Diseases of jaws

and maxillary sinus

Jan Laco, M.D., Ph.D.
 Diseases of jaws
and maxillary sinus
• 1. Jaws

• 2. Temporomandibular joint

• 3. Maxillary sinus
 1. Diseases of jaws
• 1a. Genetic diseases
• 1b. Metabolic diseases
• 1c. Diseases of unknown origin
• 1d. Inflammations
• 1e. Cysts
• 1f. Tumors
 1a. Genetic diseases
• Osteogenesis imperfecta
• Achondroplasia
• Cleidocranial dysplasia
• Cherubism
 1a. Genetic diseases
• Osteogenesis imperfecta (brittle bone d.)
– AD inheritance
– defect of biosynthesis of collagen I
– thin bones without cortex -  fragile
  multiple fractures  dwarfism
– + blue sclera + deafness
 1a. Genetic diseases
• Achondroplasia
– most common genetic skeletal disease
– short-limbed dwarf with normal trunk and head
– failure of cartilage proliferation in epiphyses
– protrusive mandible  malocclusion
 1a. Genetic diseases
• Cleidocranial dysplasia
– defective formation of clavicles
– retrusion of maxilla
– delayed eruption of permanent teeth
 1a. Genetic diseases
• Cherubism
– AD inheritance,  boys
– painless symmetrical swelling of mandible
angle
– at 2-4 years
– rapid growth until puberty  regression
– Mi: fibrous tissue + haemorrhage +
multinucleated giant cells + woven bone
 1. Diseases of jaws
• 1a. Genetic diseases
• 1b. Metabolic diseases
• 1c. Diseases of unknown origin
• 1d. Inflammations
• 1e. Cysts
• 1f. Tumors
 1b. Metabolic diseases
• Rickets
– vitamin D deficiency during bone development
– infancy
– wide fontanels + bossing of frontal and parietal
eminences
• Gigantism and acromegaly
  mandibular condyle  prognathism
– + macroglossia
 1. Diseases of jaws
• 1a. Genetic diseases
• 1b. Metabolic diseases
• 1c. Diseases of unknown origin
• 1d. Inflammations
• 1e. Cysts
• 1f. Tumors
 1c. Diseases of unknown origin
• Paget´s disease of bone

• Fibro-osseous lesions
 1c. Diseases of unknown origin
• Paget´s disease of bone (osteitis deformans)
– past middle age
– common RTG finding x clinically silent
– ? ethiology (viral)
– axial skeleton
– skull – vault + maxilla
– symmetric enlargement of alveolar processes +
fusion of teeth to sclerotic bone  difficult
extraction
 1c. Diseases of unknown origin
• Paget´s disease of bone (osteitis deformans)
– resorption (osteoclasts)  irregular new bone
formation (osteoblats)
– Mi: irregular mosaic bone trabeculae +
 osteoblasts and osteoclasts + vascularity
– result: thick spongy bone + marrow fibrosis
– complication: osteosarcoma (rare)
 1c. Diseases of unknown origin
• Fibro-osseous lesions
– Fibrous dysplasia
• monostotic
• polyostotic
– Cemento-osseous dysplasia
• periapical cemental dysplasia
• focal cemento-osseous dysplasia
• florid cemento-osseous dysplasia
 1c. Diseases of unknown origin
• Monostotic fibrous dysplasia
– painless, poorly circumscribed bone swelling
– in childhood
– self-limiting
– F : M ... 1:1
  maxilla  malocclusion
 1c. Diseases of unknown origin
• Polyostotic fibrous dysplasia
– several bones
– F : M … 3:1
– Albright´s syndrome: + skin pigmentation +
sexual precocity

– Mi: fibrous tissue + woven bone trabeculae

without osteoblasts lining
 1c. Diseases of unknown origin
• Cemento-osseous dysplasia
– of periodontal ligament origin, same process

• periapical cemental dysplasia

– F : M … 10 : 1
– asymptomatic lesion
– lower I
 1c. Diseases of unknown origin
• florid cemento-osseous dysplasia (gigantiform
cementoma)
– florid form of PCD
– symmetric lesions in all quadrants

• focal cemento-osseous dysplasia

• Mi: cellular fibrous tissue + cementum-like tissue

 calcification
 1. Diseases of jaws
• 1a. Genetic diseases
• 1b. Metabolic diseases
• 1c. Diseases of unknown origin
• 1d. Inflammations
• 1e. Cysts
• 1f. Tumors
 1d. Inflammations
• acute osteomyelitis

• chronic osteomyelitis

• alveolar osteitis
 1d. Inflammations
• Acute osteomyelitis
– sources – periapical infection, open fractures
– oral anaerobes, mixed infection
– adult males
– mandible
– clinically: severe deep-seating pain, swelling,
teeth tenderness, regional lymphadenopathy
– fever + leucocytosis
 1d. Inflammations
• Acute osteomyelitis
– suppurative inflammation in marrow spaces 
compression of blood vessels  bone necrosis
 sequestrum
  subperiostal area  perforation  fistulas
to skin and oral mucosa

– complications: fracture
 chronic osteomyelitis
 1d. Inflammations
• Chronic osteomyelitis
• de novo x low-grade infection

