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Owosho AA, Aguirre SE, Dayo AF, Omolehinwa TT, Shintaku WH. Radiographic Orofacial Findings of Systemic Diseases. Dent Clin North Am 2024; 68:409-427. [PMID: 38417998 DOI: 10.1016/j.cden.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
This article discusses the orofacial clinicoradiographic features of systemic diseases that manifest in the orofacial region. The systemic diseases discussed are grouped into the following: autoimmune diseases, endocrine diseases, bone diseases, hematologic diseases, syndromes, and malignancies. The radiographic manifestation ranges from radiolucent bony destruction, increased bone density, calcification, thinning of cortical plate, loss of trabeculation, missing teeth, and supernumerary teeth. It is imperative for clinicians to be cognizant of these findings, as they may be the first manifestation of these systemic diseases.
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Affiliation(s)
- Adepitan A Owosho
- Department of Diagnostic Sciences, College of Dentistry, The University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Sarah E Aguirre
- Department of Diagnostic Sciences, College of Dentistry, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Adeyinka F Dayo
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, PA, USA
| | - Temitope T Omolehinwa
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, PA, USA
| | - Werner H Shintaku
- Department of Diagnostic Sciences, College of Dentistry, The University of Tennessee Health Science Center, Memphis, TN, USA
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2
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Alsufyani N, Alzahrani A. Imaging of Fibro-osseous Lesions and Other Bone Conditions of the Jaws. Dent Clin North Am 2024; 68:297-317. [PMID: 38417992 DOI: 10.1016/j.cden.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
This review directs the focus on the imaging features of various fibro-osseous lesions and other bone lesions that can be of similar presentation. Broad diagnosis of "fibrous osseous lesion" may culminate in improper treatment and management. Radiographic discriminating factors between these entities are highlighted and summarized to improve the diagnostic process when encountering these lesions.
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Affiliation(s)
- Noura Alsufyani
- Department of Oral Medicine and Diagnostic Sciences, Oral & Maxillofacial Radiology, College of Dentistry, King Saud University, P.O. Box 60169, Riyadh 11545, Kingdom of Saudi Arabia; Department of Medicine and Dentistry, School of Dentistry, University of Alberta, 5-522, Edmonton Clinic Health Academy, 11405 - 87 Avenue NW, T6G 1C9, Edmonton, AB, Canada.
| | - Adel Alzahrani
- Department of Oral Medicine and Diagnostic Sciences, Oral & Maxillofacial Radiology, College of Dentistry, King Saud University, P.O. Box 60169, Riyadh 11545, Kingdom of Saudi Arabia
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3
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Huang PF, Lin JH. Fibrous dysplasia mimicking as invasive lung cancer. Am J Med Sci 2024; 367:e3-e4. [PMID: 37714271 DOI: 10.1016/j.amjms.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/28/2023] [Accepted: 09/08/2023] [Indexed: 09/17/2023]
Affiliation(s)
- Po-Feng Huang
- Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan, Republic of China (ROC).
| | - Jen-Hsien Lin
- Division of Chest Medicine, Department of Internal Medicine, Kaoshsiung Armed Forces General Hospital, Kaohsiung, Taiwan, (ROC)
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4
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Devarkonda V, Gaddam S, Morisetti M, Arora K, Beedupalli K. Fibrous Dysplasia Masquerading as Sternal Malignancy: A Rare and Challenging Presentation. Cureus 2023; 15:e50833. [PMID: 38249194 PMCID: PMC10798103 DOI: 10.7759/cureus.50833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
This case report presents a rare and challenging manifestation of polyostotic fibrous dysplasia (FD), a skeletal developmental anomaly characterized by the proliferation of fibrous connective tissue intermingled with irregular bony trabeculae. While monostotic FD is more common, polyostotic FD can occur in the context of McCune-Albright syndrome, a multisystem developmental disorder. Our patient, a 55-year-old female with a history of diabetes, hypothyroidism, and dyslipidemia, presented with progressively worsening dysphagia, sternal pain, and swelling over three years. Clinical examination revealed a tender and hard swelling in the upper sternal area, prompting further evaluation. Laboratory results, including bone turnover markers, were unremarkable. Imaging studies unveiled a sizable anterior mediastinal lesion with heterogeneous enhancement and coarse calcifications, initially raising concerns of malignancy. Subsequent positron emission tomography scan findings confirmed FD involvement in both the sternum and right femur. Histopathology of the mediastinal mass revealed a spindle cell neoplasm with bony metaplasia, consistent with FD, supported by immunohistochemistry. A multidisciplinary team affirmed the diagnosis of polyostotic FD, and follow-up imaging after one year demonstrated no significant change in lesion size, confirming a benign etiology. While bisphosphonate therapy was planned, regrettably, the patient was lost to follow-up. This case underscores the importance of a comprehensive, multidisciplinary approach in diagnosing and managing complex presentations of FD, ultimately contributing to improved patient care and outcomes in such instances.
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Affiliation(s)
- Vishal Devarkonda
- Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Shiva Gaddam
- Hematology and Medical Oncology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Manasa Morisetti
- Pathology and Laboratory Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Kshitij Arora
- Pathology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Kavitha Beedupalli
- Hematology and Oncology, Louisiana State University Health Sciences Center, Shreveport, USA
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Couto DAF, Ito FA, Lima HGD, Ono E, Pires WR, Pereira-Stabile CL, Vitti Stabile GA, Takahama A. Asymptomatic unilateral facial swelling in 10-year-old boy. J Am Dent Assoc 2023; 154:843-848. [PMID: 36058727 DOI: 10.1016/j.adaj.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/25/2022] [Accepted: 06/28/2022] [Indexed: 11/20/2022]
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Obermeier KT, Hartung JT, Hildebrandt T, Dewenter I, Smolka W, Hesse E, Fegg F, Otto S, Malenova Y, Abdullah A. Fibrous Dysplasia of the Jaw: Advances in Imaging and Treatment. J Clin Med 2023; 12:4100. [PMID: 37373793 DOI: 10.3390/jcm12124100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
A total of 7% of all benign bone lesions are diagnosed as fibrous dysplasia (FD). The symptoms of FD of the jaw range from asymptomatic to dental anomalies, pain and facial asymmetry. Due to its resemblance to other fibro-osseous bone lesions, misdiagnosis often occurs and can lead to inadequate treatment. Particularly in the jaw, this lesion does not become quiescent during puberty, making fundamental knowledge about the diagnosis and treatment of FD crucial. Mutational analysis and nonsurgical approaches offer new diagnostic and therapeutic options. In this review, we examine the advances and the difficulties of the diagnosis and the various treatment modalities of FD of the jaw in order to capture the current scientific knowledge on this bone disease.
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Affiliation(s)
- Katharina Theresa Obermeier
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig Maximilians University, 80337 Munich, Germany
| | - Jens Tobias Hartung
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig Maximilians University, 80337 Munich, Germany
| | - Tim Hildebrandt
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig Maximilians University, 80337 Munich, Germany
| | - Ina Dewenter
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig Maximilians University, 80337 Munich, Germany
| | - Wenko Smolka
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig Maximilians University, 80337 Munich, Germany
| | - Eric Hesse
- Institute of Musculoskeletal Medicine, University Hospital, LMU Munich, Fraunhoferstraße 20, 82152 Munich, Germany
- Musculoskeletal University Center Munich, University Hospital, LMU Munich, Fraunhoferstraße 20, 82152 Munich, Germany
| | - Florian Fegg
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig Maximilians University, 80337 Munich, Germany
| | - Sven Otto
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig Maximilians University, 80337 Munich, Germany
| | - Yoana Malenova
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig Maximilians University, 80337 Munich, Germany
| | - Anusha Abdullah
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig Maximilians University, 80337 Munich, Germany
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7
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Bews EA, Aytek AI, Yavuz AY, Kaya EH, Savran G, Kalata M, Bethard JD. Differential diagnosis of an osseous cranial tumor from Hellenistic Muğla, Turkey. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2023; 40:103-108. [PMID: 36724548 DOI: 10.1016/j.ijpp.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 01/21/2023] [Accepted: 01/21/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE This project evaluates a cranial lesion from a Hellenistic-era individual excavated by the Muğla Archaeological Museum in Gülağzı, Turkey. MATERIALS An osseous tumor measuring 3.02 × 3.54 × 2.98 cm originating from the occipital bone of a probable young adult male. METHODS The tumor was examined using gross morphological inspection, plain radiography (x-ray), and computed tomography (CT) imaging to identify potential differential diagnoses for the osseous cranial tumor. RESULTS The lesion in question displays features highly consistent with both osteoid osteoma and osteoblastoma. The tumor had a non-sclerotic, sharply demarcated border, a radiolucent nidus measuring less than 2 centimeters in diameter, and homogeneous sclerotic bone surrounding the nidus. CONCLUSIONS Differential diagnosis determined the osseous tumor to be a benign neoplasm, and in this case the features of the tumor are highly consistent with a diagnosis of either osteoblastoma or osteoid osteoma. SIGNIFICANCE The identification of novel neoplastic cases in paleopathology represents an important contribution to ongoing discussions regarding the temporality and regional variability of neoplastic conditions in the past. Additionally, a rigorous diagnostic study augmented by x-ray, CT scans, and 3D modeling provides data that can be utilized in future paleopathological studies. LIMITATIONS Diagnostic interpretation would be aided by histological examination of the tumor, which was impossible in this case. Histological examination would provide a definitive diagnosis. SUGGESTIONS FOR FURTHER RESEARCH Given the high incidence of benign tumors in the clinical literature but a paucity of reports in the paleopathological record, further research is indicated to better understand the implications of benign neoplasms in antiquity.
