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321 Cards in this Set

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  • Back
What are the major salivary glands, what do they secrete?
o Parotid – 100% serous
o Submandibular – mostly serous, some mucos
o Sublingual – mostly mucus glands, some serous
• What are the minor salivary glands, what do they secrete?
o Palate, 100% mucous
o Buccal mycosa, floor of mouth, labial mucosa: mucous and serous
o Etiology of a mucocele?
 Accidental trauma (bite lower lip)  severance of MSG duct  leakage of mucin into surrounding tissue  walling off by granulation tissue
o What is the morphology/color of a mucocele?
 Vesicle/bulla (> 5 mm) – fluctuant
 Blue translucent, though may appear pink if mucin located deep
o How can you tell the difference between a fibroma and a mucocele?
 If it is able to be condensed upon touch, it is a mucocele
o What is the most common site for a mucocele?
 Lower lip (due to the fact that most people have class I or II occlusion), especially halfway between midline and commissure
o What is the most common population to have mucocele?
 Adolescents
 Other common sites: buccal musoca, ventral tongue, floor of mouth
o Is a mucocele a cyst?
 Not a true cyst (no epithelial lining)
o Will a mucocele go away after local excision of mucus?
 No, must also remove severed duct and gland
o Why do mucoceles fluctuate?
 Because macrophages uptake a significant amount of the extravasated mucus
 Because macrophages uptake a significant amount of the extravasated mucus
 Ranula
o What causes a ranula most commonly?
 The severance of a sublingual gland duct
o What are differential diagnoses for a ranula?
 Dermoid cyst (will feel doughy)
 Mucus duct cyst
 Epidermoid cyst
o This is a blue fluctuant vesicle/bulla on the floor of mouth that may elevate the tongue.
 Ranula
o This extravasation of mucin dissects through the mylohyoid muscle into the neck (lateral or midline)
 Plunging ranula
o Etiology of mucus duct cyst?
 Due to obstruction of salivary gland (minor or major) such as sialolith, bacterial plug
o Is a mucus duct cyst a true cyst?
 Yes, epi-lined.
o This is the formation of a calcified structure within the salivary duct system
 Sialolithiasis
o When does pain occur with sialolithiasis?
 Classically upon salivation (just prior to meal)
o Where is the most common site of a sialolith?
 80% - submandibular duct (Wharton’s duct) due to tortuous path and viscous mucus content
o This is the term for inflammation of the salivary glands
 Sialadenitis
o This lip lesion involving the minor salivary glands can undergo malignant transformation
 Cheilitis Glandularis
o Which type of Cheilitis Glandularis causes the lower lip to be everted, extremely swollen and pus filled?
 Deep, suppurative type
o What is the treatment of Cheilitis Glandularis?
 Vermillionectomy
o Chronic, systemic, autoimmune disorder that affects the salivary and lacrimal glands
 Sjogren’s Syndrome
o This is a subjective criteria, describing feeling a dry mouth.
 Xerostomia
o This is an objective criteria, describing a declined salivary flow
 Salivary gland hypofunction
o What differentiates Sjogren’s syndrome and Sicca syndrome?
 Sicca syndrome is a general term for dry eyes, mouth. Sjogren’s is an autoimmune disease with these symptoms.
o What are the two types of Sjogren’s? What differentiates them?
 Primary: no other autoimmune disease
 Secondary: Autoimmune disorder present, usually (rheumaroid arthritis, SLE)
o Which sex is more affected by sjogren’s?
 Female 80-90%, elderly
o What are the intraoral findings of sjorgren’s?
 Xerostomia, dysphagia, predisposition to cervical caries, fissured tongue with atrophy of papillae, secondary candidiasis
o What is a common extraoral finding of sjogren’s?
 Bilateral parotid swelling (33-50%)
o What condition predisposes to a 40x higher risk of developing lymphoma?
 Sjogren’s
o What diagnostic lab values indicate Sjogren’s?
 Positive rheumatoid factor (RF), Antinuclear antibodies (ANA)
o What diagnostic test is used to measure tear secretion in Sjogren’s? What are the + and – values?
 Schirmer test. < 5 mm (suggests +), <2 mm (confirms +)
o What condition will show a sialogram with a “fruit-laden, branchless tree” pattern?
 Sjogren’s syndrome
o What sites are common for a biopsy to be performed for Sjogren’s?
 Labial mucosa biopsy or major gland (Parotid)
o Pilocarpine hydrochloride (Sialogen) or another drug, Evoxac, is the most common treatment for what condition?
 Sjogren’s
o How should you treat a patient with dry mouth?