• Chronic focal sclerosing OM

– young people with carious lower 1. M
• Diffuse sclerosing OM
– old people, superinfection of florid COD
 1d. Inflammations
• Chronic osteomyelitis with productive
periostitis (Garré´s OM)
– young people, lower 1. M
  reactive new bone formation
 1d. Inflammations
• Alveolar osteitis (dry socket)
– sources: excessive extraction trauma, low blood
supply…
– after extraction of 3. M
  females
– destruction of clot by fibrinolytic enzymes –
infection and food in contact with bone 
necrosis  granulation tissue
 1. Diseases of jaws
• 1a. Genetic diseases
• 1b. Metabolic diseases
• 1c. Diseases of unknown origin
• 1d. Inflammations
• 1e. Cysts
• 1f. Tumors
 1e. Cysts
• Odontogenic

• Non-odontogenic

• Pseudocysts
– Solitary bone „cyst“
– Aneurysmal bone „cyst“
 1e. Pseudocysts
• Solitary bone „cyst“ (simple, traumatic)
– ? ethiology
– F:M…3:2
– < 25 years
– painless swelling of mandible
– RTG: cavity expands between teeth roots
– Mi: NO epithelial lining + wall: fibrous tissue
 1e. Pseudocysts
• Aneurysmal bone „cyst“
– rare in jaws
– between 10 – 20 years
– painless swelling of mandible
– Mi: many blood-filled spaces without lining +
wall: fibrous tissue
 1. Diseases of jaws
• 1a. Genetic diseases
• 1b. Metabolic diseases
• 1c. Diseases of unknown origin
• 1d. Inflammations
• 1e. Cysts
• 1f. Tumors
 1f. Tumors
• Odontogenic

• Non-odontogenic
 Non-odontogenic tumors
• Primary: benign x malignant
– bone
– cartilage
– other

• Secondary: metastases
 Non-odontogenic tumors
• Benign primary tumors
– osteoma
– osteochondroma
– central giant cell granuloma
– cemento-ossifying fibroma - rare
– haemangioma - rare
 Non-odontogenic tumors
• Osteoma x Exostosis
– torus palatinus: posterior midline of hard palate
– torus mandibularis: lingual aspect of mandible
opposite to mental foramne, bilateral
– hard swelling
– Mi: compact or cancellous bone

• Gardner´s syndrome - AD inheritance

– multiple osteomas + polyposis coli  malignancy
 Non-odontogenic tumors
• Osteochondroma
– cartilage-capped osteoma
– hard bony protuberance
– coronoid or condylar procces
– joint dysfunction
 Non-odontogenic tumors
• Giant cell granuloma
– hyperplastic lesion, developmental ???
– < 20 years
– F:M…2:1
– anterior mandible
– RTG: rounded cyst-like area
– Mi: vascular fibrous tissue + giant cells +
bleeding + hemosiderin
– recurrency after incomplete removal
 Non-odontogenic tumors
• Osteosarcoma
  malignant,  common primary non-od.
neoplasm
– irradiation, Paget´s disease
– 30 - 40 years, males
– body of mandible
– irregular firm swelling  painfull
– Mi: osteoid formation + atypical osteoblasts +
cartilage + fibrous tissue
 Non-odontogenic tumors
• Osteosarcoma
– rapid local growth + early metastases (lungs)
– 50% recurrency in 1st year
– 5-year survival: 40% ( 5 cm)
 Non-odontogenic tumors
• Chondrosarcoma
– 45 years
– anterior maxilla
– painfull irregular swelling
– Mi: cartilage tissue with pleomorphic,
binucleated chondrocytes + mitoses
– locally aggressive + metastases (lungs)
 Non-odontogenic tumors
• Rare tumors
– Ewing´s sarcoma
– Multiple myeloma
– Langerhans´cell histiocytosis
 Non-odontogenic tumors
• Secondary tumors – haematogenous
metastases
– breast
– lungs
– prostate
– thyroid
– kidney
 Diseases of jaws
and maxillary sinus
• 1. Jaws

• 2. Temporomandibular joint

• 3. Maxillary sinus
 2. Temporomandibular joint
• Trismus - inability to open mouth fully
– inflammation
– injuries
– tetanus
• Ankylosis - permanent limitation of movement
– fibrosis
– congenital
– trauma
– arthritis
– tumors
 2. Temporomandibular joint
• Osteoarthritis
– metabolic defect of art. cartilage - defective
– old people
– pain, minimal symptoms
 2. Temporomandibular joint
• Rheumatoid arthitis - multisystemic disease
– antibodies (rheumatoid factors)
– females, 25 - 45 years
– symmetrical involvement of smaller joints
– crepitation, little pain
– inflammation of synovia - granulation tissue (pannus)
• Osteochondroma
• Condylar hyperplasia
 Diseases of jaws
and maxillary sinus
• 1. Jaws

• 2. Temporomandibular joint

• 3. Maxillary sinus
 3. Maxillary sinus
• Inflammation - sinusitis
– acute x chronic x hypersensitive
– rhinogenic x odontogenic
– periapical inflammation of P or M
– long oro-antral communication
– pain + percussion sensitivity
 3. Maxillary sinus
• Inflammation
– Mi: respiratory epithelium  squamous
metaplasia
thickened basal membrane
infiltrate - acute - neutrophils
- chronic - lymphocytes + plasma
cells
- hypersensitive - eosinophils
 3. Maxillary sinus
• Oro-antral communication
– after extraction of P or M
– nose-blowing test
– root or tooth in sinus
– prolaps of antral mucosa
 3. Maxillary sinus
• Antral cysts
– from mucous glands
– asymptomatic
– disappear spontaneously

– odontogenic cysts
– radicular, residual
 3. Maxillary sinus
• Tumors
– squamous cell carcioma
– males > 50 years
– advanced stage – local spread
– nose obstruction, nose bleeding
– paresthesia of infraorbital nerve
– visual disturbances
– poor prognosis