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Affiliation(s)
| | | | | | | | | | - Megan Kalata
- Creighton University School of Medicine, United States
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8
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Adeyemo AA, Ogunkeyede SA, Daniel A, Lasisi AO. Paediatric paranasal sinus fibrous dysplasia. Trop Doct 2023; 53:117-120. [PMID: 36112944 DOI: 10.1177/00494755221125080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Fibrous dysplasia in the bony walls of a paranasal sinus is a developmental tumour that is associated with a marked facial deformity. Delay in hospital presentation contributes to the destructive resection techniques employed and the management outcome. Our study looks at the factors for delay in hospital presentation and the management outcome by a retrospective review between January 1997 and December 2018. Of 43 children (M: F 1:1.2) with a mean age of 12 ± 1.75 years, the maxillary bones were mostly affected. All underwent surgical resection with good management outcomes except for maxillectomy. Tumour recurrence was noted in five and there was no mitotic cell at histology. The clinical symptoms of fibrous dysplasia vary in severity and age of onset, often with late hospital presentation already with complications. Health education is needed to reverse this trend.
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Affiliation(s)
- A A Adeyemo
- Institute of Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Otorhinolaryngology, University College Hospital, Ibadan, Nigeria
| | - S A Ogunkeyede
- Department of Otorhinolaryngology, University College Hospital, Ibadan, Nigeria.,Department of Otorhinolaryngology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - A Daniel
- Department of Otorhinolaryngology, University College Hospital, Ibadan, Nigeria.,Department of Otorhinolaryngology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - A O Lasisi
- Department of Otorhinolaryngology, University College Hospital, Ibadan, Nigeria.,Department of Otorhinolaryngology, College of Medicine, University of Ibadan, Ibadan, Nigeria
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A Novel Bone Contouring Technique Using Multiple Tangential Shaving for Conservative Management of Craniofacial Fibrous Dysplasia. J Craniofac Surg 2023; 34:45-52. [PMID: 36104837 DOI: 10.1097/scs.0000000000009001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/08/2022] [Indexed: 01/11/2023] Open
Abstract
This study aimed to propose a novel surgical technique, named multiple tangential shaving of bone contour, for the conservative management of craniofacial fibrous dysplasia. We retrospectively reviewed 17 patients who underwent conservative management of craniofacial fibrous dysplasia using multiple tangential shaving technique between July 2005 and December 2020. Demographics, tumor characteristics, and surgery-related factors were investigated. All patients underwent preoperative (T0) and postoperative computed tomography scans taken at least twice within 1 month for immediate assessment (T1) and at least 12 months postoperatively for long-term assessment (T2). Clinical outcomes, including tumor recurrence, perioperative complications, and physician measure of esthetic outcomes (Whitaker score), were investigated. This technique was applied for contouring of the zygomatic-maxillary and calvarial bone for patients aged between 16 and 60 years (mean age: 26 y). The mean±SD tumor volume reduction was 15.5±8.95 cm 3 , and the postoperative mean±SD tumor growth rate was 5.52±6.26% per year. Satisfactory outcome was obtained in terms of esthetics with a mean±SD Whitaker score of 1.41±0.62. Patients required a mean operation time of 1.67±0.43 hours and a mean number of shaving operations of 1.35±0.61 during the follow-up period. Five of 17 patients required reoperation because of the tumor recurrence (N=4) and to correct new-onset diplopia after surgery (N=1). In conclusion, the multiple tangential shaving technique allows an easy approach for conservative management of craniofacial fibrous dysplasia. An acceptable rate of tumor recurrence and esthetic outcomes can be obtained by selecting the appropriate candidate for a conservative approach.
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Sachar C, Agarwal A, Syed A. Bony Cyst in a Ground Glass Matrix: A Rare Case Report of Craniofacial Fibrous Dysplasia with Secondary Aneurysmal Bone Cyst. Indian J Radiol Imaging 2022; 32:145-148. [PMID: 35722638 PMCID: PMC9200484 DOI: 10.1055/s-0042-1743115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Fibrous dysplasia has various ways of presentation including syndromic associations and secondary changes within the lesion. We present a case of a 21-year-old female with craniofacial fibrous dysplasia, presenting with proptosis and intermittent blurring of vision due to focal fibrous dysplasia involving the frontal bone with secondary aneurysmal bone formation that was provisionally diagnosed on imaging and confirmed on histopathology. This case demonstrates the typical imaging findings of fibrous dysplasia with seldom encountered secondary aneurysmal bone cyst formation and also discusses about the pathology and management of the craniofacial fibrous dysplasia.
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Affiliation(s)
- Chandrika Sachar
- Department of Radiodiagnosis and Imaging, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Aakanksha Agarwal
- Department of Radiodiagnosis and Imaging, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Anjum Syed
- Department of Radiodiagnosis and Imaging, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Kaur H, Mohanty S, Kochhar GK, Iqbal S, Verma A, Bhasin R, Kochhar AS. Comprehensive management of malocclusion in maxillary fibrous dysplasia: A case report. World J Clin Cases 2021; 9:10671-10680. [PMID: 35005000 PMCID: PMC8686154 DOI: 10.12998/wjcc.v9.i34.10671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/14/2021] [Accepted: 10/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Fibrous dysplasia (FD) is a developmental hamartomatous bone disease characterized by a blend of fibrous and osseous entities. Though rarely malignant, the tumor can vary from being small and asymptomatic, to a fairly large sized lesion, progressing gradually, compromising occlusion and facial esthetics. Treatment approach depends on the stage of skeletal maturity. It primarily involves surgical management for stabilizing the disease process. Post-surgical comprehensive dental treatment is necessary for restoring form and function of the jaws and teeth. This article describes comprehensive orthodontic management of severe malocclusion in a surgically operated case of FD maxilla.
CASE SUMMARY A 19-year female presented with a chief complaint of excessive gingival display when smiling. Dental history included swelling of gums around the upper right front teeth, diagnosed at the age of 15 as FD of the right anterior maxillary segment and treated with surgical recontouring of the dysplastic bone. The clinical and radiological examinations showed adequate post-surgical healing. The surgically treated dysplastic area presented with right canting of the maxillary anterior occlusal plane. The maxillary teeth were torqued palatally, with the root of the right maxillary canine exposed clinically. We discuss sequential management of the associated malocclusion with comprehensive fixed orthodontics, along with special precautions taken to prevent reactivation of the quiescent and healed lesion.
CONCLUSION The adequate healing of fibro-dysplastic bone post-surgery must be allowed before initiating orthodontic tooth movement in the dysplastic bone. Periodic follow-ups are needed to monitor stability of occlusion and any relapse of the lesion.
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Affiliation(s)
- Harneet Kaur
- Department of Orthodontics and Dentofacial Orthopaedics, Faculty of Dentistry, Jamia Millia Islamia, Delhi 110025, Delhi, India
| | - Sujata Mohanty
- Department of Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, Delhi 110002, Delhi, India
| | - Gulsheen Kaur Kochhar
- Department of Pediatric and Preventive Dentistry, National Dental College and Hospital, Derabassi 140507, Punjab, India
| | - Shahid Iqbal
- Faculty of Dentistry, Jamia Millia Islamia, Delhi 110025, Delhi, India
| | - Anjali Verma
- Department of Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, Delhi 110002, Delhi, India
| | - Ritasha Bhasin
- Faculty of Dentistry, University of Toronto, Toronto M5G1G6, Ontario, Canada
| | - Anuraj Singh Kochhar
- Department of Orthodontics and Dentofacial Orthopaedics, Faculty of Dentistry, University of Toronto, Toronto M5G0C1, Ontario, Canada
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Core Extirpation and Zygoma Reduction: A New Surgical Approach for Fibrous Dysplasia of Zygomaticomaxillary Region. J Craniofac Surg 2021; 33:1174-1177. [PMID: 34643597 DOI: 10.1097/scs.0000000000007961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION In case of zygomaticomaxillary fibrous dysplasia (FD), surgical treatment is often required due to visual disturbance, exophthalmos, and also necessary for cosmetic reasons. However, it is not easy to determine the timing and method of operation. The objective of our study is to define a new surgical option, for the treatment of FD of zygomaticomaxillary area. MATERIALS AND METHODS Five patients affected by FD of their zygomaticomaxillary area who underwent surgery with a core extirpation were included in this study. A retrospective chart review and pre- and post-operative analysis of computed tomography scan were performed. RESULTS All patients underwent core extirpation surgery and zygoma reduction was combined in 2 patients. All patients showed the cessation of the increase of external size postoperatively and results of the operation were well maintained over the follow-up period of 1 year. CONCLUSIONS In this article, we present our experiences in the management of FD using the core extirpation with or without zygoma reduction, focusing on surgical indication, techniques, and results. Although there are limitations due to selective operative indication, the procedure can be usefully performed to prevent external growth and avoid repetitive surgery.
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13
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Pediatric Odontogenic and Maxillofacial Bone Pathology: A Global Analysis. J Craniofac Surg 2021; 33:870-874. [PMID: 34560739 DOI: 10.1097/scs.0000000000008201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Although pathology in the maxillary and mandibular bones is rare in young patients, the differential diagnosis is broad. The World Health Organization (WHO) updated its classification of maxillofacial bone pathology in 2017. Using these updated guidelines, a systematic review of common maxillofacial bone lesions in the pediatric population was performed. METHODS A PubMed search was conducted capturing English language articles from inception to July 2020. Thirty-one articles were identified that described the frequency of maxillofacial bone pathology. Data were extracted and organized using the WHO 2017 classification of odontogenic and maxillofacial bone tumors. Prevalence data were analyzed among diagnostic categories and geographical regions. The SAS version 9.4 was used to complete statistical analyses. RESULTS The articles included patients from birth to a maximum age of 14 to 19 years. The most common odontogenic cysts included radicular cyst (42.7%) and dentigerous cyst (39.0%) followed by odontogenic keratocyst (15.0%). Among odontogenic bone tumors, odontoma (49.3%) was most common followed by ameloblastoma (29.1%). The most common nonodontogenic bone tumor was fibrous dysplasia (42.4%), and the most common malignant bone tumor was osteosarcoma (75.0%). Significant variations were found by geographic region, with dentigerous cyst more common than radicular cyst, and ameloblastoma more common than odontoma in African and Asian countries (P < 0.0001). CONCLUSIONS This systematic review uses the WHO 2017 guidelines to classify common odontogenic and nonodontogenic maxillofacial bone lesions around the world. Pathogenesis, presentation, and available treatment options for the most common maxillofacial bone lesions are reviewed.