 With sialologues, daily fluoride applications
o This condition is an unusual non-inflammatory disorder causing salivary gland (parotid) enlargement
 Sialadenosis
o This condition is when minor salivary glands on the palate shut down (possibly from ischemia), causing painful swelling, then forms a deep ulcer with sharply defined borders, will self-resolve.
 Necrotizing Sialometaplasia
o This ulcerative condition on the palate may be misdiagnosed as malignancy and overtreated.
 Necrotizing Sialometaplasia
o What helps to differentiate between Necrotizing Sialometaplasia and malignancy?
 Necrotizing Sialometaplasia will happen very immediately (24-48 hours)
o The most common site for salivary neoplasia?
 On the palate, off the midline
o *Firm palatal swelling off the midline in an otherwise healthy mouth. What do you think?
 Salivary gland tumor
o How do you distinguish between benign vs malignant salivary gland neoplasia?
 Perform biopsy
o A rapid increase in growth of a palatal firm swelling after initial slow growth indicates what?
 Possibly malignant salivary neoplasm
o What are 3 signs of possible malignancy for salivary neoplasms?
 Paresthesia, Fixation, Rapidly increased growth rate
o What is the most common salivary gland neoplasm?
 Pleomorphic adenoma
o Most common sites for salivary neoplasms?
 minor salivary gland site: palate
 major salivary gland site: parotid
o Most common parotid gland tumor?
 Pleomorphic adenoma
o Most common benign salivary gland tumor?
 Pleomorphic adenoma
o Most common malignant salivary gland tumor?
 Mucoepidermoid carcinoma
o What are the two types of monomorphic adenomas?
 Canalicular adenoma
 Basal cell adenoma
o What is the most common site for a canalicular adenoma?
 Upper lip
o What is the most common site for a basal cell adenoma?
 Parotid gland
o What is the most likely site for Warthin’s tumor?
 The parotid (95%)
o What is the most likely salivary gland tumor to be bilateral?
 Warthin’s tumor
o What population is most commonly affected by Warthin’s tumor?
 Male > 40 yrs
o What is the characteristic histology of Warthin’s tumor?
 Papillary, cystic, with lymphoid stroma in wall
o What is the most common location for oncocytoma
 Parotid gland
o What is characteristic of oncocytes?
 Cytoplasm has massive amounts of degenerating swollen mitochondria
o What is the most common salivary gland malignancy?
 Mucoepidermoid cyst
o What ages are affected by mucoepidermoid cysts?
 People in the 3rd and 6th decade of life (bimodal)
o What is the most common childhood salivary gland malignancy?
 Mucoepidermoid Carcinoma
o What malignant tumor is found more often in the submandibular gland than the parotid?
 Adenoid cystic carcinoma
o What is the most common malignant salivary tumor IN the mouth?
 Adenoid Cystic Carcinoma
o 50% of adenoid cystic carcinomas develop where?
 In the minor salivary glands (23% on the palate)
o Most common malignancy on the palate?
 Adenoid cystic carcinoma
o 25-33% of adenoid cystic carcinoma patients experience what symptoms?
 Pain and paresthesia
o A radiographic finding of apical radiolucency with root resorption in a pointed “pencil tip” like root apearence indicated what salivary gland tumor?
 Adenoid Cystic Carcinoma
o A biopsy report showing areas of swiss cheese pattern or cribiform pattern is indicative of what condition?
 Adenoid cystic carcinoma
o Neurotropism is involved in 25-33% of occurrences of what salivary gland tumor?
 Adenoid cystic carcinoma
o What are the most common sites of metastasis of adenoid carcinoma?
 Lung and bone
o Is the prognosis more favorable with a parotid as opposed to a MSG adenoid cystic carcinoma?
 Parotid is more favorable
o This salivary tumor is a slow growing and painless mass, more common in females, African americans, and occurs in the 6th and 8th decade.
 Polymorphous Low-grade Adenoma
o This salivary gland tumor shows a histological pattern of ‘indian filing’ and neurotropism
 Polymorphous Low-grade Adenoma
o Which malignant salivary gland tumor has the best prognosis?
 Polymorphous Low-Grade Adenoma
• What does NOS mean?
o Not otherwise Specified, can’t be identified exactly but is malignant
• Which malignant salivary gland tumor has the worst prognosis?
o Adenoid cystic carcinoma
• Should you treat a benign salivary gland tumor with radiation therapy?
o No, can create a malignant chance
• What is the order of locations for prognoses, most to least favorable, for malignant salivary gland tumors?
o MSG > palate > submandibular
o What is the main difference between chronic and acute lymphoid hyperplasia?
 Chronic is non-tender
o What is the name of the scattered aggregates of lymphoid tissue in the mouth?
