Presentation on theme: "Nonneoplastic Diseases of Bone"— Presentation transcript:
1 Nonneoplastic Diseases of Bone Chapter 8Nonneoplastic Diseases of Bone
2 Outline Benign Fibro-osseous Lesions Paget Disease of Bone Central Giant Cell GranulomaOsteomalacia
3 Nonneoplastic Diseases of Bone (pg. 277) (Box 8-1)These diseases fall into several categories.Several are discussed in other chapters.Inherited diseases affecting bone – Ch 6Benign and malignant neoplasms – Ch 7Central and peripheral giant cell granulomas – Ch 2Aneurysmal bone cyst – Ch 5This chapter covers several other nonneoplastic diseases not included elsewhere.
5 Periapical Cemento-osseous Dysplasia (pgs )A relatively common disease of unknown cause that affects periapical boneClinical and radiographic featuresDiscovered on radiographsOccurs most commonly in the anterior mandible of patients older than 30More common in women than men – many studies indicate a predilection for black women.Early lesions are well circumscribed and radiolucent.With time, they become increasingly calcified.Older lesions may be radiolucent with central opacifications.
7 Periapical Cemento-osseous Dysplasia (cont.) (pgs )Diagnosis and treatmentA biopsy may be necessary in cases where characteristic radiographic features are not evident.Histologic examination reveals a fibro-osseous lesion composed of fibrous tissue and calcifications.Early lesions consist of mainly fibrous tissue, where older lesions contain numerous calcifications.TreatmentNone
9 Focal Cemento-osseous Dysplasia (cont.) (pgs )An asymptomatic fibro-osseous lesionThe histologic features are similar to periapical cemento-osseous dysplasia and florid cemento-osseous dysplasia, but it has unique clinical and radiographic features.
10 Focal Cemento-osseous Dysplasia (cont.) Clinical and radiographic featuresUsually occurs in women between 30 and 50 years of ageMore common in white than in black individualsTypically arises in the posterior mandibleAppears as an isolated, well-delineated radiolucent to radiopaque lesion less than 1.5 cm
11 Focal Cemento-osseous Dysplasia (cont.) Diagnosis and TreatmentBiopsy and histologic examination are usually necessary to establish a diagnosis,A surgical feature is that it is composed of numerous gritty pieces of soft and hard tissue.
12 Florid Cemento-osseous Dysplasia (pgs )A condition of disordered cementum and bone developmentCharacteristically involves multiple quadrants in the maxilla and mandible.
13 Florid Cemento-osseous Dysplasia (cont.) (pgs )Clinical and Radiographic FeaturesOccurs most often in middle-aged black women who are older than 49It typically affects more than one quadrant of the maxilla and mandible, often in posterior areas.Masses of irregular opacification are noted that are composed of dense, sclerotic bone, cementum, or both.
15 Florid Cemento-osseous Dysplasia (cont.) Diagnosis and TreatmentOften diagnosed based on characteristic clinical presentation and radiographic appearanceIn an edentulous patient, the sclerotic masses may perforate the mucosa.This may lead to osteomyelitis, requiring surgery and antibiotics.
16 Fibrous Dysplasia(pg. 279)A disease characterized by replacement of bone with abnormal fibrous connective tissue interspersed with varying amounts of calcificationThe cause is unknown.One theory is it may be due to abnormal mesenchymal cell function.Histologically, it is a benign fibro-osseous lesion, with vascularized, cellular fibrous connective tissue interspersed with irregular trabeculae of bone.
17 Types of Fibrous Dysplasia Monostotic fibrous dysplasiaPolyostotic fibrous dysplasia
18 Monostotic Fibrous Dysplasia (pg. 279)Characterized by involvement of a single boneThe maxilla is more frequently involved than the mandible.Most commonly diagnosed in children and young adults with no sex predilectionClinical examination reveals a painless swelling or bulging of the buccal plate.
19 Polyostotic Fibrous Dysplasia (pgs )Characterized by involvement of more than one boneTypically occurs in children with a female predilectionWhen long bones are involved, they may exhibit bowing and an associated dull aching pain.Patients may have skin lesions appearing as light-brown macules called café au lait spots.
20 Polyostotic Fibrous Dysplasia (cont.) There are several typesCraniofacial fibrous dysplasiaInvolves the maxilla with extension into the sinuses and adjacent zygoma, sphenoid, and occipital bonesJaffe typeInvolves multiple bones along with café au lait macules on the skinAlbright syndromeCharacterized by endocrine abnormalities, precocious puberty in females, stunting or deformity of skeletal growth in both sexes as a result of premature closing of the epiphyseal plates café au lait spots
21 Polyostotic Fibrous Dysplasia (cont.) (pgs )Clinical and radiographic featuresA painless enlargement of affected bone or bonesTypically, a painless, progressive, unilateral enlargement of the mandible or maxilla.The classic radiographic appearance is a diffuse radiopacity looking like “ground glass.”
23 Polyostotic Fibrous Dysplasia (cont.) (pgs )Diagnosis and treatmentCharacterized by cellular fibrous connective tissue interspersed with irregularly shaped bony trabeculaeIn fibrous dysplasia, radiographic changes blend into the surrounding normal bone.TreatmentSurgical recontouring of bone for cosmetic reasons
25 Paget Disease of Bone (Osteitis deformans) (pgs )A chronic metabolic bone diseaseCharacterized by resorption, osteoblastic repair, and remineralization of involved boneUnknown cause – may be due to a virusMost commonly occurs in men over age 50The maxilla is more commonly affected than the mandible.
26 Paget Disease of Bone Clinical and radiographic features Radiographic (pgs )Clinical and radiographic featuresEnlargement is common; the patient often complains of pain.Spaces may increase between teeth as bone enlarges.RadiographicA patchy radiolucency and radiopacity, “cotton wool”Hypercementosis, loss of lamina dura, and obliteration of the periodontal ligament may occur.
28 Paget Disease of Bone (cont.) (pgs )Diagnosis and TreatmentThe serum alkaline phosphatase level is significantly elevated in active disease.Histologic examination reveals bony trabeculae surfaced with numerous osteoclasts and osteoblasts.Prominent reversal lines may create a pattern known as mosaic bone.TreatmentExperimental; the disease is slowly progressive
30 Central Giant Cell Granuloma(Central Giant Cell Lesion) (pgs )Composed of well-vascularized connective tissue containing many multinucleated giant cellsOccurs within boneA disease of bone that develops over a long period of timeThe result of calcium deficiencyIn young children, it is usually caused by a deficiency of vitamin D.In adults, it may be related to various health problems.
31 Central Giant Cell Granuloma(Central Giant Cell Lesion) (cont.)
32 Osteomalacia Clinical and radiographic features Treatment May be associated with delayed tooth eruption and periodontal diseaseTreatmentBased on identification of the cause
33 Discussion QuestionsWith what disease are “ground glass” and “fingerprint pattern” associated?What is Paget disease?What are the signs of osteomalacia?