ORAL RADIOLOGY PRINCIPLES AND INTERPRETATION

STUART C. WHITE & MICHAEL J. PHAROAH

7TH EDITION
CH #23
OTHER BONE DISEASES

Done by: Jewana J. Ghazal

21.10.2014

Other Bone Diseases

This chapter discusses disorders of bone

that dont easily fit into well-defined
categories of diseases.

Outline

Bone Dysplasias

(Fibro-osseous lesions)

Disease mechanism
Fibrous Dysplasia
Periapical Osseous Dysplasia

Other Lesions Of Bone

Central Giant Cell Granuloma (CGCG)
Aneurysmal Bone Cyst (ABC)
Cherubism
Pagets Disease
Langerhans Cell Histiocytosis.

Bone Dysplasia
Disease Mechanism:
-Normal bone is replaced with fibrous tissue containing
abnormal bone.
-Their treatment differ from Tumors.
-Fibro-osseous lesions : (histopathological term)
commonly used term that includes: bone dysplasias,
neoplasms and other lesions of bone.

Fibrous Dysplasia

Disease Mechanism:
-Caused by mutation in Gs alpha(GNASI) gene
detected in 93% of fibrous dysplasia cases
-localized change in normal bone metabolism
-Replacement of cancellous bone by fibrous tissue
containing abnormal bone
-Histologically Short, irregularly shaped trabeculae of
woven bone that have random orientation this
appearance responsible for abnormal internal
trabecular pattern seen in diagnostic images.
.

Fibrous Dysplasia

Clinical Features: Two types

-Can affect ribs, Femur, tibia, maxilla,mandible
1-Solitary (monostotic)70%
* most often affect jaws Maxilla> Mandible
*Accidently found in diagnostic image, in older age group
2-multiple (polyostitic) 30%- children younger than 10y/o
* Jaffe type-less severe type
*Albright type (McCune Albright Syndrome-more severe type): usually comprises:
1-Polyostotic Fibrous dysplasia
2-Cautaneous pigmentations(Caf au lait)
3-Hyperfunction of one or more endocrine glands
Generally:
*lesions become static when skeletal growth stops except in polyostotic
lesions.
*active in pregnancy or with the use of oral contraceptive, abnormal growth may
occur after surgical interventions.
*No sexual predilection in fibrous dysplasia except for McCune-Albright
Syndrome F>M
Symptoms mild or absent, pain and pathological features are rare.
*Unilateral facial swelling or an enlarging deformity of alveolar process.
*when extensive : anosmia(loss of smell) , deafness, blindness.

Fibrous Dysplasia

Imaging Features:
1-Location:
1-Twice common in
posterior maxilla.
2-unilateral

Fibrous Dysplasia

Imaging
Features:
2-Periphery:
Ill Defined ,
gradual blending
of normal bone
into abnormal
pattern except in
young lesions
boundary
considered sharp
and corticated.

Fibrous Dysplasia

Imaging Features:
3-Internal structure:
Density of trabecular bone pattern vary: maxilla more
homogenous than mandible.
Lesions may appear RO, RL or Mixed
*Maxilla and base of the skull: RO
*Early lesions more RL than Mature lesions and in rare cases
may appear
multilocular. (Fig 23-3)

Fibrous Dysplasia
Internal structure Continued:
Abnormal trabeculae, shorter, thinner irregularly shaped
and more numerous than normal trabeclae so the RO
pattern vary:
1- Granular appearance (Ground-glass appearance)
2-Peau Dorange (like surface of an orange)
3-Cotton wool appearance
4-Amorphous dense pattern
5- Fingerprint (swirling appearance)
6-RL regions resembling cyst in mature fibrous
dysplasia, bone cavities like Simple Bone cyst more
common in mandible.

Very dense amorphous

pattern involving left
maxilla and preventing
eruption of cuspid and
bicuspid.

DPanoramic image with

homogenous dense
pattern that occupies
most of the right
maxillary sinus.

Amorphous dense
pattern occupies most
of the Right Maxillary
sinus:
C-Occlusal
D-Axial CT
E-Coronal Ct

A. Fingerprint, with
change in Lamina
Dura into the abnormal
bone.

C. Cotton wool
pattern, Circular
RO regions.

B. Granular, GroundGlass pattern.

D.Orange peal
pattern

E. Coronal
Cone
beam CTGranular
internal
pattern
with
strands of
more
amorphou
s bone.

A. Cropped
panoramic image,
Mandible FD.
There is Cystlike
RL lesion in the
bicuspid region.

B. Axial CT- reveals

Simple Bonelike
Cyst.

Fibrous Dysplasia

Imaging Features
4-Effect on surrounding structures:
-small lesion, usually no effect.
1-Expansion with maintenance of thinned outer cortex, expansion occur along
bone length rather than concentric expansion seen in benign tumors.
2-Maxillary sinus:
expansion by displacing its cortical boundary usually from lateral wall .
Extension into sinuses appears as parallel thickening of outer cortical border
resulting in residual antral space(approx. normal anatomic shape of sinus).
3-cortical boundries like : floor of antrum may change to abnormal pattern often
without affecting dentition also lamina dura may disappear due to this change.
4-if bone density increases the PDL space appear narrow
5-it can displace teeth or interfere with normal eruption
6-root resorption may occur.
7-hypercementosis
8-Displace IDC to superior direction.

Coronal CT- Lateral wall

expansion with
mantinance of cortical
boundries.

Mandibular fibrous dysplasia

displace IDC to superior
direction

Fibrous Dysplasia

Imaging Features:
5- Differential diagnosis:
* Hyperparathyrodisim - polyostotic, bilateral, DONT cause bone
expansion
*Pagets disease cause bone expansion, but occurs in older age,involve
whole mandible (FD unilateral and most commonly affect maxilla)
*Periapical Cemental Dysplasia bilateral , periapical region ,older age
group
*Simple Bone Cyst Histologically and radiographically the spontaneous
healing and the pattern of new bone appears like FD.
++**Osteomylitis jaw enlargement Bone laid down on the surface of
outer cortex(outer cortex disappear)
(FD expands in internal aspects of bone displacing and thinning the
outer cortex so cortex maintain its position in outer surface of bone)
++**Osteogenic Sarcoma show more malignant features
*Juvenile Ossifying Fibroma* Neoplasms- more convex extension in antral wall
(FD- reflect the original contour of antral wall)

Fibrous Dysplasia

Imaging Features:
6-Management:
*No need for biopsy in most cases for diagnosis when there is
enough information from Radio and histo
* stimulation of growth after surgical intervention in young
children- referal to Radiologist advisable.
*CT imaging for accurate , 3D representation of extent of the
lesion for future comparisons.
*follow up
*growth is complete at skeletal maturation BUT In
*Female patient: 1-hormonal changes 2- oral contraceptive may :
A. stimulate growth
B.Development of lesions in areas of FD like: Aneurysmal bone
cyst(ABC)
Giant Cell Granuloma (GCG).
*Sarcomatous changes unusual- but may appear after
therapeutic radiation.

Any Questions ?!
Thank You
!