 Waldeyer’s Ring
o Hyperplastic Lymphoid tissue can appear what color?
 Pink, or yellow-orange
o Bi-lateral pink papules on the posterior lateral border of the tongue, history of pneumonia.
 Lingual tonsils
• Excessive bleeding upon primary tooth extraction might suggest what condition?
o Hemophilia A
• Most common inherited bleeding disorder
o Von Wilderbrand’s disease
• What lab tests should be abnormal in vWD?
o Abnormal von willebrand’s factor
o Abnormal platelets
o Abnormal BT and prolonged PTT
• A slick, depapillated tongue that is light pink in coloration could be due to what condition?
o Anemia
• What condition is precipitated by hypoxia, infection, hypothermia, and dehydration?
o Sickle-cell anemia
• What is the most common cause of death in children affected by sickle-cell anemia?
o Strep pneumonia
• A radiographic pattern of a “step ladder” for the jaw bone, and “hair on end” skull, or reduced trebecular pattern appearance is indicative of what condition?
o Sickle-cell anemia
• What is causing the unique radiographic patterns shown in sickle-cell anemia?
o Marrow areas are being recruited to make more red-blood cells
• This a class of disorders affects hemoglobin
o Thalassemia
• What is Hydrops Fetalis?
o A genetic disorder of alpha hemoglobins, (a thalassemic condition)
• What condition experiences anemia, deficiency of WBC, and thrombocytopenia?
o Aplastic Anemia
• What are the oral symptoms of aplastic anemia?
o Gingival hemorrhage (sometimes hyperplasia), petechiae, ecchymoses, ulcerations associated with infection.
• What constitutes Neutropenia?
o <1500 ANC count
• Are infections associated with neutropenia likely to be bacterial, viral, or fungal?
o Bacterial
• Rare idiopathic hematologic disorder characterized by regular periodic reuctions in neutrophils
o Cyclic neutropenia
• How long is the usual cycle for cyclic neutropenia?
o 21 days
• What hematologic condition can cause severe periodontal bone loss and gingival recession?
o Cyclic Neutropenia
• How is Cyclic Neutropenia diagnosed?
o 2-3 blood tests a week for 8 weeks (3 cycles)
o What is the etiology of agranulocytosis?
 Usually induced by exposure to drugs (chemotherapeutic drugs)
o The gingival appearance in agranulocytosis mimicks what condition?
 ANUG
• Term for decreased number of circulatory blood platelets
o Thrombocytopenia
• What is Polycythemia Vera?
o Too many red blood cells
• What are the common clinical signs of polycythemia vera?
o Ruddy complexion
o Pruritus with no rash
o Epistaxis, ecchymoses, gingival hemorrhage
• What are the oral signs of leukemia?
o Oral ulcers (deep punched out lesions with a gray white necrotic base)
o Oral herpetic infections
o Oral candidiasis
o Diffuse gingival enlargement
o Gingival tumor like growth
• What type of leukemia most often has gingival enlargement?
o Myelomonocytic type
• What is Myelophthisic anemia? What conditions is it associated with?
o Crowding out of normal hematopoietic stem cells by malignant proliferation
o Associated with leukemia and multiple myeloma
o What are the forms of langerhans cell disease?
 Acute Disseminated Form
 Chronic, localized form
 Chromic, disseminated form
o Which form of langerhans cell disease shows an eosinophilic granuloma of bone?
 Chronic, localized form
o Hand-Schuller-Christian disease exhibits what triad? Is another name for what disease?
 Triad: bone lesions, exophthalmos, diabetes insipidus. AKA chronic, disseminated form of langerhans cell disease
o What is another name for the acute disseminated form of langerhans cell disease?
 Letterer-Siwe disease
o What age distribution is often affected by Letterer-Siwe (acute disseminated langerhans)?
 Infants
o In general, what are the most commonly affected sights of langerhans cell disease?
 Skull, ribs, vertebrae and mandible common
o What is the radiographic appearance of langerhans cell disease?
 ‘Tooth floating in air’ or severe periodontitis
o Birbeck bodies will be seen in the cytoplasm of cells in what condition?
 Langerhans cell disease
o What is the treatment for chronic localized langerhans cell disease?
 Solitary jaw lesions, curettage
o Etiology of Hodgkin’s lymphoma?
 It is thought to be from E-B virus
o What is the classic cell seen in hodgkin’s lymphoma?
 Reed-Sternberg cells (neoplastic, exhibit owl-eye nuclei) ***going to be on the exam
o What is the age distribution for hodgkins lymphoma?
 Bimodal (15-35 and >50)
o What are the clinical signs and symptoms of hodgkin’s lymphoma?
