OTHER BONE DISEASES PART 1 DONE BY : FATIMA ALSAYED JAFFAR 20102050074
Dec 22, 2015
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.