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Questions and Answers
What age group is primarily affected by juvenile ossifying fibroma?
Which of the following is a radiographic feature of ossifying fibroma?
What is a common clinical feature of fibrous dysplasia?
Which of the following treatments is indicated for a small lesion of fibrous dysplasia?
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Osteoblastoma is typically characterized by which of the following?
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What type of intervention does not alter survival rates but improves quality of life?
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Which medication is specifically mentioned to help prevent destructive bone lesions?
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Which clinical feature is least likely to be associated with multiple myeloma?
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What is a characteristic radiographic feature seen in multiple myeloma?
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What might contribute to the overall poor prognosis in multiple myeloma patients?
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In the treatment of multiple myeloma, which option is NOT typically used?
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Which of the following supportive care measures is aimed at managing anemia?
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What histopathologic finding is characteristic of multiple myeloma?
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What is the common type of coronoid hyperplasia that results in limitation of mandibular movement?
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Which group is most often affected by coronoid hyperplasia?
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What histopathologic feature is observed in bilateral coronoid hyperplasia?
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Which of the following is NOT a subtype of malignant non-odontogenic neoplasm of the jaws?
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What is a common clinical feature of osteosarcoma in the jaw?
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What is the typical treatment approach for osteosarcoma of the jaw?
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What is the overall 5-year survival rate for patients with jaw osteosarcoma?
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Which location is most common for metastasis in osteosarcoma?
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What is the most commonly associated feature with a periapical cyst?
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Which of the following describes the typical radiographic appearance of a lateral periodontal cyst?
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What is the preferred treatment for a botryoid odontogenic cyst?
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What age group is most commonly affected by lateral periodontal cysts?
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What histopathologic feature is typical of a periapical cyst?
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What might the clinical appearance of a large lateral periodontal cyst include?
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Which of the following is a potential consequence of performing an extraction without curettage on a periapical cyst?
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What is a distinguishing feature of the botryoid odontogenic cyst?
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What is a common feature of the odontogenic keratocyst in terms of radiographic appearance?
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Which age group is most commonly affected by the odontogenic keratocyst?
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Which histopathologic feature is characteristic of the typical odontogenic keratocyst?
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What is the most appropriate treatment for a small odontogenic keratocyst?
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In which area do calcifying odontogenic cysts predominantly occur?
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What is a distinguishing radiographic feature of the calcifying odontogenic cyst?
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Which differential diagnosis is least likely to be confused with a calcifying odontogenic cyst?
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What is the shape of the radiolucency associated with the globulomaxillary cyst?
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Study Notes
Ossifying Fibroma
- Occurs in the third and fourth decades of life
- Slow-growing, asymptomatic, and expansile lesion
- Most commonly found in the mandibular premolar area