 Weight loss, fver, night sweats, generalized pruritus, enlarged lymphnodes
o What two conditions (that are covered on the exam) have bimodal age distribution?
 Mucoepidermoid cysts and hodgkin’s lymphoma
o Which has a better prognosis, Hodgkin’s or Non-Hodgkin’s lymphoma?
Hodgkin's
o How does Hodgkin’s lymphoma affect nodes?
 Mess with their architecture
o What virus is thought to play a role in Burkitt’s lymphoma (a type of non-hodgkin’s lymphoma)?
 Epstein Barr virus
o What cell type does non-hodgkins lymphoma originate from most commonly?
 Most commonly originate from B-lymphocyte (~80%)
o Which type of lymphoma more commonly occurs in the mouth?
 Non-hodgkins
o What is the number of oral cavity and oropharyngeal cancer diagnoses a year?
 35,000/yr (at least 7000 is in the oropharynx)
o What autoimmune disease would predispose someone 40x to nonhodgkins lymphoma?
 Sjorgrens
o Which has a more organized classification scheme, non-hodgkins or hodgkins?
 Hodgkins lymphoma
o What are the oral soft tissue lesion characteristics of non-hodgkins lymphoma?
 Nontender, diffuse swelling, buccal vestibule, gingival, or posterior hard palate, boggy consistency, erythmatous or purplish, some ulcerated
o What is the worst of the non-hodgkins lymphomas?
 Burkitt’s
o What percent of African form Burkitt’s lymphomas form in the jaw?
 50-70% form in the jaw (more in the posterior maxilla, common in young)
o Where does Burkitt’s lymphoma most commonly occur in America?
 Usually in the abdominal region, only some in jaw
o What are radiographic signs of Burkitt’s lymphoma in the jaw?
 Radiolucent bone, will ragged, ill defined margins,
 Patchy loss of lamina dura is an early sign
o What is the histological pattern of Burkitt’s lymphoma?
 Starry sky pattern
• This condition is rare, aggressive, nonrelenting, destruction of palate and nasal fossa
o Extranodal NK/T-lymphoma
• Where does Extranodal NK/T-lymphoma arise? In what age population?
o Intranasal in adults
• This lymphoma can cause midline ulceration leading to palatal perforation
o Extranodal NK/T-lymphoma
• What are the complications of Extranodal NK/T-lymphoma?
o Secondary infection, hemorrhage
• What lymphoma begins with signs of epistaxis and nasal stuffiness/pain?
o Extranodal NK/T-lymphoma
• This is a malignancy of plasma cell origin; multicentric origin in bone
o Multiple myeloma
• This is the number one primary bone malignancy in the US
o Multiple myeloma
• What population, age and race, is most commonly affected by multiple myeloma?
o Ages 60-70, 2x more likely in Blacks vs whites
• What types of antibodies are usually formed by the malignant clone plasma cells in multiple myeloma?
o Most commonly IgG and IgM
• What is the number one sign or symptom of multiple myeloma?
o Bone pain
• What is the etiology of petechiae of skin and oral mucosa in multiple myeloma?
o Lack of platelets due to myelophthisic anemia
• What is the significance of Bence-Jones proteinuria?
o Seen in renal failure caused by multiple myeloma
• What lab exam finding in multiple myeloma?
o Monoclonal gammopathy with serum protein immunoelectrophoresis (which means the antibody produced by the malignant plasma cell will be the only one present)
• What condition can lead to amyloid deposits in various soft tissue (ex. tongue) in some patients?
o Multiple myeloma
• What condition will have a radiographic appearance of multiple well defined “punched out” radiolucencies common on skull films?
o Multiple myeloma
• What is the name for a solitary focal form of multiple myeloma?
o Plasmacytoma
• This is the most commonly biopsied oral pathology lesion
o Fibroma
• This is a reactive fibrous hyperplasia, not a true neoplasm
o Fibroma
• Most common locations of fibroma?
o Commonly bitten areas (buccal mucosa, lip, tongue)
• What form of fibrous hyperplasia can occur in denture wearing patients?
o Epulis fissuratum
• Raised areas or ridges of tissue on or near edentulous ridge caused from tissue trauma?
o Epulis Fissuratum
• What is the name for a pedunculated, pressed down fibrous hyperplasia under palatal part of removable denture?
o Fibroepithelial polyp
• What is the treatment for epulis fissuratum?
o Local excision, reline denture or fabricate new, advise patient to remove denture at night
• What is the common patient to present with inflammatory papillary hyperplasia?
o Patients who wear dentures 24/7, ill-fitting dentures, poor denture hygiene
• Where are the common sites for inflammatory papillary hyperplasia?
