| arise in the nasal septum & ethmoid
sinuses (nasal septum – bone that
separates the nasal cavity from the brain so
located at the roof of the nasal membrane) | CHONDROMA |
| arise in the nasal septum & ethmoid
sinuses (nasal septum – bone that
separates the nasal cavity from the brain so
located at the roof of the nasal membrane) | CHONDROMA |
| arise in the nasal septum & ethmoid
sinuses (nasal septum – bone that
separates the nasal cavity from the brain so
located at the roof of the nasal membrane) | CHONDROMA |
| arise in the nasal septum & ethmoid
sinuses (nasal septum – bone that
separates the nasal cavity from the brain so
located at the roof of the nasal membrane) | CHONDROMA |
| arise in the nasal septum & ethmoid
sinuses (nasal septum – bone that
separates the nasal cavity from the brain so
located at the roof of the nasal membrane) | CHONDROMA |
| rare in the jaw seen in third & fourth
decades of life | GIANT CELL TUMOR |
| rare in the jaw seen in third & fourth
decades of life | GIANT CELL TUMOR |
| rare in the jaw seen in third & fourth
decades of life | GIANT CELL TUMOR |
| appear during second or third decade of life | TORI |
| appear during second or third decade of life | TORI |
| Swelling and localize pain | OSTEOSARCOMA |
| Pain, visual disturbances, nasal signs and
headaches may result from extension from jaw bones to contiguous
structures | CHONDROSARCOMA |
| a benign neoplasm of bone that has the potential for
excessive growth & bone destruction. | OSSIFYING FIBROMA |
| treatment and prognosis of ossifying fibroma | TREATMENT: Curettage or enucleation
PROGNOSIS: Recurrence is rare after removal |
| a. occurs in children & young adults
b. causes exopthalmus, proptosis, sinusitis &
nasal symptoms | Juvenile (aggressive) ossifying fibroma |
| popping of the eyes | exopthalmus |
| eye displacement | proptosis |
| inflammation of the sinus. | sinusitis |
| a condition in which normal medullary bone is
replaced by an abnormal fibrous connective tissue
proliferation in which new, non-maturing bone is
formed. | FIBROUS DYSPLASIA |
| is an uncommon primary lesion of bone that
occasionally arises in the maxilla or the
mandible | OSTEOBLASTOMA |
| represent a smaller version of
osteoblastoma | OSTEOID OSTEOMA |
| consist of mature, compact, or cancellous
bone | OSTEOMA |
| well circumscribed
radiopacities | Periosteal osteoma: |
| ramus of the mn is
seen | Endosteal osteoma |
| endosteal and
periosteal osteoma | Gardner’s syndrome |
| locally aggressive lesion of bone that can be
considered the bony counterpart of
fibromatosis | DESMOPLASTIC FIBROMA |
| present as a painless, slowly progressive
swelling | CHONDROMA |
| benign proliferation of fibroblast &
multinucleated giant cells that occurs
almost exclusively within the jaw. | CENTRAL/ PERIPHERAL GIANT CELL
GRANULOMA |
| • commonly in long bones especially in the
knee joint | GIANT CELL TUMOR |
| rare intraosseous vascular malformation
that can mimic both odontogenic &
nonodontogenic lesion. | HEMANGIOMA OF THE BONE |
| DIFFERENTIAL DIAGNOSES:
• Ameloblastoma
• central giant cell granuloma
• aneurysmal bone cyst
• odontogenic myxoma
• odontogenic keratocyst | HEMANGIOMA OF THE BONE |
| a. cavernous type large caliber vessels
b. capillary type- small caliber vessels | TWO TYPES OF HEMANGIOMA OF THE BONE |
| formerly known as histiocytes X & idiopathic
histiocytosis, | LANGERHANS CELL DISEASE |
| THREE DISORDERS OF THE LANGERHAN'S CELLS | a. eosinophilic granuloma (chronic
localized)
b. hand-schuller- Christian syndrome
(chronic dessiminated)
c. letterer siwe disease (acute
