benign osteoblastoma, and osteochondroma. For malignant tumors, it focuses on explaining osteosarcoma, including its etiology, classification, and characteristics. It provides histologic images and descriptions of the key features of many of these tumors. In summary, the document provides an overview of the classification and characteristics of both benign and malignant primary bone tumors.
Chondroblastoma is a benign bone tumor caused by rapid division of chondroblast cells in long bone epiphyses. It most commonly affects males in their second decade of life. While the cause is idiopathic, chromosomal abnormalities on chromosomes 5 and 6 have been associated. Clinically, patients experience pain, swelling and limping. Imaging shows a well-defined lytic lesion near the bone cortex, often with surrounding sclerosis or mottled appearance from calcification. Treatment involves surgical curettage and bone grafting for small lesions or excision for large lesions.
This document discusses various pseudosarcomas, which are non-neoplastic lesions that can be mistaken for sarcomas due to their rapid growth and cellular appearance. It describes several categories of pseudosarcomas, including reactive fibroblastic/myofibroblastic proliferations (e.g. nodular fasciitis), reactive endothelial proliferations (e.g. papillary endothelial hyperplasia), mass forming inflammatory/infective lesions (e.g. Rosai-Dorfman disease), and benign connective tissue tumors (e.g. cellular fibrous histiocytoma). The document emphasizes that accurate recognition of these pseudosarcomas helps prevent excessive or
This document discusses various types of ulcers, including their definitions, parts, classifications, and management. The key points are:
1. An ulcer is a break in the skin or mucous membrane epithelium due to cell death. Ulcers have a margin, edge, floor, and base.
2. Ulcers can be classified as spreading, healing, non-healing, or callous based on their clinical appearance. They can also be classified as acute or chronic based on duration.
3. Investigation and management of ulcers includes identifying the cause, treating infection, debriding necrotic tissue, promoting granulation with dressings, and closing defects once healed.
Based on the information provided, the key differentials would be:
- Radicular cyst: Most common cyst in jaws, associated with non-vital tooth. Location and association with tooth fits.
- Dentigerous cyst: Second most common, associated with crown of unerupted tooth. Location fits.
- Odontogenic keratocyst: Aggressive cyst, often multilocular radiolucency. Less likely based on description.
- Aneurysmal bone cyst: Often multilocular "soap bubble" appearance. Less likely based on description.
- Traumatic bone cyst: Often interradicular in location. Possible based on location described.
Further investigation with tooth
This document discusses staging of oral malignancies. It begins with an introduction about oral cancer prevalence and challenges with late detection. It then covers the TNM staging system and STNMP classification system used to stage oral cancers. Different staging criteria are provided for various oral cancer sites. The conclusion emphasizes that early diagnosis is important for prognosis and outlines how staging helps clinicians determine operability and treatment plans.
Surgical approaches to the facial skeletonAbhishek Roy
This document discusses surgical approaches to different areas of the face and skull. It begins by outlining general principles for facial incisions, including considerations like scar visibility and proximity to vital structures. It then describes specific approaches for different regions, such as the periorbital area (coronal, subciliary incisions), mandible (transoral, transfacial, TMJ approaches), nasal skeleton, and others. For each approach, it discusses preparation, incision placement, planes of dissection, and closure. Throughout, it emphasizes the importance of adequate exposure while avoiding injury to nerves, vessels and ensuring good cosmetic outcomes due to the face's aesthetic significance.
This document discusses midface fractures, including:
- The Le Fort classification system divides midface fractures into 3 types based on the fracture lines. Le Fort I involves the maxilla, Le Fort II is a pyramidal fracture, and Le Fort III is a craniofacial disjunction.
- Common causes of midface fractures are motor vehicle accidents, assaults, and falls. Maxillary bones and the zygomatic bone are frequently involved.
