Bone Disease Interpretation PDF

Interpretation ofdiseasesof bonemanifestedinthejaws so 0 Dr. Asim Mustafa Khan Dept. of Biomedical dental sciences College of Dentistry Outline Bone dysplasia • Fibrous dysplasia • Periapical osseous dysplasia Other lesions of bone • Central giant cell granuloma • Aneurysmal bone cyst • Cherubi...

Interpretation ofdiseasesof bonemanifestedinthejaws so 0 Dr. Asim Mustafa Khan Dept. of Biomedical dental sciences College of Dentistry Outline Bone dysplasia • Fibrous dysplasia • Periapical osseous dysplasia Other lesions of bone • Central giant cell granuloma • Aneurysmal bone cyst • Cherubism • Paget’s disease • Langerhans’ cell histiocytosis FIBROUS DYSPLASIA – Localized change in normal bone metabolism that results in the replacement of all the components of cancellous bone by fibrous tissue – Monostotic (solitary) – Polyostotic usually is found in children younger than 10 years – McCune-Albright syndrome: – comprises polyostotic fibrous dysplasia, – cutaneous pigmentation (café au lait spots) – hyperfunction of one or more of the endocrine glands. Location – Involves the maxilla almost twice as often as the mandible and occurs more frequently in the posterior aspect – Lesions more commonly are unilateral Unilateral fibrous dysplasia involving the left maxilla and mandible Periphery Ill defined, with a gradual blending of normal trabecular bone into an abnormal trabecular pattern. Fibrous dysplasia in the posterior maxilla, with an ill-defined anterior margin that blends into the normal bone pattern in the region of the unerupted cuspid. The internal pattern is granular (arrow) nor Internal Structure Early lesions may be more radiolucent than mature lesions and in rare cases may appear to have granular internal septa, giving the internal aspect a multilocular appearance. Early radiolucent stage Same case 18 years later shows a more mature radiopaque appearance Fingerprint pattern Granular or ground-glass pattern Cotton-wool pattern Orange-peel pattern Peau d’orange Cystlike radiolucent lesion Axial CT image Effects on Surrounding Structures Occlusal radiograph Occlusal views of both sides of the mandible of the same patient. Note the expansion of the right side of the mandible caused by fibrous dysplasia. The outer cortical plates have been displaced and thinned but are still intact Coronal CT image using bone algorithm of a maxillary lesion of fibrous dysplasia. The lesion has caused the lateral wall of the maxilla to expand into the maxillary antrum. The shape of the lateral wall of the sinus has maintained the zygomatic recess Mandibular fibrous dysplasia that has displaced the inferior alveolar nerve canal in a superior direction (arrows). • • • The expansion appears to affect the bone more evenly along its length. Displaces its cortical boundaries A distinct lamina dura disappears because this bone also is changed into the abnormal bone pattern • • Root resorption may occur Involved teeth may have hypercementosis – hyperparathyroidism – Paget’s disease DD – Osteomyelitis cotton wall appearance inflammation of bone – Osteogenic sarcoma sun raytriangles codman • Synonyms: Periapical cemental dysplasia, periapical cementoosseous dysplasia, cementoma. PERIAPICAL OSSEOUS DYSPLASIAS • • Occurs in middle age; mean age is 39 years. It occurs nine times more often in females than in males and almost three times more often in blacks than in whites. • The involved teeth are vital. 9 Females 3 blacks vital Location • • VERY Important Predilection for the periapical bone of the mandibular anterior teeth Lies at the apex of a tooth vital tooth The lamina dura around the central incisor has been lost The periodontal membrane space can still be seen around some of the teeth If the involved teeth have been extracted, this lesion can still develop, but the periapical location is less evident Periphery and Shape • Well defined, irregularly shaped or may have an overall round or oval shape centred over the apex • Often a radiolucent border of varying width is present, surrounded by a band of sclerotic bone that also can vary in width. VERY Important come in common in exam KSA Multiple lesions. Note the band of sclerotic bone reaction at the periphery of the lesion. Internal Structure Early stage Radiolucent stage A 10 sac Intermediate stage Mixed stage Mature stage Radiopaque stage • The normal lamina dura of the teeth involved with the lesion is lost, making the periodontal ligament Effects on Surrounding Structures me space either less apparent or appear wider. • Small lesions do not cause expansion. • Larger lesions may cause expansion, which are usually undulating in shape – Periapical abscess – Cementoblastoma DD – Odontomas excessively intricate or elaborate Florid Osseous Dysplasia • Synonyms: florid cemento-osseous dysplasia • Female and middle-aged (mean age, 42 years) • Predilection for african americans and asians. Location • Bilateral and present in both jaws Why its orid: it’s Bilateral multiple areas. Area above the inferior alveolar nerve canal • The epicentre is apical to the teeth, within the alveolar process and usually posterior to the cuspid. • In the mandible, lesions occur above the inferior alveolar canal. Well defined and has a sclerotic border that can vary in width Periphery • Varies from mixture of radiolucent and radiopaque regions to almost complete radiopacity. Internal Structure • The radiopaque regions can vary from small oval and circular regions (cotton-wool appearance) to large, irregular, amorphous areas of calcification. • Prominent radiolucent regions may be present, which usually represent the development of a simple bone cyst. Effects on Surrounding Structures • Large FOD lesions can displace the inferior alveolar nerve canal in an inferior direction. • FOD also can displace the floor of the antrum in a superior direction and can cause enlargement of the alveolar bone by displacement of the buccal and lingual cortical plates. • The roots of associated teeth may have a considerable amount of hypercementosis, which may fuse with the abnormal surrounding foci of amorphous bone in the lesion. • Extraction of these teeth may be difficult – Paget’s disease DD – Osteomyelitis VERY • Synonyms: CENTRAL GIANT CELL GRANULOMA IMPORTANT • Giant cell reparative granuloma, giant cell lesion, and giant cell tumor. • Occur in individuals younger than 20 years old. • Painless swelling. • Overlying mucosa may have a purple color. Location • Lesions develop in the mandible twice as often as in the maxilla. • Epicentre of the lesion is anterior to the first molar in the mandible and anterior to the cuspid in the maxilla. Periphery to see • Because this neoplasm grows relatively slowly, it usually produces a well-defined radiographic margin in the mandible. • In most cases, the periphery shows no evidence of cortication. • Lesions in the maxilla may have ill-defined, almost malignantappearing, borders. Internal Structure No evidence of internal structure Lesion in the anterior maxilla with a very fine granular pattern C Wispy, ill-defined internal septa Soap bubble appearance - rare VERY IMPORTNT poorly calcified, barely visible internal septation (arrow) uneven expansion with indentation right-angled septum Characteristic expansion of the outer cortical plates caused by giant cell granulomas Effects on Surrounding Structures • Displaces and resorbs teeth • The lamina dura of teeth within the lesion usually is missing. • Inferior alveolar canal may be displaced in an inferior direction. Undulating expansion and containing two rightangled septa – Ameloblastoma DD – Odontogenic myxomas racket Tennis young ANEURYSMAL BONE CYST • • females Mand Occurs in individuals younger than 30 years old. molar The condition appears to have a predilection for females. Location The mandible is involved more often than the maxilla (ratio of 3 : 2), and the molar and ramus regions are more involved than the anterior region Periphery and Shape The periphery usually is well defined, and the shape is circular or “hydraulic.” Unilocular, circular radiolucent lesion with well-defi ned borders Internal structure Axial coro c (a) Coronal CBCT image demonstrating expansile radiolucent lesion of the left mandible. (b) Circular radiolucent lesion with well-defined borders on the left mandible is remarkable on axial CBCT image. (c) Cross-sectional CBCT images demonstrating the lesion above the mandibular canal with thinning of the cortical borders of mandible Internal Structure Axial CT image using a soft tissue algorithm demonstrates the presence of an ABC of the left mandibular condyle. Note the severe expansion and the wispy, ill-defined septa (arrows) 20sec • After an ABC becomes large, there is a strong propensity for extreme expansion of the outer Effects on Surrounding Structures cortical plates. • ABCs can displace and resorb teeth. – Giant cell granulomas DD – Cherubism Cherub Cherub angel CHERUBISM • Synonym • Familial fibrous dysplasia is a synonym for cherubism. • Develops in early childhood between 2 and 6 years of age. • Presenting sign is a painless, firm, bilateral enlargement of the lower face Profound swelling of the maxilla may result in stretching of the skin of the cheeks, which depresses the lower eyelids, exposing a thin line of sclera and causing an “eyes raised to