dessiminated) |
| RADIOGRAPHIC FEATURES
• exhibit solitary radiolucent lesion | LANGERHANS CELL DISEASE |
| sessile, nodular mass of
bone that presents along the midline of the
hard palate | torus palatinus |
| bony exophytic
growth that present along the lingual aspect
of the mandible superior to the mylohyoid
ridge | torus mandibularis |
| • occur in females twice as often in males | TORI |
| • present along the lingual aspect of the
mandible superior to the mylohyoid ridge | torus mandibularis |
| • Multiple or single bony excrescences that
occur less commonly than do tori. | EXOSTOSES |
| • is an uncommon condition that is often
associated with limitation of mandibular
motion. | CORONOID HYPERPLASIA |
| ➔ unilateral
➔ bilateral - results in limitation of mandibular | CORONOID HYPERPLASIA TWO TYPES |
| Second most common primary bone tumor | OSTEOSARCOMA |
| *most common type osteosarcoma | Parosteal |
| o Arise the periphery of bone at the
periosteal surface | Periosteal |
| -common on long bones | PAROSTEAL OSTEOSARCOMA |
| Occurs much less than parosteal sarcoma | PERIOSTEAL OSTEOSARCOMA |
| Maxillofacial area (60%) – lateral incisor and
canine region and palate | CHONDROSARCOMA |
| Treatment
Wide local radical surgical excision
Prognosis
Death – local recurrence and extension into
adjacent vital structures
Metastasis – lungs or bone | CHONDROSARCOMA |
| Highly lethal round cell sarcoma | EWING’S SARCOMA |
| Treatment
Multiple method protocols – surgery and
radiation for local control; chemotherapy for
systemic micrometastases
Prognosis
Metastatic to lungs, other bones and lymph
nodes
Poor prognosis for patient below 30 years old,
metastasis,
systemic
symptoms,
high
erythrocyte sedimentation rate, elevated serum
lactate
dehydrogenase
thrombocytosis | EWING’S SARCOMA |
| Translocation of the distal part of chromosome 8
to chromosome 14--- enhanced tumor cell
proliferation of Burkitt’s lymphoma | BURKITT’S LYMPHOMA |
| Third & fourth decade of life slow growing,
asymptomatic & expansile lesion most often in the
mandibular premolar area. | ossifying fibroma |
| composed of fibrous connective tissue with
well differentiated spindled fibroblast
collagen fibers | ossifying fibroma |
| • well circumscribed, sharply defined border
• unilocular or multilocular radiolucencies | OSSIFYING FIBROMA |
| DIFFERENTIAL DIAGNOSIS:
• fibrous dysplasia
• Osteoblastoma
• focal cementoosseous dysplasia
• focal osteomyelitis | OSSIFYING FIBROMA |
| • Slow progressive enlargement of the
affected jaw | FIBROUS DYSPLASIA |
| usually painless & typically presents as a
unilateral swelling | fibrous dysplasia |
| Facial asymmetry
• Displacement of teeth
• 1st pic: jaw bone that does not develop or
mature; 2nd is the unaffected part of jaw bone
is enlarged. But the affected part of the jaw
stops in growing that causes teeth
displacement | fibrous dysplasia |
| • consist of a slight to moderate cellular
fibrous connective tissue stroma that
contains foci of irregularly shaped
trabeculae of immature bone
• fibroblast exhibit uniform spindle shaped
nuclei | fibrous dysplasia |
| ranges from a radiolucent lesion to a
uniformly radiopaque mass | fibrous dysplasia |
| DIFFERENTIAL DIAGNOSIS:
• ossifying fibroma
• chronic osteomyelitis | fibrous dysplasia |
| • Small lesion no treatment
• Large lesion surgical recontouring Malignant
transformation radiation therapy | fibrous dysplasia |
| lesion measuring 1.5 cm. in diameter | osteoblastoma |
| usual sites is in the posterior tooth bearing
regions of the maxilla & mandible | osteoblastoma |
