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Jaw bone DiseaseJaw bone DiseaseMazen Abood Bin ThabitMazen Abood Bin Thabit
Senior lecturer of Oral pathologySenior lecturer of Oral pathology and and oral histologyoral histology. .
Classification of bone Classification of bone diseasedisease
1.1. Inflammatory bone disease.Inflammatory bone disease.2.2. Hereditary bone disease .Hereditary bone disease .3.3. Metabolic bone disease . Metabolic bone disease . 4.4. Disease of unknown etiology .Disease of unknown etiology . a. Paget’s disease .a. Paget’s disease . b. Fibro-osseous disease b. Fibro-osseous disease 5.5. Bone tumors . Bone tumors .
Normal bone histologyNormal bone histology
Haversian system
Inflammatory disease of Inflammatory disease of jaw bonejaw bone
Bone infection Bone infection ( Oteomyelitis) can be ( Oteomyelitis) can be classified into : classified into :
1.1.Suppurative : Suppurative : Acute osteomyelitis Acute osteomyelitis Chronic osteomyelitis .Chronic osteomyelitis .2.2.Granulomatous Granulomatous 3.3.Non suppurative Non suppurative Chronic sclerosing O Chronic sclerosing O a. Focal a. Focal b. Diffuse b. Diffuse
Chronic osteomyelitis Chronic osteomyelitis with proliferative with proliferative periostitis ( Garr’s periostitis ( Garr’s disease) disease)
Alveolar ostitis .Alveolar ostitis . Special types Special types a Osteoradionecrosis .a Osteoradionecrosis . b. Chemical b. Chemical
osteomyelitis osteomyelitis c. Osteomyelitis of c. Osteomyelitis of
newborn and infant newborn and infant ( Neonatal maxillitis) ( Neonatal maxillitis)
d. Chronic periostitisd. Chronic periostitis
OsteomyelitisOsteomyelitis• Is an inflammation of the medullary Is an inflammation of the medullary
portion of the jaw bone which extends portion of the jaw bone which extends to involve the periosteum of the affected to involve the periosteum of the affected areaarea
Acute osteomyelitisAcute osteomyelitis• Rare disease .Rare disease .• An infection of bone follow an infection An infection of bone follow an infection
associated with teeth associated with teeth • The potential source of infection is The potential source of infection is 1. Periapical infection .1. Periapical infection . 2. Periodontal pocket’s .2. Periodontal pocket’s . 3. Acute gingivitis .3. Acute gingivitis . 4. Penetrating and contaminated injuries4. Penetrating and contaminated injuries 5. Tooth extraction .5. Tooth extraction .
Systemic:Systemic: 1.1.Immunodeficiency .Immunodeficiency .2.2.Immunosuppressant .Immunosuppressant .3.3.Malignancy .Malignancy .4.4.Poorly controlled D.MPoorly controlled D.M5.5.Chronic alcoholism and malnutrition Chronic alcoholism and malnutrition
Acute osteomyelitisAcute osteomyelitis • Clinical feature: Clinical feature: • More common in adult with More common in adult with
mnadibular infection mnadibular infection • Osteomyelitis of Maxilla more Osteomyelitis of Maxilla more
common in neonate .common in neonate .• Sever throbbing pain , deeply Sever throbbing pain , deeply
sited pain .sited pain .• Swelling ,malaise and pyrexia Swelling ,malaise and pyrexia • Gingiva red swollen and tender Gingiva red swollen and tender • Involved teeth tender and Involved teeth tender and
mobile .mobile .• Intra and extra-oral pus Intra and extra-oral pus
Acute osteomyelitisAcute osteomyelitis Radiography: Radiography: 1.1.Normal in early Normal in early
stages.stages.2.2.In 10-14 days, In 10-14 days,
sufficient bone sufficient bone resorption occurs to resorption occurs to produce irregular, produce irregular, moth-eaten areas of moth-eaten areas of radiolucency.radiolucency.
Low grade Low grade inflammation with inflammation with associated with bone associated with bone destruction , granulation destruction , granulation tissue formation with tissue formation with little suppuration little suppuration
• Causes : Causes : 1.1. Inadequate treatment of Inadequate treatment of
acute osteomyelitisacute osteomyelitis..2.2. Infection by weak Infection by weak
bacteria .bacteria .3.3. Infection of avscular Infection of avscular
• Localized inflammation Localized inflammation of bone following either of bone following either failure of blood clot to failure of blood clot to form in socket, or form in socket, or premature loss or premature loss or disintegration of clotdisintegration of clot..