- Juvenile (aggressive) ossifying fibroma occurs in children and young adults, causing exophthalmos, proptosis, sinusitis, and nasal symptoms
- Composed of fibrous connective tissue with well-differentiated spindled fibroblast collagen fibers
-
Radiographic features:
- Well-circumscribed, sharply defined border
- Unilocular or multilocular radiolucencies
-
Differential diagnosis:
- Fibrous dysplasia
- Osteoblastoma
- Focal cementoosseous dysplasia
- Focal osteomyelitis
-
Treatment and prognosis:
- Curettage or enucleation
- Recurrence after removal is rare
Fibrous Dysplasia
- Slow progressive enlargement of the affected jaw
- Usually painless and typically presents as a unilateral swelling
- Facial asymmetry
- Displacement of teeth
- Bone doesn't develop, doesn't mature
- Consists of a slight to moderate cellular fibrous connective tissue stroma that contains foci of irregularly shaped trabeculae of immature bone
-
Radiographic features:
- Ranges from a radiolucent lesion to a uniformly radiopaque mass
-
Differential diagnosis:
- Ossifying fibroma
- Chronic osteomyelitis
-
Treatment and prognosis:
- Small lesions require no treatment
- Large lesions require surgical recontouring
- Malignant transformation treated with radiation therapy
Osteoblastoma
- Lesion measuring 1.5 cm
- Painful, not associated with facial asymmetry
- Most often found in young males
- Age onset is around puberty
Coronoid Hyperplasia
- Painless, not associated with facial asymmetry
- Most often found in young males
- Age onset is around puberty
- Two types:
- Unilateral
- Bilateral - results in limitation of mandibular movement, which is progressive over time; common type
- Bilateral type consists of mature hyperplastic bone, which may be partially covered by cartilaginous and fibrous connective tissue
-
Radiographic features:
- Unilateral type results in a misshapen or mushroom-shaped coronoid process on radiographs
-
Differential diagnosis:
- Osseous and chondroid neoplasms
-
Treatment and prognosis:
- Surgical excision
- Rare recurrence
Malignant Non-Odontogenic Neoplasms of the Jaws
- Originate in the hard tissues and marrow cavity of the mandible and maxilla
- Subtypes:
- Osteosarcoma
- Chondrosarcoma
- Ewing's sarcoma
- Burkitt's Lymphoma
- Plasma cell neoplasm
- Metastatic carcinoma
Osteosarcoma
- Second most common primary bone tumor
-
Site of origin:
- Mandible
- Maxilla
-
Clinical features:
- Swelling and localized pain
- Loosening and displacement of teeth
- Mandibular paresthesia (impingement of the inferior alveolar nerve)
- Swelling and localized pain; maxillary paresthesia (impingement of the infraorbital nerve), epistaxis, nasal obstruction or eye problems
-
Radiographic features:
- Variable depending on the degree of calcification
-
Histopathologic features:
- Sarcomatous stroma directly producing tumor osteoid
- Variable histologic patterns
- More differentiated in the jaw than those in the skeleton, leading to a better prognosis
-
Differential diagnosis:
- Scleroderma (widening of the periodontal ligament space)
- Chronic osteomyelitis, other malignancies, several benign neoplasms (moth-eaten radiographic appearance)
- Pindborg tumor and metastatic carcinomas (sclerotic radiographic appearance)
- Chondrosarcoma, fibrosarcoma of bone, aneurysmal bone cyst or giant cell tumor
-
Treatment and prognosis:
- Radical mandibulectomy or maxillectomy
- Radiotherapy and chemotherapy for recurrences, soft tissue extension, and metastatic disease
- Presurgical insertion of radium needles for mandibular osteosarcoma (76% 5-year survival rate)
-
Prognosis:
- Overall, 5-year survival for 35 to 40% of jaw osteosarcoma
- Mandibular tumors have a better prognosis than maxillary tumors
- Rarely metastasize to lymph nodes
- Most common sites of metastasis: Lung and brain; 6 months' survival rate.
- Local recurrences treated with surgical excision and chemotherapy
Multiple Myeloma
- Rarely seen before the fifth decade, with male predominance
- Asymptomatic or may cause pain, swelling expansion, numbness, mobility of the teeth, or pathologic fractures
- Soft tissue mass
- Weakness, weight loss, anemia, and hyperviscosity
- May develop systemic amyloidosis
-
Radiographic features:
- Variable
- Punch-out appearance (non-corticated radiolucent area of bone) in the jaws and many of the hematopoietic marrow-containing bones of the skeleton
- May be expansile and osteosclerotic
-
Histopathologic features:
- Monotonous proliferation of pure plasma cells
- Wide range of differentiation from mature to less differentiated forms
-
Differential diagnosis:
- Metastatic carcinoma
- Lymphoma
- Idiopathic histiocytosis (LCD)
- Carcinoma
- Neuroblastoma
-
Treatment and prognosis:
- Chemotherapy with local radiation
- Death due to infection, renal failure, disseminated myeloma, cardiac complications, hemorrhage or thrombosis
- Poor prognosis for patients with severe azotemia, hypercalcemia, or anemia