- Clinical features of a Le Fort I fracture include swelling of the upper lip and palate, a "cracked pot" sound from tapping teeth, and mobility of the maxilla. Le Fort II fractures result in "moon face" swelling and "raccoon
Internal derangement of the temporomandibular joint (TMJ) refers to an abnormal positioning of the articular disc within the joint that interferes with smooth movement. Common causes include trauma, microtrauma from grinding or clenching, and degenerative joint disease. Non-surgical treatments include splint therapy, medications, acupuncture, and physical therapy techniques like ultrasound or TENS. Surgical procedures are considered when non-surgical options fail to provide adequate relief of symptoms like pain and restricted opening.
Benign odontogenic and non odontogenic tumoursAbhishek Roy
This document provides information on various benign odontogenic tumors of the jaws. It begins by classifying these tumors into three categories based on their histological composition. It then discusses specific tumor types in more detail, including their clinical features, radiographic appearance, histology, treatment and prognosis. The tumors covered include ameloblastoma (solid/multicystic, unicystic and peripheral subtypes), calcifying epithelial odontogenic tumor, and adenomatoid odontogenic tumor. For each tumor, the summary highlights their defining characteristics and typical presentation.
The document discusses the venous and lymphatic drainage of the head and face. It describes the major veins of the head and face, including the facial vein, maxillary vein, superficial temporal vein, and occipital vein. It notes that the facial vein has no valves and connects to the cavernous sinus through two routes, making infections of the facial vein dangerous as they could spread to the intracranial venous sinuses. The document also provides an overview of the lymphatic system and notes the major lymph nodes of the head and neck.
The document discusses various types of biopsies used to diagnose oral lesions. It describes incisional, excisional, scalpel, punch, frozen section, brush and fine needle aspiration biopsies. For each type it provides details on the procedure, advantages, and disadvantages. The goal of a biopsy is to obtain a tissue sample for histopathological examination to establish a diagnosis and guide treatment. Proper biopsy technique is important for collecting representative samples and making an accurate diagnosis.
Antibiotics, analgesics and emergency drugsAbhishek Roy
This document discusses antibiotics, analgesics, and emergency drugs. It begins by describing different classes of antibiotics including their chemical structures, mechanisms of action, and examples. Specific antibiotics discussed in detail include sulfonamides, quinolones, beta-lactams like penicillins and cephalosporins, tetracyclines, and chloramphenicol. The document also briefly covers analgesics and classifications and examples of opioids and non-opioids. It concludes with a short section on emergency drugs that can be injected or are non-injectable.
The document discusses pain and its pathways in the human body. It defines pain and describes its characteristics and theories. It discusses the neurochemistry and types of pain receptors. The main pain pathway described is the lateral spinothalamic tract, which carries pain and temperature sensations from the periphery to the thalamus and somatosensory cortex via the dorsal horn and spinal cord. It relays information via three orders of neurons and can be modulated in the substantia gelatinosa of the spinal cord.
General anesthesia and its complicationsAbhishek Roy
General anesthesia refers to the reversible loss of sensation and consciousness achieved through a combination of inhaled and intravenous drugs. It involves stages including analgesia, delirium, and surgical anesthesia. Complications may include respiratory depression, arrhythmias, nausea, and emergence delirium. Anesthesia is induced and maintained using inhalational agents like nitrous oxide, halothane, and sevoflurane or intravenous drugs like propofol and ketamine. Premedication, reversal agents, and conscious sedation techniques help optimize anesthesia outcomes and safety.
Fascial spaces of the jaws and its managementAbhishek Roy
This document discusses the fascial spaces of the jaws and their management. It begins by introducing fascia and fascial spaces, and then provides detailed descriptions of the primary and secondary fascial spaces of the maxilla and mandible, including their boundaries, contents, etiologies and clinical features. It also discusses the microbiology of odontogenic infections, investigation methods, and management approaches like antibiotic therapy and surgical drainage. Ludwig's angina is introduced as a firm, acute, toxic cellulitis involving the submandibular, sublingual and submental spaces bilaterally.
