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Diseases of jaws and maxillary sinus

Diseases of jaws and maxillary sinus. Jan Laco, M.D., Ph.D. Diseases of jaws and maxillary sinus. 1. Jaws 2. Temporomandibular joint 3. Maxillary sinus. 1. Diseases of jaws. 1a. Genetic diseases 1b. Metabolic diseases 1c. Diseases of unknown origin 1d. Inflammations 1e. Cysts

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Diseases of jaws and maxillary sinus

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  1. Diseases of jaws and maxillary sinus Jan Laco, M.D., Ph.D.

  2. Diseases of jaws and maxillary sinus • 1. Jaws • 2. Temporomandibular joint • 3. Maxillary sinus

  3. 1. Diseases of jaws • 1a. Genetic diseases • 1b. Metabolic diseases • 1c. Diseases of unknown origin • 1d. Inflammations • 1e. Cysts • 1f. Tumors

  4. 1a. Genetic diseases • Osteogenesis imperfecta • Achondroplasia • Cleidocranial dysplasia • Cherubism

  5. 1a. Genetic diseases • Osteogenesis imperfecta (brittle bone d.) • AD inheritance • defect of biosynthesis of collagen I • thin bones without cortex -  fragile •  multiple fractures  dwarfism • + blue sclera + deafness

  6. 1a. Genetic diseases • Achondroplasia • most common genetic skeletal disease • short-limbed dwarf with normal trunk and head • failure of cartilage proliferation in epiphyses • protrusive mandible  malocclusion

  7. 1a. Genetic diseases • Cleidocranial dysplasia • defective formation of clavicles • retrusion of maxilla • delayed eruption of permanent teeth

  8. 1a. Genetic diseases • Cherubism • AD inheritance,  boys • painless symmetrical swelling of mandible angle • at 2-4 years • rapid growth until puberty  regression • Mi: fibrous tissue + haemorrhage + multinucleated giant cells + woven bone

  9. 1. Diseases of jaws • 1a. Genetic diseases • 1b. Metabolic diseases • 1c. Diseases of unknown origin • 1d. Inflammations • 1e. Cysts • 1f. Tumors

  10. 1b. Metabolic diseases • Rickets • vitamin D deficiency during bone development • infancy • wide fontanels + bossing of frontal and parietal eminences • Gigantism and acromegaly •  mandibular condyle  prognathism • + macroglossia

  11. 1. Diseases of jaws • 1a. Genetic diseases • 1b. Metabolic diseases • 1c. Diseases of unknown origin • 1d. Inflammations • 1e. Cysts • 1f. Tumors

  12. 1c. Diseases of unknown origin • Paget´s disease of bone • Fibro-osseous lesions

  13. 1c. Diseases of unknown origin • Paget´s disease of bone (osteitis deformans) • past middle age • common RTG finding x clinically silent • ? ethiology (viral) • axial skeleton • skull – vault + maxilla • symmetric enlargement of alveolar processes + fusion of teeth to sclerotic bone  difficult extraction

  14. 1c. Diseases of unknown origin • Paget´s disease of bone(osteitis deformans) • resorption (osteoclasts)  irregular new bone formation (osteoblats) • Mi: irregular mosaic bone trabeculae +  osteoblasts and osteoclasts + vascularity • result: thick spongy bone + marrow fibrosis • complication: osteosarcoma (rare)

  15. 1c. Diseases of unknown origin • Fibro-osseous lesions • Fibrous dysplasia • monostotic • polyostotic • Cemento-osseous dysplasia • periapical cemental dysplasia • focal cemento-osseous dysplasia • florid cemento-osseous dysplasia

  16. 1c. Diseases of unknown origin • Monostotic fibrous dysplasia • painless, poorly circumscribed bone swelling • in childhood • self-limiting • F : M ... 1:1 •  maxilla  malocclusion

  17. 1c. Diseases of unknown origin • Polyostotic fibrous dysplasia • several bones • F : M … 3:1 • Albright´s syndrome: + skin pigmentation + sexual precocity • Mi: fibrous tissue + woven bone trabeculae without osteoblasts lining

  18. 1c. Diseases of unknown origin • Cemento-osseous dysplasia • of periodontal ligament origin, same process • periapical cemental dysplasia • F : M … 10 : 1 • asymptomatic lesion • lower I

  19. 1c. Diseases of unknown origin • florid cemento-osseous dysplasia (gigantiform cementoma) • florid form of PCD • symmetric lesions in all quadrants • focal cemento-osseous dysplasia • Mi: cellular fibrous tissue + cementum-like tissue  calcification

  20. 1. Diseases of jaws • 1a. Genetic diseases • 1b. Metabolic diseases • 1c. Diseases of unknown origin • 1d. Inflammations • 1e. Cysts • 1f. Tumors

  21. 1d. Inflammations • acute osteomyelitis • chronic osteomyelitis • alveolar osteitis

  22. 1d. Inflammations • Acute osteomyelitis • sources – periapical infection, open fractures • oral anaerobes, mixed infection • adult males • mandible • clinically: severe deep-seating pain, swelling, teeth tenderness, regional lymphadenopathy • fever + leucocytosis

  23. 1d. Inflammations • Acute osteomyelitis • suppurative inflammation in marrow spaces  compression of blood vessels  bone necrosis  sequestrum •  subperiostal area  perforation  fistulas to skin and oral mucosa • complications: fracture  chronic osteomyelitis

