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LESIONS OF THE JAWS LESIONS OF THE JAWS

LESIONS OF THE JAWS - PowerPoint Presentation

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LESIONS OF THE JAWS - PPT Presentation

ML Chindia School of Dental Sciences UNIVERSITY OF NAIROBI Presentation Objectives To provide an appraisal of some common and rare jaw lesions To provide a review of the existing nomenclature ID: 614217

radiographic occurs appearance bone occurs radiographic bone appearance features tissue clinical presentation fibroma lesion bones age dysplasia bodies condyle

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Slide1

LESIONS OF THE JAWS

M.L. Chindia

School of Dental Sciences

UNIVERSITY OF NAIROBISlide2

Presentation Objectives:

To provide an appraisal of some common and rare jaw lesions.

To provide a review of the existing nomenclature

To stimulate some discussion on management approachesSlide3

Compound Odontoma

Tiny teeth varying in number:

Only afew to numerous

Do not resemble normal teeth

Usually cone-shaped

Histologically:

Normal arrangement of a centrally placed fibrovascular pulp

Tissue surrounded by dentine

Crown area covered by enamel

Cementum covers the root part.Slide4
Slide5

Complex Odontoma

Haphazard arrangement of a usually well, delineated mass of dental hard tissues

Bulk of the lesion consists of dentine

Enamel plays a minor role

Stroma consists of a mature fibrous connective tissue:

Sometimes contains areas identical to the Calcifying Odontogenic cyst

Ghost cells maybe includedSlide6

Complex OdontomaSlide7

Osseous Dysplasia (OD)

A pathologic process of unknown aetiology

Located in the tooth bearing jaw areas

Proliferation of periodontal ligament fibroblasts

Bone and cementum deposition

Occurs in various clinical formsSlide8

Radiographic presentation of ODSlide9
Slide10

Histomorphology of OD

Cellular fibrous tissue

Trabeculae

of woven and lamellar bone

Spherules of

cementum

-like material

Lacks encapsulation or demarcation

Merges with cortical or

medullary

boneSlide11

Tissue Variation in OD

Reflected in radiographic appearance thus:

Predominantly radiolucent

Predominantly radiodense

MixedSlide12

Subtypes of OD

Distinguished by clinical and radiological features:

Periapical

O

sseous Dysplasia

Focal Cemento-Osseous Dysplasia

occurs in the Posterior jaw quadrant

is a limited lesionSlide13

Focal ODSlide14

Florid Osseous Dysplasia

Occurs bilaterally in the mandible or may involve all four quadrants

Non-

expansile

Occurs in middle-aged black femalesSlide15

FODSlide16
Slide17

Familial Gigantiform CementomaMay involve two or more quadrantsIs expansible

Occurs at a young age

Shows an autosomal dominant inheritance

Sporadic cases reportedSlide18

FGCSlide19

CementoblastomaSlide20

Ossifying Fibroma (OF)

A well-demacated lesion

Composed of:

Fibrocellular tissue

Mineralized material of varying appearances

Most commonly occurs in the 2

nd

to 4

th

decates

Shows a preponderance for females

Varied mean age of histological sub-typesSlide21

Histological Subtypes of OF

Juvenile Trabecular Ossifying Fibroma (JTOF)

Maxilla the site of predilection

Occurs at an older age

Mitoses present at histology

Less typical features: multinucleated giant cells,pseudocystic stroma degeneration,haemorrhageSlide22

Juvenile Psammomatoid Ossifying Fibroma (JPOF)Mainly occurs in the bony walls of the paranasal sinuses

Occurs at a much younger age

Histology shows small ossicles resembling psammoma bodies

Loose and fibrocellular to intensely cellular

Minimal intervening collagen

Spherical or curved ossicles

Differential diagnosis: Intra – cranial meningioma with psammoma bodies.

The psammoma bodies in JPOF are clearly different from the a cellular spherical true psammoma bodiesSlide23

Clinical appearance of OFSlide24

Radiographic appearance of OFSlide25

Fibrous Dysplasia

A genetically – based sporadic disease of bone

May affect a single (monostotic) or multiple (polyostotic) bones

FD occuring in multiple adjacent craniofacial bones is regarded as monostotic (craniofacial FD)

FD may be part of the Mc Cune – Albright sydrome (MAS).Slide26

FDSlide27

FDSlide28

Radiographic appearance of FDSlide29

Ground glass appearance of FD Slide30

Radiographic appearance of FDSlide31

Epeclemiology of FD

The monostotic (MFD) is equally distributed in both genders and ethnic groups

The polystotic(PFD) is more frequent in females (F/M ratio;3:1)

Both entities are mainly diagnosed in childhood and young adults

MAS constitutes 3% of all PFD cases which may manifest at infancySlide32

Aetiology of FD

Proliferation and differentiation of preosteoblasts affected by:

Mutation in the gene (GNAS1) which encodes for the a-submit

a signal transduction G-protein (Gs-alpha)

Leads to increased C-AMP productionSlide33

Clinical Features of FD

Occurs more often in the maxilla than in the mandible

May involve adjacent bones like the zygoma,sphenoid and temporal plates

Base of skull and ribs are the most frequently affected sites in the skeleton

Painless swelling leading to facial asymmetry

Occasionally café,

au lait

pigmentation is manifestSlide34

Gardener’s Syndrome (GS)

Multiple polyposis of the large intestine (premalignant)

Osteomas of the bones: long bones, skull and jaws

Multiple epidermoid or sebeceous cysts of the skin scalp and back

Occasional occurrence of desmoid tumours

Impacted supernumerary and permanent teethSlide35

Clinico-radiographic presentationSlide36

Aetiology of GS

Due to a single phenotypic gene

Autosommal pattern of inheritance

With complete penetrance and variable expressionSlide37

Osteoma

A benign neoplasm

Characterized by the proliferation of either compact or cancellous bone

Usually in an endosteal or periosteal locationSlide38

Clinical Features of Osteoma

Is an uncommon oral lesion

May occur at any age but more common in the young adult

Is slow growing

The periosteal form of the disease manifests as a sclerotic, circumscribed mass

At histology it is composed either of extremely dense compact bone or course cancellous bone.Slide39

Clinico-radiographic presentationSlide40

Ameloblastic Fibroma (AF)

Displays soft tissues similar to those found in an immature tooth germ

Lacks a hard tissue component

Epithelial strands lie in a myxoid cell-rich mesenchyme

Mitotic figures are extremely rare

May contain granular cells: Granula cell AF or Granular Cell Odontogenic fibroma

Epithelial component closely resembles that of ameloblastoma

The stromal component is, however, different

Stroma in AF: immature,embryonic,cell rich myxoid tissueSlide41

Clinico-radiologic Features of AF

Painless swelling

Centrally placed: a radiolucent lesion

Peripherally located: swelling in the gingivae

Bone saucerization in peripheral locationSlide42

Clinical presentationSlide43

Intra-operative appearanceSlide44

Surgical defectSlide45

Hyperplasia of the Mandibular Condyle (HPMC)

A rare unilateral enlargement of the condyle

Should not be confused with neoplasia

May superficially resemble osteoma or chondroma

Aetiology remains obscure

Mild chronic inflammation has been suggested:

Proliferative osteomyelitis

Unilateral occurrence suggests a local phenomenonSlide46

Clinical Features of HPMC

Unilateral slowly progressive elongation of the face

Deviation of the chin away from the affected side

Enlarged condyle may be clinically evident

Striking radiographic features in all views

Affected condyle may be painful or not

A severe malocclusion is the sequelaSlide47

Clinico- radiographic presentation Slide48

Treatment of HPMC

Resection