NEET MDS Lessons
Oral Pathology
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Bull Neck: Seen in Diphtheria and Ludwig's Angina.
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Bull's Eye Lesion / Target Lesions: Characteristic of Stevens-Johnson Syndrome and Erythema Multiforme.
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Bull's Teeth: Refers to Taurodontism.
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Circus Rubber Man: Clinical appearance associated with Ehlers-Danlos Syndrome (due to hypermobility and skin elasticity).
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Claw Hands: A physical deformity seen in advanced Scleroderma.
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Coup de Sabre: A linear depression or groove resembling a "saber cut" seen in Facial Hemiatrophy (Parry-Romberg Syndrome) and localized Scleroderma (linear scleroderma).
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CREST Syndrome: A limited form of Scleroderma, characterized by:
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Calcinosis
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Raynaud's phenomenon
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Esophageal dysfunction
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Sclerodactyly
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Telangiectasias
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Crowe's Sign: Axillary or inguinal freckling seen in Neurofibromatosis Type 1.
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Frog Facies: A characteristic facial appearance seen in Crouzon Syndrome (due to midfacial hypoplasia and exophthalmos).
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Gorlin Sign: The ability to touch the tip of the nose with the tongue, seen in Ehlers-Danlos Syndrome (due to increased joint laxity).
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Hockey Stick Deformity of Femur and Shepherd's Crook Sign: Radiographic findings typically associated with Fibrous Dysplasia.
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Parrot's Beak Nose: A nasal deformity seen in Crouzon Syndrome.
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Red Strawberry Tongue and Pastia's Lines: Clinical signs characteristic of Scarlet Fever.
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Rodent Facies: A facial appearance often associated with Thalassemia.
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Simian Stance: A stooped posture, reminiscent of an ape, seen in Paget's Disease of Bone.
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Snail Track Ulcers: Serpiginous, grayish-white lesions on mucous membranes, characteristic of Syphilis (mucous patches in secondary syphilis).
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Socks Feet and Mitten Hands: Refers to syndactyly (fusion of digits) appearing like a sock or mitten, seen in Apert's Syndrome.
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Parrot Beak Shaped Nails: A nail deformity (onychogryphosis) seen in Congenital Syphilis.
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Inverted Pear-shaped Radiolucency: Globulomaxillary cyst.
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Associated teeth need not be non-vital.
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Klestadts’s cyst: Soft tissue variant of Globulomaxillary cyst.
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Tear Drop-shaped Radiolucency: Lateral Periodontal Cyst.
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Associated teeth are vital.
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Cluster of Similar Cysts / Cluster of Grapes: Botryoid Odontogenic Cyst.
Garre’s Osteomyelitis (Chronic Osteomyelitis with Proliferative Perosteitis)
- Chronic Non Suppurative Sclerosing Osteitis/ Periostitis Ossificans.
- Non suppurative productive disease characterized by a hard swelling.
- Occurs due to low grade infection and irritation
- The infectious agent localizes in or beneath the periosteal covering of the cortex & spreads only slightly into the interior of the bone.
- Occurs primarily in young persons who possess great osteogenic activity of the periosteum.
Clinical Features
- Uncommonly encountered, described in tibia and in the head and neck region, in the mandible.
- Typically involves the posterior mandible & is usually unilateral.
- Patients present with an asymptomatic bony, hard swelling with normal appearing overlying skin and mucosa.
- On occasion slight tenderness may be noted
- pain is most constant feature
- The increase in the mass of bone may be due to mild toxic stimulation of periosteal osteoblasts by attenuated infection.
Radiographic features
- Laminations vary from 1 – 12 in number, radiolucent separations often are present between new bone and original cortex. (“onion skin appearance”)
- Trabeculae parallel to laminations may also be present.
Histologic Features
- Reactive new bone.
- Parallel rows of highly cellular & reactive woven bone in which the individual trabeculae are oriented perpendicular to surface.
- Osteoblasts predominate in this area.
D/D for Garre’s Osteomyelitis
- Ewing's sarcoma
- Caffey’s disease
- Fibrous dysplasia
- Osteosarcoma
Treatment
- Removal of the offending cause.
- Once inflammation resolves, layers of the bone consolidate in 6 – 12 months, as the overlying muscle helps to remodel.
- If no focus of infection evident, biopsy recommended.
| Syndrome | Confirmatory Sign |
|---|---|
| Trigeminal Neuralgia | Relief with carbamazepine |
| Eagle’s Syndrome | Relief after styloidectomy |
| Frey’s Syndrome | Positive Minor’s starch-iodine test (sweat mapping) |
| Ramsay Hunt Syndrome | Vesicular eruptions in ear/oral mucosa + facial palsy |
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Epithelial Plaques (localized thickenings): Found in:
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Lateral Periodontal Cyst
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Botryoid Odontogenic Cyst
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Gingival Cyst of Adults
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Glandular Odontogenic Cyst
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Most Common Benign Odontogenic Tumor: Odontoma (Ameloblastoma is second).
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Adenoid Cystic Carcinoma vs. Adenomatoid Odontogenic Tumor (AOT):
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Adenoid Cystic Carcinoma: Salivary gland malignancy.
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Adenomatoid Odontogenic Tumor (AOT): Benign odontogenic tumor. Do not confuse them.
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Liesegang Rings: Can be seen in CEOT/Pindborg's Tumor (primarily) and AOT (rarely).
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Amyloid-like Deposits: Characteristic feature of CEOT (Calcifying Epithelial Odontogenic Tumor).
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Duct-like Structures: Seen in AOT (Adenomatoid Odontogenic Tumor).
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Granular Cell Ameloblastoma: Granules are lysosomal aggregates.
Benign Lymphoepithelial Lesion / Mikulicz Syndrome
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Chronic enlargement of lacrimal and salivary glands
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Associated with Sjogren’s syndrome
Sialosis / Sialadenosis
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Non-inflammatory, non-neoplastic enlargement of salivary glands
Sialadenitis
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Inflammatory disease of salivary glands
Sialadenoma Papilliferum
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Papillomas of salivary gland excretory ducts
Atresia
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Congenital absence or occlusion of major salivary gland ducts
Sialorrhea
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Increased salivation
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Seen in conditions like Parkinson’s disease
Sialolithiasis
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Salivary duct stones in glands or ducts
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Common in submandibular gland
Sialodochitis
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Inflammation of salivary gland ducts