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Sweeney J, McCann C, McLaughlin P. The importance of casting an eye beyond the dental arch: A case report. J Orthod 2021; 49:79-82. [PMID: 34100296 DOI: 10.1177/14653125211021871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Study models are frequently used in orthodontics and are a key part of both initial assessment and treatment planning. They are an important part of comprehensive orthodontic records; furthermore, study models are an essential diagnostic aid that can be studied in detail without the patient being present. We present a case of a 14-year-old boy with an abnormal palatal swelling detected by his specialist orthodontist after review of study models taken at the initial appointment. At the assessment alone, the significance of the abnormality was not recognised and without the help of study models, diagnosis and treatment of his fibrous dysplasia may have been significantly delayed.
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Affiliation(s)
- Jill Sweeney
- Department of Paediatric Dentistry, Glasgow Dental Hospital, Glasgow, UK
| | - Catherine McCann
- Department of Paediatric Dentistry, Glasgow Dental Hospital, Glasgow, UK
| | - Paul McLaughlin
- Department of Paediatric Dentistry, Glasgow Dental Hospital, Glasgow, UK
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15
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Holmes KR, Holmes RD, Martin M, Murray N. Practical Approach to Radiopaque Jaw Lesions. Radiographics 2021; 41:1164-1185. [PMID: 34086497 DOI: 10.1148/rg.2021200187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Radiopaque lesions of the jaw are myriad in type and occasionally protean in appearance. In turn, the radiologic analysis of these lesions requires a systematic approach and a broad consideration of clinical and imaging characteristics to enable reliable radiologic diagnosis. Initially categorizing lesions by attenuation pattern provides a practical framework for organizing radiopaque jaw lesions that also reflects important tissue characteristics. Specifically, the appearance of radiopaque lesions can be described as (a) densely sclerotic, (b) ground glass, or (c) mixed lytic-sclerotic, with each category representing a distinct although occasionally overlapping differential diagnosis. After characterizing attenuation pattern, the appreciation of other radiologic features, such as margin characteristics or relationship to teeth, as well as clinical features including demographics and symptoms, can aid in further narrowing the differential diagnosis and lend confidence to clinical decision making. The authors review the potential causes of a radiopaque jaw lesion, including pertinent clinical and radiologic features, and outline a simplified approach to its radiologic diagnosis, with a focus on cross-sectional CT. An invited commentary by Buch is available online. ©RSNA, 2021.
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Affiliation(s)
- Kenneth R Holmes
- From the Departments of Medicine (K.R.H.) and Radiology (R.D.H.), University of British Columbia, 2775 Laurel St, 11th Floor, Vancouver, BC, Canada V5Z 1M9; BC Cancer Agency, Vancouver, British Columbia, Canada (M.M.); and Vancouver General Hospital, Vancouver, British Columbia, Canada (N.M.)
| | - R Davis Holmes
- From the Departments of Medicine (K.R.H.) and Radiology (R.D.H.), University of British Columbia, 2775 Laurel St, 11th Floor, Vancouver, BC, Canada V5Z 1M9; BC Cancer Agency, Vancouver, British Columbia, Canada (M.M.); and Vancouver General Hospital, Vancouver, British Columbia, Canada (N.M.)
| | - Montgomery Martin
- From the Departments of Medicine (K.R.H.) and Radiology (R.D.H.), University of British Columbia, 2775 Laurel St, 11th Floor, Vancouver, BC, Canada V5Z 1M9; BC Cancer Agency, Vancouver, British Columbia, Canada (M.M.); and Vancouver General Hospital, Vancouver, British Columbia, Canada (N.M.)
| | - Nicolas Murray
- From the Departments of Medicine (K.R.H.) and Radiology (R.D.H.), University of British Columbia, 2775 Laurel St, 11th Floor, Vancouver, BC, Canada V5Z 1M9; BC Cancer Agency, Vancouver, British Columbia, Canada (M.M.); and Vancouver General Hospital, Vancouver, British Columbia, Canada (N.M.)
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16
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Liu K, Gao Y, Abdelrehem A, Zhang L, Chen X, Xie L, Wang X. Augmented reality navigation method for recontouring surgery of craniofacial fibrous dysplasia. Sci Rep 2021; 11:10043. [PMID: 33976233 PMCID: PMC8113548 DOI: 10.1038/s41598-021-88860-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 04/13/2021] [Indexed: 11/09/2022] Open
Abstract
The objective of this study is to introduce the application of augmented reality (AR) navigation system developed by the authors in recontouring surgery of craniofacial fibrous dysplasia. Five consecutive patients with craniofacial fibrous dysplasia were enrolled. Through three-dimensional (3D) simulation, a virtual plan was designed to reconstruct the normal anatomical contour of the deformed region. Surgical recontouring was achieved with the assistance of the AR navigation system. The accuracy of the surgical procedure was assessed by superimposing the post-operative 3D craniomaxillofacial model onto the virtual plan. The pre-operative preparation time and operation time were also counted. In all patients, AR navigation was performed successfully, with a mean ± SD of the errors of 1.442 ± 0.234 mm. The operative time of the patients ranged from 60 to 80 min. The pre-operative preparation time was 20 min for each patient. All the patients showed uneventful healing without any complications, in addition to satisfaction with the post-operative aesthetics. Using our AR navigation system in recontouring surgery can provide surgeons with a comprehensive and intuitive view of the recontouring border, as well as the depth, in real time. This method could improve the efficiency and safety of craniofacial fibrous dysplasia recontouring procedures.
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Affiliation(s)
- Kai Liu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9Th People's Hospital, Shanghai Jiaotong University College of Medicine, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Yuan Gao
- Institute of Forming Technology and Equipment, Shanghai JiaoTong University, Shanghai, China
| | - Ahmed Abdelrehem
- Department of Craniomaxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Lei Zhang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9Th People's Hospital, Shanghai Jiaotong University College of Medicine, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Xi Chen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9Th People's Hospital, Shanghai Jiaotong University College of Medicine, Shanghai, China
| | - Le Xie
- Institute of Forming Technology and Equipment, Shanghai JiaoTong University, Shanghai, China. .,Institute of Medical Robot, Shanghai JiaoTong University, Shanghai, China. .,Quanzhou Normal University, Fujian, China.
| | - Xudong Wang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai 9Th People's Hospital, Shanghai Jiaotong University College of Medicine, Shanghai, China. .,Shanghai Key Laboratory of Stomatology, Shanghai, China.
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17
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Jaffe Lichtenstein Type of Polyostotic Skeletal Fibrous Dysplasia With the Involvement of Cranial Bones. J Craniofac Surg 2021; 32:e705-e708. [PMID: 33935141 DOI: 10.1097/scs.0000000000007700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Fibrous dysplasia (FD), a benign fibro-osseous bone tumor commonly involving the craniofacial region, presents a wide spectrum of radiographic patterns. When FD lesions are suspected, various imaging modalities and histopathologic analyses may be required to reach a firm diagnosis. Here, the authors report the case of a 10-year-old male patient presenting with polyostotic type of FD with follow-up data for the next 9 years. The patient showed involvement of cranial bones and bilateral femurs, with skin pigmentation and no endocrine disease, consistent with the diagnosis of Jaffe Lichtenstein disease. The craniofacial radiographic features obtained with computed tomography and cone-beam computerized tomography are documented in this article.
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Soluk-Tekkesin M, Sinanoglu A, Selvi F, Cakir Karabas H, Aksakalli N. The importance of clinical and radiological findings for the definitive histopathologic diagnosis of benign fibro-osseous lesions of the jaws: Study of 276 cases. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:364-371. [PMID: 33878496 DOI: 10.1016/j.jormas.2021.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/07/2021] [Accepted: 04/14/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE Benign fibro-osseous lesions (BFOLs) are heterogeneous intraosseous disease processes sharing overlapping histopathologic features and demonstrate a wide range of biological behavior. The aim of this study is to highlight the importance of clinical and radiological findings for the definitive histopathologic diagnosis of benign fibro-osseous lesions of the jaws. MATERIALS AND METHODS This is a cross-sectional retrospective study evaluating the three main groups of BFOLs: Cemento-osseous dysplasia, ossifying fibromas, and fibrous dysplasia. Previously diagnosed BFOL cases were searched for thoroughly from the archives of Istanbul University, Institute of Oncology, Department of Tumor Pathology in between 2005 and 2015. Clinical and radiological data of these cases were identified and recorded. The histopathologic features were reevaluated from the H&E-stained slides. RESULTS A total of 276 BFOL cases were identified and reevaluated for the study. The most common BFOL type was cemento-osseous dysplasia (n = 135), followed by cemento-ossifying fibroma (n = 77), fibrous dysplasia (n = 53) and juvenile ossifying fibroma (n = 11). The female/male ratio was 3.4:1 with a strong predilection for the 4th decade (n = 102). The mandible (n = 209) was the predominantly affected jaw. Prominent osteoblastic rimming around the bony lesion was commonly observed for cemento-ossifying fibroma (n = 60/77), followed by cemento-osseous dysplasia (n = 23/135). Predominant ossification patterns showed some differences among the groups. The most common radiological feature was the mixed radiolucent/radiopaque internal structure. CONCLUSION Our results document various clinical, radiological and histopathologic findings of BFOLs. Even some histopathologic differences are observed, clinical and radiographic correlation is mandatory prior to the definitive histopathologic diagnosis of BFOLs for the prevention of possible misdiagnoses or inappropriate treatments.
