Bone Swellings

Bone Swellings

Developmental lesions
1. Torus palatinus
  1. Bony hard swelling in palate
  2. Often design denture around torus
  3. May have surgical reduction to aid denture fit
2. Mandibular torii
  1. Bony prominence in mandible (from lingual aspect)
Reactive lesions
1. Reactive exostosis
2. Cause = chronic trauma
3. Treatment = eliminate cause & remove surgically
4. Very hard, may have ulceration
Fibro-osseous lesions
1. Pathologic term for group of intra-osseous lesions
2. Fibroblastic background with bone formation (irregular trabeculae arrangement)
3. Histopathology of all are indistinguishable
4. Fibrous dysplasia
  1. Painless bone expansions
  2. Children
  3. Slow growth
    1. Usually stops when child stops growing
  4. No tooth displacement
  5. No systemic abnormality
  6. Radiographically
    1. Lesion merges into normal bone
    2. Begins radiolucent -> ossifies over time -> radiopaque
  7. Forms
    1. Monostotic (solitary)
    2. Multiple (cranio-facial)
    3. Polyostotic = McCune-Albright syndrome
  8. Management
    1. Wait until growth stops (18yrs)
    2. Jaw recontoured (lesion not removed)
5. Ossifying fibroma
6. Cemento-osseous dysplasia
  1. Female, Asian/Black
  2. Radiographically
    1. Radiolucent -> ossify over time -> Radiopaque
    2. Usually mandible & above IAN canal
  3. Teeth vital
  4. Types
    1. Localised = periapical
    2. Generalised = florid
  5. Treatment = leave & monitor
7. Cherubism
  1. Radiographically
    1. Bilateral, multilocular radioluncencies
    2. Buccal expansion
  2. Facial deformity
    1. 'chubby face'
  3. Treatment
    1. Facial recontour when stopped growing (18yrs)
  4. Exclude hyperparathyroidism
Neoplasms
1. Benign
  1. Ossifying fibroma
    1. Rare
    2. Slow growing
    3. Radiographically
      1. More defined outline (circumscribed)
      2. Mixed radiopaque centre with radiolucent outline
    4. Treatment = surgical removal with small margin
  2. Osteoma
    1. Radiographically
      1. Well-circumscribed outline
      2. Radiopaque
    2. Histologically
      1. Cancellous
      2. Compact
    3. Clinical types
      1. Solitary
      2. Multiple
        Gardner syndrome
        Multiple odontomes
        Multiple intestinal polyps
        High malignant potential
        APC gene mutation
    4. Maxilla, mandible, sinuses
    5. Treatment = surgical removal
2. Malignant
  1. 3) Marrow neoplasms
    1. Ewing's tumour = primary bone marrow tumour
    2. Myeloma, lymphoma
  2. 1) Metastatic bone tumour
    1. Most common
    2. Neurological sign e.g. numb lip
    3. From e.g. breast, lung, prostate
  3. 4) Primary bone tumour
    1. Osteosarcoma
      1. Malignant osteoblasts depositing malignant bone
      2. Central or juxtacortical (most common)
      3. Radiograph
        Sun ray spicule on CT scan
      4. 8-15yrs or >50yrs
    2. Chrondosarcoma, Mesenchymal chondrosarcoma
  4. 2) SCC (spread to bone)

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	Created by sanna pathy about 5 years ago