  24. 1d. Inflammations • Chronic osteomyelitis • de novo x low-grade infection • Chronic focal sclerosing OM • young people with carious lower 1. M • Diffuse sclerosing OM • old people, superinfection of florid COD

  25. 1d. Inflammations • Chronic osteomyelitis with productive periostitis (Garré´s OM) • young people, lower 1. M •  reactive new bone formation

  26. 1d. Inflammations • Alveolar osteitis (dry socket) • sources: excessive extraction trauma, low blood supply… • after extraction of 3. M •  females • destruction of clot by fibrinolytic enzymes – infection and food in contact with bone  necrosis  granulation tissue

  27. 1. Diseases of jaws • 1a. Genetic diseases • 1b. Metabolic diseases • 1c. Diseases of unknown origin • 1d. Inflammations • 1e. Cysts • 1f. Tumors

  28. 1e. Cysts • Odontogenic • Non-odontogenic • Pseudocysts • Solitary bone „cyst“ • Aneurysmal bone „cyst“

  29. 1e. Pseudocysts • Solitary bone „cyst“ (simple, traumatic) • ? ethiology • F : M … 3 : 2 • < 25 years • painless swelling of mandible • RTG: cavity expands between teeth roots • Mi: NO epithelial lining + wall: fibrous tissue

  30. 1e. Pseudocysts • Aneurysmal bone „cyst“ • rare in jaws • between 10 – 20 years • painless swelling of mandible • Mi: many blood-filled spaces without lining + wall: fibrous tissue

  31. 1. Diseases of jaws • 1a. Genetic diseases • 1b. Metabolic diseases • 1c. Diseases of unknown origin • 1d. Inflammations • 1e. Cysts • 1f. Tumors

  32. 1f. Tumors • Odontogenic • Non-odontogenic

  33. Non-odontogenic tumors • Primary: benign x malignant • bone • cartilage • other • Secondary: metastases

  34. Non-odontogenic tumors • Benign primary tumors • osteoma • osteochondroma • central giant cell granuloma • cemento-ossifying fibroma - rare • haemangioma - rare

  35. Non-odontogenic tumors • Osteoma x Exostosis • torus palatinus: posterior midline of hard palate • torus mandibularis: lingual aspect of mandible opposite to mental foramne, bilateral • hard swelling • Mi: compact or cancellous bone • Gardner´s syndrome - AD inheritance • multiple osteomas + polyposis coli  malignancy

  36. Non-odontogenic tumors • Osteochondroma • cartilage-capped osteoma • hard bony protuberance • coronoid or condylar procces • joint dysfunction

  37. Non-odontogenic tumors • Giant cell granuloma • hyperplastic lesion, developmental ??? • < 20 years • F : M … 2 : 1 • anterior mandible • RTG: rounded cyst-like area • Mi: vascular fibrous tissue + giant cells + bleeding + hemosiderin • recurrency after incomplete removal

  38. Non-odontogenic tumors • Osteosarcoma •  malignant,  common primary non-od. neoplasm • irradiation, Paget´s disease • 30 - 40 years, males • body of mandible • irregular firm swelling  painfull • Mi: osteoid formation + atypical osteoblasts + cartilage + fibrous tissue

  39. Non-odontogenic tumors • Osteosarcoma • rapid local growth + early metastases (lungs) • 50% recurrency in 1st year • 5-year survival: 40% ( 5 cm)

  40. Non-odontogenic tumors • Chondrosarcoma • 45 years • anterior maxilla • painfull irregular swelling • Mi: cartilage tissue with pleomorphic, binucleated chondrocytes + mitoses • locally aggressive + metastases (lungs)

  41. Non-odontogenic tumors • Rare tumors • Ewing´s sarcoma • Multiple myeloma • Langerhans´cell histiocytosis

  42. Non-odontogenic tumors • Secondary tumors – haematogenous metastases • breast • lungs • prostate • thyroid • kidney

  43. Diseases of jaws and maxillary sinus • 1. Jaws • 2. Temporomandibular joint • 3. Maxillary sinus

  44. 2. Temporomandibular joint • Trismus - inability to open mouth fully • inflammation • injuries • tetanus • Ankylosis - permanent limitation of movement • fibrosis • congenital • trauma • arthritis • tumors

  45. 2. Temporomandibular joint • Osteoarthritis • metabolic defect of art. cartilage - defective • old people • pain, minimal symptoms

  46. 2. Temporomandibular joint • Rheumatoid arthitis - multisystemic disease • antibodies (rheumatoid factors) • females, 25 - 45 years • symmetrical involvement of smaller joints • crepitation, little pain • inflammation of synovia - granulation tissue (pannus) • Osteochondroma • Condylar hyperplasia

  47. Diseases of jaws and maxillary sinus • 1. Jaws • 2. Temporomandibular joint • 3. Maxillary sinus

  48. 3. Maxillary sinus • Inflammation - sinusitis • acute x chronic x hypersensitive • rhinogenic x odontogenic • periapical inflammation of P or M • long oro-antral communication • pain + percussion sensitivity

  49. 3. Maxillary sinus • Inflammation • Mi: respiratory epithelium  squamous metaplasia thickened basal membrane infiltrate - acute - neutrophils - chronic - lymphocytes + plasma cells - hypersensitive - eosinophils

  50. 3. Maxillary sinus • Oro-antral communication • after extraction of P or M • nose-blowing test • root or tooth in sinus • prolaps of antral mucosa

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