o Palatal vault and alveolar ridge
• What is possible etiology of inflammatory papillary hyperplasia?
o Candidiasis
• What benign condition, common in denture wearers, mimics the epithelial islands seen in squamous cell carcinoma? (psuedoepitheliomatous hyperplasia)
o Inflammatory papillary hyperplasia
• Which condition can occur in NON-denture wearers, epulis fissuratum or inflammatory papillary hyperplasia?
o Inflammatory papillary hyperplasia
• What are the 3 conditions that start in the interpapillary gingival?
o PG – pyogenic granuloma
o PGCG – peripheral giant cell granuloma
o POF – peripheral ossifying fibroma
• This lesions have a female predilection, and can be due to hormonal changes
o Pyogenic granuloma
• What is the most common location from pyogenic granuloma?
o Gingival
• What is the classic appearance of pyogenic granuloma
o Red, rapid growth, bleeds easily, frequently secondarily ulcerated
• What is the treatment of a pyogenic granuloma?
o Conservative excision
o Eliminate the triggering factor or recurrence is likely
• This is a gingival reactive lesion in response to local irritant histologically shows multinucleated giant cells
o Peripheral giant cell granuloma
• Which of the 3 P’s ONLY occurs on the gingival?
o Peripheral giant cell granuloma AND peripheral ossifying fibroma
• Which of the 3 P’s are true granulomatous inflammation?
o None of them
• What gingival condition may show radiographic bone resorption creating cupping or saucerization or resorption?
o Peripheral giant cell granuloma
• What is the most common mesenchymal tumor of the skin?
o Lipoma
• This is a smooth yellow nodule that happens 50% of the time on the buccal mucosa.
o Lipoma
• What must be ruled out with a possible lipoma on the buccal mucosa?
o Herniation of buccal fat pad
• True or false, lipoma is a reactive growth.
o False, it is a true benign neoplasm
• This is a tender nodule that has the appearance of a fibroma.
o Traumatic neuroma
• Is a traumatic neuroma a reactive or a true neoplastic lesion?
o Reactive
• What is the typical histology of a schwannoma?
o Antoni A with verocay bodies
o Antoni B tissue no associated verocay bodies
• This neoplasm composed of neural tissue can present as a solitary or multiple lesions, and does not contain verocay bodies.
o Neurofibroma
• What are the stigmata with neurofibromatosis type 1 (von recklinghaus)?
o Crowe’s sign (axillary freckling)
o Café Au lait
o Multiple neurofibromas
o Lisch nodules (macules on the iris)
• What is a major complication of neurofibromatosis?
o Neurosarcoma
• Neuromas of the oral mucosa are the first sign of what disease?
o MEN
• This condition often also presents with pheochromocytoma of the adrenal medulla
o MEN
• Medullary thyroid carcinoma is an VERY common complication (90%) of what condition?
o MEN
• What body type is often associated with MEN?
o Marfanoid
• Multiple NON-tender neuromas on the tongue or lips, are indicative of what condition?
o MEN
• What condition would be suspected with a teenager showing signs of hypertension from an over-secretion of catecholamines and nodules on the tongue?
o MEN
• What is the origin of neuroectodermal tumor of infancy?
o Neural crest cells
• This condition presents in infants as a melanotic lesion on the anterior maxillary alveolar ridge
o Neuroectodermal Tumor of Infancy
• This condition can cause bone destruction in the maxilla of an infant
o Neuroectodermal tumor of infancy
• This is a deep-seated nodule commonly on the tongue that is thought to originate from Schwann cells
o Granular cell tumor
• What nodular lesion commonly on the dorsum of the tongue commonly presents with a histology of pseudoepitheliomatous hyperplasia?
o Granular cell tumor
• What is the most common site in the body for a granular cell tumor?
o Tongue
• Is a granular cell tumor considered cancer?
o No, though it histologically appears very similar
• What is the gender and common site commonly affected by congenital epulis of the newborn?
o Maxillary alveolar ridge, 90% female
• What condition common in infants has a histology that appears similar to granular cell tumors but without neural tissue?
o Congenital Epulis of the Newborn
• This is the MOST common tumor of humans and infants
o Hemangioma
• This vesicle or bulla is compressible and blanches upon pressure
o Hemangioma
• What is the difference between vascular malformations and hemangiomas?
o A hemangioma arises within the 1st year of life and should resolve
o A vascular malformation is present at birth and will persist throughout life
• What condition presents with a “port wine” stain and often follows the distribution of a branch of the trigeminal?
o Vascular malformation
• Most intrabony vascular malformations in the mandible are fed by what vessel?