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Affiliation(s)
- Merva Soluk-Tekkesin
- Istanbul University, Institute of Oncology, Department of Tumour Pathology, Istanbul, Turkey.
| | - Alper Sinanoglu
- Kocaeli University, Faculty of Dentistry, Department of Oral and Maxillofacial Radiology, Kocaeli, Turkey
| | - Firat Selvi
- Istanbul University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul, Turkey
| | - Hulya Cakir Karabas
- Istanbul University, Faculty of Dentistry, Department of Oral and Maxillofacial Radiology, Istanbul, Turkey
| | - Nihan Aksakalli
- Istanbul University, Institute of Oncology, Department of Tumour Pathology, Istanbul, Turkey
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19
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Abstract
Sclerotic lesions of the jaw are uncommon but may be clinically relevant. In this pictorial review, the most common sclerotic lesions are discussed. Three categories of lesions are distinguished; odontogenic sclerotic lesions, non-odontogenic sclerotic lesions, and mixed lytic-sclerotic lesions. In each group, non-neoplastic conditions are discussed first, followed by benign and malignant neoplasms. For each disease a brief overview is given, including histological features, epidemiology, symptoms, typical location, imaging features, and treatment. This review emphasizes which basic observations are essential to the evaluation of sclerotic jaw lesions and what elements have to be taken into account to create a proper differential diagnosis.
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20
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Alsufyani NA, Aldosary RM, Alrasheed RS, Alsaif RF. A systematic review of the clinical and radiographic features of hybrid central giant cell granuloma lesions of the jaws. Acta Odontol Scand 2021; 79:124-131. [PMID: 32730731 DOI: 10.1080/00016357.2020.1797160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Central giant cell granuloma (CGCG) can coexist with other benign lesions of the jaw. These hybrid lesions are diagnostically challenging to both oral pathologists and radiologists. This work systematically reviews the clinical and radiographic features of hybrid-CGCG lesions in the jaws. MATERIALS AND METHODS Three reviewers conducted an electronic search of five databases for histologically diagnosed hybrid-CGCG lesions in human jaws. RESULTS Thirty-four of 1224 articles met the inclusion criteria. Of 39 hybrid-CGCG lesions, 14 (35.9%) were central odontogenic fibroma, 11 (28.2%) were central ossifying fibroma, seven (17.9%) were fibrous dysplasia, and seven (17.9%) were other bone conditions. There were 22 females and 17 males with a mean age of 30.5 ± 19.9 years. 89.5% of hybrid-CGCG lesions were well defined, 57.9% were non-corticated, 60.5% were radiolucent, and 66.7% were in the posterior mandible. Most hybrid lesions affected the cortical plates by thinning, expansion, or perforation (93.1%), displaced, or resorbed teeth (60%). CONCLUSION The radiographic features of hybrid-CGCG lesions vary according to the concurrent bony lesion. Hybrid-CGCG lesions altered the radiographic appearance with the following entities: fibrous dysplasia, melorheostosis, and Paget's disease. Optimal imaging modalities are crucial to detail radiographic features and direct representative biopsy of suspicious sites that may host a CGCG hybridisation.
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Affiliation(s)
- Noura A. Alsufyani
- Division of Oral and Maxillofacial Radiology, Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
- Adjunct, Division of Oral Medicine, Pathology and Radiology, School of Dentistry, Department of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Reem M. Aldosary
- College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | | | - Rand F. Alsaif
- College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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21
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Zhang J, Troulis MJ, August M. Diagnosis and Treatment of Pediatric Primary Jaw Lesions at Massachusetts General Hospital. J Oral Maxillofac Surg 2020; 79:585-597. [PMID: 33038300 DOI: 10.1016/j.joms.2020.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To review the demographic data, presenting symptoms, location, radiographic findings, treatment, and prognosis of pediatric jaw lesions in children treated at a single academic institution. PATIENTS AND METHODS A retrospective medical record review was undertaken of patients younger than 18 years who presented to the Massachusetts General Hospital for Children between 2006 and 2018 with a primary jaw lesion. RESULTS About 164 patients were identified. The most common lesions were giant cell tumors (n = 25), odontogenic keratocysts (n = 24), simple bone cysts (n = 19), odontomas (n = 17), fibrous dysplasia (n = 11), and dentigerous cysts (n = 11). Fifty-one patients (30.7%) were asymptomatic. About 94% were referred by their dentist, outside oral and maxillofacial surgeon or orthodontist. Most common presenting symptoms were swelling (66.9%), pain (32.5%), tooth mobility (17.5%), and neurosensory change (6.6%). Mandibular location was most common (72.3%). Radiographically, most were well-circumscribed radiolucencies with mean size of 2.9 cm (range, 0.7 to 15.6). Treatment varied from excisional biopsy to wide composite resection. Mean follow-up time was 38 months (range, 1 to 204). Recurrence was found in 21%. CONCLUSIONS Pediatric jaw lesions are often asymptomatic and discovered incidentally by dental practitioners on routine examination. Clinical features (age, gender, location, and radiographic appearance) can help narrow the differential and expedite treatment. It is important that clinicians involved in the care of children be familiar with the wide differential diagnosis and management considerations of primary jaw lesions.
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Affiliation(s)
- Jie Zhang
- Associate professor, Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China; and Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital Harvard School of Dental Medicine, Boston, MA
| | - Maria J Troulis
- Department Head, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital Harvard School of Dental Medicine, Boston, MA
| | - Meredith August
- Professor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital Harvard School of Dental Medicine, Boston, MA.
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22
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Mupparapu M, Shi KJ, Ko E. Differential Diagnosis of Periapical Radiopacities and Radiolucencies. Dent Clin North Am 2020; 64:163-189. [PMID: 31735225 DOI: 10.1016/j.cden.2019.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Periapical pathoses represent changes noted at the apices of teeth within the alveolar process that are suspected on examination, visualized via imaging, and confirmed via histopathology. They can be bone forming or destructive. There are pathologic entities that show both types of changes at the apical regions. These lesions must be identified if they are odontogenic in origin because treatment modalities differ. This article discusses identification of radiopaque and radiolucent lesions noted on radiographs. The common opacities and lucencies are described. When required, advanced imaging is used to depict changes within the bone near the periapical regions of mandibular and maxillary teeth.
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Affiliation(s)
- Mel Mupparapu
- Department of Oral Medicine, Robert Schattner Center, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA.
| | - Katherine Jie Shi
- Department of Endodontics, Tufts University School of Dental Medicine, 1 Kneeland Street, Boston, MA 02111, USA
| | - Eugene Ko
- Department of Oral Medicine, Robert Schattner Center, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA
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23
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Correlation Between Soft and Hard Tissue Changes in the Zygomaticomaxillary Region After Bone Contouring Surgery for Fibrous Dysplasia—A Preliminary Study. J Oral Maxillofac Surg 2019; 77:1904.e1-1904.e11. [DOI: 10.1016/j.joms.2019.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 05/01/2019] [Accepted: 05/01/2019] [Indexed: 11/22/2022]
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24
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Popkov A, Dučić S, Lazović M, Lascombes P, Popkov D. Limb lengthening and deformity correction in children with abnormal bone. Injury 2019; 50 Suppl 1:S79-S86. [PMID: 30987742 DOI: 10.1016/j.injury.2019.03.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 03/28/2019] [Indexed: 02/08/2023]
Abstract
Flexible intramedullary nailing (FIN) provides multiple advantages in limb lengthening and progressive deformity correction in combination with external fixation. The article presents brief literature review and authors' experience in limb lengthening of abnormal bone (Ollier's disease, fibrous dysplasia, osteogenesis imperfecta). Titanium and, especially, hydroxyapatite-coated bent elastic nails in combination with external fixator are appropriate in limb lengthening of abnormal bone in children. FIN left in situ after lengthening procedure and external frame removal should be applied for long-term reinforcement of lengthened bone in patients with abnormal bone (metabolic bone disorders, skeletal dysplasias with compromised bone tissue development). The FIN respects bone biology, which is mandatory for good bone consolidation. Osteoactive properties of intramedullary elastic implants are favorable for bone formation and as well as for stable position of nails without risks of migration in long-term follow-up.
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Affiliation(s)
- Arnold Popkov
- Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, 6, M. Ulyanova Street, 640014, Kurgan, Russian Federation
| | - Siniša Dučić
- Children's University Hospital, Tiršova 10, Belgrade, Serbia
| | - Mikan Lazović
- Children's University Hospital, Tiršova 10, Belgrade, Serbia
| | - Pierre Lascombes
- Division of Paediatric Orthopaedics, Hôpitaux Universitaires de Genève, rue Willy Donzé 6, CH - 1211, Geneva 14, Switzerland
| | - Dmitry Popkov
- Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, 6, M. Ulyanova Street, 640014, Kurgan, Russian Federation.
