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Diseases of jaws and maxillary sinus Jan Laco, M.D., Ph.D.

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Presentation on theme: "Diseases of jaws and maxillary sinus Jan Laco, M.D., Ph.D."— Presentation transcript:

1 Diseases of jaws and maxillary sinus Jan Laco, M.D., Ph.D.

2 Diseases of jaws and maxillary sinus 1. Jaws 2. Temporomandibular joint 3. Maxillary sinus

3 1. Diseases of jaws 1a. Genetic diseases 1b. Metabolic diseases 1c. Diseases of unknown origin 1d. Inflammations 1e. Cysts 1f. Tumors

4 1a. Genetic diseases Osteogenesis imperfecta Achondroplasia Cleidocranial dysplasia Cherubism

5 1a. Genetic diseases Osteogenesis imperfecta (brittle bone d.) –AD inheritance –defect of biosynthesis of collagen I –thin bones without cortex -  fragile –  multiple fractures  dwarfism –+ blue sclera + deafness

6 1a. Genetic diseases Achondroplasia –most common genetic skeletal disease –short-limbed dwarf with normal trunk and head –failure of cartilage proliferation in epiphyses –protrusive mandible  malocclusion

7 1a. Genetic diseases Cleidocranial dysplasia –defective formation of clavicles –retrusion of maxilla –delayed eruption of permanent teeth

8 1a. Genetic diseases Cherubism –AD inheritance,  boys –painless symmetrical swelling of mandible angle –at 2-4 years –rapid growth until puberty  regression –Mi: fibrous tissue + haemorrhage + multinucleated giant cells + woven bone

9 1. Diseases of jaws 1a. Genetic diseases 1b. Metabolic diseases 1c. Diseases of unknown origin 1d. Inflammations 1e. Cysts 1f. Tumors

10 1b. Metabolic diseases Rickets –vitamin D deficiency during bone development –infancy –wide fontanels + bossing of frontal and parietal eminences Gigantism and acromegaly –  mandibular condyle  prognathism –+ macroglossia

11 1. Diseases of jaws 1a. Genetic diseases 1b. Metabolic diseases 1c. Diseases of unknown origin 1d. Inflammations 1e. Cysts 1f. Tumors

12 1c. Diseases of unknown origin Paget´s disease of bone Fibro-osseous lesions

13 1c. Diseases of unknown origin Paget´s disease of bone (osteitis deformans) –past middle age –common RTG finding x clinically silent –? ethiology (viral) –axial skeleton –skull – vault + maxilla –symmetric enlargement of alveolar processes + fusion of teeth to sclerotic bone  difficult extraction

14 1c. Diseases of unknown origin Paget´s disease of bone (osteitis deformans) –resorption (osteoclasts)  irregular new bone formation (osteoblats) –Mi: irregular mosaic bone trabeculae +  osteoblasts and osteoclasts + vascularity –result: thick spongy bone + marrow fibrosis –complication: osteosarcoma (rare)

15 1c. Diseases of unknown origin Fibro-osseous lesions –Fibrous dysplasia monostotic polyostotic –Cemento-osseous dysplasia periapical cemental dysplasia focal cemento-osseous dysplasia florid cemento-osseous dysplasia

16 1c. Diseases of unknown origin Monostotic fibrous dysplasia –painless, poorly circumscribed bone swelling –in childhood –self-limiting –F : M... 1:1 –  maxilla  malocclusion

17 1c. Diseases of unknown origin Polyostotic fibrous dysplasia –several bones –F : M … 3:1 –Albright´s syndrome: + skin pigmentation + sexual precocity –Mi: fibrous tissue + woven bone trabeculae without osteoblasts lining

18 1c. Diseases of unknown origin Cemento-osseous dysplasia –of periodontal ligament origin, same process periapical cemental dysplasia –F : M … 10 : 1 –asymptomatic lesion –lower I

19 1c. Diseases of unknown origin florid cemento-osseous dysplasia (gigantiform cementoma) –florid form of PCD –symmetric lesions in all quadrants focal cemento-osseous dysplasia Mi: cellular fibrous tissue + cementum-like tissue  calcification

20 1. Diseases of jaws 1a. Genetic diseases 1b. Metabolic diseases 1c. Diseases of unknown origin 1d. Inflammations 1e. Cysts 1f. Tumors

21 1d. Inflammations acute osteomyelitis chronic osteomyelitis alveolar osteitis

22 1d. Inflammations Acute osteomyelitis –sources – periapical infection, open fractures –oral anaerobes, mixed infection –adult males –mandible –clinically: severe deep-seating pain, swelling, teeth tenderness, regional lymphadenopathy –fever + leucocytosis

23 1d. Inflammations Acute osteomyelitis –suppurative inflammation in marrow spaces  compression of blood vessels  bone necrosis  sequestrum –  subperiostal area  perforation  fistulas to skin and oral mucosa –complications: fracture  chronic osteomyelitis

24 1d. Inflammations Chronic osteomyelitis de novo x low-grade infection Chronic focal sclerosing OM –young people with carious lower 1. M Diffuse sclerosing OM –old people, superinfection of florid COD

25 1d. Inflammations Chronic osteomyelitis with productive periostitis (Garré´s OM) –young people, lower 1. M –  reactive new bone formation

