7_Diseases of Jaws and Maxillary Sinus

8/8/2019 7_Diseases of Jaws and Maxillary Sinus

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Diseases of jaws

and maxillary sinus 1. Jaws

2. Temporomandibular joint

3. Maxillary sinus


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1. Diseases of jaws

1a. Genetic diseases

1

b. Metabolic diseases 1c. Diseases of unknown origin

1d. Inflammations

1e. Cysts

1f. Tumors


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Osteogenesis imperfecta

Achondroplasia

Cleidocranial dysplasia

Cherubism


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Osteogenesis imperfecta (brittle bone d.)

AD inheritance

defect of biosynthesis of collagen I

thin bones without cortex - o fragile

multiple fractures dwarfism

+ blue sclera + deafness


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Achondroplasia

most common genetic skeletal disease

short-limbed dwarf with normal trunk and head

failure of cartilage proliferation in epiphyses

protrusive mandiblep malocclusion


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Cleidocranial dysplasia

defective formation of clavicles

retrusion of maxilla

delayed eruption of permanent teeth


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Cherubism

AD inheritance, oboys

painless symmetrical swelling of mandible

angle

at 2-4 years

rapid growth until pubertyp regression Mi: fibrous tissue + haemorrhage +

multinucleated giant cells + woven bone


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1. Diseases of jaws


1b. Metabolic diseases

1c. Diseases of unknown origin

1d. Inflammations

1e. Cysts

1f. Tumors


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Rickets

vitamin D deficiency during bone development

infancy

wide fontanels + bossing of frontal and parietaleminences

Gigantism and acromegaly

omandibular condylepprognathism

+ macroglossia


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1. Diseases of jaws




1d. Inflammations

1e. Cysts

1f. Tumors


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Pagets disease of bone

Fibro-osseous lesions


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Pagets 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 bonep difficultextraction


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Pagets disease of bone (osteitis deformans)

resorption (osteoclasts) p irregular new bone

formation (osteoblats)

Mi: irregular mosaic bone trabeculae +

o osteoblasts and osteoclasts + vascularity

result: thick spongy bone + marrow fibrosis complication: osteosarcoma (rare)


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Fibro-osseous lesions

Fibrous dysplasia

monostotic

polyostotic

Cemento-osseous dysplasia

periapical cemental dysplasia focal cemento-osseous dysplasia

florid cemento-osseous dysplasia


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Monostotic fibrous dysplasia

painless, poorly circumscribed bone swelling

in childhood

self-limiting

F : M ... 1:1

omaxillap malocclusion


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Polyostotic fibrous dysplasia

several bones

F : M 3:1

Albrights syndrome: + skin pigmentation +

sexual precocity

Mi: fibrous tissue + woven bone trabeculae

without osteoblasts lining


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Cemento-osseous dysplasia

of periodontal ligament origin, same process

periapical cemental dysplasia

F : M 10 : 1

asymptomatic lesion

lower I


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florid cemento-osseous dysplasia (gigantiformcementoma)

florid form ofPCD symmetric lesions in all quadrants

focal cemento-osseous dysplasia

Mi: cellular fibrous tissue + cementum-like tissuep calcification


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1. Diseases of jaws




1d. Inflammations

1e. Cysts

1f. Tumors


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1d. Inflammations

acute osteomyelitis

chronic osteomyelitis

alveolar osteitis


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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


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1d. Inflammations

Acute osteomyelitis

suppurative inflammation in marrow spacesp

compression of blood vesselspbone necrosisp sequestrum

p subperiostal areapperforationp fistulasto skin and oral mucosa

complications: fracture

p chronic osteomyelitis


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1d. Inflammations

Chronic osteomyelitis

de novo x low-grade infection

Chronicfocal sclerosing OM

young people with carious lower1. M

Diffuse sclerosing OM

old people, superinfection of florid COD


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1d. Inflammations

Chronic osteomyelitis with productive

periostitis (Garrs OM)

young people, lower1. M

o reactive new bone formation


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1d. Inflammations

Alveolar osteitis (dry socket)

sources: excessive extraction trauma, low blood

supply

after extraction of 3. M

o females

destruction of clot by fibrinolytic enzymes infection and food in contact with bonep

necrosisp granulation tissue


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1. Diseases of jaws




1d. Inflammations

1e.C

ysts 1f. Tumors


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1e. Cysts

Odontogenic

Non-odontogenic

P

seudocysts Solitary bone cyst

Aneurysmal bone cyst


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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


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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


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1. Diseases of jaws




1d. Inflammations

1e. Cysts

1f. Tumors


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1f. Tumors

Odontogenic

Non-odontogenic


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Non-odontogenic tumors Primary: benign x malignant

bone

cartilage

other

Secondary: metastases


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Non-odontogenic tumors Benign primary tumors

osteoma

osteochondroma

central giant cell granuloma

cemento-ossifying fibroma - rare

haemangioma - rare


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Non-odontogenic tumors Osteochondroma

cartilage-capped osteoma

hard bony protuberance

coronoid or condylar procces

joint dysfunction


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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


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Non-odontogenic tumors Osteosarcoma

omalignant, o common primary non-od.

neoplasm irradiation, Pagets disease

30 - 40 years, males

body of mandible

irregular firm swellingppainfull

Mi: osteoid formation + atypical osteoblasts +cartilage + fibrous tissue


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Non-odontogenic tumors Osteosarcoma

rapid local growth + early metastases (lungs)

50% recurrency in 1st year

5-year survival: 40% ( 5 cm)


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Non-odontogenic tumors Chondrosarcoma

45 years

anterior maxilla

painfull irregular swelling

Mi: cartilage tissue with pleomorphic,

binucleated chondrocytes + mitoses locally aggressive + metastases (lungs)


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Non-odontogenic tumors Secondary tumors haematogenous

metastases

breast

lungs

prostate

thyroid kidney


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Diseases of jaws



3. Maxillary sinus


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2. Temporomandibular joint Trismus - inability to open mouth fully

inflammation

injuries tetanus

Ankylosis - permanent limitation of movement

fibrosis

congenital trauma

arthritis

tumors


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2. Temporomandibular joint Osteoarthritis

metabolic defect of art. cartilage - defective

old people

pain, minimal symptoms


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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


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Diseases of jaws



3. Maxillary sinus


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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


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3. Maxillary sinus

Inflammation

Mi: respiratory epitheliump squamous

metaplasia

thickened basal membrane

infiltrate - acute - neutrophils

- chronic - lymphocytes + plasmacells

- hypersensitive - eosinophils


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3. Maxillary sinus

Oro-antral communication

after extraction of P or M

nose-blowing test

root or tooth in sinus

prolaps of antral mucosa


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3. Maxillary sinus

Antral cysts

from mucous glands

asymptomatic

disappear spontaneously

odontogenic cysts radicular, residual


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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

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7_Diseases of Jaws and Maxillary Sinus