| occur during second decade before the age
of 30 | osteoblastoma |
| nocturnal pain is common | osteoblastoma |
| almost the same to periapical abscess. | osteoblastoma |
| Irregular trabeculae of osteoid and immature bone
within a stroma containing a prominent vascular
network | osteoblastoma |
| Well circumscribed or spherical | OSTEOBLASTOMA |
| DIFFERENTIAL DIAGNOSIS:
• cementoblastoma ossifying fibroma
• fibrous dysplasia
• Osteosarcoma | OSTEOBLASTOMA |
| CLINICAL FEATURES
• lesion is lesser than 1.5 cm. in diameter | osteoid osteoma |
| occur during second decade of life pain is
relieved by aspirin | OSTEOID OSTEOMA |
| Well circumscribed and has a mixed lucent
opaque pattern. | OSTEOID OSTEOMA |
| DIFFERENTIAL DIAGNOSIS:
• Cementoblastoma
• ossifying fibroma
• fibrous dysplasia
• Osteosarcoma | OSTEOID OSTEOMA |
| associated with Gardner syndrome
autosomal dominant disorder) | osteoma |
| arise in the maxilla or mandible as well as in
facial & skull bones & within paranasal
sinuses | osteoma |
| headaches, recurrent sinusitis &
ophthalmologic complains (symptoms) | OSTEOMA |
| HISTOPATHOLOGIC FEATURES
Two variants:
a. composed of relatively dense, compact
bone with sparse marrow tissue
b. consist of lamellar trabeculae of cancellous
bone with abundant fibrofatty marrow | OSTEOMA |
| DIFFERENTIAL DIAGNOSIS: exostoses | OSTEOMA |
| condition where there are
fibrous overgrowths of dermal and
subcutaneous connective tissue. | Fibromatosis |
| occur in patient under the age of 30, with a
mean age of 14 years | DESMOPLASTIC FIBROMA |
| Body or ramus of the mandible is more
affected than the maxilla swelling of the jaw
with displacement of teeth | DESMOPLASTIC FIBROMA |
| Lesion consists of interlacing bundles &
whorled aggregates of densely collagenous
tissue that contains uniform spindled &
elongated fibroblast (rubbery to firm tissue) | DESMOPLASTIC FIBROMA |
| DIFFERENTIAL DIAGNOSES:
• odontogenic cyst odontogenic tumor
• odontogenic fibroma
• Fibrosarcoma | DESMOPLASTIC FIBROMA |
| TREATMENT: Surgical resection & curettage
PROGNOSIS: Curettage alone with significant
recurrence | DESMOPLASTIC FIBROMA |
| arise in the nasal septum & ethmoid
sinuses (nasal septum – bone that
separates the nasal cavity from the brain so
located at the roof of the nasal membrane) | CHONDROMA |
| anterior of the maxilla are most often | CHONDROMA |
| appear before 50 years of age | CHONDROMA |
| location mandible most often location is in
the body & symphysis area | CHONDROMA |
| HISTOPATHOLOGIC FEATURES
• consist of well defined lobules of mature
hyaline cartilage | CHONDROMA |
| chondrocytes are small & contain single
regular nuclei | CHONDROMA |
| DIFFERENTIAL DIAGNOSIS: chondrosarcoma | CHONDROMA |
| TREATMENT: Surgical excision
PROGNOSIS: Recurrence is unusual. | CHONDROMA |
| arise in the nasal septum & ethmoid
sinuses (nasal septum – bone that
separates the nasal cavity from the brain so
located at the roof of the nasal membrane) | CHONDROMA |
| anterior of the maxilla are most often | CHONDROMA |
| location mandible most often location is in
the body & symphysis area | CHONDROMA |
| location mandible most often location is in
the body & symphysis area | CHONDROMA |
| HISTOPATHOLOGIC FEATURES
• consist of well defined lobules of mature
hyaline cartilage | CHONDROMA |
| chondrocytes are small & contain single
regular nuclei | CHONDROMA |
| DIFFERENTIAL DIAGNOSIS: chondrosarcoma | CHONDROMA |
| TREATMENT: Surgical excision
PROGNOSIS: Recurrence is unusual. | CHONDROMA |
| before 30 years of age females are more
affected | CENTRAL/ PERIPHERAL GIANT CELL