This document discusses exodontia, or tooth extraction. It begins by defining exodontia as the painless removal of a tooth or root with minimal trauma. It then lists the common indications for extraction such as dental caries, periodontal disease, and impacted teeth. The document describes various factors that can complicate extractions as well as different types of dental elevators, forceps, and flap designs that are used for extractions. It concludes by discussing potential immediate and delayed complications following tooth extraction.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
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One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
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2. CONTENTS
DEFINITION OF GIANT CELLS
ORIGIN
CLASSIFICATION OF GIANT CELL LESIONS
GIANT CELL GRANULOMA / TUMOR
ANEURYSMAL BONE CYST
TRAUMATIC BONE CYST
OSTEOID OSTEOMA / OSTEOBLASTOMA
CHERUBISM
BROWN TUMOR OF HYPERPARATHYROIDISM
HISTIOCYTOSIS
2
3. DEFINITION
Giant cells are very large, multinucleate, modified
macrophages which may be formed by
coalescence of mononuclear cells or by nuclear
division without cytoplasmic division of
monocytes, particularly in response to the
presence of a foreign body.
3
4. ORIGIN
Giant cells are derived from the cells of mononuclear
phagocyte system.
Originate from precursor cell in the bone marrow and also
closely related cells of bone marrow origin.
They are transported in blood as monocytes, which are
pool of immature cells.
4
5. Monocytes invade areas of damage & inflammation, where
they differentiate into macrophages.
When the macrophages fail to deal with particles to be
removed they fuse together to form multinucleated giant
cells.
5
7. CLASSIFICATION OF GIANT CELL LESION
Chatterjee et al, 2015
Inflammatory / Reactive:
• Peripheral Giant Cell
Granuloma
• Central Giant Cell
Granuloma
Aneurysmal Bone Cyst•
Metabolic:
•
•
•
•
•
Hyperparathyroidism
Cherubism
Histiocytosis
Neoplastic:
Central Giant Cell Tumor
Osteoid osteoma /
Osteoblastoma
7
8. CENTRAL GIANT CELL GRANULOMA
• Was 1st described in jaws by Jaffe (1953)
• Designated as Giant Cell Reparative Granuloma.
• Waldron & Shafer (1966)
8
9. • Classified on the basis of biologic behavior as:
Non-aggressive & Aggressive.
Etiology:
• Reactive lesion
• Trauma
• Origin from odontoclasts
9
10. Clinical Features:
• Male : female ratio of 1:2
• Age: 11-30yrs
• Present almost exclusively in jaws
• Mandible > maxilla
• Frequent site in mandible is the anterior region usually
crossing midline.
10
11. • Non-aggressive type:
Asymptomatic, slow
expansion of the affected
bone.
• Aggressive type:
Painful, rapid growth, root
resorption, perforation of
cortical bone, paraesthesia. 11
12. Radiographic Features:
• Solitary unicystic radiolucency,
as it grows it becomes
multilocular with soap-bubble
appearance.
• Multilocular > unilocular
• Root displacement / resorption
• Loss of lamina dura
• Expansion of cortical plate
12
14. Histologic Features:
• Proliferation of spindle cells in collagenous stroma.
• Numerous small vascular channels.
• Giant cells with 15-20 nuclei present throughout the
stroma, adjacent to capillaries.
14
19. Surgical technique
• Incisions placed (1cm away from radiographic
extent of the lesion)
• Mucoperiosteal flap raised
• Buccal bone overlying lesion removed
• Through curettage is done
19
20. • Peripheral ostectomy may be done
Doesn’t spread via perineural spread so preserve
neurovascular bundle
Through debribment of bony cavity
• Control of hemorrhage
• Flap repositioned & sutured
20
21. Preserve teeth in area of lesion
With good prognosis
(adequate bone support)
Treat endodontically before surgery
Extract teeth in area of lesion
With poor prognosis (poor bone support)
Compromising access to the lesion
21
22. Recurrence
Varies from 10 – 50 %
Higher for Locally aggressive lesion
•
•
• Recurrent lesion respond well to further curettage, aggressive
lesions may require more radical surgery for cure.