o Carotid artery
• What vascular condition can appear as a radiographic radiolucency with trebeculi?
o Intrabony Vascular malformation
• What are the major components of sturge-weber syndrome?
o Vascular malformations involving face and brain and angiomatosis of leptomeninges
o Seizure disorders, mental retardation
• This is a hamartoma growth rather than true neoplasm
o Lymphangioma
• What type of lymphangioma is very large, seen in newborns and often involves the neck?
o Cystic Hygroma
• This is the MOST common cause of macroglossia
o Lymphangioma
• What is the most common site for lymphangioma?
o On the tongue
• This is the term for a benign smooth muscle tumor
o Leiomyoma
• Leiomyomas are very common in what part of the body?
o Uterus
• What is the origin of a leiomyoma in the mouth?
o Smooth muscle cells around blood vessels (vascular leiomyoma)
• This benign tumor of skeletal muscle is most commonly seen on the tongue:
o Rhabdomyoma
• Which is more common, Rhabdomyoma or Rhabdomyosarcoma?
o Rhabdomyosarcoma
• What are the definitions of choristoma and hamartoma?
o Hamartoma= tumor in normal tissue in a normal location
o Choristoma = tumor in normal tissue in an abnormal location
• What is the most common site for Choristoma?
o Tongue
• What are the most common components in Choristoma?
o Bone or cartilage
• What is the most common soft tissue sarcoma seen in the mouth?
o Rhabdomyosarcoma
• What is the most common soft tissue sarcoma in childhood (60%)?
o Rhabdomyosarcoma
• What is the tissue origin of rhabdomyosarcoma?
o Skeletal muscle
• What are the common head and neck sites of rhabdomyosarcoma
o Orbit, nasopharynx, palate
• What is the most common type of inherited bone disease?
o Osteogenesis imperfecta
• What is a systemic manifestation of dentinogenesis imperfect?
o Osteogenesis imperfecta
• This is a rare hereditary disease with increased bone density
o Osteopetrosis
• What are the two forms of osteopetrosis?
o Infantile and adult
• Which form of osteopetrosis is most deadly?
o Infantile
• In what disease is osteomyelitis common following tooth extraction?
o Osteopetrosis
• True or false, Osteopetrosis patients exhibit a deficiency in the numbers of osteoclasts
o False, normal number of osteoclasts but functionally defective
• What condition presents with globular amorphous bone deposited in marrow spaces?
o Osteopetrosis
• What sex and body site is most commonly affected by focal osteoporotic marrow defect?
o 75% female and 70% posterior mandible
• What is the condition that is non-pathologic and appears radiographically as a radiolucency with thin fine radiopaque trebeculae?
o Focal osteoporotic marrow defect
• This condition could be confused with condensing osteitis
o Idiopathic osteosclerosis
• Where is the most common location for idiopathic osteosclerosis?
o 90% in mandible near 1st molar region
• What is the radiographic appearance of idiopathic osteosclerosis?
o Well-defined radiopaque mass
• What is the required treatment for idiopathic osteosclerosis?
o None!
• This radiopaque bone lesion is associated with pulpitis or pulpal necrosis
o Condensing Osteitis
• This radiopaque bone lesion commonly occurs in children and young adults and exhibits no bony swelling
o Condensing osteitis
• What is the radiographic appearance of condensing osteitis?
o Localized radiopacity at or adjacent to apex of tooth with inflammation, no radiolucent border (distinguishes it from focal cemento-osseous dysplasia)
• What is the treatment for condensing osteitis?
o No specific treatment for affected bone, associated tooth should be extracted or RCT
• This abnormal resorption and deposition of bone affects older, generally Caucasian patients, who experience thickened distortion and weakening of bones
o Paget’s disease of bone
• What condition exhibits narrowing of foramina leading to vertigo, deafness, and visual disturbances?
o Paget’s disease of bone
• How often is the jaw affected in Paget’s disease of bone?
o 17% of cases, bilaterally
• What is the LATE radiographic appearance of paget’s bone disease?
o “cotton wool” radiopacities similar to cement-osseous dysplasias
• Elevation of what lab value is associated with paget’s disease of bone?
o Serum alkaline phosphatase
• What is the characteristic histology of paget’s disease of bone?
o Jigsaw puzzle or mosaic pattern
• What are two common complications of paget’s disease of bone?
o Hypercementosis 50% (difficult extractions) and Osteosarcoma (mostly in pelvis and long bones)
• This bone disease that affects the anterior jaw and often crosses the midline is histologically indistinguishable from hyperparathyroidism, cherubism, and peripheral giant cell granuloma
o Central Giant Cell Granuloma
• This bone condition that often affects children has an early appearance of bilateral mandibular swelling
o Cherubism
• What condition has maxillary involvement stretching skin to expose more sclera of the eye?
