NEET MDS Lessons
Oral Pathology
Osteoradionecrosis
Clinical features
A reduction in vascularity, secondary to endarteritis obliterans, and damage to osteocytes as a consequence of ionising
Radiotherapy can result in radiation-associated osteomyelitis or Osteoradionecrosis. The mandible is much more commonly affected than the maxilla, because it is less vascular. Pain may be severe and there may be pyrexia. The overlying oral mucosa often appears pale because of radiation damage. Osteoradionecrosis in the jaws arises most often following radiotherapy for squamous cell carcinoma.
Scar tissue will also be present at the tumour site, often in close relation to the necrotic bone.
Radiology
Osteoradionecrosis appears as rarefying osteitis within which islands of opacity (sequestra) are seen. Pathological
fracture may be visible in the mandible.
Pathology
The affected bone shows features similar to those of chronic osteomyelitis. Grossly, the bone may be cavitated
And discoloured, with formation of sequestra.
Acute inflammatory infiltrate may be present on a background of chronic inflammation, characterized by formation
Of granulation tissue around the non-vital trabeculae.
Blood vessels show areas of endothelial denudation and obliteration of their lumina by fibrosis.
Small telangiectatic vessels lacking precapillary sphincters may be present.
Fibroblasts in the irradiated tissues lose the capacity to divide and often become binucleated and enlarged.
Management
Prevention of Osteoradionecrosis is vital. Patients who require radiotherapy for the management of head and
neck malignancy should ideally have teeth of doubtful prognosis extracted at least 6 weeks prior to treatment.
The dose of radiation,
The area of the mandible irradiated and
the surgical trauma involved in the dental extractions.
Surgical management of Osteoradionecrosis is similar to osteomyelitis.
| 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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Cheiloscopy: The examination of lip prints.
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Gustafson's Method for Age Estimation: Includes assessment of:
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Amount of occlusal attrition
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Secondary dentine deposition (coronal)
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Periodontal attachment loss
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Cementum apposition at root apex
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Root resorption at apex
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Dentine translucency
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Acute suppurative osteomyelitis
- Serious sequela of periapical infection.
- Leads to spread of pus through the medullary cavities of bone.
- Depending upon the main site of involvement of bone, can be of two types-
- Acute intramedullary
- Acute subperiosteal
Acute Intramedullary Osteomyelitis
CLINICAL FEATURES:
- Patient experiences dull , continuous pain , indurated swelling forms over the affected region of jaw involving the cheek , febrile.
- When mandible involved, loss of sensation occurs on lower lip on affected side due to involvement of inferior alveolar nerve.
- Teeth become loose later along with tender on percussion
- Pus discharge , trismus , foul smell , regional lymphadenopathy , weakness
RADIOGRAPHIC FEATURES
- Earliest radiographic change is that trabeculae in involved area are thin, of poor density & slightly blurred.
- Subsequently multiple radiolucencies appear which become apparent on radiograph.
- In some cases there is saucer shaped area of destruction with irregular margins.
- Loss of continuity of lamina dura, seen in more than one tooth.
HISTOLOGIC FEATURES:
- Dense infiltration of marrow by polymorphonuclear leukocytes.
- Bone trabeculae in involved site (sequestrum) are devoid of cells in the lacunae.
- separation of considerable portions of devitalized bone.
Acute Subperiosteal Osteomyelitis
CLINICAL FEATURES
- Pain , febrile condition , i/o and e/o swelling , parasthesia
- Bone involvement limited to localized areas of cortex.
- Pus ruptures rapidly through the overlying cortex, tracks along the surface of mandible under the periosteal sheath.
- Elevation of periosteum from cortex is followed eventually by minute cortical sequestration.
Leukoedema
- Diagnostic Feature: Lesions do not rub off; disappear when cheek is stretched
Heck's Disease (Focal Epithelial Hyperplasia)
- Appearance: Cobblestone mucosa
- Also Seen In: Pyostomatitis vegetans, Keratosis follicularis
Infectious Mononucleosis
- Nickname: Kissing disease
- Etiology: Epstein–Barr Virus (EBV)
|
Condition |
Key Features |
|
Paget's Disease |
- Denture tightening (arch expansion) |
|
Osteopetrosis |
- Rugger jersey spine |
|
Fibrous Dysplasia |
- Leontiasis ossea |
|
Cemento-Ossifying Fibroma |
- Leontiasis ossea |
|
Hyperparathyroidism |
- Ground glass appearance (Brown tumor) |
|
Cherubism |
- Giant cells + vascular stroma + hemosiderin |
|
Central Giant Cell Granuloma |
- Giant cells + vascular stroma + hemosiderin |
|
Juvenile Ossifying Fibroma |
- More aggressive than COF |
Mnemonics Flashcards
|
Mnemonic |
Meaning |
|
Paget's Patients Prefer Tight Dentures |
Paget's → Denture tightening due to arch expansion |
|
Fibrous Faces Feel Funny |
Fibrous dysplasia → Leontiasis ossea, Chinese script, Ground glass, Hockey stick femur |
|
Giant Cells Have Three Homes |
Seen in: Hyperparathyroidism, Cherubism, CGCG |
Benign Migratory Glossitis
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Also called Erythema migrans, wandering rash, or geographic tongue.
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Associated with fissured tongue.
Fissured Tongue
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Seen in:
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Melkersson-Rosenthal syndrome
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Down syndrome
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Benign migratory glossitis
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Melkersson-Rosenthal Syndrome
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Triad:
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Bell’s palsy
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Cheilitis granulomatosa (lip/facial swelling)
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Fissured tongue
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Ankyloglossia
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Tongue-tie may cause speech defects.
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Affects articulation of: l, r, t, d, n, th, sh, z