Other Bone Diseases Slides

OTHER BONE DISEASESPART 1DONE BY : FATIMA ALSAYED JAFFAR

20102050074

1. FIBROUS DYSPLASIA

DISEASE MECHANISM : Localized change in normal bone

metabolism that result in the Replacement of cancellous bone by fibrous tissue containing varying amount of abnormal appearing bone .

CLINICAL FEATURES: solitary lesions in 70% of all cases Polyostotic lesions found in children younger

than 10 yrs old . Most common sites : rib > femur > tibia >

maxilla > mandible. No sexual difference except in maccune albright

syndrome F>>M. Asymptomatic or mild symptoms . Discovered incidentally. unilateral facial swelling in Jaw involvement, or

enlarging of alveolar process.

CLINICAL FEATURES:

IMAGING FEATURES:LOCATION : Maxilla>> mandible In the posterior aspect Unilateral

IMAGING FEATURES:PERIPHERY :

most commonly ill defined periphery , with gradual blending with normal bone .

IMAGING FEATURES:PERIPHERY :

Lesions may have sharp well defined and even corticated margins

Sagittal cone beam CT of the mandible

Well defined with almost corticated

IMAGING FEATURES:INTERNAL STRUCTURE :

internal aspect of bone may be radiopaque ,radiolucent or mixed compared with normal bone.

IMAGING FEATURES:INTERNAL STRUCTURE :

it is more radiopaque in the maxilla and base of the skull.

IMAGING FEATURES:INTERNAL STRUCTURE :

early lesions may be more radiolucent , and it changes with time.

Same case in 18 years interval

IMAGING FEATURES:INTERNAL STRUCTURE :

The short thin irregular trabeculae creates variable radiopaque patterns

1. granular (ground glass appearance)

IMAGING FEATURES:INTERNAL STRUCTURE :

2. resembling a surface of an orange .

IMAGING FEATURES:INTERNAL STRUCTURE :

3. wispy arrangement cotton wool .

IMAGING FEATURES:INTERNAL STRUCTURE :

4. fingerprint(swirling) pattern.

IMAGING FEATURES:INTERNAL STRUCTURE :

5. radiolucent appearance resembling cysts.

IMAGING FEATURES:EFFECT ON SURROUNDING STRUCTURES:

No effect if small Expansion with thinned intact outer cortex.

IMAGING FEATURES:EFFECT ON SURROUNDING STRUCTURES:

Expand into the antrum occupying part of the maxillary sinus .

Coronal CT showing the lateral wall of the maxilla expanding into the antrum

IMAGING FEATURES:EFFECT ON SURROUNDING STRUCTURES:

Bone surrounding the teeth altered without effecting the dentation.

Distinct lamina Dura disappears . ID canal displacement in superior direction .

IMAGING FEATURES:EFFECT ON SURROUNDING STRUCTURES:

Hypercementosis of teeth. Root resorption

DIFFERENTIAL DIAGNOSIS:1. HYPERPARATHYROIDISM :

hyperparathyroidism Fibrous dysplasia

Bilateral unilateral

Don’t cause bone expansion

Do cause bone expansion

Radiopaque teeth in contrast to a radiolucent jaw

DIFFERENTIAL DIAGNOSIS:2. PAGET’S DISEASE :

Pagets disease Fibrous dysplasia

Older age groups In young children

Whole jaw effected esp:mn

unilateral

Almost the whole mandible affected in pagets

DIFFERENTIAL DIAGNOSIS:3. PERIAPICAL CEMENTAL DYSPLASIA:

periapical cemental dysplasia

Fibrous dysplasia

Bilateral unilateral

Older age groups Young patients

4. spontaneous healed simple bone cyst

DIFFERENTIAL DIAGNOSIS:5. OSTEIOMYELITIS:

osteiomyelitis Fibrous dysplasia

Bone laid on outer cortex by the periosteum.

Internal resorbtion & displacing and thinning the outer cortex

Original cortex may be identified within the expanded portion.

The outer cortex remain the most outer surfas

Sequestra identification No Sequestra found

DIFFERENTIAL DIAGNOSIS:6. OSSIFYING FIBROMA :

Ossifying fibroma Fibrous dysplasia

cause teeth displacement

don’t cause teeth displacement

Convex extension of the neoplasm into the antrum

Keeps the original antrum shape .

7. osteogenic sarcoma:

The disease must show malignant features

MANAGEMENT :

The lesion growth usually stop at skeletal maturation

Ortho tx and cosmetic surgery delayed till that time

2. PERIAPICAL OSSEOUS DYSPLASIA

DISEASE MECHANISM : PCD is a localized(near apex of tooth) change in

bone metabolism, where resorption of normal cancellous bone occur and replacement with fibrous tissue and amorphous bone.

Early phase

Normal one resorption Radiolucent

Mixed phase

Abnormal Bone

development

Mixed radiolucent

and radiopaque

Maturation phase

Abnormal bone

dominate the lesion

radiopaque

CLINICAL FEATURES : Mean age = 39 yrs Teeth are vital Usually an incidental radiographic finding F:M 9:1 3:1 African: Caucasian Lesion may cause notable expansion of the

alveolar process

IMAGING FEATURES:LOCATION : Apices of mandibular anterior teeth Maxillary teeth may be affected rarely . Mostly Multiple & bilateral Solitary lesions arise occasionally

IMAGING FEATURES:PREPHRY & SHAPE : Well defined Round, oval or irregular shape centered over

the apex of teeth May have radiolucent border surrounded by

sclerotic bone

IMAGING FEATURES:PREPHRY & SHAPE :

Multiple lesions with sclerotic border

IMAGING FEATURES:INTERNAL STRUCTURE : Varies from lucent to mixed density to

opaque as the lesion matures Early lesions appear as apical radiolucencies Mixed stage lesions have irregular

amorphous opacities within the lucency.

Same lesion in different stages

IMAGING FEATURES:INTERNAL STRUCTURE : Mature lesions are uniformly radiopaque,

often with a lucent rim or margin. Why ?

IMAGING FEATURES:INTERNAL STRUCTURE : POD may have abnormal trabecular structure

resembling fibrous dysplasia

IMAGING FEATURES:EFFECT ON SURROUNDING STRUCTURES:

Lost of the lamina dura of adjacent teeth PDL space either less apparent or wider Root resorption is rare Hyper cementation of adjacent teeth

IMAGING FEATURES:EFFECT ON SURROUNDING STRUCTURES:

Surrounding bone may become sclerotic Occasionally, large lesions may cause

expansion of the jaws Elevation of theMaxillary sinus floor

DIFFERENTIAL DIAGNOSIS:1.PERIAPICAL RAREFYING OSTEITIS :

In early stages of POD its indistinguishable radiographicly from per apical rarefying osteitis.

Tooth vitality can help in this situation where teeth associated with POD usually vital and PRO not

PODPRO

DIFFERENTIAL DIAGNOSIS:2. BENIGN CEMENTOBLASTOMA:

It causes resorption of the root attached to it .

Its tissue capsule is better defined . Its internal stx has unique pattern like

radiating. Causes concentric(spherical) expansion .

PODbenign cementoblastoma

DIFFERENTIAL DIAGNOSIS:3. ODONTOMAS:

Internal stx of tooth like tissue esp: enamel Soft tissue capsule more uniform in width

odontomasPOD

DIFFERENTIAL DIAGNOSIS:4. DENSE BONE ISLAND:

Identification of the soft tissue capsule in POD

5. CEMENTO OSSIFYING FIBROMA:

DBI POD

growing mass that cause teeth displacement

MANAGEMENT:

No TX is required unless got exposed and 2nd infected.