Unpredictable complication of tooth extraction (~1-3%).
of socket wall reveal of socket wall reveal formation of necrotic formation of necrotic bone containing bone containing empty lacunae empty lacunae
Chronic osteomyelitis with Chronic osteomyelitis with proliferative periostitisproliferative periostitis
• Represent areactive Represent areactive sub-periosteal new sub-periosteal new bone formation in bone formation in response to low grade response to low grade periapical infection , periapical infection , perifolliculitis or perifolliculitis or trauma trauma
Garr’s disease Periostitis
Chronic osteomyelitis Chronic osteomyelitis with proliferative with proliferative
periostitisperiostitis• Clinical feature:Clinical feature: 1.1.Young adult of both Young adult of both
• Represent a proliferative bone Represent a proliferative bone reaction ( Osteosclerosis) of reaction ( Osteosclerosis) of the jaw bone to low grade the jaw bone to low grade inflammation , the source of inflammation , the source of infection here is through the infection here is through the PDLPDL
• Bone necrosis follow Bone necrosis follow irradiation of oral irradiation of oral malignancy malignancy
Endarteritis obliterans and thrombosis of inferior dental artery
Bone sterile and more susceptible for infection
Osteo-radionecrosis
Specific osteomyelitisSpecific osteomyelitis• Neonatal Neonatal
MaxillatitisMaxillatitis• Rare type of Rare type of
osteomyelitis osteomyelitis • Infection during Infection during
delivery or breast delivery or breast feeding .feeding .
• Red , swollen , Red , swollen , painfull maxilla with painfull maxilla with multiple sinus .multiple sinus .
• Sequestration of Sequestration of developing teeth developing teeth
• Chemical Chemical osteomyelitisosteomyelitis
• Rare condition .Rare condition .• Incorrect use of Incorrect use of
medicaments .medicaments .• Paraformaldehyde Paraformaldehyde • Phosphorus or Phosphorus or
mercury mercury
Fibro-osseous disease Fibro-osseous disease • Group of disorder Group of disorder
characterized histologically characterized histologically by replacement of the by replacement of the normal bone by fibrous normal bone by fibrous tissue within which tissue within which trabeculae of nonfunctional trabeculae of nonfunctional osseous structure or osseous structure or metaplastic bone metaplastic bone
• Classification :Classification :1.1.Fibrous dysplasia Fibrous dysplasia : : a. a. Monostatic .Monostatic . b. Polystatic .b. Polystatic .2.2.Cemento-osseous Cemento-osseous
dysplasia.dysplasia. a. a. Periapical –cemental Periapical –cemental
dysplasia dysplasia b. Focal cemento-osseous dys b. Focal cemento-osseous dys c. Florid cemento –osseous c. Florid cemento –osseous
Fibrous dysplasiaFibrous dysplasia • A self limiting disease A self limiting disease
characterized by characterized by fibrous replacement of fibrous replacement of medullary bone by medullary bone by metaplastic woven metaplastic woven bone that eventually bone that eventually replaced by dense replaced by dense lamellar bonelamellar bone
1. Monostatic 2. Polystatic
Fibrous dysplasiaFibrous dysplasia • Monostatic : Monostatic : 1.1. More common 70%.More common 70%.2.2. Any bone affected Any bone affected 3.3. In the Jaw bone maxilla is In the Jaw bone maxilla is
more affected more affected 4.4. Start in childhood .Start in childhood .5.5. Slow growing painless, Slow growing painless,
smooth , rounded bony smooth , rounded bony swelling with facial swelling with facial asymmetry .asymmetry .
6.6. Enlarge to make dysfunction Enlarge to make dysfunction with malocclusion and with malocclusion and displacing teeth and some displacing teeth and some time prevent it’s eruption time prevent it’s eruption
Monostatic fibrous dysplasia
Fibrous dysplasiaFibrous dysplasia 7.7. No pain on palpation No pain on palpation 8.8. Maxillary lesion may Maxillary lesion may
cause exophthalmos , cause exophthalmos , proptosis and nasal proptosis and nasal obstruction .obstruction .
9.9. Mandibular lesion Mandibular lesion occur in molar and occur in molar and premolar region premolar region
10.10. Protuberance and Protuberance and increase the depth of increase the depth of jaw jaw
Fibrous dysplasiaFibrous dysplasia • Polystatic: Polystatic: 1.1. Rare . Rare . 2.2. Several bone .Several bone .3.3. More common in female.More common in female.4.4. 5% in the head and neck .5% in the head and neck .5.5. ( Albright syndrome) ( Albright syndrome)
Patchy pigmentation Patchy pigmentation Café Café au lait au lait with precocious with precocious puberty and oth puberty and oth endocrine dysfunction.endocrine dysfunction.