• Incomplete removal
22
23. PERIPHERAL GIANT CELL GRANULOMA
Common tumor like growth in the oral cavity.
Does not represent a true neoplasm but a reactive lesion.
Arising from periosteum or PDL membrane.
•
•
•
• Often called as peripheral giant cell reparative granuloma.
C/F:
Age: 5th or 6th decade of life.
Common in females.
•
•
• Mandible is affected more often.
23
24. • Occurs exclusively on
gingiva, alveolar ridge
• Reddish or bluish nodule,
most lesions smaller than
•
2cm in diameter.
May be ulcerated
due to trauma.
24
25. H/F:
• Fibroblast are the basic element.
• Giant cells are scattered throughout the stroma.
• Foci of hemorrhage, liberation of hemosiderin pigment.
25
26. R/F:
• May or may not be present
• Larger lesion may exhibit superficial erosion of the
cortical bone
• May demonstrate widening of adjacent PDL spaces
Treatment:
Local surgical excision down to the underlying bone
26
27. ANEURYSMAL BONE CYST
• First described by Jaffe & Lichtenstein in 1942.
• First case in jaw was reported by Bhaskar & Bernier in
1958.
• Is a non-neoplastic, reactive lesion of bone generally
consisting of several cavities filled with blood and
deprived of an endothelial lining.
• Not a true cyst, sinusoidal blood filled space.
27
28. • Word “Aneurysm” was used to describe the blown out
appearance of the contour of the affected area.
• Exist in two clinico-pathologic forms:
1. Primary
2. Secondary – arising in other osseous conditions like
Fibrous Dysplasia, Ossifying Fibroma, CGCG,
Osteoblastoma, Osteosarcoma, Ameloblastoma
28
29. Etiology:
Cause is controversial, the theories put forth regarding the
pathogenesis of the lesion are:
- Trauma
- Local changes in haemodynamics
- Reparative response to the hematoma
29
30. C/F:
• Occurs below 20 yrs of age.
• Predilection towards female.
• Mandible > maxilla, molar region is the most common site.
• Slow growing, may expand the cortical plate, does not
destroy them.
• Aggressive lesions may perforate cortical plate with soft
tissue extension.
30
31. • Teeth may be tender, missing or displaced.
• Pain is occasional complaint.
• On palpation: egg-shell crackling, non-pulsatile.
• On surgical exploration: ‘welling up’ of blood.
• Gross examination: blood-soaked sponge.
31
32. R/F:
• Well defined radiolucency
• Extreme expansion of cortical
plates - honey - comb or
soap - bubble appearance
• Can displace teeth
• Cortex may be destroyed
32
33. H/F:
• Consist
tissue
of a fibrous
stromaconnective
containing of many
sinusoidal blood filled
spaces.
• Fibroblast are numerous
as well multinucleated
giant cells.
• Vascular spaces lack any
endothelial lining, and
giant cells form part of
their walls.
33
34. Treatment:
• Surgical curettage & partial resection are primary means of
treatment.
• Cryotherapy.
• Recurrence rate is high, ranging from 19% to about 50%.
• Follow up is necessary.
34
35. TRAUMATIC BONE CYST
Etiology:
• Trauma → Failure of organization of blood clot →
Degeneration of clot → Empty cavity within bone.
C/F:
• Young persons (<20 yrs).
• Male predilection.
• Mandible frequently affected.
35
36. • Asymptomatic, pain or tenderness
rarely present.
• Rarely expansion of jaw.
• Teeth - vital, No tipping / migration.
• Aspiration – air
• On surgical exploration – usually empty cavity, sometimes
filled with little straw colored fluid.
36
37. R/F:
• Well defined, scalloped
margin.
• Oval / round shape.
• No root resorption.
• Lamina dura intact.
