Non odontogenic Nima Fartash.pptx maxiofacial

non odontogenic maxiofacial diseases

1. Non-odontogenic Lesions of the Jaw Nima Fartash mc 552

2. Fibrous Dysplasia Fibrous dysplasia is composed of cellular fibrous tissue containing trabeculae of woven bone. It occurs in three clinical subtypes: monostotic which affects one single bone, polyostotic which affects multiple bones, and Albright syndrome in which multiple bone lesions are accompanied by skin hyperpigmentation and endocrine disturbances leading to precocious puberty, hyperthyroidism, growth hormone excess, and Cushing syndrome. Rare lesion. Maxilla more often involved than mandible. Polyostotic form is more common in females. Young adults and adolescents. When part of McCune-Albright syndrome, nearly always identified < 15 years.

3. Radiographic features The classical appearance is described as “orange-skin” or “ground-glass” radio-opacity without defined borders, blending with the surrounding bone. In less typical cases, the afflicted bone may be mainly radiolucent or predominantly sclerotic or show a cotton-wool appearance. In the maxilla, fibrous dysplasia may extend by continuity across suture lines to involve adjacent bones. Calcifications may be seen. Radiographic features

4. Two computed tomography scans show fibrous dysplasia, one involving the maxilla with calcifications (A), while the right image (B) shows near complete obliteration and opacification of the maxillary sinus.

5. Pathologic features Gross findings Resected specimens consist of gritty fragments of bony tissue. Microscopic findings Fibrous dysplasia shows replacement of the normal bone by moderately cellular fibrous tissue containing irregularly shaped trabeculae consisting of woven bone without rimming osteoblasts that fuse with adjacent bone. Jaw lesions may also occasionally show lamellar bone. Sometimes, tiny calcified spherules may be present.

6. Bony prominence in the left buccal vestibule.

7. 🔪  3. Types of Surgical Procedures Conservative Contouring (Bone Remodeling) Indication:  Most common approach for monostotic (single bone) and stable polyostotic lesions. Goal:  Improve appearance and relieve minor symptoms. Technique: Shave or contour the dysplastic bone using burrs and saws. Preserve vital structures. Radical (Total) Resection Indication: Extensive lesions involving critical areas Severe deformity or functional loss. Suspicion of malignancy. Procedure: Complete removal of the dysplastic bone. Reconstruction with bone grafts, titanium mesh, or patient-specific implants.

8. Ossifying fibroma Ossifying fibroma, formerly also called cemento-ossifying fibroma, is a well-demarcated lesion composed of fibrocellular tissue and mineralized material of varying appearances. Mandible > > maxilla (90%), premolar-molar area specifically. Females > > males (5:1). Wide age range with a predilection for third to fourth decade. Multifocality may occur, and if a patient shows more than only one ossifying fibroma or when there are other family members with this lesion, one should consider the possibility of the hyperparathyroidism–jaw tumor syndrome (HPT-JT), an autosomal dominantly inherited disorder that combines jaw lesions with the appearance of ossifying fibroma with neoplastic and/or cystic lesions in the parathyroid glands and the kidneys.

9. Ossifying fibroma

10. Pathologic features Gross findings Lesions are well demarcated, frequently described as “shelling out” of the bone. The intact tumor is a smooth, glistening, white, firm-elastic mass. Microscopical findings Variably cellular fibrous stroma with calcified tissue. Mineralized material may be cementum-like basophilic deposits or trabeculae of lamellar or woven bone. Osteoblastic rimming is noted along with mitotic figures.

11. Giant Cell Lesions Central giant cell granuloma, cherubism , and aneurysmal bone are defined by the presence of osteoclastic giant cells and are taken together because of their mainly identical histological features. The first two entities are confined to the jaws; the third may occur at other sites as well. Central Giant Cell Granuloma The central giant cell lesion is a localized lytic lesion of the jawbones associated with fibrosis , hemorrhage, reactive bone, and osteoclastic giant cells. In the past the terms reparative giant cell granuloma and central giant cell granuloma have been used as synonyms but are to be discouraged.

12. Clinical features Central giant cell lesions are found in a wide age range, although the average is 20 years. Females are affected more often than males (1.5 to 2:1), and there is a definitive predilection for the mandible. Lesions show a range of biologic potential with some cases acting in a nonaggressive manner: usually asymptomatic, incidental findings, although aggressive lesions may present with pain, paresthesias, and resorption of teeth. Central giant cell lesions present as expansile unilocular or multilocular radiolucent defects with scalloped and usually well-defined borders. Tooth displacement may be seen. Intralesional bony septa are helpful, although radiographic Features are not diagnostic.

13. Central giant cell granuloma

14. Pathological features Gross Findings Red to brown hemorrhagic tissue with associated bone. Microscopic Findings Multinucleated , osteoclastic giant cells in a background of ovoid to spindle-shaped fibroblastic cells. Richly vascularized; associated with extravasated erythrocytes and hemosiderin-laden macrophages. Metaplastic bone and osteoid traverse the lesion. Mitotic figures are common (although not atypical).

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