6.6. Jaffe syndrome when Jaffe syndrome when these is absence of these is absence of endocrine abnormalitisendocrine abnormalitis
Café au lait
Fibrous dysplasiaFibrous dysplasia• Histopathology:Histopathology: 1.1. Normal bone replaced by Normal bone replaced by
loose cellular fibrous tissue .loose cellular fibrous tissue .2.2. Newly formed bony Newly formed bony
trabeculae are delicate and trabeculae are delicate and irregular (likened to Chinese irregular (likened to Chinese characters).characters).
3.3. Spherical areas of Spherical areas of calcification resembling calcification resembling cemetum may be present.cemetum may be present.
4.4. At the margins, lesional At the margins, lesional bone fuses with normal bone bone fuses with normal bone ..
5.5. With age fibrous tissue With age fibrous tissue decrease and bone formation decrease and bone formation increase with remodeling to increase with remodeling to lamellar bonelamellar bone
Fibrous stroma with metaplastic
bone
Fibrous dysplasiaFibrous dysplasia • Radiography:Radiography: . . Radiolucent area Radiolucent area
with fine orange peal with fine orange peal textures textures
. Borders are difficult . Borders are difficult to define because of to define because of gradual transition to gradual transition to normalnormal..
• A disease of jaw bone of A disease of jaw bone of unknown etiology with unknown etiology with reactive and dysplastic reactive and dysplastic process characterized process characterized microscopically by the microscopically by the replacement of normal replacement of normal bone with a collagenous bone with a collagenous matrix containing matrix containing trabeculae of immature trabeculae of immature bone and, in some bone and, in some instances,cementum-instances,cementum-like materlike mater
• Cemento-osseous Cemento-osseous dysplasia of three typesdysplasia of three types: :
1.1. Gigantiform cementomaGigantiform cementoma2.2. Less common .Less common .3.3. Represent an exuberant Represent an exuberant
and sever form of and sever form of periapical type periapical type
4.4. Middle age black women Middle age black women 5.5. Typically symmetrical Typically symmetrical
and bilateral .and bilateral .6.6. Some time all four Some time all four
quadrant evolved quadrant evolved
Radio-opaque masses with radiolucent porder at the root
CherubimCherubim• Benign and self-Benign and self-
limited hereditary limited hereditary autosomal autosomal dominant disease dominant disease of the jaw bone of the jaw bone
Symmetrical jaw bone swelling
Chromosome 4pl6.3, which encodes the SH3-binding protein, SH3 BP2.
CherubimCherubim• Clinical featureClinical feature: : 1.1. Young children 2-5 years Young children 2-5 years 2.2. More common in male .More common in male .3.3. Familial .Familial .4.4. At birth patient appears At birth patient appears
normal .normal .5.5. Later develop bilateral , Later develop bilateral ,
painless , symmetrical swelling painless , symmetrical swelling at the angles of mandible .at the angles of mandible .
6.6. The swelling grow rapidly for The swelling grow rapidly for few years then slow regression few years then slow regression untill childhood and become untill childhood and become static at puberty static at puberty
7.7. In sever cases maxilla In sever cases maxilla involved and give Chubby involved and give Chubby face.face.
CherubimCherubim8.8. Exhibit fullness of cheek with Exhibit fullness of cheek with
widening of alveolar ridges widening of alveolar ridges and flat palatal vaultand flat palatal vault
9.9. Premature exfoliation of Premature exfoliation of deciduous teeth deciduous teeth
10.10. Malocclusion .Malocclusion .11.11. Difficulty in mastication , Difficulty in mastication ,
swallowing and speech swallowing and speech 12.12. Sever maxillary lesion Sever maxillary lesion
produce pressure at the orbit produce pressure at the orbit floor result in upward turn of floor result in upward turn of the pupils ( Heavenward look) the pupils ( Heavenward look) with an angelic appearance .with an angelic appearance .
13.13. Enlargement of Enlargement of submandibular L.Ns may submandibular L.Ns may occur .occur .
CherubimCherubim• Radiography:Radiography:1.1.Well defined Well defined
multilocular cyst like multilocular cyst like radiolucent areas radiolucent areas
2.2.Expansion and Expansion and thinning of the thinning of the cortical plates cortical plates
Multilocular cyst like radiolucent
CherubimCherubim• HistopathologyHistopathology1.1. Highly cellular and Highly cellular and
vascular connective tissue vascular connective tissue arrange in whorls.arrange in whorls.
2.2. Large number of Large number of multinucleated giant multinucleated giant cells .cells .
3.3. Eosinophilic peri-vascular Eosinophilic peri-vascular cuffing of collagen fibers .cuffing of collagen fibers .
4.4. Extravassated RBCsExtravassated RBCs5.5. Variable amount of Variable amount of
metaplastic bone metaplastic bone trabeculaetrabeculae