• Bull Neck: Seen in Diphtheria and Ludwig's Angina.

• Bull's Eye Lesion / Target Lesions: Characteristic of Stevens-Johnson Syndrome and Erythema Multiforme.

• Bull's Teeth: Refers to Taurodontism.

• Circus Rubber Man: Clinical appearance associated with Ehlers-Danlos Syndrome (due to hypermobility and skin elasticity).

• Claw Hands: A physical deformity seen in advanced Scleroderma.

• Coup de Sabre: A linear depression or groove resembling a "saber cut" seen in Facial Hemiatrophy (Parry-Romberg Syndrome) and localized Scleroderma (linear scleroderma).

• CREST Syndrome: A limited form of Scleroderma, characterized by:

  • Calcinosis

  • Raynaud's phenomenon

  • Esophageal dysfunction

  • Sclerodactyly

  • Telangiectasias

• Crowe's Sign: Axillary or inguinal freckling seen in Neurofibromatosis Type 1.

• Frog Facies: A characteristic facial appearance seen in Crouzon Syndrome (due to midfacial hypoplasia and exophthalmos).

• Gorlin Sign: The ability to touch the tip of the nose with the tongue, seen in Ehlers-Danlos Syndrome (due to increased joint laxity).

• Hockey Stick Deformity of Femur and Shepherd's Crook Sign: Radiographic findings typically associated with Fibrous Dysplasia.

• Parrot's Beak Nose: A nasal deformity seen in Crouzon Syndrome.

• Red Strawberry Tongue and Pastia's Lines: Clinical signs characteristic of Scarlet Fever.

• Rodent Facies: A facial appearance often associated with Thalassemia.

• Simian Stance: A stooped posture, reminiscent of an ape, seen in Paget's Disease of Bone.

• Snail Track Ulcers: Serpiginous, grayish-white lesions on mucous membranes, characteristic of Syphilis (mucous patches in secondary syphilis).

• Socks Feet and Mitten Hands: Refers to syndactyly (fusion of digits) appearing like a sock or mitten, seen in Apert's Syndrome.

• Parrot Beak Shaped Nails: A nail deformity (onychogryphosis) seen in Congenital Syphilis.

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.

1. Zone 1 – Normal Dentin:
   Healthy tissue; no treatment needed

2. Zone 2 – Subtransparent Dentin:
   Acid-demineralized, no bacteria, remineralizable; preserve

3. Zone 3 – Transparent Dentin:
   Softened, no bacterial invasion; remineralizable; preserve

4. Zone 4 – Turbid Dentin:
   Bacterial invasion; not remineralizable; must be removed

5. Zone 5 – Infected Dentin:
   Fully decomposed; heavily infected; must be removed

Regional Odontodysplasia

• Key Feature: Widened pre-dentin layer
• Histology: Large areas of interglobular dentin

Supernumerary Roots

• Most Common: Mandibular canines and premolars

Congenitally Missing Teeth

Permanent Teeth (Descending Order):

1. Third molar
2. Mandibular 2nd premolar
3. Maxillary lateral incisor
4. Maxillary 2nd premolar

Deciduous Teeth: Maxillary and mandibular lateral incisors

• Inverted Pear-shaped Radiolucency: Globulomaxillary cyst.

  • Associated teeth need not be non-vital.

  • Klestadts’s cyst: Soft tissue variant of Globulomaxillary cyst.

• Tear Drop-shaped Radiolucency: Lateral Periodontal Cyst.

  • Associated teeth are vital.

• Cluster of Similar Cysts / Cluster of Grapes: Botryoid Odontogenic Cyst.

Paget's Disease

• Chief Complaint: Denture tightening (due to arch expansion)
• Fractures: Chalk-stick fractures
• Facial Feature: Leontiasis ossea (lion-like facies)
• Radiology: Cotton wool appearance
• Histology: Jigsaw puzzle pattern
• Clinical: Bone warm to touch (↑ vascularity)
• Laboratory: ↑ Alkaline phosphatase (>250 Bodansky units)
• Other Signs: Osteoporosis circumscripta, platybasia
• Memory Aid: "Paget's Patients Prefer Tight Dentures"

Osteopetrosis

• Radiographic Sign: Rugger Jersey Spine (classic)
• Fractures: Chalk-stick fractures

Fibrous Dysplasia

• Facial Feature: Leontiasis ossea
• Histology: Chinese script pattern
• Radiology:
  • Ground glass appearance
  • Rind sign, orange peel appearance
• Bone Deformity: Hockey stick/Shepherd's crook deformity (femur)
• Key Feature: Lesional bone fused with normal bone (vs COF)
• Memory Aid: "Fibrous Faces Feel Funny"

Cemento-Ossifying Fibroma (COF)

• Histology: Chinese script pattern
• Facial Feature: Leontiasis ossea
• Difference: NOT fused with normal bone (vs Fibrous Dysplasia)

Hyperparathyroidism

• Radiology: Ground glass appearance (brown tumor)
• Histology: Numerous giant cells, vascular stroma, hemosiderin deposits

Cherubism & Central Giant Cell Granuloma

• Histology: Same as hyperparathyroidism (giant cells + vascular stroma + hemosiderin)
• Note: Cherubism previously called "Familial fibrous dysplasia"
• Memory Aid: "Giant Cells Have Three Homes" (Hyperparathyroidism, Cherubism, CGCG)

Juvenile Ossifying Fibroma

• Aggressiveness: More aggressive than Cemento-ossifying fibroma
• Types:
  • Trabecular type: Common in jaws
  • Psammomatoid type: Involves base of skull