1. The document discusses the differential diagnosis of various fibro-osseous lesions and bone diseases that should be considered, including fibrous dysplasia, central giant cell granuloma, Paget's disease, and florid osseous dysplasia.
2. Key distinguishing radiographic features and clinical findings between these conditions are provided, such as location preferences in the jaw, age of presentation, laboratory findings, and presence of infection.
3. Differential diagnoses are narrowed by assessing factors like lesion borders, tooth displacement, serum markers, and patterns of bone involvement.
1. The document discusses the differential diagnosis of various fibro-osseous lesions and bone diseases that should be considered, including fibrous dysplasia, central giant cell granuloma, Paget's disease, and florid osseous dysplasia.
2. Key distinguishing radiographic features and clinical findings between these conditions are provided, such as location preferences in the jaw, age of presentation, laboratory findings, and presence of infection.
3. Differential diagnoses are narrowed by assessing factors like lesion borders, tooth displacement, serum markers, and patterns of bone involvement.
1. The document discusses the differential diagnosis of various fibro-osseous lesions and bone diseases that should be considered, including fibrous dysplasia, central giant cell granuloma, Paget's disease, and florid osseous dysplasia.
2. Key distinguishing radiographic features and clinical findings between these conditions are provided, such as location preferences in the jaw, age of presentation, laboratory findings, and presence of infection.
3. Differential diagnoses are narrowed by assessing factors like lesion borders, tooth displacement, serum markers, and patterns of bone involvement.
(INTERN) • Premordial cyst: It is associated with missing permanent tooth. • Ameloblastoma: It occurs in the posterior most part of the mandible. • Paget disease: Cotton wool appearance and enlargement of theaffected bone. • Condensing osteitis: It can be ruled out because it occurs at the periapex of the non vital tooth. It does not have radioluscent rim which is seen on the fibro-osseous lesion. DIFFERENTIAL DIAGNOSIS
• Ossifying fibroma: Juvenile ossifying fibromas occurs at far
lower mean age(8.5years) than the ossifying fibroma(26.4 yers). Ossifying fibroma contains lamellar bone and cementicles as well as smoothly contoured cells, poor curvilinear trabaculae features that are absent in the juvenile ossifying fibroma. FIBROUS DYSPLASIA • Traumatic bone cyst: There is no cortical bulging and displacement of teeth. • Dental cyst: It has a well defined cortex which is smooth while in fibrous dysplasia cortex tends to be wider and more granular. • Aneurysmal bone cyst: There is hemorrhagic aspirate. • Metastatic tumor: seen in older age groups and predilection for premolar & molar region of mandible. CENTRAL GIANT CELL GRANULOMA INTRODUCTION • Non-neoplastic bone disease. • Has been called as OSTEOCLASTOMA, MYELOIDSARCOMA,CHRONIC HEMORRHAGIC OSTEOMYELITIS initially but now a days , it is called as GIANT CELL GRANULOMA only.
1. Non-aggressive: It exhibits slow growing benign behaviour.
2. Aggressive: It shows typical features of rapidly growing destructive lesion. CLINICAL FEATURES • Age: Lesions of adolescent and young adults with 60% cases in in younger than 20 years & 74 % cases in younger that 30 years. • Sites: Mandible is twice frequently involved than maxilla, with anterior half showing greatest incidence with fairly high percentage crossing the symphysis. Commonest site in maxilla are canine fossa & ethmoid region & in mandible are anterior & bicuspid region. • Symptoms: Expansion of bone with premature loosening and shedding of deciduos tooth. Facial asymmetry & is usually painless. • Growth: slow. • Teeth: Become mobile. DIFFERENTIAL DIAGNOSIS • Ameloblastoma: Uncommon in younger age group, seen in posterior mandible in contrast to GCG, which occurs anterior to the first molar. • Aneurysmal bone cyst: It does not occur in the anterior segment of the mandible. • Odontogenic myxoma: Multiloculated, missing or impacted tooth is usually a finding. • Traumatic bone cyst: No bodily movement of the teeth is present, no expansion of overlying bone cortex. • Cherubism: It is bilateral in the posterior part of the mandible & there is the history of family involvement. It does not cross the midline. DIFFERENTIAL DIAGNOSIS • Fibrous dysplasia: Cherubism is bilateral. • Giant cell granuloma: It occurs frequently in the anterior segment of mandible in contrast to cherubic lesions which are seen in the posterior part of the mandible. • Central hemangioma: There is localised gingival bleeding. • Ameloblastoma: Seen unilaterally and frequently in the older age group. • Multiple dentigerous cyst: Impacted teeth present. • Giant cell lesions of the Hyperthyroidism: These are not bilateral & they can be differentiated on the abnormal blood chemistry levels. DIFFERENTIAL DIAGNOSIS EARLY STAGE RADIOLUSCENT APPEARANCE:
• Giant cell lesions of hyperparathyroidism: In Paget disease,
increase in the serum alkaline phosphatase only, whereas in these lesions, increase in the serum phosphatase & serum calcium levels with decrease in serum phosphate levels. • Osteomalacia: Pseudo-fractures are common in these cases. There is decrease in serum calcium and serum phosphorous levels whereas these are normal in paget’s disease. SECOND STAGE MIXED • Cementifying & ossifying fibroma: Predominantly seen in younger age group & they show well defined margins whereas in Paget’s disease there are diffuse margins. • Chronic osteomyelitis: It is rare in maxilla. • Chondroma: It produces pain which is not a feature of Paget’s disease. • Osteogenic sarcoma: It occurs in younger age group than Paget’s disease.
• Florid osseuos dysplasia: It is confined to jaw bone & hypercementosis is
present. • Osteosclerosis: Small & confined to jaw bone. DIFFERENTIAL DIAGNOSIS • Paget disease: No radioluscent capsule & increased serum alkaline phosphate levels. Paget disease affects entire mandible while the FCOD occur above the inferior alveolar canal. • Chronic sclerosing osteomyelitis: Signs of infection are present in the osteomyelitis. • Osteopetrosis: Profused thickening of the skull base & diffuse bony radio-opacities. It will cause the enlargement of the bone which is not the feature of FCOD.