• Usually located above
mandibular canal.
37
38. H/F:
• Thin connective tissue
membrane.
• No epithelial lining.
• Presence of giant cells.
Treatment:
• Curettage
• Re-establish bleeding into the lesion.
38
39. OSTEOBLASTOMA
•
•
It is a benign neoplasm of bone that arises from osteoblasts.
Osteid osteoma is thought to represent a smaller version of
the same tumor.
C/F:
Occurs mostly in young persons (<30yrs).
Slight male predilection.
Affects both the jaws, more in post region.
Characterized by Pain and swelling at tumor site.
•
•
•
•
• Size: 2-4cm ,but may be larger than 10cms,
measuring <1.5cm is osteoid osteoma.
39
40. R/F:
•
•
Well circumscribed.
Radiolucent - mixed -
radiopaque pattern.
• A thin radiolucency may
be surrounding calcified
•
central tumor mass.
Occasional sun-ray
appearance - resembling
osteosarcoma.
40
41. H/F:
• Irregular
osteoid &
trabeculae of
immature bone
within the stroma.
• Prominent vascular network.
• Actively proliferating
osteoblasts & moderate no.
of multinucleated giant
cells.
41
42. Treatment :
• surgical excision.
• Recurrence is rare.
• Malignant transformation into osteosarcoma has also been
reported.
42
43. CHERUBISM
• Rare developmental jaw condition.
• The condition is named due to the facial appearance
-plump cheeked little angels with upward directed look
depicted in renaissance painting.
Etiology:
• Inherited as an autosomal dominant trait.
• Gene for cherubism present on chromosome 4p16.3
43
44. • Disturbance in development of permanent II & III
molars.
• Dysregulation of mesenchymal bone formation and
development of giant cell granulomas.
C/F:
• Occurs between the age of 2-5yrs.
• Progressive, painless, symmetric
swelling of the jaws- mandible or
maxilla.
44
45. • Cherub like facies arise from
bilateral involvement of posterior
mandible that tends to include the
angles & rami region - angelic
chubby cheeks.
• Eyes ‘up turned to heaven’
appearance – due to b/l maxillary
involvement.
45
46. • Lesion grows slowly but no perforation of cortex.
• Marked cervical lymphadenopathy.
• Premature shedding of deciduous teeth.
• Permanent dentition – teeth missing, failure of teeth
eruption, teeth displacement.
• Speech difficulty.
• Bony lesions regresses after puberty.
46
48. H/F:
• Consists variable number
of multinucleated giant
cells.
• Foci of extravasated blood
are commonly present.
• Cuff like deposits
surrounding small blood
vessels throughout the
lesion.
48
49. Treatment:
• The lesions tend to show varying degree of remission after
puberty.
• By 4th decade facial feature approach normalcy.
• Early surgical intervention for cosmesis has given good
results.
• Some studies showed the use of calcitonin, but still not
proved.
49
50. BROWN TUMOR OF HYPERPARATHYROIDISM
• Parathormone (PTH) is normally produced by parathyroid
glands, which regulates the Ca2+ metabolism.
• Excessive production of PTH results in a condition known
as Hyperparathyroidism.
• It is an exaggerated form of ‘Osteitis fibrosa cystica’
discovered by von Recklinghausen in 1891.
50
52. C/F:
‘Stones , Bones, Abdominal
• Incidence: 1 in 500
• Predilection for females.
• Describes the features -
Groans & Psychic Moans’
• Metastatic calcifications - Nephrocalcinosis, blood vessels.
52
53. Jaw - not as frequent as in long bones and skull.•
• Vague aches, severe bone pain, tenderness following
fractures.
Swelling develops, firm in consistency, tender.•
• Mobility of teeth.
53
54. R/F:
• Sub-periosteal erosion of
middle phalanges is the
hallmark.
• Very rarely jaw affected
first.
• Generalized loss of lamina
dura.
• Ground glass appearance.
