evoluation of fibro osseous lesions /prosthodontic courses

LYTIC TO BLASTIC: EVOLUTION OF
FIBRO-OSSEOUS LESIONS
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
ww.indiandentalacademy.com

Introduction
Fibro-Osseous Lesions
Are diverse group of processes that are characterized by
replacement of normal bone by fibrous tissue containing
a newly formed mineralized product
Classification:
I. Indian Association of Oral and Maxillofacial
Pathologists {Modification of classification of
Waldron 1985 & Makek 1987}
a) Developmental or hereditary
• Cherubism
• Florid osseous dysplasia
Lytic To Blastic: Evolution of Fibro-Osseous Lesions

b) Reactive or reparative
• Central giant cell granuloma
• Periapical cemental dysplasia
• Aneurysmal bone cyst
c) Neoplastic
• Ossifying fibroma
• Juvenile ossifying fibroma
• Osteoma
• Osteoblastoma
d) Metabolic
• Brown tumour of hyperparathyroidism
Introduction

e) Idiopathic
• Fibrous dysplasia
• Paget’s disease
• Solitary bone cyst
Introduction
II. Burket’s Oral Medicine: Diagnosis and Treatment,
8th
edition
a) Periodontal membrane origin
• Cementifying fibroma
• Ossifying fibroma
• Cemento-ossifying fibroma
• Fibroma

Introduction
b) Medullary bone origin:
• Fibro-osteoma
• Active juvenile ossifying fibroma
• Paget’s disease
• Cherubism
• Giant cell tumour
• Hyperparathyroidism jaw lesion
* Neville BW, Damm DD, Allen CM, Bouquot JE: Oral and maxillofacial
pathology, 2nd
edition
* Indian Association of Oral and Maxillofacial Pathologists
* Burket’s Oral Medicine: Diagnosis and Treatment, 8th
and 10th
edition

Present 3 radiographic stages:
Early or Radiolucent stage
Intermediate stage
Mature or Radiopaque
stage
Introduction

Introduction
Cherubism: Early stage

Introduction
Cemento-ossifying fibroma: Intermediate stage

Fibrous dysplasia: Mature stage
Introduction

CASE REPORT

Initial Presentation: December 2007
• Swelling at right angle of mandible since 1 month

On inspection:
• A well-localized swelling at right angle of
mandible
• Colour of overlying skin: normal
On palpation:
• Bony hard swelling at right angle of mandible
• Tenderness on palpation
Extra-oral examination:
Intra-oral examination:
• No evidence of swelling
• Tooth 48 Grade I mobile
Clinical Examination

Review of Literature
• 2% of ABCs occur in jaws (Motamedi and
Yazdi 1994)
• Motamedi et al (2008) assessed 51 treated cases
during a 30-year period for variable presentation
for diagnosis and treatment.
• Pubmed search revealed 35 case reports till date

Clinical features:
Age: Young persons, less than 30 years
Gender: Slight female predilection
Site: Long bones, mandible > maxilla
Symptoms and Signs:
•Fairly rapid bony swelling
•Occasional pain
•Tenderness on palpation
•Excessive bleeding upon entering the lesion,
blood “welling up” from the tissue: blood
soaked sponge
•Hemorrhagic aspirate

Radiographic Examination: December 2007
Panoramic: Unilocular radiolucency

Computed Tomography: A well-defined expansile lytic
soft tissue density lesion and thinning of cortex with no
evidence of new bone formation
Radiographic Examination: December 2007

Radiographic features:
•Periphery and shape: Well-defined periphery with
circular and hydraulic shape
•Internal structure: Often multilocular
•3 stages of development:
i.Initial stage: An ill-defined lytic area
ii.Growth phase: Enlarged area of bone destruction
with early signs of peripheral cortication
iii.Mature stage: Bony expansion, cortication and
faint septa coursing through the lesion in a random
pattern
* Goaz PW, White SC: Oral Radiology: Principles and Interpretation,
3rd
edition

Differential Diagnosis
• Ameloblastoma
• Traumatic bone cyst

Clinical Presentation
October 2008
October 2008
December 2007

Panoramic: A predominantly radiopaque lesion with
regular outline
December 2007
Radiographic Examination
October 2008

Computed Tomography: A well-defined non-enhancing
expansile lesion
December 2007
October 2008

Computed Tomography
October 2008

3-D Reconstruction CT images
Radiographic Examination: October 2008

Differential Diagnosis
• Cemento-ossifying fibroma

Treatment:
•Simple curettage
•Cryotherapy
•Block resection
•Microvascular bone grafting
•Therapeutic embolization and open packing

Management
Enbloc resection
Surgical specimen

Histopathological Diagnosis
Aneurysmal bone cystAneurysmal bone cyst
Sinusoidal blood-filled spaces (10X)

Giant cell (40X)

Osteoid (40X)

Histological features:
• Fibrous connective tissue stroma with many
cavernous or sinusoidal blood-filled spaces which
may or may not show thrombosis
• Numerous fibroblasts with multinucleated giant
cells
• Varying amounts of hemosiderin
• Invariable new osteoid and bone formation

Conclusion
• It is rare to observe in the same individual a
transition from the initial radiolucent stage to a
mature radiopaque stage.
• This case is unusual with the large amount of bone
formation in the mature stage.

Conclusion
• Even though this type of variable radiographic
presentation is rare, Aneurysmal Bone Cyst should
be included in the differential diagnosis of
unilocular and multilocular lesions in the early
stage and in the mature stage.

Acknowledgements
• Department of Oral Medicine and Radiology, BVU
Dental College and Hospital, Pune
• Dr. R. S. Deshmukh, Professor and Head, Department
of Oral Pathology and Microbiology, BVU Dental
College and Hospital, Pune
• Department of General Pathology, BVU Medical
College and Hospital, Pune
• Department of Radiodiagnosis, BVU Medical College
and Hospital, Pune

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