Oral Pathology p117-149 of 149

oeshnoeugo123's version from 2018-02-19 20:19

Oral Pathology p116-149/149

Question Answer
Lateral Periodontal Cyst• Developmental odontogenic cyst
• Most often in mandibular canine-premolar
• Radiographic differential includes lateral
radicular cyst (if adjacent tooth is nonvital)
Gingival Cyst of the Adult– Developmental odontogenic cyst
– Soft tissue counterpart to lateral periodontal
– Most often noted on mandibular gingiva facial
to canines-premolars
Keratocystic Odontogenic Tumor• Formerly odontogenic keratocyst
• May mimic any other odontogenic cysts
• Notable for growth potential, recurrence rate,
and association with NBCCS
Gorlin Syndrome• multiple basal cell carcinomas of skin
• multiple KOTs of the jawbones
• intracranial calcifications
• bifid ribs
• scoliosis (curvature of spine)
• frontal bossing
• palmar and plantar pitting
Ameloblastoma• Average age is 34
• Most common in posterior mandible but can
develop anywhere
• After odontoma, second most common
odontogenic tumor
• Unilocular or multilocular radiolucency
• Often associated with impacted tooth
• Histopathology exhibits reverse polarization
and areas resembling stellate reticulum
Adenomatoid Odontogenic Tumor– 2:1 female predilection
– 2:1 maxilla predilection
• Often associated with
impacted maxillary canines
– Typically in patients < age
– Radiolucency with fine
snowflake calcifications
– Rarely recurs following
conservative enucleation
Odontogenic Myxoma– Ectomesenchymal odontongenic tumor
most often seen in young patients
– Multilocular radiolucency
• May resemble ameloblastoma
Odontoma– #1 most common odontogenic tumor
– Affect young patients (< age 20)
– Radiopacity with radiolucent rim
–Compound - identifiable toothlets
• > Anterior maxilla
–Complex – disorganized masses
• > Posterior of jaws
Ameloblastic Fibroma– Affect young patients (< age 20)
– Mixed odontogenic tumor
–Most often in posterior mandible
– Pure radiolucency
– Histopathologically similar to
ameloblastic fibro-odontoma, but
without the radiopaque odontoma
Simple Bone Cyst• a.k.a. Traumatic bone cyst
• NOT a true cyst
– Empty cavity within jawbones
• Radiolucency with scalloped margins
Langerhans Cell Histiocytosis• Neoplastic proliferation of
Langerhans cells
• Male predilection?
• Half of patients < age 15
• Any bone may be involved
– 10-20% of cases involve the
• Adults usually lack visceral
Langerhans Cell Histiocytosis– Historical classification
• Eosinophilic granuloma of bone
• Chronic disseminated histiocytosis
– Hand-Schuller-Christian Disease
• Acute disseminated histiocytosis
– Letterer-Siwe Disease
– Current classification
• Single organ involvement (unifocal or multifocal)
• Multiorgan involvement
– No organ dysfunction
– Organ dysfunction
– High risk
Cherubism– Rare developmental condition
– Usually noted in children
– Multilocular, bilateral
– Enlargement of jaws until puberty
Condensing Osteitis• a.k.a. focal sclerosing osteitis
• Localized area of bone sclerosis
• Radiopaque lesions associated
with apices of teeth with pulpitis
or pulpal necrosis
• May be mistaken for idiopathic
osteosclerosis or cementoosseous
Idiopathic Osteosclerosis• a.k.a. enostosis or dense bone island
• Focally increased bone density of
unknown cause
– No pulpitis in adjacent tooth
– Distinguishes from condensing osteitis
• 90% in mandible
• Asymptomatic
Fibrous Dysplasia– Developmental benign fibroosseous
– Unilateral mandibular or maxillary
expansion before puberty
– Painless swelling, usually ceases at
age 20
– Café au lait pigmentation seen in
polyostotic fibrous dysplasia
• Jaffe and McCune-Albright syndromes
– Characteristic ground-glass
– Surgical recontouring ideally
deferred until after puberty
Cemento-Osseous Dysplasia– Often in middle-aged African-American females
– Mandibular anterior vital teeth
– Asymptomatic
– Multifocal periapical lucencies mature over time;
become mixed lucent/opaque, then mainly opaque
– No treatment necessary
– Late stage predisposes to osteomyelitis
– Variants
• Periapical pattern- classically in mandibular anterior
• Florid pattern- multiple quadrants
• Focal pattern- solitary lesion
– Hardest to diagnose radiographically
– Reported more commonly in Caucasians
Paget Disease– Affects older individuals
– Bilateral maxilla affected
– Cranial nerve deficits due to compressed
– Characteristic cotton wool appearance
– 50% exhibit hypercementosis
– May undergo malignant transformation
Osteopetrosis– Overproduction of dense, nonvital bone of
both jaws
– May be seen in patients of all ages
– Expansion
– May lead to osteomyelitis
Osteoma• Benign tumor of compact bone
• Rarely diagnosed outside jaws
• Multiple lesions associated with
Gardner syndrome
Gardner Syndrome• Autosomal dominant disorder
• Multiple organ systems may be involved
• Gastrointestinal polyps with high rate of
malignant transformation
• Multiple osteomas
• Supernumerary and impacted teeth
• Epidermoid cysts of the skin
• Extra-abdominal desmoid tumors
Osteosarcoma– Most common primary malignancy of bone in
patients < age 40
– May present with localized pain, swelling,
and/or parasthesia
– May be associated with generalized widening
of multiple PDL spaces
– May present as radiolucent and/or radiopaque
• “Sunburst” pattern may or may not be seen
Multiple Myeloma• Most common primary malignancy of
bone in patients > age 40
• Multiple malignant plasma cell
• Associated with punched-out
radiolucencies and pathologic fractures
• Bence-Jones proteinuria
• Immunoglobulin spike
• Amyloidosis
Leukemia• May present with gingival
– Red, boggy, and hemorrhagic
• May be diagnosed with
biopsy and/or bloodwork
• Neutropenia may
predispose to infections
• Thrombocytopenia may
present with bleeding,
• Anemia may present with
Metastasis to the Jawbones144
• Most common site is mandible (especially
posterior), less often maxilla
– Metastases rarely to soft tissues
• Usually a poorly defined lucency without sclerotic
malignancymore likely malignancy or benign?
-spontaneous paresthesia
benignmore likely malignancy or benign?
-cortex thinned or expanded, but intact
malignancymore likely malignancy or benign?
-destruction of cortical plates
Bell Palsy– Cranial nerve VII paralysis
– Unilateral lip droop at
corner, inability to close or
wink eyelid
– Usually lasts less than one
Auriculotemporal Syndrome• a.k.a. Frey Syndrome
• Often after parotid gland surgery
• Sweating of unilateral facial skin on
Trigeminal Neuralgia• Tic douloureaux
• Cranial nerve V pain
• Often mimics pain of dental origin
• Mandibular branch most often
• Associated with a trigger stimulus

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