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Davidova LA, Bhattacharyya I, Islam MN, Cohen DM, Fitzpatrick SG. An Analysis of Clinical and Histopathologic Features of Fibrous Dysplasia of the Jaws: A Series of 40 Cases and Review of Literature. Head Neck Pathol 2019; 14:353-361. [PMID: 31079311 PMCID: PMC7235148 DOI: 10.1007/s12105-019-01039-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/02/2019] [Indexed: 10/26/2022]
Abstract
Fibrous dysplasia (FD) is a rare condition commonly involving the jaws. While FD has a typical clinical and histological presentation, considerable variation exists. Moreover, overlap of features with other disorders is possible. This study serves to characterize the features of a large case series of FD of the jaws. With IRB approval, the University of Florida Oral Pathology Biopsy Service archive was retrospectively searched from 1994 to 2015 for cases of FD. Epidemiological data, location, duration, clinical and radiographic appearance, clinical impression and exact microscopic diagnosis were recorded. The average age was 37.3 years (range 7-87 years) with majority of cases in females (67.5%). The most common ethnicity was Caucasian. Maxillary location was predominant (59%), followed by mandible (38%) and multiple locations (3%). Expansion was reported in 78% of cases. Radiographically, most cases exhibited ground glass opacity, however some presented with a mottled or mixed radiopaque/radiolucent appearance. Histologically, a wide variation in terms of stromal cellularity, presence of osteoblastic rimming, and presence of calcified material mimicking cemento-osseous dysplasia was observed. Clinicians and pathologists should be cognizant of the significant variability in clinical, histopathologic, and radiographic presentation of FD, which may pose a diagnostic challenge.
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Affiliation(s)
- L. A. Davidova
- grid.15276.370000 0004 1936 8091University of Florida College of Dentistry, 1395 Center Dr, Gainesville, FL 32610 USA
| | - I. Bhattacharyya
- grid.15276.370000 0004 1936 8091University of Florida College of Dentistry, 1395 Center Dr, Gainesville, FL 32610 USA
| | - M. N. Islam
- grid.15276.370000 0004 1936 8091University of Florida College of Dentistry, 1395 Center Dr, Gainesville, FL 32610 USA
| | - D. M. Cohen
- grid.15276.370000 0004 1936 8091University of Florida College of Dentistry, 1395 Center Dr, Gainesville, FL 32610 USA
| | - S. G. Fitzpatrick
- grid.15276.370000 0004 1936 8091University of Florida College of Dentistry, 1395 Center Dr, Gainesville, FL 32610 USA
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26
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Abstract
Benign fibro-osseous lesions (BFOLs) are a particularly challenging set of diagnoses for the pathologist. This diverse collection of diseases includes fibrous dysplasia, ossifying fibroma and cemento-osseous dysplasia. While all three conditions have similar microscopic presentations, their treatment and prognosis differ, demanding an accurate and definitive diagnosis. A practical and systematic approach considering the patient's history, demographics, intraoperative presentation, and gross appearance with an emphasis on radiology and histology will be discussed.
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27
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Adnot J, Moizan H, Trost O. Dental implants in a patient with left mandibular fibrous dysplasia: Two-year outcomes on the normal and affected sides. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2019; 120:575-578. [PMID: 30763781 DOI: 10.1016/j.jormas.2019.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/15/2019] [Accepted: 02/01/2019] [Indexed: 01/07/2023]
Abstract
Dental rehabilitation raises specific challenges in patients with mandibular fibrous dysplasia. We report the 2-year post-operative outcomes on the normal and affected sides in a 64-year-old female with focal left mandibular fibrous dysplasia and bilateral posterior edentulism. On the left, bone shaving of the lesion to restore sufficient vertical height was followed by the insertion of two dental implants. Three dental implants were inserted into the normal bone on the right. Dental prostheses were added 6 months later. Two years after the first procedure, no complications had been recorded and the patient reported similar high satisfaction for both sides. This comparison of outcomes of dental implants inserted into dysplastic versus normal bone in the same patient suggests that dental implants may constitute a valid option for managing edentulism in selected patients with fibrous dysplasia, provided appropriate precautions are taken.
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Affiliation(s)
- J Adnot
- Oral and Maxillofacial surgery department, Rouen university hospital, 1, rue de Germont, 76031 Rouen, France.
| | - H Moizan
- Odontology department, Rouen university hospital, 1, rue de Germont, 76031 Rouen, France
| | - O Trost
- Oral and Maxillofacial surgery department, Rouen university hospital, 1, rue de Germont, 76031 Rouen, France; Laboratory of anatomy, Rouen faculty of medicine, 22, boulevard Léon-Gambetta, 76031 Rouen, France; French national institute for health (Inserm), LIMICS UMR-1142, 76031 Rouen, France
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28
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Kang M, Jee YJ, Lee DW, Jung SP, Kim SW, Yang S, Ryu DM. Midfacial degloving approach for management of the maxillary fibrous dysplasia: a case report. Maxillofac Plast Reconstr Surg 2018; 40:38. [PMID: 30588475 PMCID: PMC6281586 DOI: 10.1186/s40902-018-0177-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 10/23/2018] [Indexed: 11/24/2022] Open
Abstract
Background Fibrous dysplasia (FD) is a benign bone lesion characterized by the progressive replacement of normal bone with fibro-osseous connective tissue. The maxilla is the most commonly affected area of facial bone, resulting in facial asymmetry and functional disorders. Surgery is an effective management option and involves removing the diseased bone via an intraoral approach: conservative bone shaving or radical excision and reconstruction. Case presentation This case report describes a monostotic fibrous dysplasia in which the patient’s right midface had a prominent appearance. The asymmetric maxillary area was surgically recontoured via the midfacial degloving approach under general anesthesia. Follow-up photography and radiographic imaging after surgery showed the structures were in a stable state without recurrence of the FD lesion. Furthermore, there were no visible scars or functional disability, and the patient reported no postoperative discomfort. Conclusions In conclusion, the midfacial degloving approach for treatment of maxillary fibrous dysplasia is a reliable and successful treatment option. Without visible scars and virtually free of postoperative functional disability, this approach offers good exposure of the middle third of the face for treatment of maxillary fibrous dysplasia with excellent cosmetic outcomes.
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Affiliation(s)
- Miju Kang
- 1Department of Oral and Maxillofacial Surgery, Dental Hospital, Kyung-hee University Hospital at Gang-dong, #892 Dongnam-ro, Gangdong-gu, Seoul, 05278 Republic of Korea
| | - Yu-Jin Jee
- 1Department of Oral and Maxillofacial Surgery, Dental Hospital, Kyung-hee University Hospital at Gang-dong, #892 Dongnam-ro, Gangdong-gu, Seoul, 05278 Republic of Korea.,2Department of Oral and Maxillofacial Surgery, College of Dentistry, School of Dentistry, Kyung-Hee University, 7-13, Kyungheedae-ro 6-gil, Dongdaemun-gu, Seoul, 02453 Republic of Korea
| | - Deok Won Lee
- 1Department of Oral and Maxillofacial Surgery, Dental Hospital, Kyung-hee University Hospital at Gang-dong, #892 Dongnam-ro, Gangdong-gu, Seoul, 05278 Republic of Korea.,2Department of Oral and Maxillofacial Surgery, College of Dentistry, School of Dentistry, Kyung-Hee University, 7-13, Kyungheedae-ro 6-gil, Dongdaemun-gu, Seoul, 02453 Republic of Korea
| | - Sang-Pil Jung
- 1Department of Oral and Maxillofacial Surgery, Dental Hospital, Kyung-hee University Hospital at Gang-dong, #892 Dongnam-ro, Gangdong-gu, Seoul, 05278 Republic of Korea
| | - Se-Won Kim
- 1Department of Oral and Maxillofacial Surgery, Dental Hospital, Kyung-hee University Hospital at Gang-dong, #892 Dongnam-ro, Gangdong-gu, Seoul, 05278 Republic of Korea
| | - Sunin Yang
- 1Department of Oral and Maxillofacial Surgery, Dental Hospital, Kyung-hee University Hospital at Gang-dong, #892 Dongnam-ro, Gangdong-gu, Seoul, 05278 Republic of Korea
| | - Dong-Mok Ryu
- 1Department of Oral and Maxillofacial Surgery, Dental Hospital, Kyung-hee University Hospital at Gang-dong, #892 Dongnam-ro, Gangdong-gu, Seoul, 05278 Republic of Korea.,2Department of Oral and Maxillofacial Surgery, College of Dentistry, School of Dentistry, Kyung-Hee University, 7-13, Kyungheedae-ro 6-gil, Dongdaemun-gu, Seoul, 02453 Republic of Korea
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Magnetic resonance imaging features of craniofacial fibrous dysplasia. Pol J Radiol 2018; 84:e16-e24. [PMID: 31019590 PMCID: PMC6479141 DOI: 10.5114/pjr.2019.82747] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 11/06/2018] [Indexed: 12/22/2022] Open
Abstract
Purpose To assess the value of magnetic resonance imaging (MRI) in detecting craniofacial fibrous dysplasia (CFD) and diagnosing and differentiating it from intraosseous meningioma. Additionally, the MRI appearance of the typical computed tomography (CT) imaging feature, the ground glass phenomenon, was evaluated. Material and methods MRI datasets of 32 patients with CFD were analysed retrospectively. Detectability in MRI was assessed by analysis of 10 randomly selected patients with CFD and 10 normal controls by two blinded readers. Changes of affected bone, internal lesion structure, T1 and T2 signal intensity, and contrast enhancement of the lesion in general and ground glass areas in particular were assessed. Ten patients with intraosseous meningioma (one in each) served as differential diagnosis for CFD. Results All 10 CFD lesions were reliably detected in MRI. In 32 patients 36 CFD lesions were evaluated. In 66.7% CFD were iso- to hypointense in T1 and hyperintense in T2; this proportion was similar for ground glass areas (65.7%). Ground glass areas were more homogeneously structured than the whole CFD lesion in both T1 (100% vs. 56%, respectively) and T2 (91% vs. 61%, respectively). Contrast enhancement was found in 97% of complete CFD lesions and 93% of ground glass areas. The accuracy for CFD vs. intraosseous meningioma was 100% for 'no soft-tissue component' and 98% for 'bone broadening' in MRI. Conclusions Distinct morphological changes of CFD are reliably detected in MRI and allow differentiation from intraosseous meningioma. Areas with ground glass phenomenon in CT show a predominantly homogenous internal structure in MRI with contrast enhancement.
