Bone Diseases of the Jaw

Cherubism

males

5

Bilateral/symmetric

Genetic Disorder,

Rare, inherited autosomal dominant Mendelian disorder

100% prevalence in?

Onset by age?

___________ mandibular swelling (can involve mx)

Cherubism

Cherubism

Cherubism

bilateral/symmetric, MN involvement

Tori and Exostoses

Localized Protuberances of excess dense cortical bone due to local factors in genetically susceptible host.

May be due to Excessive physical forces on jaws

Torus Palatinus

very firm

Torus Palatinus

Torus Mandibularis

Buccal Exostoses

Buccal Exostoses

Buccal Exostoses

Osteomyelitis

necrosis

odontogenic

2 wks

infection spreading through bone marrow spaces.

causing______ of bone

if in the jaw: _____ origin

takes >__ wks to see lucency in radiograph

LEFT: Acute Osteomyelitis-ill defined radiolucency of the right body of the MN

RIGHT: Aute Osteomyelitis with sequestrum appearing as radiolucent in the right body of MN w/ central opaque mass of necrotic bone

Chronic Osteomyelitis

LEFT: in region of 3rd molar extraction

RIGHT: Moth-eaten radiolucent appearance

Chronic Osteomyelitis

LEFT: ill-defined lucency of right body of MN, adjacent to recent extraction site

RIGHT: Enlarged, ill-defined lucency of R. body of MN 2 yrs after initial TX

1. Eliminate source of infection

2. Surgical Drainage

3. Remove dead bone by curettage

4. Treat w/ antibiotics

Chronic Osteomyelitis TX

Condensing Osteitis

pulpal inflammation or irritation

pulpitis due to large restorations/caries that encroach on the pulp

Reactive Inflammatory lesion characterized by increased bone density at the apex of the tooth.

Stimulated by chronic, low grade:

Usually starts in bone at/around tooth that has _____ due to?

Any age, any tooth

No bone symptoms (tooth may be symptomatic)

No bondy expansion

Clinical features of Condensing Osteitis

1. Variable opacity around apex

2. Joins with lamina dura

3. Blending border

4. Tooth with large restoration/caries

5. NO radiolucent rim

Rad features of Condensing Osteitis

Condensing Osteitis

well defined, no radiolucent rim

Condensing Osteitis

RIGHT: bone scar following extraction of affected tooth

Increased density of both root apices of nonvital 1st M

Widened PDL

NO radiolucent rim

Idiopathic Osteosclerosis

Increased bone density at the apex of a healthy tooth

MORE common than Condensing Osteitis

AGE: adolescent/young adult + persists for life

SITE: Post. MN

Asymptomatic

NO bony expansion

Clinical Features of Idiopathic Osteosclerosis

AGE?

SITE?

SYMPTOMS?

BONY EXPANSION?

Idiopathic Osteosclerosis

LEFT: bone sclerosis btwn apical to roots 1st + 2nd molars

Large area of radiopacity fusing with lamina dura

NO TX

1. Early osteolytic stage = radiolucent

2. Intermediate blastic stage = mixed with lucent rim

3. Mature stage = opaque with lucent rim

root end and PDL in all stages

Cemento-osseous Dysplasia:

Reactive/dysplastic fibro-osseous lesions

3 types go through same three stages:

Can always see _____ + _____ in all stages

1. Teeth Vital

2. Common in Ant. MN of adults (40 yrs)

3. STRONG Female Predilection

4. STRONG African American Predilection

5. NO symptoms

6. Lucent > Opaque progression

6 Clinical Features of Periapical Cemento-Osseous Dysplasia

Periapical cemento-osseous dysplasia

Lesions confined to the periapices of MN anterior teeth

Periapical cemento-osseous dysplasia

LEFT: Radiolucent 1st phase

RIGHT: Mixed 2nd phase

Radiolucent rim

Which ones the 1st and 2nd phase?

Periapical cemento-osseous dysplasia

LEFT: mixed stage

RIGHT: mature stage

Which ones the mixed stage (2nd) vs the mature stage (3rd)?

Confined to anterior mandible, no symptoms, Lucent to opaque migration.