o Cherubism
• What is the radiographic appearance of cherubism?
o Multiple, multilocular radiolucencies
• Is a simple bone cyst a true cyst?
o No, no epi lining, therefore a pseudocyst
• What is the presumed etiology of simple bone cyst?
o Trauma, however >50% of cases report no history of trauma
• What gender, body site, age group is mostly affected by simple bone cysts
o Males 2:1, mandible most often, adolescents and young adults
• This bone condition is usually asymptomatic and exhibits a radiographic appearance of scallop shape margins extending between roots of involved teeth without affecting them
o Simple bone cyst
• What does the surgeon usually encounter upon exploratory surgery of simple bone cyst?
o An empty cavity, or more rarely one filled with seroanginous fluid
• What are the clinical features (common age of pts, common location, symptoms) of aneurismal bone cysts?
o Young adults, mandible molar region, and rapid facial swelling (pain)
• What is the radiographic appearance of an aneurismal bone cyst?
o Uni or multilocular radiolucency with a “blow-out” distension of bone contours
• This is a diverse group of processes that replace normal bone with fibrous connective tissue and metaplastic bone
o Benign Fibro-osseous lesions
• What are three benign fibro-osseous lesions?
o Fibrous dysplasia, cemento-osseous dysplasia, ossyfing cemetifying fibroma
• What is the most common site for fibrous dysplasia?
o The jaw
• Does fibrous dysplasia more commonly affect one bone or multiple?
o 80% of cases are monostotic
• What are two syndromes that are characterized by polyostotic fibrous dysplasia?
o Jaffe’s syndrome and McCune-Albright syndrome
• When is the typical onset of fibrous dysplasia?
o In children and teenagers typically before puberty
• This is a painless, slow enlargement of the maxilla or mandible that commonly affects children before puberty.
o Fibrous dysplasia
• What are the radiographic appearances of immature and mature fibrous dysplasia lesions?
o Early: mottled radiolucency
o Late: ground glass radiopaque bone with poorly defined margins
• This polyostotic disease presents with café au lait macules with irregular borders and precocious puberty
o Albright’s syndrome
• What is the characteristic histology of fibrous dysplasia?
o Irregular trabeculae of immature (woven) bone shaped like Chinese writing characters
• What is the treatment of large, diffuse maxillary fibrous dysplasia? What treatment should be avoided?
o Delay treatment until growth ceases and hope the disease will stabilize
o Avoid radiation therapy since osteosarcomatous transformation has been seen
• What is the common population affected by periapical cemento-osseous dysplasia? (age, sex, race)
o 30-50 yrs old
o Black predilection
o Female predominance 14:1
• What is the most commonly affected site with periapical cement-osseous dysplasia?
o Mandibular anterior teeth (happens with vital teeth)
• What is the radiographic appearance of periapical cemento-osseous dysplasia?
o Asymptomatic periapical radiolucencies which transform into radiopacities
• What is the treatment for periapical cemento-osseous dysplasia?
o None
• What is the most common benign fibro-osseous lesion?
o Focal cemento-osseous dysplasia
• What population is most often affected by focal cemento-osseous dysplasia?
o 30-50 yrs old, whites, 90% women
• Where is the most common site for focal cemento-osseous dysplasia?
o Most often in posterious mandible and usually asymptomatic and solitary
• Treatment of focal cemento-osseous dysplasia?
o Observe after diagnosis (hemorrhagic, fragmented gritty tissue that is much more difficult to remove than ossifying fibroma)
• What is the most commonly affected population for Florid Cemento-Osseous Dysplasia?
o Middle aged, female, 90% black
• What fibrous bone condition exhibits bilateral, symmetrical posterior jaw involvement that is multiquadrant and not tooth related?
o Florid Cemento-osseous Dysplasia
• What bone condition may become secondarily infected and mimic diffuse, chronic sclerosing osteomyelitis?
o Florid Cemento-Osseous Dysplasia
• What is the characteristic histology of Florid Cemento-Osseous Dysplasia?
o Sequestrum/involcrum in advanced cases with secondary infection
• What is the treatment of asymptomatic and symptomatic Florid Cemento-Osseous Dysplasia?
o Asymptomatic: prevent or control Periodontitis, avoid biopsy or tooth extraction
o Symptomatic: antibiotics, sequestrectomy, chronic mgmt
• What is the age range, sex, and location most affected by Cementifying-Ossifying Fibroma?