54
55. • Cortical plate may be
thinned or lost.
• There is a cystic type
of radiolucency.
• On gross examination-Vascularity, hemorrhage & deposits
of haemosidrin imparts a dark reddish brown color to the
lesion –”Brown Tumor”
55
56. H/F:
• Giant cells of osteoclastic
origin scattered over the
fibrovascular stroma in
which foci of hemosiderin
are present.
Lab. investigations:
• Serum calcium level,
alkaline phosphatase &
PTH level will be raised
56
57. Treatment:
• Primary:
– Surgical excision of parathyroid adenoma.
– Bone lesions resolve spontaneously.
• Secondary:
– Management of kidney disorders.
• Tertiary:
– Oral Ca supplement
– Vit. D analogue
57
58. LANGERHANS CELL HISTIOCYTOSIS
• Results from abnormal proliferation of Langerhans cells or
their precursors.
• Langerhans cells are specialized cells of the histiocytic cell
line that normally are found in the skin.
Types :
Eosinophilic granuloma (Solitary)
Hand Schuller Christian disease (Chronic disseminated)
•
•
• Letterer Siwe disease (Acute disseminated)
58
59. Eosinophilic granuloma
C/F:
Occurs in older children & young adults.
Male > female
May be asymptomatic – incidental finding on R/F.
Affects skull & mandible, also long bones.
Local pain, swelling, tenderness.
•
•
•
•
•
• General malaise and fever occasionally accompany.
59
60. • May cause bony swelling
and involve overlying soft
tissue.
• Gingival bleeding, pain &
ulceration.
• Loosening
often occurs
of the teeth
after
destruction of alveolar
bone.
60
61. R/F:
• Single or multiple irregular
radiolucent lesions.
• Well circumscribed.
• Usually involving superficial
alveolar bone.
• Cortex often destroyed.
• Tooth ‘floating in air’
appearance.
• Pathologic fractures may occur.
61
62. H/F:
• Sheets of Histiocytes.
• Histiocytes coalesce to
form Giant cells.
• Early lesion – large no.
of eosinophils.
• Mature lesion – fibrosis,
eosinophils decrease.
Treatment:
• Curettage
62
63. C/F:
• Occurs in early life (Age < 5 yrs).
• Widespread skeletal & extra-skeletal lesions.
• Chronic clinical course.
• Classic triad of:
1. Multiple ‘punched-out’ lesions of skull.
2. U/L or B/L Exophthalmos.
3. Diabetes insipidus with or without Dyspituitarism.
Hand-Schuller-Christian Disease
63
64. • Oral manifestations – earliest signs of diseases.
• Stomatitis, Gingivitis, Halitosis
• Loose teeth, premature exfoliation.
• Failure of healing of post-extraction sockets.
• Loss of supporting alveolar bone mimicking advanced
periodontal disease – characteristic.
64
65. R/F:
• Individual lesions – sharply
outlined.
• Jaw lesions – more diffuse.
• Destruction of alveolar bone
with tooth displacement.
65
69. • Lymphadenopathy
• Nodular or Diffuse involvement of visceral organs –
Lungs & GIT.
• Diffuse involvement of skeletal system.
• Ulcerative lesions of oral mucosa.
• Gingival hyperplasia.
• Loosening & premature loss of teeth.
69
70. H/F:
Histiocytic proliferation with or without eosinophils.
Foam cells – not prominent.
•
•
• No fibrosis.
Treatment:
Chemotherapy – only few pt. respond.
Poor prognosis.
•
•
• Rapid course of disease – terminates fatally in short time.
70
71. Advances in surgical treatments
• Laser
• Cryosurgery
• Electrosurgery
• Radiofrequency Ablation
• Mohs micrographic surgery
71
72. REFERENCES
Textbook of OMFS – Peterson
Textbook of OMFS – Laskin
Oral Pathology – Shafer
Textbook on Cysts - Shear
•
•
•
•
Internet
•
•
•
•
72