GRANULOMA |
| almost exclusively in the maxilla &
mandible | CENTRAL/ PERIPHERAL GIANT CELL
GRANULOMA |
| Lesion tend to involve the jaws anterior to
the permanent teeth | CENTRAL/ PERIPHERAL GIANT CELL
GRANULOMA |
| produces painless expansion or swelling | CENTRAL/ PERIPHERAL GIANT CELL
GRANULOMA |
| RADIOGRAPHIC FEATURES
• consist of multilocular less commonly
locular radiolucency of the bone | CENTRAL/ PERIPHERAL GIANT CELL
GRANULOMA |
| RADIOGRAPHIC FEATURES
• consist of multilocular less commonly
locular radiolucency of the bone | CENTRAL/ PERIPHERAL GIANT CELL
GRANULOMA |
| HISTOPATHOLOGIC FEATURES
• hemosiderin-laden macrophages &
extravasated erythroeytes are usually
evident | CENTRAL/ PERIPHERAL GIANT CELL
GRANULOMA |
| HISTOPATHOLOGIC FEATURES
• multinucleated giant cells are present
throughout connective tissue stroma | CENTRAL/ PERIPHERAL GIANT CELL
GRANULOMA |
| DIFFERENTIAL DIAGNOSIS:
• Ameloblastoma
• Odontogenic myxoma
• Odontogenic keratocyst | CENTRAL/ PERIPHERAL GIANT CELL
GRANULOMA |
| TREATMENT: excision or curettage | CENTRAL/ PERIPHERAL GIANT CELL
GRANULOMA |
| rare in the jaw seen in third & fourth
decades of life | GIANT CELL TUMOR |
| rare in the jaw seen in third & fourth
decades of life | GIANT CELL TUMOR |
| exhibit slow growth & bone expansion or
sometimes they produce rapid growth, pain
or paresthesia | GIANT CELL TUMOR |
| numerous multinucleated giant cells
dispersed evenly among mononuclear
fibroblast. | GIANT CELL TUMOR |
| RADIOGRAPHIC FEATURES
• produces radiolucent image | GIANT CELL TUMOR |
| TREATMENT: surgical excision
PROGNOSIS: 30% recurrence noted after
curettage | GIANT CELL TUMOR |
| occur in the mandible especially in the
posterior region | HEMANGIOMA OF THE BONE |
| second decade of life | HEMANGIOMA OF THE BONE |
| spontaneous bleeding around the teeth | HEMANGIOMA OF THE BONE |
| paresthesia or pain are evident bruits or
pulsation of large lesion may be detected | HEMANGIOMA OF THE BONE |
| HISTOPATHOLOGIC FEATURES
• Represents proliferation of blood vessels | HEMANGIOMA OF THE BONE |
| HISTOPATHOLOGIC FEATURES
• Represents proliferation of blood vessels | HEMANGIOMA OF THE BONE |
| RADIOGRAPHIC FEATURES
- Large lesions can have the sun ray
appearance of an osteosarcoma. | HEMANGIOMA OF THE BONE |
| RF
Root resorption of adjacent teeth is
common | HEMANGIOMA OF THE BONE |
| RF
Developing teeth may be larger and erupt
earlier. | HEMANGIOMA OF THE BONE |
| RF
When the lesion involves the inferior dental
canal, the canal can be enlarged. | HEMANGIOMA OF THE BONE |
| TREATMENT: Surgery, radiation therapy,
sclerosing agents, cryotherapy & presurgical
embolization technique | HEMANGIOMA OF THE BONE |
| proliferation of cells exhibiting phenotypic
characteristics of Langerhans cells. | LANGERHANS CELL DISEASE |
| Ranges from solitary or multiple bone lesion
to dessiminated visceral, skin, & bone lesion
condition of children & young adult | LANGERHANS CELL DISEASE |
| Ranges from solitary or multiple bone lesion
to dessiminated visceral, skin, & bone lesion
condition of children & young adult | LANGERHANS CELL DISEASE |
| loosening of teeth on the affected area | LANGERHANS CELL DISEASE |
| inflammation of gingival tissue, hyperplastic
& ulcerated | LANGERHANS CELL DISEASE |
| RF
• sharp circumscribed punched out
appearance. | LANGERHANS CELL DISEASE |
| DIFFERENTIAL DIAGNOSES:
• juvenile or diabetic periodontitis
• Agranulocytosis
• Hypophosphatasia
• Leukemia
• periapical cyst or granuloma
• primary or metastatic malignant neoplasm
• cyclic neutropenia
• multiple myeloma | LANGERHANS CELL DISEASE |