26 1d. Inflammations Alveolar osteitis (dry socket) –sources: excessive extraction trauma, low blood supply… –after extraction of 3. M –  females –destruction of clot by fibrinolytic enzymes – infection and food in contact with bone  necrosis  granulation tissue

27 1. Diseases of jaws 1a. Genetic diseases 1b. Metabolic diseases 1c. Diseases of unknown origin 1d. Inflammations 1e. Cysts 1f. Tumors

28 1e. Cysts Odontogenic Non-odontogenic Pseudocysts –Solitary bone „cyst“ –Aneurysmal bone „cyst“

29 1e. Pseudocysts Solitary bone „cyst“ (simple, traumatic) –? ethiology –F : M … 3 : 2 –< 25 years –painless swelling of mandible –RTG: cavity expands between teeth roots –Mi: NO epithelial lining + wall: fibrous tissue

30 1e. Pseudocysts Aneurysmal bone „cyst“ –rare in jaws –between 10 – 20 years –painless swelling of mandible –Mi: many blood-filled spaces without lining + wall: fibrous tissue

31 1. Diseases of jaws 1a. Genetic diseases 1b. Metabolic diseases 1c. Diseases of unknown origin 1d. Inflammations 1e. Cysts 1f. Tumors

32 Odontogenic Non-odontogenic

33 Non-odontogenic tumors Primary: benign x malignant –bone –cartilage –other Secondary: metastases

34 Non-odontogenic tumors Benign primary tumors –osteoma –osteochondroma –central giant cell granuloma –cemento-ossifying fibroma - rare –haemangioma - rare

35 Non-odontogenic tumors Osteoma x Exostosis –torus palatinus: posterior midline of hard palate –torus mandibularis: lingual aspect of mandible opposite to mental foramne, bilateral –hard swelling –Mi: compact or cancellous bone Gardner´s syndrome - AD inheritance –multiple osteomas + polyposis coli  malignancy

36 Non-odontogenic tumors Osteochondroma –cartilage-capped osteoma –hard bony protuberance –coronoid or condylar procces –joint dysfunction

37 Non-odontogenic tumors Giant cell granuloma –hyperplastic lesion, developmental ??? –< 20 years –F : M … 2 : 1 –anterior mandible –RTG: rounded cyst-like area –Mi: vascular fibrous tissue + giant cells + bleeding + hemosiderin –recurrency after incomplete removal

38 Non-odontogenic tumors Osteosarcoma –  malignant,  common primary non-od. neoplasm –irradiation, Paget´s disease – years, males –body of mandible –irregular firm swelling  painfull –Mi: osteoid formation + atypical osteoblasts + cartilage + fibrous tissue

39 Non-odontogenic tumors Osteosarcoma –rapid local growth + early metastases (lungs) –50% recurrency in 1st year –5-year survival: 40% (  5 cm)

40 Non-odontogenic tumors Chondrosarcoma –45 years –anterior maxilla –painfull irregular swelling –Mi: cartilage tissue with pleomorphic, binucleated chondrocytes + mitoses –locally aggressive + metastases (lungs)

41 Non-odontogenic tumors Rare tumors –Ewing´s sarcoma –Multiple myeloma –Langerhans´cell histiocytosis

42 Non-odontogenic tumors Secondary tumors – haematogenous metastases –breast –lungs –prostate –thyroid –kidney

43 Diseases of jaws and maxillary sinus 1. Jaws 2. Temporomandibular joint 3. Maxillary sinus

44 2. Temporomandibular joint Trismus - inability to open mouth fully –inflammation –injuries –tetanus Ankylosis - permanent limitation of movement –fibrosis –congenital –trauma –arthritis –tumors

45 2. Temporomandibular joint Osteoarthritis –metabolic defect of art. cartilage - defective –old people –pain, minimal symptoms

46 2. Temporomandibular joint Rheumatoid arthitis - m ultisystemic disease –antibodies (rheumatoid factors) –females, years –symmetrical involvement of smaller joints –crepitation, little pain –inflammation of synovia - granulation tissue (pannus) Osteochondroma Condylar hyperplasia

47 Diseases of jaws and maxillary sinus 1. Jaws 2. Temporomandibular joint 3. Maxillary sinus

48 Inflammation - sinusitis –acute x chronic x hypersensitive –rhinogenic x odontogenic –periapical inflammation of P or M –long oro-antral communication –pain + percussion sensitivity

49 3. Maxillary sinus Inflammation –Mi: respiratory epithelium  squamous metaplasia thickened basal membrane infiltrate - acute - neutrophils - chronic - lymphocytes + plasma cells - hypersensitive - eosinophils

50 3. Maxillary sinus Oro-antral communication –after extraction of P or M –nose-blowing test –root or tooth in sinus –prolaps of antral mucosa

51 3. Maxillary sinus Antral cysts –from mucous glands –asymptomatic –disappear spontaneously –odontogenic cysts –radicular, residual

52 3. Maxillary sinus Tumors –squamous cell carcioma –males > 50 years –advanced stage – local spread –nose obstruction, nose bleeding –paresthesia of infraorbital nerve –visual disturbances –poor prognosis


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