NEET MDS Lessons
Oral Pathology
Non-epithelial cysts (not true cysts)
Solitary bone cyst
Radiology
The solitary bone cyst appears as a well-defined but non-corticated radiolucency. Typically, it has little effect
on adjacent structures and 'arches' up between the roots of teeth .
The inferior dental canal may not be displaced, but the cortical margins of the canal may be lost where it overlies the lesion. Expansion is rare.
Pathology
The cyst is lined by fibrovascular tissue that often includes haemosiderin and multinucleate giant cells.
Aneurysmal bone cyst
Radiology
The aneurysmal bone cyst typically presents as a fairly well-defined radiolucency. Sometimes it has a multilocular appearance because of the occurrence of internal bony septa and opacification. Marked expansion is a feature.
Pathology
The predominant feature of an aneurysmal bone cyst is the presence of blood-filled spaces of variable size lying in a stroma rich in fibroblasts, multinucleate giant cells and haemosiderin. Deposits of osteoid are also seen
Osteomyelitis
Osteomyelitis is an extensive inflammation of a bone. It involves the cancellous portion, bone marrow, cortex, and periosteum
Conditions that alter HOST IMMUNITY
Leukemia, Severe anemia, Malnutrition, AIDS, IV- drug abuse, Chronic alcoholism, Febrile illnesses, Malignancy, Autoimmune disease, Diabetes mellitus, Arthritis, Agranulocytosis
Conditions that alter vascularity of bone
Osteoporosis, Paget’s disease, Fibrous dysplasia, Bone malignancy, Radiation, Virulence of the organisms
Certain organisms precipitate thrombi formation by virtue of their destructive lysosomal enzymes.
Organisms proliferate in enriched host medium while protected from host immunity.
Etiology
- Odontogenic infections
- Trauma
- Infections of oro facial region
- Infections derived from hematogenous route
- Compound fractures of the jaws.
PATHOGENESIS
DEV . OF INFECTION --> BACTERIAL INVASION --> PUS FORMATION --> SPREAD OF INFECTION --> INCREASED INTRAMEDULLARY PRESSURE , BLOOD FLOW , OSTEOCLASTIC ACTIVITY --> INFLAMMATORY RESPONSES --> INCREASED PERIOSTEAL PRESSURE --> PROCESS BECOMES CHRONIC GRANULATION TISSUE FORMATION --> LYSIS OF BONE --> SEQUESTRUM FORMATION
Classification
Classification based on clinical picture, radiology, and etiology
Suppurative osteomyelitis
I. Acute suppurative osteomyelitis
II. Chronic suppurative osteomyelitis
– Primary chronic suppurative osteomyelitis
– Secondary chronic suppurative osteomyelitis
III. Infantile osteomyelitis
Nonsuppurative osteomyelitis
I. Chronic sclerosing osteomyelitis
– Focal sclerosing osteomyelitis
– Diffuse sclerosing osteomyelitis
II. Garre's sclerosing osteomyelitis
III. Actinomycotic osteomyelitis
IV. Radiation osteomyelitis and necrosis