| TREATMENT:
• chemotherapeutic agents
• surgical or low dose therapy
PROGNOSIS
• poor prognosis
• patient survival is 10 to 15 years | LANGERHANS CELL DISEASE |
| appear during second or third decade of life | TORI |
| exhibit slow growth generally asymptomatic | TORI |
| formed various configuration nodular,
spindled, lobular or flat | TORI |
| HISTOPATHOLOGIC FEATURES
• Composed of hyperplastic bone consisting
of mature cortical and trabecular bone. | TORI |
| HF
• Outer surface exhibits a smooth rounded
contour | TORI |
| RS
• Large tori may be evident as diffuse
radiopaque lesion | TORI |
| TREATMENT:
• No treatment needed
• Surgical removal for prosthetic purposes
PROGNOSIS: no recurrence | TORI |
| • present along the lingual aspect of the
mandible superior to the mylohyoid ridge | torus mandibularis |
| almost always bilateral occurring in
premolar region | torus mandibularis |
| appear during the second or third decades
of life | torus mandibularis |
| asymptomatic bony nodules | EXOSTOSES |
| present along the buccal aspect of the
alveolar bone | EXOSTOSES |
| most often in the posterior portion of both
the maxilla & the mandible | EXOSTOSES |
| reported as rare occurrence following skin
graft vestibuloplasty, gingival grafts, as well
as beneath the pontic of a fixed bridge | EXOSTOSES |
| RADIOGRAPHIC FEATURES
• well defined radiopacity that resembles
periosteal osteoma. | EXOSTOSES |
| TREATMENT: surgical removal for prosthetic
purposes.
PROGNOSIS: Rare recurrence after surgical
excision. | EXOSTOSES |
| CLINICAL FEATURES
• painless not associated with facial
asymmetry a most often in young males age
onset is around puberty | CORONOID HYPERPLASIA |
| HISTOPATHOLOGIC FEATURES
• bilateral – consists of mature hyperplastic
bone. | CORONOID HYPERPLASIA |
| RADIOGRAPHIC FEATURES
• Unilateral type – results in misshapen or
mushroom shaped coronoid process on
radiographs. | CORONOID HYPERPLASIA |
| DIFFERENTIAL DIAGNOSIS: osseous and
chondroid neoplasm | CORONOID HYPERPLASIA |
| TREATMENT: surgical excision
PROGNOSIS: recurrence is rare | CORONOID HYPERPLASIA |
| Swelling and localize pain | OSTEOSARCOMA |
| Loosening and displacement of teeth | OSTEOSARCOMA |
| Mandibular paresthesia – inferior alveolar
nerve involved | OSTEOSARCOMA |
| Swelling and localized pain; Maxillary
paresthesia – infraorbital nerve, epistaxis,
nasal obstruction, or eye problem | OSTEOSARCOMA |
| Radiographic features
o Variable, depending on degree of
calcification | OSTEOSARCOMA |
| Sarcomatous stroma directly producing tumor
osteoid | OSTEOSARCOMA |
| Differential diagnosis
1. Scleroderma – widening of periodontal ligament
space
2. Chronic osteomyelitis, other malignancies,
several
neoplasms-moth
benign
radiographic appearance
3. Pindborg tumor and metastatic carcinomas –
sclerotic radiographic appearance
4. Chondrosarcoma, fibrosarcoma of bone,
aneurysmal bone cyst or giant cell tumor | OSTEOSARCOMA |
| Variable histologic patterns
o Osteoblastic
o Chondroblastic – most common the jaws
o Fibroblastic
o Telangiectatic – multiple aneurysmal blood
filled spaces lined by malignant cells | OSTEOSARCOMA |
| Treatment
1. Radical mandibulectomy or maxillectomy
2. Radiotherapy
and
chemotherapy
eaten
for
recurrences, soft tissue extension, metastatic
disease
3. Presurgical insertion of radium needles for
mandibular osteosarcoma – 76% 5-year-survival
rate | OSTEOSARCOMA |
| Prognosis
1. Overall, 5 year survival rate for 35 to 40% of jaw
osteosarcoma
2. Mandibular tumor better then maxillary tumors
3. Rarely metastasize to lymph nodes
