Nonneoplastic Diseases of Bone

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Chapter 8 Nonneoplastic Diseases of Bone
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• Outline
• Benign Fibro-osseous Lesions
• Paget Disease of Bone
• Central Giant Cell Granuloma
• Osteomalacia

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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 6
• Benign and malignant neoplasms Ch 7
• Central and peripheral giant cell granulomas Ch
  2
• Aneurysmal bone cyst Ch 5
• This chapter covers several other nonneoplastic
  diseases not included elsewhere.

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Benign Fibro-osseous Lesions

• Periapical Cemento-osseous Dysplasia
• Focal Cemento-osseous Dysplasia
• Florid Cemento-osseous Dysplasia
• Fibrous Dysplasia

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Periapical Cemento-osseous Dysplasia

• (pgs. 277-278)
• A relatively common disease of unknown cause that
  affects periapical bone
• Clinical and radiographic features
• Discovered on radiographs
• Occurs most commonly in the anterior mandible of
  patients older than 30
• More 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.

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Periapical Cemento-osseous Dysplasia (cont.)
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Periapical Cemento-osseous Dysplasia (cont.)

• (pgs. 277-278)
• Diagnosis and treatment
• A 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.
• Treatment
• None

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Periapical Cemento-osseous Dysplasia (cont.)
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Focal Cemento-osseous Dysplasia (cont.)

• (pgs. 277-278)
• An asymptomatic fibro-osseous lesion
• The histologic features are similar to periapical
  cemento-osseous dysplasia and florid
  cemento-osseous dysplasia, but it has unique
  clinical and radiographic features.

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Focal Cemento-osseous Dysplasia (cont.)

• Clinical and radiographic features
• Usually occurs in women between 30 and 50 years
  of age
• More common in white than in black individuals
• Typically arises in the posterior mandible
• Appears as an isolated, well-delineated
  radiolucent to radiopaque lesion less than 1.5 cm

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Focal Cemento-osseous Dysplasia (cont.)

• Diagnosis and Treatment
• Biopsy 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.

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Florid Cemento-osseous Dysplasia

• (pgs. 278-279)
• A condition of disordered cementum and bone
  development
• Characteristically involves multiple quadrants in
  the maxilla and mandible.

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Florid Cemento-osseous Dysplasia (cont.)

• (pgs. 278-279)
• Clinical and Radiographic Features
• Occurs most often in middle-aged black women who
  are older than 49
• It 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.

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Florid Cemento-osseous Dysplasia (cont.)
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Florid Cemento-osseous Dysplasia (cont.)

• Diagnosis and Treatment
• Often diagnosed based on characteristic clinical
  presentation and radiographic appearance
• In an edentulous patient, the sclerotic masses
  may perforate the mucosa.
• This may lead to osteomyelitis, requiring surgery
  and antibiotics.

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Fibrous Dysplasia

• (pg. 279)
• A disease characterized by replacement of bone
  with abnormal fibrous connective tissue
  interspersed with varying amounts of
  calcification
• The 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.

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Types of Fibrous Dysplasia

• Monostotic fibrous dysplasia
• Polyostotic fibrous dysplasia

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Monostotic Fibrous Dysplasia

• (pg. 279)
• Characterized by involvement of a single bone
• The maxilla is more frequently involved than the
  mandible.
• Most commonly diagnosed in children and young
  adults with no sex predilection
• Clinical examination reveals a painless swelling
  or bulging of the buccal plate.

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Polyostotic Fibrous Dysplasia

• (pgs. 279-280)
• Characterized by involvement of more than one
  bone
• Typically occurs in children with a female
  predilection
• When 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.

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Polyostotic Fibrous Dysplasia (cont.)

• There are several types
• Craniofacial fibrous dysplasia
• Involves the maxilla with extension into the
  sinuses and adjacent zygoma, sphenoid, and
  occipital bones
• Jaffe type
• Involves multiple bones along with café au lait
  macules on the skin
• Albright syndrome
• Characterized 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

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Polyostotic Fibrous Dysplasia (cont.)

• (pgs. 279-280)
• Clinical and radiographic features
• A painless enlargement of affected bone or bones
• Typically, a painless, progressive, unilateral
  enlargement of the mandible or maxilla.
• The classic radiographic appearance is a diffuse
  radiopacity looking like ground glass.

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Polyostotic Fibrous Dysplasia (cont.)
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Polyostotic Fibrous Dysplasia (cont.)

• (pgs. 279-280)
• Diagnosis and treatment
• Characterized by cellular fibrous connective
  tissue interspersed with irregularly shaped bony
  trabeculae
• In fibrous dysplasia, radiographic changes blend
  into the surrounding normal bone.
• Treatment
• Surgical recontouring of bone for cosmetic reasons

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Polyostotic Fibrous Dysplasia (cont.)
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Paget Disease of Bone (Osteitis deformans)

• (pgs. 280-281)
• A chronic metabolic bone disease
• Characterized by resorption, osteoblastic repair,
  and remineralization of involved bone
• Unknown cause may be due to a virus
• Most commonly occurs in men over age 50
• The maxilla is more commonly affected than the
  mandible.

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Paget Disease of Bone

• (pgs. 280-281)
• Clinical and radiographic features
• Enlargement is common the patient often
  complains of pain.
• Spaces may increase between teeth as bone
  enlarges.
• Radiographic
• A patchy radiolucency and radiopacity, cotton
  wool
• Hypercementosis, loss of lamina dura, and
  obliteration of the periodontal ligament may
  occur.

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Paget Disease of Bone (cont.)
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Paget Disease of Bone (cont.)

• (pgs. 280-281)
• Diagnosis and Treatment
• The 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.
• Treatment
• Experimental the disease is slowly progressive

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Paget Disease of Bone (cont.)
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Central Giant Cell Granuloma(Central Giant Cell
Lesion)

• (pgs. 281-282)
• Composed of well-vascularized connective tissue
  containing many multinucleated giant cells
• Occurs within bone
• A disease of bone that develops over a long
  period of time
• The result of calcium deficiency
• In young children, it is usually caused by a
  deficiency of vitamin D.
• In adults, it may be related to various health
  problems.

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Central Giant Cell Granuloma(Central Giant Cell
Lesion) (cont.)
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Osteomalacia

• Clinical and radiographic features
• May be associated with delayed tooth eruption and
  periodontal disease
• Treatment
• Based on identification of the cause

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Discussion Questions

• With what disease are ground glass and
  fingerprint pattern associated?
• What is Paget disease?
• What are the signs of osteomalacia?