Periapical Cyst
- Etiology: Periapical granuloma
- Most common cyst in the oral and perioral region
- Asymptomatic
- Causes bone resorption
- Associated with non-vital teeth
- Occurs at any age, peaks at the 3rd decade of life
- Commonly seen in the anterior maxillary and posterior mandibular regions
-
Radiographic features:
- Round to ovoid radiolucency with a narrow opaque margin that is continuous with the lamina dura
-
Histopathologic features:
- Lined by stratified squamous epithelium, polymorphonuclear leukocytes, and few lymphocytes
- Epithelial lining are residues from the rest of Malassez
-
Differential diagnosis:
- Anterior region:
- Posterior region:
-
Treatment and prognosis:
- Extraction and curettage of the apical zone
- RCT with apicoectomy
- Extraction only without curettage will lead to the development of a residual cyst that can weaken the bone
Lateral Periodontal Cyst
- Etiology: Dental lamina remnants within bone
- Adults older than 21 years, with male predilection
- Associated with vital teeth; non-mobile and may show root divergence
- Bluish discoloration when large (seen in the soft tissue as a bluish discoloration reflecting the fluid content)
- Location: Mandibular premolar and cuspid region, small soft tissue swelling within or slightly inferior to the interdental papilla
-
Radiographic features:
- Well-delineated, round or teardrop-shaped unilocular radiolucency between teeth
-
Histopathologic features:
- Lined by non-keratinized epithelium
- With glycogen-containing clear cells
-
Differential diagnosis:
- Botryoid odontogenic cyst
- Odontogenic keratocyst
- Squamous odontogenic tumor
-
Treatment and prognosis:
- Extraction and curettage of the apical zone
- RCT with apicoectomy
Botryoid Odontogenic Cyst
-
Radiographic features:
- Well-delineated, round or teardrop-shaped unilocular radiolucency between teeth
-
Histopathologic features:
- Multilocular cyst lined by thin stratified squamous epithelium
-
Treatment and prognosis:
- Enucleation is curative
- No recurrence potential
- Bone regeneration occurs over 6 months to 1 year
- Root divergence normalizes, even without orthodontic tooth movement
Odontogenic Keratocyst
- Asymptomatic but can cause jaw expansion and tooth mobility if affected area
- Occurs at any age, peaking in the 2nd and 3rd decades
- Occurs in children as part of basal cell nevus syndrome
- Commonly affects the posterior portion of the body of the ramus of the mandible and the maxillary canine and 3rd molar areas
-
Two basic types:
- Parakeratinized odontogenic keratocyst: Found in the anterior part of the mandible.
- Orthokeratinized odontogenic keratocyst: Found in the posterior part of the mandible.
-
Radiographic features:
- Well-circumscribed radiolucency with a smooth radiopaque rim
-
Histopathologic features:
- Keratinizing odontogenic cyst showing orthokeratin, a granular cell layer, and flattened basal cells
- Typical odontogenic keratocyst shows parakeratinized corrugated surface, hyperchromatic palisaded basal cells.
-
Differential diagnosis:
- Dentigerous cyst
- Adenomatoid odontogenic cyst
- Ameloblastoma
- Lateral periodontal cyst
- Residual cyst
-
Treatment and prognosis:
- Marsupialization and an unerupted tooth that is associated with the cyst is guided into the arch
- Enucleation and curettage for small cysts
- Resection for large multilocular keratocyst
- Resection for multiple recurrences after enucleation and curettage
Calcifying Odontogenic Cyst
- Originates from odontogenic epithelial remnants within the gingival area of either jaw
- Location: Maxilla
- Peak: 2nd decade, individuals younger than 40
- Female predilection
- Expansion of alveolar bone or soft tissues
- Absence of tenderness
-
Radiographic features:
- Unilocular or multilocular radiolucency
- Opacities may produce a "salt and pepper" type of pattern
-
Histopathologic features:
- Ghost cell keratinization is a characteristic microscopic feature
- Well-delineated cystic proliferation with a fibrous CT wall
-
Differential diagnosis:
- Calcifying epithelial odontogenic tumor
- Peripheral ossifying fibroma
- Adenomatoid odontogenic tumor
-
Treatment and prognosis:
- Enucleation with no recurrence potential
Globulomaxillary Cyst
- Nonspecific designation for any lesion in the globulomaxillary area (between maxillary lateral incisor and canine)
- Inverted pear-shaped radiolucency
- Asymptomatic, teeth are vital, divergence of roots
-
Treatment and prognosis:
- Treatment is usually surgical enucleation
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Description
This quiz covers the characteristics and clinical features of ossifying fibroma and fibrous dysplasia, focusing on their presentation and treatment options. It will help learners understand the differences between these conditions and their associated complications. Ideal for dental and medical students focusing on oral pathology.