4. Most common sites of metastasis – lung and
brain; 6 months survival rate
5. Local recurrences – surgical excision and
chemotherapy | OSTEOSARCOMA |
| Female predominance | PAROSTEAL OSTEOSARCOMA |
| Most commonly involves distal femoral
metaphysic | PAROSTEAL OSTEOSARCOMA |
| Slow-growing swelling or palpable mass, dull
aching sensation | PAROSTEAL OSTEOSARCOMA |
| Periphery is ossified than the base, may have
lobulated cartilaginous cap or may be irregular
because extensions into soft tissue | PAROSTEAL OSTEOSARCOMA |
| RS
Radiodense and attached to the external surface
of the bone by broad sessile base | PAROSTEAL OSTEOSARCOMA |
| Histopathologic Features
Well-differentiated has spindle shape stroma
with minimal atypia and rare mitotic figures
separating irregular trabeculae of woven bone
having foci of osteoid and cartilage | PAROSTEAL OSTEOSARCOMA |
| Histopathologic Features
Periphery is ossified than the base, may have
lobulated cartilaginous cap or may be irregular
because extensions into soft tissue | PAROSTEAL OSTEOSARCOMA |
| Differential diagnosis
Osteoma, osteochondroma, heterotropic
ossification and myositis ossificans | PAROSTEAL OSTEOSARCOMA |
| Treatment
En bloc resection
Prognosis
Significant local recurrence underlying cortical
bone | PAROSTEAL OSTEOSARCOMA |
| Common location – upper tibial metaphysis | PERIOSTEAL OSTEOSARCOMA |
| Rarely seen in jaw | PERIOSTEAL OSTEOSARCOMA |
| RF
Cortex of involved bone radiographically intact
and sometimes thickened, with no tumor
involvement of the underlying marrow cavity | PERIOSTEAL OSTEOSARCOMA |
| HS
Lobules of poorly differentiated malignant
cartilage with central ossification, minimal tumor
infiltration into cortical bone without medullary
involvement | PERIOSTEAL OSTEOSARCOMA |
| Differential diagnosis
Chondroblastic intramedullary osteosarcoma | PERIOSTEAL OSTEOSARCOMA |
| Pain, visual disturbances, nasal signs and
headaches may result from extension of
chondrosarcomas from jaw bones to contiguous
structures | CHONDROSARCOMA |
| Mandibular area (40%) – premolar, molar,
symphysis, coronoid and condylar process | CHONDROSARCOMA |
| Adulthood and old age | CHONDROSARCOMA |
| Painless swelling and expansion of affected
bones | CHONDROSARCOMA |
| Loosening of teeth or ill fitting dentures | CHONDROSARCOMA |
| Radiographic features
Variable
Moth – eaten radiolucency | CHONDROSARCOMA |
| Diffusely opaque lesions, unilocular or
multilocular | CHONDROSARCOMA |
| May contain mottle densities – areas of
calcification | CHONDROSARCOMA |
| Histopathologic features
Variable, see grading | CHONDROSARCOMA |
| Differential diagnosis
Chondroblastic type of osteosarcoma
Cartilaginous tumors of bone
Synovial chondromatosis involving tmj | CHONDROSARCOMA |
| Pain and swelling, mucosal ulcers | EWING’S SARCOMA |
| Facial deformity, destruction of alveolar bone
with loosening of teeth | EWING’S SARCOMA |
| Histopathologic Features
Proliferation of uniform, closely packed cells that
may be compartmentalized by fibrous bands | EWING’S SARCOMA |
| Round to oval nuclei have finely dispersed
chromatin inconspicuous nucleoli | EWING’S SARCOMA |
| Cytoplasm has glycogen – stains with Schiff stain | EWING’S SARCOMA |
| Radiographic features
Non-specific
May simulate infectious process as well as
malignant process | EWING’S SARCOMA |
| Moth eaten destructive radiolucency medullar
and erosion of cortex with expansion | EWING’S SARCOMA |
| Differential diagnosis
Lymphoma/leukemia
Metastatic carcinoma
Metastatic neuroblastoma
Mesenchymal chondrosarcoma
Small cell osteosarcoma | EWING’S SARCOMA |