Florid Cemento-osseous Dysplasia

Middle-aged older adults

Black females

Vital teeth

Asymptomatic

Multiple lesions involving 3-4 quadrants

Common in: AGE, GENDER, RACE?

Associated with _____teeth

Symptomatic?

Florid Cemento-osseous Dysplasia

Implants + dentures contraindicated. DON'T extract immediately!

LEFT: radiolucent phase

RIGHT: Radiopaque phase

2 contraindications?

Florid Cemento-osseous Dysplasia

it indicates NO infection present

LEFT: multiple mixed radiolucent/radipaque lesions involving ant/post mandible

RIGHT: multifocal radiopaque lesions of post jaw

What does opacity in the middle indicate?

1. none for bony lesions

2. Periodical radiographic evalv recommended

Florid form has a risk for:

Secondary infection

Simple bone cysts

Cemento-osseous Dysplasia TX

Florid form has a risk for (2)?

Fibrous Dysplasia

Developmental disorder characterized by disordered maturation of bone and expansion.

Characteristics include:

Sm irregular trabecular of woven bone

Loose fibrous CT stroma

Age: early teens

Monostotic: adolescence

Polystotic: childhood

Symptoms: Painless gradual bony enlargement

RAD features: ground glass bone

Fibrous Dysplasia Clinical Features

AGE?

Monostotic/Polystotic prevalent in what age?

Symptoms?

RAD features?

Fibrous Dysplasia

asymmetric expansion

gradual taper to normal

Fibrous Dysplasia Monostotic

diffuse ground glass effect

blending borders, no sharp edges

Fibrous Dysplasia Monostotic

Expansile mass of the left maxilla in a 45 yr old

Lesion known to be present for 20 yrs

Diffuse ground glass radiopacity

Fibrous Dysplasia Monostotic

Diffuse "ground glass" radiographic appearance

Takes over lamina dura + alveolar crests

Margins ill-defined + blend into bone

surgical recontouring for cosmetics after growth spurt

asymptomatic and self limiting

OCCURS: between 10-20, stabilizes at puberty and very slow growth afterward.

Fibrous Dysplasia TX?

OCCURS WHEN?

Ossifying Fibroma

Benign fibro-osseous lesion

True neoplasm

Age: 20-40 yrs

Site: Mandibular Molar or PM

Twice as common in females

Well-defined lesion

Round

Lucent to mixed

Clinical Features + Radiographic features of Ossifying Fibroma

Age?

Site?

Twice as common in?

Well/Ill defined?

Shape?

Opacity?

Ossifying Fibroma

Well-defined capsule w/ radiolucent border.

Very round + mixed lesion.

LEFT: cortical expansion in Ant. MN

RIGHT: Lesion radiolucent at apices of MN PM

Ossifying Fibroma

Very round cortical expansion of maxilla

Ossifying Fibroma

Enlargement of post. maxilla

More discrete edges

RIGHT: mixed radiolucent and radiopaque lesion expanding into post MX

Fibrous Dysplasia:

Age: 10-20

Site: Maxilla

Appearance: Diffuse opacity

Growth: Self-limited

Stabilizes at: Puberty

Ossifying Fibroma:

Age: 30-40

Site: Mandible

Appearance: Circumscribed

Growth: Continuous

Stabilizes: NOT hormone related

Fibrous Dysplasia vs. Ossifying Fibroma

Central Giant Cell Granuloma

This jaw lesion has both reactive and neoplastic features

The equivalent lesion in the skeleton is considered to be a neoplasm

Age: <30 (can be under 10 yrs old)

Site: Mandible

Symptoms: Asymptomatic jaw swelling (can have pain/paresthesia)

Clinical Features of Central Giant Cell Granuloma

Age?

Site?

Symptoms?

Pure lucency

No border reaction

Unilocular/Multilocular

Radiographic features of Central Giant Cell Granuloma

Opacity?

Border reaction?

Unilocular or Multilocular or both?

Central Giant Cell Granuloma

Dentigerous cyst

Odontomas

Ameloblastic fibroma

What 4 diseases can occur in kids <10?

