Oral & Maxillofacial Surgery Fifth Year

1. Related Jaw Lwsions


< 7% of benign lesions.

Children / young adult.

Female.

Mandible (anterior - premolar).

1-Central giant cell
granuloma.
Clinical features
Neoplastic-like reactive proliferation.
Expansile / root resorption or
divergence.

2-Brown tumors of
hyperparathyroidism.
Tumors of bone arise in excess
osteoclast activity such as
hyperparathyroidism.

Consist of fibrous tissue, woven
bone, & vasculature.

RL.

Involve periosteum causing bone
pain.

Hemosiderin deposition into
osteolytic cyst (brown coloration).

Older patient.
Radiation – out of favor
(risk of sarcoma).
Intralesional steroids –
younger pt., very large
lesions.
Cortical perforation.

Treatment
Recurrence:
Aggressive 75%
Non-aggressive 11%
Curettage, segmental
resection.
Hormonal influence.

types

May be slow growing &
asymptomatic.


Histopathology
Multineucleated giant
cells in fibrovascular
stroma.
Individualized Tx
depending on
charactaristics and
location of tumor.


Identical to CGCG.

2. 
3-Cherubism.
Genetic disorder (bilateral
mandibular & maxillary intraosseous
fibrous swellings).

Young / with autosomal dominant
inheritance.




4-Fibrous dysplasia

Condition in which normal medullary 
bone is replaced by an abnormal
fibrous connective tissue proliferation
in which new, nonmaturing bone is
formed.

A genetic defect involving Gs-alpha
proteins appears to underlie this
process.

Defect in the control of bone cell
activity.

Painless, expansile, dysplastic
process of osteoprogenitor CT.

Maxilla.

Antrum, orbital floor involvement.
Differential diagnosis:
Indistinguishable
histologically from
Select up to 2 DD to compare
CGCG.
with Cherubism:
Osteoclast-like
- CGCG (mandible &
multinucleated giant cells
maxilla).
- Primary
hyperparathyroidism.
- Ossifying fibroma.
Cellular fibrous CT
stroma contain foci of
trabeculae of immature
bone.
Osteoclast-like
multineucleated giant cell also
in:
1- CGCG.
2- Giant cell tumor
(osteoclastoma).
3- Fibro-osseous lesion.
4- Bone lesion of
hyperparathyroidism.
5- Aneurismal bone cyst.
1- Monostatic:
More common in jaw &
cranium. (one bone)
(much more common) 80%
2- Polystatic:
McCune-Albright’s syndrome.
Cutaneous pigmentation.
Hyper-functioning endocrine
glands.
Precocious puperty.
(more than one bone).
If quiescent – contour
excision (cosmesis or
function).
Accelerated growth or
disabling functional
impairment - surgical
intervention

3. (globe displacement).


With involvement of several adjacent
bone (referred to as craniofacial
fibrous dysplasia)

The most common mandibular
involvement is body portion.

facial asymmetry may be initial
presenting complaint.

1st & 2nd decades.

Polystatic (females).

5-Ossifying fibroma
“ground-glass appearance”.
Poorly defined RL to uniformly
radiopaque.

True neoplasm of medullary jaws

3rd & 4th decades.

Females.

slow-growing, asymptomatic, &
expansile lesion.

Jaws & craniofacial
bones.(mandibular premolar-molar
area)

expansion and thinning of the buccal
and lingual cortical plates.

Solitary.

well-circumscribed RL (osteolysis)

A mixed radiolucent-radiopaque
juvenile (aggressive): younger
than 15 years
paranasal sinuses and
periorbital bones
the former lends itself to
ready enucleation, while
the latter can be admixed
with surrounding tissues,
making surgery more
complicated.
surgical removal using
CURETTAGE OR
ENUCLEATION.

4. image is seen when islands of tumor
bone are densely calcified.

Root displacement & tooth resorption

Cementifying fibroma, and
cemento-ossifying fibroma, are terms
occasionally used when the bony
islands in these lesions have a round
or spheroidal shape.

 Other differential considerations are osteoblastoma,
focal cementoosseous dysplasia, and focal osteomyelitis.
 Osteoblastoma is evident in a slightly younger age-group and is often characterized by pain.
In addition, osseous trabeculae in these lesions are
rimmed by abundant plump osteoblasts, and a central
nidus may be evident.
 Periapical cemento-osseous dysplasia in posterior teeth may appear radiographically similar and require a biopsy to separate it from ossifying fibroma.
 Focal osteomyelitis is associated with a source of inflammation and is possibly accompanied by pain and swelling.

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
Distinguishing between ossifying fibroma and fibrous dysplasia is the primary diagnostic challenge.
Both lesions may exhibit similar clinical, radiographic, and microscopic features.
The most helpful feature in distinguishing the two is the well circumscribed radiographic appearance of ossifying fibroma and the ease with which it can be
separated from normal bone.
In most cases the well defined
appearance of ossifying fibroma is evident radiographically.
 Historically, differentiating the two lesions was based primarily on histologic criteria.
 Fibrous dysplasia was reported to contain only woven bone, without evidence of osteoblastic rimming of bone.
 The presence of more mature lamellar bone was believed to be characteristic of ossifying fibroma
Done by/ Mahdi 207 for ever
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