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Koch G, Cazzato RL, Gilkison A, Caudrelier J, Garnon J, Gangi A. Percutaneous Treatments of Benign Bone Tumors. Semin Intervent Radiol 2018; 35:324-332. [PMID: 30402015 DOI: 10.1055/s-0038-1673640] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Benign bone tumors consist of a wide variety of neoplasms that do not metastasize but can still cause local complications. Historical management of these tumors has included surgical treatment for lesion resection and possible mechanical stabilization. Initial percutaneous ablation techniques were described for osteoid osteoma management. The successful experience from these resulted in further percutaneous image-guided techniques being attempted, and in other benign bone tumor types. In this article, we present the most common benign bone tumors and describe the available results for the percutaneous treatment of these lesions.
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Affiliation(s)
- Guillaume Koch
- Interventional Imaging, Nouvel Hôpital Civil, 1 place de l'Hôpital, Strasbourg Cedex, France.,Department of Anatomy, University of Strasbourg, Strasbourg, France
| | - Roberto Luigi Cazzato
- Interventional Imaging, Nouvel Hôpital Civil, 1 place de l'Hôpital, Strasbourg Cedex, France
| | - Andrew Gilkison
- Radiology Department, Christchurch Public Hospital, Christchurch, New Zealand
| | - Jean Caudrelier
- Interventional Imaging, Nouvel Hôpital Civil, 1 place de l'Hôpital, Strasbourg Cedex, France
| | - Julien Garnon
- Interventional Imaging, Nouvel Hôpital Civil, 1 place de l'Hôpital, Strasbourg Cedex, France
| | - Afshin Gangi
- Interventional Imaging, Nouvel Hôpital Civil, 1 place de l'Hôpital, Strasbourg Cedex, France
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Isobe Y, Takahashi K, Kiso H, Nakao K, Ikeno M, Koyama N, Sugai M, Shimizu A, Haga H, Bessho K. Direct evidence for the age-dependent demise of GNAS-mutated cells in oral fibrous dysplasia. Arch Oral Biol 2018; 93:133-140. [DOI: 10.1016/j.archoralbio.2018.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 04/29/2018] [Accepted: 05/23/2018] [Indexed: 10/16/2022]
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32
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Extranodal lymphoma arising within the maxillary alveolus: a systematic review. Oral Radiol 2018; 34:113-126. [PMID: 30147235 DOI: 10.1007/s11282-017-0309-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 10/19/2017] [Indexed: 11/27/2022]
Abstract
Objectives Extranodal lymphomas affecting the head and neck infrequently arise within the jaw bones. Although clinical examination and conventional radiography may initially suffice for such lesions arising within the mandible, those arising within the maxillary alveolus generally require cross-sectional imaging because of the complex anatomy of this region. This study was performed to determine the prevalence, demographic characteristics, and clinical presentations of these lesions and the imaging modalities used for their diagnosis. Study design A systematic review (SR) on case series and another SR on case reports were performed to investigate the demographic, clinical, and radiological features of extranodal lymphomas arising within the maxillary alveolus. Results Most case series were derived from just four nations, whereas the case reports were derived from a wider range of ethnicities. The more detailed case reports significantly reported at least one imaging modality. Most patients were aware of their lesions for nearly 2 months before presentation. The most frequent symptom was swelling. Most case reports included a provisional diagnosis, the most frequent of which was dental infection followed by squamous cell carcinoma. Discussion Extranodal lymphomas arising within the maxillary alveolus were sufficiently frequent in four communities to be reported in two or more case series, and the occasional single case report indicated that such lesions are more widespread globally. Although the SR on case series revealed differences in the relative period prevalence and maxillary/mandibular ratio, the SR on case reports revealed details of the clinical presentation and imaging modalities used.
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Abstract
Fibrous dysplasia (FD) is a rare bony disorder in which normal bone is replaced by abnormal fibro-osseous tissue. It often involves the long bones, craniofacial bones, ribs, and pelvis. Approximately 30% of monostotic FD (MFD) lesions are found in the cranial or facial bones. In general, FD is found in teenagers, and it usually becomes static after adulthood. FD involves the maxilla almost two times more often than the mandible. It frequently appears in the posterior region of the jaw bone and is usually unilateral. Here, we present an unusual case of symptomatic MFD affecting the anterior region of the mandible in a 43-year-old female with the clinical, radiographical, and histopathological features. The clinical examination showed both the labial and lingual bone expansion in the anterior mandible. The radiographic examination revealed a lesion with both radiopaque and radiolucent features showing a “ground-glass” appearance. The diagnosis was obtained after confirmatory intrabony biopsy with the histopathological examination, and it was diagnosed with benign FD. The patient preferred regular follow-up of MFD after discussion. During the regular follow-up, MFD lesion showed no obvious signs of progression or malignancy features.
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Affiliation(s)
- Hsien-Yi Yang
- Department of Dentistry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Bor-Cherng Su
- Department of Pathology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Ming-Jay Hwang
- Department of Pathology, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yi-Pang Lee
- Department of Dentistry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,Department of Health Administration, Tzu Chi University of Science and Technology, Hualien, Taiwan
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Kato CDNADO, Nunes LFM, Chalub LLFH, Etges A, Silva TA, Mesquita RA. Retrospective Study of 383 Cases of Fibro-Osseous Lesions of the Jaws. J Oral Maxillofac Surg 2018; 76:2348-2359. [PMID: 29859157 DOI: 10.1016/j.joms.2018.04.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 04/26/2018] [Accepted: 04/28/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE The aims of this study were to describe the clinical and radiologic features of 383 fibro-osseous lesions (FOLs) from an oral pathology reference service in Brazil and to compare the findings with previous studies. The hypothesis of the study was that the most common type of FOL would differ from other investigations. MATERIALS AND METHODS We conducted a descriptive and retrospective study with review of the records of the clinical and biopsy services (1990 to 2015). All records of the patients included showed a definitive diagnosis of FOL. The primary outcome variable was the type of FOL, and the predictor variables were gender, age, ethnicity, location, and clinical and radiologic characteristics. Descriptive analyses and χ2 tests were performed. The P value was set at .05. RESULTS From the 27,998 records available, 383 showed FOLs, with 187 (48.8%) being cemento-osseous dysplasias (CODs), 103 (26.9%) being fibrous dysplasias (FDs), and 93 (24.3%) being ossifying fibromas (OFs). The mean age of the patients was 38.5 ± 17.5 years. CODs presented a predilection for female gender (n = 314, 82.0%), African descent (n = 134, 71.6%), and the mandible (n = 248, 64.6%). The most common radiologic feature was a mixed radiolucent-radiopaque image (n = 149, 51.7%). FDs and OFs were commonly diagnosed during the first and second decades of life (P < .001), whereas CODs were more frequently diagnosed beyond the third decade (P < .001). Secondary osteomyelitis was more significantly observed in CODs (P < .001) than in FDs and OFs. Swelling was more frequently reported for FDs and OFs than for CODs (P < .001). CONCLUSIONS CODs were the most frequently observed FOLs in this Brazilian population. Female patients, patients of African descent, and patients with mandibular localization were most commonly affected by these conditions. The most common type of FOL differed from that in similar case reports or series from various geographic locations. It is believed that the data source (clinical and/or biopsy services) can directly influence the outcome.
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Affiliation(s)
| | | | - Loliza Luiz Figueiredo Houri Chalub
- Professor, Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Adriana Etges
- Professor, Departament Oral Pathology, School of Dentistry, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Tarcília Aparecida Silva
- Professor, Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ricardo Alves Mesquita
- Professor, Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Duan C, Dai Q, Liu Q, Yu H. Characteristics of sinonasal fibrous dysplasia: experience from a single department. Acta Otolaryngol 2018; 138:50-55. [PMID: 28830313 DOI: 10.1080/00016489.2017.1367101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES We summarized the characteristics of fibrous dysplasia patients in our department to obtain clinical data on this disease. METHODS We retrospectively reviewed 28 patients who were diagnosed with sinonasal fibrous dysplasia based on pathological examination results from March 2012 to February 2017 in our department. RESULTS The 28 patients included 16 females and 12 males, and the median age was 31.5 (range, 7-69) years. The three most common symptoms were nasal obstruction (25%), impaired vision (21%) and headache (18%). Most of the tumors were located in the sphenoid sinus (50%), nasal cavity (39%) or ethmoid sinus (36%). The surgical strategy included an exclusive endoscopic approach (25 cases) and an endoscopic approach combined with sublabial incision (three cases). The median follow-up period was 29 months (range, 3-62 months), and three patients were lost to follow-up. Two of the remaining 25 patients developed recurrence. However, since the second surgery, there has been no recurrence to date. CONCLUSIONS Our study indicates that the treatment of fibrous dysplasia patients should be tailored according to patient and disease characteristics. The main surgical procedure is the endoscopic approach, and the effect is good. Although the recurrence rate is low, follow-up is necessary.