o 20-40yrs old, females 5:1, Mandible 90% molar region
• What lesion is radiographically a well-defined unilocular radiolucent to radiopaque lesion with centripetal expansion of the inferior border of the mandible?
o Cementifying-Ossifying Fibroma
• What is the treatment of Cementifying-Ossifying Fibroma?
o Curettage – shell out from surrounding bone
• This is a benign tumor of mature compact bone
o Osteoma
• What is the most common location for an osteoma to occur?
o Mandibular angle is a frequent location
• What condition presents with multiple osteomas of the jaw and other cranial bones at puberty?
o Gardner Syndrome
• What are 4 stigmata of Gardner Syndrome?
o Multiple osteomas of jaw and cranium, supernumerary teeth/impacted teeth/odontomas, multiple epidermoid cysts of skin, multiple colon or rectal polyp
• Colorectal polyps associated with Gardner syndrome increase the likely hood of the patient developing what?
o Malignant transformation to invasive colorectal carcinoma (50% by age 30, chance increases to almost 100% with increasing age)
• What prophylactic treatment is typically done after the discovery of oral lesions assoicaited with Gardner Syndrome?
o Colonectomy due to the high risk of malignant transformation of polyps
• The is a true neoplasm that is frequently classified as a bone lesion, although it is a tumor of the cementum
o Cementoblastoma
• A cementoblastoma most often occurs in what age group? What region of the mouth?
o Young adults, mandibular first molar region
• True or false, a tooth involved with a cementoblastoma must be non-vital.
o False, involved tooth is vital
• Is a cementoblastoma associated with pain and swelling?
o 2/3rds of the time, yes
• What is the radiographic appearance of a cementoblastoma?
o Root anatomy and PDL obscured by dense radiopaque tumor with thin radiolucent border
• What lesion presents as a jaw swelling with tooth mobility “pumping action” with pulsation or bruit present?
o Central (Intrabony) Hemangioma
• What gender and location is most commonly affected with central (intrabony) hemangioma?
o Females, mandible
• What are the 3 types of primary malignant tumors of the jaw?
o Osteosarcoma
o Chrondrosarcoma
o Ewing’s sarcoma
• This bone malignancy will occur on average 10-15 years later in the jaw than in the long bones
o Osteosarcoma
• What is the clinical presentation of osteosarcoma?
o Bone pain, swelling, tooth mobility
• What is the radiographic appearance of Osteosarcoma?
o Ill-defined radiolucency or moth-eaten radiopacity, Codman’s triangle (tumor raises periosteum away from the bone)
o Symmetrical widening of PDL space
o 25% have sunburst pattern
• What lesion presents radiographically with Codman’s triangle?
o Osteosarcoma (tumor raises periosteum away from bone)
• What is the prognosis of osteosarcoma with and without metastasis?
o 30-70% without metastasis. 1 in 3 metastasize within 2 years (ave survival = 6 mo)
o maxilla, older age have worse prognosis
• To what locations is metastasis of osteosarcoma common?
o Lung and brain
• What is the average age for jaw osteosarcoma and chonrosarcoma?
o 35 yrs
• Does a chonrosarcoma occur more often in the maxilla or mandible?
o Maxilla 4:1
• What lesion looks similar radiographically to chondrosarcoma?
o Osteosarcoma
• This malignant bone lesion that can occur in the jaw most commonly affects white males, age 5-25 and presents most frequently in the mandible.
o Ewing’s sarcoma
• This malignant lesion, when occurring in the jaw, presents with pain, rapid jaw swelling, tooth mobility and parasthesia and can be misdiagnosed as a dental infection
o Ewing’s sarcoma
• This malignant lesion radiographically mimics Garre’s osteomyelitis in the onion skin periosteal appearance.
o Ewing’s sarcoma
• This bone malignancy is considered a small ‘blue dot’ tumor
o Ewing’s sarcoma
• Are most malignancies found in the jaw primary or secondary?
o Secondary (eg. Multiple myeloma, osteosarcoma)
• What are 6 common origin sites for metastatic tumors found in the jaw?
o Lung, brest, kidney, colon, prostate, thyroid glands
• What is the hypothesized route of metastasis for tumors from distant sites to the head and neck?
o Paravertebral venous plexus of Batson (Batson’s plexus)
• Where do metastatic tumors going to the jaw usually appear? Max or mandible?
o Mandible 4:1
• Bone swelling, pain or parasthesia, tooth mobility and post extraction extrusion from the socket in 50+ yr old adult might indicate what?
o Metastatic jaw tumor
• What are common radiographic appearances of metastatic tumors in the jaw?
o Most are ill defined radiolucencies but some may be radiopaque since they produce calcifications