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Diseases of Bone
Sarah Ahmed
Pagets disease
Monostotic or polyostotic
Unclear etiology
MOA:
Wave of osteoclastic activity causing irregular resorption cavities
After a period of time osteoblastic activity increases, forming
woven bone
I.
II.
Pagets disease
M:F = 2:1
Clinical Features
Pagets disease
Clinical Features
Pagets disease
Radiographic Features
Mx:Mn = 2:1
Pagets disease
Saggital
Coronal
Radiographic features
Pagets disease
Internal structure
I.
II.
III.
Pagets disease
Internal structure
Pattern of trabeculae
I.
II.
III.
Pagets disease
Surrounding structures
When jaws are enlarged the outer cortex maybe thinned but
remains intact
The disease may involve the sinus floor and the boundaries will be
less apparent but the air space is not diminished to a great extent
Pagets disease
Surrounding structures
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Pagets disease
Similarities:
I.
Granular pattern
II. Cause jaw expansion
Differences:
I.
Pagets disease occur in older group
II. Almost always bilateral
III. Fibrous dysplasia has tendency to encroach antral air space
.
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Pagets disease
Similarities:
Cotton wool appearance
Differences:
FOD Lesions centered above the inferior alveolar nerve canal
FOD lesions have radiolucent capsules
Changes seen in FOD do not affect all of the jaw
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Pagets disease
I.
II.
.
I.
Similarities:
Bone pattern
Bilateral
Differences:
Metabolic diseases do not enlarge bones
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Pagets disease
Management
I.
II.
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Pagets disease
Complications
I.
II.
III.
15
LCH
Old classification:
Eosinophilic granuloma (solitary)
Hand-Schuller-Christian disease (chronic disseminated)
Letterer-Siwe disease (acute disseminated)
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LCH
New Classification
Non-malignant disorders (ex, unifocal or multifocal eosinophilic granuloma)
Malignant disorders (ex, Letterer Siwe disease and histiocytic lymphoma)
Often the oral changes are the first clinical signs of the disease.
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LCH
Eosinophilic Granuloma
Appears in the skeleton (ribs, pelvis, long bones, skull and jaws)
I.
II.
III.
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Bony swelling
19
LCH
Letterer-Siwe disease
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LCH
Letterer-Siwe disease
Intermittent fever
Hepatosplenomegaly
III. Anemia
IV. Lymphadenopathy
V. Hemorrhage
VI. Failure to thrive
I.
II.
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LCH
Radiographic features
Mn > Mx
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The alveolar lesions commonly start in the midroot region of the teeth.
The bone destruction progresses in a circular shape.
LCH
Radiographic Features
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LCH
Radiographic features
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LCH
Radiographic Features
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LCH
I.
II.
III.
IV.
V.
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LCH
Surrounding structures
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LCH
Surrounding structures
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LCH
Differential diagnosis
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LCH
Differential Diagnosis
2. SCC
LCH
Differential Diagnosis
32
LCH
Management
Surgical Curettage
Chemotherapy
33