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Affiliation(s)
- Chen Duan
- Department of Otolaryngology, Eye, Ear, Nose & Throat Hospital, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Fudan University, Shanghai, China
| | - Qi Dai
- Department of Otolaryngology, Eye, Ear, Nose & Throat Hospital, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Fudan University, Shanghai, China
| | - Quan Liu
- Department of Otolaryngology, Eye, Ear, Nose & Throat Hospital, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Fudan University, Shanghai, China
| | - Hongmeng Yu
- Department of Otolaryngology, Eye, Ear, Nose & Throat Hospital, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Fudan University, Shanghai, China
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Du Z, Jiang Y, Chen L. The Status of Affected Infraorbital Nerve and Inferior Alveolar Nerve in Patients With Jaw Fibrous Dysplasia. J Craniofac Surg 2017; 28:e566-e569. [DOI: 10.1097/scs.0000000000003873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Gupta D, Garg P, Mittal A. Computed Tomography in Craniofacial Fibrous Dysplasia: A Case Series with Review of Literature and Classification Update. Open Dent J 2017; 11:384-403. [PMID: 28839487 PMCID: PMC5543691 DOI: 10.2174/1874210601711010384] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/07/2016] [Accepted: 12/14/2016] [Indexed: 02/06/2023] Open
Abstract
Introduction: Fibrous dysplasia (FD) is a fibroosseous lesion of the osseous structures of the body. It is not a commonly reported lesion yet it is considered as an important lesion which can affect the maxillofacial region as well. As a result, it can cause deformity of the jaw bones which can further lead to severe facial asymmetry. Craniofacial fibrous dysplasia (CFD) is one of the subtypes of FD that can affect the bones of the craniofacial complex, including the mandible and maxilla. It can also present as facial asymmetry and can be investigated with the help of Maxillofacial Radiology and Imaging. The radiographic findings may vary according to the extent and degree of the disease. Although conventional radiographs provide a good clue regarding the lesion, advanced maxillofacial imaging is capable of providing detailed extent of the disease. Furthermore the classification of CFD is not very clear in the literature. Case Report: This particular paper attempts to document and report the CT appearance of CFD with an attempt to propose a better classification system for the same. Four different patients are reported which presented with FD with involvement of bones of craniofacial region. Working diagnosis of CFD was made with the help of clinical features as well as with radiographic assessment. Advanced imaging included CT scan of the lesions. The article highlights the importance of computed tomography in diagnosis as well as assessment of extent of the disease. Conclusion: It can be concluded that the Dental professionals must be aware regarding the different radiographic appearances of CFD. Advanced imaging modality like CT can provide with exact diagnosis as well as extent of the lesions like FD. Further collaboration of researchers is required to incorporate this proposed change in classification of CFD.
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Affiliation(s)
- Deepak Gupta
- Department of Oral Medicine and Radiology, M.M. College of Dental Sciences and Research, Mullana, Ambala, Haryana, India
| | - Preeti Garg
- Department of Oral Medicine and Radiology, M.M. College of Dental Sciences and Research, Mullana, Ambala, Haryana, India
| | - Amit Mittal
- Department of Radiodiagnosis and Imaging, M.M. Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
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Florid cemento-osseous dysplasia: review of an uncommon fibro-osseous lesion of the jaw with important clinical implications. Skeletal Radiol 2017; 46:581-590. [PMID: 28194495 DOI: 10.1007/s00256-017-2590-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 01/22/2017] [Accepted: 01/27/2017] [Indexed: 02/02/2023]
Abstract
Florid cemento-osseous dysplasia (FCOD) is a rare, benign, multifocal fibro-osseous dysplastic process affecting tooth-bearing areas of the jaw, characterized by replacement of normal trabecular bone with osseous tissue and dense acellular cementum in a fibrous stroma. It is one clinicopathologic variant in a spectrum of related non-neoplastic fibro-osseous lesions known as cemento-osseous dysplasias (CODs), thought to arise from elements of the periodontal ligament. Diagnosis primarily relies upon radiographic and clinical findings; unnecessary biopsy should be avoided, as inoculation with oral pathogens may precipitate chronic infection in these hypovascular lesions. Appropriate management of uncomplicated FCOD consists of periodic radiographic follow-up. Accordingly, it is important that both radiologists and clinicians performing endodontic interventions possess familiarity with this entity in order to prevent misdiagnosis and inappropriate intervention, which may result in a protracted clinical course. Lesions are usually asymptomatic in the absence of infection, typically discovered on routine dental radiographs or imaging performed for unrelated indications. Radiographically, the condition typically manifests as widespread non-expansile intraosseous masses of varying internal lucency and sclerosis that surround the root apices of vital teeth or edentulous areas in the posterior jaw. While all CODs share similar microscopic features, FCOD is distinguished by its multifocal distribution, involving two or more quadrants of the maxilla and mandible, often in a bilateral symmetric fashion. The vast majority of cases are sporadic, though few exhibit an autosomal dominant familial inheritance pattern. In this pictorial review, we discuss the radiologic characteristics of this entity, pertinent clinical and histologic features, differential diagnoses, and management options.
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Florid Cemento-Osseous Dysplasia Simultaneous the Chronic Suppurative Osteomyelitis in Mandible. J Craniofac Surg 2017; 27:2173-2176. [PMID: 28005783 DOI: 10.1097/scs.0000000000003095] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION The florid cemento-osseous dysplasia is an uncommon condition nonneoplastic, of unknown cause with higher prevalence in melanodermic women, limited the maxillary bones, is characterized by the presence of dispersed and diffuse radiopaque calcifications, constituted of bone and dense cemento; however, when the bone is infected it induces the suppuration and formation of osseous sequestra, thus resulting in an osteomyelitis frame. CLINICAL REPORT The patient was attended in a Dental Specialties Center in the state of Alagoas, Brazil, presenting on clinical examination edema and extra oral fistula with pus drainage in hemiface submandibular of the right side. Radiographically it was possible to observe area of sclerosis and osseous sequestra involving the right side region of the mandible body, and it increases zones of the bone density. In association with clinical data and complementary diagnosis examinations, the option of treatment adopted was the complete removal of the bone fragment, followed by adaptation and plate fixation and titanium screws to reduce the risk of mandibular fracture. OBJECTIVE The aim of the present paper was to relate a clinical patient of florid cemento-osseous dysplasia simultaneous the chronic suppurative osteomyelitis, highlighting their clinical, radiographic, and histological characteristics, as well as their diagnosis and treatment.
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Lee BD, Lee W, Park YC, Kim MH, Choi MK, Yoon JH. Fibrous dysplasia of the maxilla in an elderly female: Case report on a 14-year quiescent phase. Imaging Sci Dent 2016; 46:259-265. [PMID: 28035304 PMCID: PMC5192024 DOI: 10.5624/isd.2016.46.4.259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/05/2016] [Accepted: 09/11/2016] [Indexed: 11/18/2022] Open
Abstract
Fibrous dysplasia (FD) is an uncommon skeletal disorder in which normal bone is replaced by abnormal fibro-osseous tissue. Mainly, FD is found in children, and by adulthood it usually becomes quiescent. Our case showed FD of more than 14-year duration in the left maxilla. Our evaluation was that growth ceased in adulthood and had achieved the static stage. Because FD cases in elderly patients are rarely reported, we hereby present a monostotic FD case in a 65-year-old female. We presented sequential radiographic images and scintigraphic images of this case, and combined them with a literature review that emphasized the progression of the disease.
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Affiliation(s)
- Byung-Do Lee
- Department of Oral and Maxillofacial Radiology and Research Institute of Dental Education, College of Dentistry, Wonkwang University, Iksan, Korea
| | - Wan Lee
- Department of Oral and Maxillofacial Radiology, College of Dentistry, Wonkwang University, Iksan, Korea
| | - Yong-Chan Park
- Department of Oral and Maxillofacial Radiology, College of Dentistry, Wonkwang University, Iksan, Korea
| | - Myoung-Hyoun Kim
- Department of Nuclear Medicine, Wonkwang University, School of Medicine and Institute of Wonkwang Medical Science, Iksan, Korea
| | - Moon-Ki Choi
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Wonkwang University, Iksan, Korea
| | - Jung-Hoon Yoon
- Department of Oral and Maxillofacial Pathology, College of Dentistry, Wonkwang Bone Regeneration Research Institute, Daejeon Dental Hospital, Wonkwang University, Daejeon, Korea
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Oostenbroek-Bisschop JSLI, Verweij JP, van Merkesteyn JPR. Custom Made Replacement of the Mandibular Condyle in a Case of Fibrous Dysplasia with Cystic Degeneration; A Case Report. Dent J (Basel) 2016; 4:dj4040042. [PMID: 29563484 PMCID: PMC5806957 DOI: 10.3390/dj4040042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 11/07/2016] [Accepted: 11/09/2016] [Indexed: 11/16/2022] Open
Abstract
This paper describes a rare case of fibrous dysplasia with cystic degeneration in the mandibular condyle. Diagnostic and therapeutic considerations are discussed. A 40-year old woman presented with pain near the region of her right ear. Physical and radiographic examination showed no abnormalities besides the presence of a mixed radiopaque/radiolucent expansive lesion of the right condyle. Pathologic examination showed high bone-turnover with bone formation. Bone scintigraphy showed a monostotic active fibrous lesion in the right part of the mandible. Bisphosphonate treatment did not sufficiently treat the patient's symptoms and physiotherapy to treat craniomandibular dysfunction as a factor in the pain was also unsuccessful. The patient later developed an acute external otitis due to a narrowed outer ear canal and had to be admitted to the hospital for treatment with intravenous antibiotics. Approximately two years after first presentation, resection of the affected bone (condylectomy) and reconstruction with a custom total joint prosthesis was indicated due to repeated functional deficits with considerable morbidity. Pathologic examination of the resected mandibular condyle showed increased bone formation including formation of neocortex and some cystic formation. This was diagnosed as fibrous dysplasia with cystic degeneration. Approximately two years after surgery, the patient functioned well.
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Affiliation(s)
| | - Jop P Verweij
- Department of Oral and Maxillofacial Surgery & Special Dental Care, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands.
| | - J P Richard van Merkesteyn
- Department of Oral and Maxillofacial Surgery & Special Dental Care, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands.