Central Giant Cell Granuloma

Central Giant Cell Granuloma

Well defined lucency with no cortication

Central Giant Cell Granuloma

loculations and cortical expansion

Central Giant Cell Granuloma

Blue-purple mass present on the anterior alveolar ridge of a 4 yr old boy

*cortical expansion

Central Giant Cell Granuloma

what lesions can present as perfectly round corticated expansion?

conservative excision by curettage

Central Giant Cell Granuloma TX

1. Paresthesia (numbness)

2. Pain

3. Mobility

4. Tooth resorption

5. Rapid growth

6. Ill-defined lesion

6 Malignancies in the Jaws: Signs and Symptoms

Osteosarcoma

Pagets disease

Prior irradiation in area

Malignant neoplasm of osteoblasts.

Most common primary bone malignancy of the jaws.

2 predisposing factors?

Age: 20-40 yrs old

Symptoms: bone swelling + pain (loose teeth or paresthesia)

Osteosarcoma Clinical Features?

Age?

Symptoms?

1. Expansile mixed lesion

2. May have widened PDL around entire root

3. Classic osteosarcoma of skeleton showing sunburst pattern (sunburst pattern uncommon in jaw lesions)

Radiographic Features of Osteosarcoma

Osteosarcoma

LEFT: surrounding roots of the first molar tooth (widened PDL ligament)

RIGHT: lesion between a MN lateral incisor + canine (widening of PDL)

widened PDL, increased density, no corticated edge

Osteosarcoma

Osteosarcoma of MN showing sunburst pattern of tumor radiating from alveolar ridge (on left) + mandible (on right)

Osteosarcoma

on the mandible

Osteosarcoma

Gradual > more opaque bone pattern

Widened PDL

Firm painful swelling of the left maxilla

Osteosarcoma

sunburst pattern

advanced due to ______ pattern

Osteosarcoma

Ill defined, increased density, mobile teeth.

Exophytic tumor bone production resulting in a "sunburst" pattern.

RIGHT: tumor of the anterior mandible, widening of PDL and mottled radiopacity superimposed on teeth.

Wide to radical surgical resection

Osteosarcoma TX

Metastatic Tumors to the Jaws

Most common malignancy in jaws is metastasis from some other site in a middle-aged person! (STILL not as common as SCC)

AGE: older adult

Symptoms: Pain, swelling, paresthesia or pathologic fracture

Rad Features: Ill-defined, moth-eaten radiolucency

Clinical features of Metastatic Tumors to the Jaws

age?

symptoms?

rad features?

1. Breast

2. Lung

3. Thyroid

4. Prostate

4 MOST COMMON metastatic tumors to the jaws

Metastatic Carcinomas to the Jaws

irregular, pure lucency

"moth-eaten" bone destruction

Metastatic Carcinomas to the Jaws

LEFT: destruction of alveolar bone surrounding roots of MN 2nd M

RIGHT: carcinoma metastatic to jaws, widening of PDL

Metastatic Carcinomas to the Jaws

irregular jaw path with history of cancer

Metastatic Carcinomas to the Jaws

1. Metastatic cancers (more common)

2. Multiple Myeloma (more common)

3. Osteosarcoma (in younger pts)

PRIMARY:

1. Osteosarcoma

2. Chondrosarcoma

Most common malignant tumors occurring in jaws + most common PRIMARY malignant tumors in jaws?

1. Cemento-osseous dysplasia

2. Central giant cell granuloma

3. Ossifying fibroma

3 Unilocular Radiolucent Radiographic Presentations

1. CGCG

2. Cherubism

Multilocular Radiolucent Radiographic Presentations

1. Tori and exostoses (most common)

2. Idiopathic osteosclerosis

3. Condensing osteitis

4. Osteosarcoma

4 Radiopaque Radiographic Presentations

1. Osteomyelitis

2. Mets to jaws

2 Moth-eaten Radiographic Presentations

1. Cemento-osseous dysplasia

2. Ossifying fibroma

3. Osteosarcoma

3 Mixed Radiographic Presentations

Fibrous dysplasia

1 Ground Glass Radiographic Presentations