Bone disease manifested in jaw l Oral radiology MCQs

 Disease of bone manifested in the jaw l Oral radiology MCQs for dental students 

Important points to remember in Bone disease manifested in jaw

1. Fibrous dysplasia: It is also known as leontiasis ossea. It can be monostotic fibrous dysplasia (only single bone is affected).
2. polyostotic fibrous dysplasia (multiple bones are affected), McCune–Albright syndrome (polyostotic form accompanied by cutaneous pigmentation, endocrine dysfunction)   
3. craniofacial fibrous dysplasia (bones of only craniofacial complex are affected). Polyostotic type shows cafe-au-lait spot.
4. Mazabraud syndrome: Occasional occurrence of multiple intramuscular soft-tissue myxomas may be the extraskeletal manifestation of polyostotic fibrous dysplasia.
5. Radiological features of fibrous dysplasia: Radiolucent pattern (ill-defined radiolucent pattern represents the early lesion of fibrous dysplasia), mixed stage (smoke screen pattern is the intermediate stage recognisable by its smoky, hazy or mottled radiolucent/radio-opaque pattern) and radio-opaque stage (there is complete radio-opacity of the lesion).
6. Periapical cemental dysplasia: It is also known as fibrocementoma. It is asymptomatic and discovered during routine radiographic examination. It is manifested in three different stages: radiolucent stage (there is well-defined radiolucent area present at the apex of mandibular anterior teeth), mixed stage (small radio-opacity occurs in the radiolucency) and radio-opaque stage (there is complete opacification of the lesion).
7. Focal cemento-osseous dysplasia: The only potential complication of the focal cemento-osseous dysplasia is infection. It has well-circumscribed radio-opacity with a narrow rim of decreased radiodensity and may have a radio-opaque edge.
8. Florid cemento-osseous dysplasia: A patient must manifest the typical changes in at least two quadrants for a clinicoradiographic diagnosis of florid cemento-osseous dysplasia to be made.
9. Ground-glass appearance: Radiographs usually display diffuse distribution of lobular, irregularly shaped radio-opacities throughout the alveolar process.
10. Familial gigantiform cementoma: These patients manifest multiquadrant involvement characterised by dense, lobular radio-opacities of the alveolar process virtually identical to those seen in florid cemento-osseous dysplasia.
11. Cemento-ossifying fibroma: A growing facial asymmetry (generally unpainful) can be caused due to bone’s cortical curvature. It is a mixed radiolucent/radio-opaque density with a pattern that depends on the amount and form of the manufactured calcified material. These neoplasms have propensity for osseous cortical expansion and encroachment on contiguous structures.
12. Peripheral ossifying fibroma: Reddish brown, firm, pedunculated or sessile masses at the site of trauma. Superficial erosion of the underlying bone on radiographs.
13. Juvenile ossifying fibroma: Slootweg et al. have separated the lesions into two distinct groups: juvenile ossifying fibroma (WHO type) and juvenile ossifying fibroma with psammoma-like ossicles. There is facial asymmetry and paraesthesia. The internal structure ranges from completely radiolucent to mix radiolucent/radio-opaque.
14. Mandibular canal may be displaced inferiorly.
15. Cherubism: The patient exhibits a progressive, painless, symmetric swelling of the jaws, producing the typical chubby face suggestive of a ‘cherub’. The internal structure shows fine, granular bone and wispy trabeculae forming a prominent multilocular pattern; expansile multilocular radiolucencies are present as well.
16. Paget disease: It is also known as osteitis deformans. Many patients suffer considerably from bone pain and deformity, and severe headache. Deformity of the long bones, broadening and flattening of the chest and spinal curvature may lead to the ‘simian appearance’ of the patient. Progressive and irregular overgrowth of the jawbones, especially maxilla, may occur and may lead to the facial appearance described as ‘leontiasis ossea’. Skull lesions begin in early stages as focal radiolucencies, so-called ‘osteitis circumscripta’, and later produce ‘cotton-wool’ appearance. Hypercementosis develops in a few or most of the teeth in the involved jaw.
17. Central giant-cell granuloma: Patient usually presents with an asymptomatic localised swelling with expansion of the cortical plates depending on the extent of bone involvement. The epicentre of multilocular radiolucency is usually anterior to the first molar, although large lesions can extend posterior to the first molar. Lesions can cross the midline in the mandible; the internal aspect has a multilocular appearance. Giant-cell granuloma often displaces and resorbs teeth.