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Mainville GN, Turgeon DP, Kauzman A. Diagnosis and management of benign fibro-osseous lesions of the jaws: a current review for the dental clinician. Oral Dis 2016; 23:440-450. [PMID: 27387498 DOI: 10.1111/odi.12531] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 06/28/2016] [Accepted: 07/02/2016] [Indexed: 02/07/2023]
Abstract
Benign fibro-osseous lesions of the maxillofacial skeleton constitute a heterogeneous group of disorders that includes developmental, reactive (dysplastic) and neoplastic lesions. Although their classification has been reviewed multiple times in the past, the most common benign fibro-osseous lesions are fibrous dysplasia, osseous dysplasia and ossifying fibroma. For the dental clinician, the challenges involve diagnosis and treatment (or lack thereof). A careful correlation of all clinical, radiologic and microscopic features is essential to establish a proper diagnosis and a clear treatment plan. This article aimed to review the clinical, radiologic and histopathologic characteristics of benign fibro-osseous lesions of the jaws, with emphasis on their differential diagnoses. With a deeper understanding of benign fibro-osseous lesions, clinicians will be better prepared to manage these lesions in their practice.
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Affiliation(s)
- G N Mainville
- Department of Stomatology, Faculty of Dentistry, Université de Montréal, Montreal, QC, Canada
| | - D P Turgeon
- Department of Stomatology, Faculty of Dentistry, Université de Montréal, Montreal, QC, Canada
| | - A Kauzman
- Department of Stomatology, Faculty of Dentistry, Université de Montréal, Montreal, QC, Canada
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A Rare Cause of Shoulder Pain: Monostotic Fibrous Dysplasia. Arch Rheumatol 2016; 31:184-187. [PMID: 29900939 DOI: 10.5606/archrheumatol.2016.5828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 01/15/2016] [Indexed: 11/21/2022] Open
Abstract
Fibrous dysplasia is a rare bone disease which has a wide spectrum of symptoms depending on the involvement area such as pain, deformity, fracture, dyspnea or visual loss. One of the rare involvement areas is the bones around the shoulder. Fibrous dysplasia presents in two forms named monostotic or polyostotic. In this article, we present a case with monostotic fibrous dysplasia of the humeral head who admitted to our clinic with shoulder pain.
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Stojanov IJ, Woo SB. Rapidly expanding mass of the maxilla and paranasal sinuses. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 122:117-23. [PMID: 26712683 DOI: 10.1016/j.oooo.2015.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/30/2015] [Accepted: 10/20/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Ivan J Stojanov
- Resident, Oral and Maxillofacial Pathology, Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA.
| | - Sook-Bin Woo
- Associate Professor of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA; Co-director, Center for Oral Pathology, StrataDx Inc., Lexington, MA, USA
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Рогожин ДВ, Бертони Ф, Ванель Д, Гамбаротти М, Риги А, Булычева ИВ, Коновалов ДМ, Талалаев АГ, Рощин ВЮ, Эктова АП, Болотин МВ, Лопатин АВ. Benign Fibro-Osseous Lesions of the Craniofacial Area in Children and Adolescents: A Review. Arkh Patol 2015; 77:63-70. [PMID: 26485782 DOI: 10.17116/patol201577463-70] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Benign fibro-osseous lesions (BFOL) of the craniofacial area are represented by a variety of morphologic processes that are characterized by pathologic ossifications and calcifications in association with a hypercellular fibroblastic marrow element. The current classification includes neoplasms, developmental dysplastic lesions and inflammatory/reactive processes [5]. The final diagnosis depends on-clinical, radiological and pathological features. The clinico-pathologic features of this heterogeneous group of diseases are presented in this article.
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Affiliation(s)
- Д В Рогожин
- Russian Children's Clinical Hospital, Moscow, Russian Federation; Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Ф Бертони
- Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Д Ванель
- Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - А Риги
- Istituto Ortopedico Rizzoli, Bologna, Italy
| | - И В Булычева
- Russian Children's Clinical Hospital, Moscow, Russian Federation
| | - Д М Коновалов
- Russian Children's Clinical Hospital, Moscow, Russian Federation; Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - А Г Талалаев
- Russian Children's Clinical Hospital, Moscow, Russian Federation; Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - В Ю Рощин
- Russian Children's Clinical Hospital, Moscow, Russian Federation; Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - А П Эктова
- Russian Children's Clinical Hospital, Moscow, Russian Federation; Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - М В Болотин
- Russian Children's Clinical Hospital, Moscow, Russian Federation
| | - А В Лопатин
- Russian Children's Clinical Hospital, Moscow, Russian Federation
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Cordeiro MS, Backes AR, Júnior AFD, Gonçalves EHG, de Oliveira JX. Fibrous Dysplasia Characterization Using Lacunarity Analysis. J Digit Imaging 2015; 29:134-40. [PMID: 26307180 DOI: 10.1007/s10278-015-9815-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Fibrous dysplasia (FD) is a developmental anomaly in which the normal medullary space of the affected bone is replaced by fibro-osseous tissue. This condition is typically encountered in adolescents and young adults. It affects the maxillofacial region and it can often cause severe deformity and asymmetry. Therefore, accurate diagnosis is critical to determine the appropriate treatment of each case. In this sense, computed tomography (CT) is a relevant resource among the imaging techniques for correct diagnosis of this condition. Thus, in this paper, we propose to analyze fibrous dysplasia through its texture pattern. To accomplish this task, we propose to use lacunarity analysis, a multiscale method for describing patterns of spatial dispersion. Results indicated lower lacunarity values for fibrous dysplasia in comparison to normal bone samples, an indication that their texture images are more homogeneous, and a high separability between the classes when using principal component analysis (PCA) and decision trees for statistical analysis.
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Affiliation(s)
- Mirna S Cordeiro
- School of Dentistry, University of São Paulo, Av. Professor Lineu Prestes, 2227-05508-000, São Paulo, SP, Brazil.
| | - André R Backes
- School of Computing, Federal University of Uberlândia, Av. João Naves de Ávila, 2121-38408-100, Uberlândia, MG, Brazil.
| | | | - Elmar H G Gonçalves
- School of Medicine, Federal University of Uberlândia, Av Marcos Freitas Costa, 180-38400328, Uberlândia, MG, Brazil.
| | - Jefferson X de Oliveira
- School of Dentistry, University of São Paulo, Av. Professor Lineu Prestes, 2227-05508-000, São Paulo, SP, Brazil.
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MacDonald DS. A systematic review of the literature of nevoid basal cell carcinoma syndrome affecting East Asians and North Europeans. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120:396-407. [PMID: 26297395 DOI: 10.1016/j.oooo.2015.05.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 05/06/2015] [Accepted: 05/29/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To compare, by systematic review, North European and East Asian consecutive case series of nevoid basal cell carcinoma syndrome (NBCCS). STUDY DESIGN A systematic review of the literature was performed for all consecutive case series of NBCCS, which included keratocystic odontgenic tumors (KCOTs) arising in North European and East Asian communities. The clinical and radiologically apparent features were identified and synthesized, and a meta-analysis was performed. RESULTS East Asian reports were significantly more "proband only" compared with North European reports. Significant differences between these 2 communities were observed for 5 of the 6 major features and 11 of the 27 minor features. With regard to the major NBCCS features, the North Europeans displayed significantly more frequent basal cell carcinomas, calcified falx cerebri, palmar and plantar pits, and a family history, whereas the East Asians displayed KCOTs significantly more frequently. With regard to minor features, East Asians displayed significantly more frequent cleft lips and palates and hypertelorism. CONCLUSIONS East Asians displayed multiple KCOTs and cleft lips and palates more frequently compared with North Europeans.
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Affiliation(s)
- David S MacDonald
- University of British Columbia, Chairman of the Division of Oral & Maxillofacial Radiology, Faculty of Dentistry, University of British Columbia, Vancouver, Canada.
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Hakim DN, Pelly T, Kulendran M, Caris JA. Benign tumours of the bone: A review. J Bone Oncol 2015; 4:37-41. [PMID: 26579486 PMCID: PMC4620948 DOI: 10.1016/j.jbo.2015.02.001] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 02/23/2015] [Indexed: 02/08/2023] Open
Abstract
Benign tumours of the bone are not cancerous and would not metastasise to other regions of the body. However, they can occur in any part of the skeleton, and can still be dangerous as they may grow and compress healthy bone tissue. There are several types of benign tumours that can be classified by the type of matrix that the tumour cells produce; such as bone, cartilage, fibrous tissue, fat or blood vessel. Overall, 8 different types can be distinguished: osteochondroma, osteoma, osteoid osteoma, osteoblastoma, giant cell tumour, aneurysmal bone cyst, fibrous dysplasia and enchondroma. The incidence of benign bone tumours varies depending on the type. However, they most commonly arise in people less than 30 years old, often triggered by the hormones that stimulate normal growth. The most common type is osteochondroma. This review discusses the different types of common benign tumours of the bone based on information accumulated from published literature.
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Li L, Hou X, Li Q, Zhang L. En bloc resection and bone graft: does it alter the natural history of monostotic expansile fibrous dysplasia in children? World J Surg Oncol 2014; 12:349. [PMID: 25407316 PMCID: PMC4246437 DOI: 10.1186/1477-7819-12-349] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 10/01/2014] [Indexed: 11/20/2022] Open
Abstract
The surgical treatment of fibrous dysplasia remains a challenge for the pediatric orthopedist because of its high recurrence rate. Although a few successful treatments have been reported by using en bloc resection and bone graft in adults, this has not been reproduced in children. In this report, the authors present two children (2.5 and 6 years old) with monostotic expansile fibrous dysplasia involving the ulna and fibula, respectively, who underwent en bloc resection and autograft to replace the involved bones. Good bone union and functional recovery were obtained postoperatively. However, during a follow-up period of 8 and 5 years, respectively, the lesions recurred completely, and the deformities remained progressing over time. En bloc resection and bone graft cannot prevent recurrence in skeletally immature patients with monostotic expansile fibrous dysplasia, and cannot alter for the natural history of the disease. A combination of other management should be considered in children with fibrous dysplasia.
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Affiliation(s)
| | | | | | - Lijun Zhang
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang City, Liaoning Province, P,R, China.
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