heaven” appearance. classic uppenance to Cheburism Location • This lesion is bilateral and often affects both jaws. • Mandible is the most common location. • The epicenter is always in the posterior aspect of the jaws, in the ramus of the mandible or the tuberosity of the maxilla. Peripheryor The periphery usually is well defined and in some instances corticated. Internal Structure The internal structure resembles CGCG, with fine, granular bone and wispy trabeculae forming a prominent multilocular pattern. Effects on Surrounding Structures • Expansion of the cortical boundaries of the maxilla and mandible. • Because the epicentre is in the posterior aspect of the jaws, the teeth are displaced in an anterior direction. • Tooth buds are destroyed with some lesions. The doctor gave us how to study, we can make a chart for each characteristic feature like to cotton feature and enumerate the lesions • Synonym - Osteitis deformans Man • Occurs in individuals older than 40 years of age • Occurs in men twice commonly than women. • Affected bone is enlarged and commonly deformed because of the poor quality of bone formation, resulting in PAGET’S DISEASE enlargement of skull Capsize Keep for bowing of the legs, curvature of the spine, and enlargement of the skull. • The jaws also enlarge when affected. • Separation and movement of teeth may occur, causing malocclusion. • Dentures may be tight or may fit poorly in edentulous changing x ray patients. • Patients with Paget’s disease may also have ill-defined neurologic pain as the result of bone impingement on foramina and nerve canals. • Patients with Paget’s disease often have severely elevated levels of serum alkaline phosphatase and levels of hydroxyproline in the urine. IMPORTANT what exam Board is percentage Location to see • Affects pelvis, femur, skull, and vertebrae. • Affects the maxilla about twice as often as the mandible. • Whenever the jaws are involved, the entire mandible or maxilla is always affected. Internal Structure (1) An early radiolucent resorptive stage (2) A granular or ground-glass appearance second stage (3) A denser, more radiopaque appositional late stage The trabeculae may be long and may align themselves in a linear pattern – A pattern occurs when the trabeculae may be organized into rounded, radiopaque patches of abnormal bone, creating a cotton-wool appearance. Multiple radiopaque masses in the mandible that have a cotton-wool appearance cotton-wool appearance Fibrous dysplasia florid Paget osseous disease dysplasi Effects on Surrounding Structures • Prominent pagetoid skull bones may swell to three or four times their normal thickness. In enlarged jaws, the outer cortex may be thinned but remains intact. • Cortical boundaries such as the sinus floor may be more granular and less apparent as sharp boundaries. • The lamina dura may become less evident. • Hypercementosis 3lesions Doctor disaffed oseousdysplasia Florid periapicalseendeaplasia – Fibrous dysplasia DD – Florid osseous dysplasia LANGERHANS’ CELL HISTIOCYTOSIS • disease Aggressive Occurs in older children and young adults • Loosening or sloughing of the teeth often occurs after destruction of alveolar bone. • LCH may have a single focus or may develop into a multifocal, aggressive disease. • The disseminated form may involve multiple bone lesions, diabetes insipidus, losac and exophthalmos, a condition previously defined as Hand-Schüller-Christian disease. • Letterer-Siwe disease is a malignant form of LCH that most often occurs in children younger than 3 years of age. intown Location • The mandible is a more common site than the maxilla, and the posterior regions are more involved than the anterior regions. • The mandibular ramus is a common site of intraosseous lesions. Scooped-out shape of the bone destruction in the mandible Periphery and Shape • Varies from moderately to well defined but without cortication; the periphery sometimes appears punched out. • The alveolar lesions commonly start in the midroot region of the teeth. scooped-out shape Extensive bone destruction o out panned 8020 aggress listens Aggressive LCH destroys bone around teeth, including the lamina dura, is destroyed, and as a result the teeth appear to be standing in space. teeth g Tuplicate Go oneoscape These lesions are able to stimulate periosteal new bone formation – Periodontal disease DD – squamous cell carcinoma – White S.C and Pharoah M.J. Oral Radiology Principles and Interpretation. 7th Ed. 2014. Mosby, St. Louis, Missouri, U.S.A References – Karjodkar F.R. Textbook of Dental and Maxillofacial Radiology. 2nd Ed. 2009. Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India. Thank you…