Diseases of jaws and maxillary sinus

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Diseases of jaws and maxillary sinus

• Jan Laco, M.D., Ph.D.

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Diseases of jaws and maxillary sinus

• 1. Jaws
• 2. Temporomandibular joint
• 3. Maxillary sinus

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1. Diseases of jaws

• 1a. Genetic diseases
• 1b. Metabolic diseases
• 1c. Diseases of unknown origin
• 1d. Inflammations
• 1e. Cysts
• 1f. Tumors

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1a. Genetic diseases

• Osteogenesis imperfecta
• Achondroplasia
• Cleidocranial dysplasia
• Cherubism

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1a. Genetic diseases

• Osteogenesis imperfecta (brittle bone d.)
• AD inheritance
• defect of biosynthesis of collagen I
• thin bones without cortex - ? fragile
• ? multiple fractures ? dwarfism
• blue sclera deafness

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1a. Genetic diseases

• Achondroplasia
• most common genetic skeletal disease
• short-limbed dwarf with normal trunk and head
• failure of cartilage proliferation in epiphyses
• protrusive mandible ? malocclusion

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1a. Genetic diseases

• Cleidocranial dysplasia
• defective formation of clavicles
• retrusion of maxilla
• delayed eruption of permanent teeth

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1a. Genetic diseases

• Cherubism
• AD inheritance, ? boys
• painless symmetrical swelling of mandible angle
• at 2-4 years
• rapid growth until puberty ? regression
• Mi fibrous tissue haemorrhage multinucleated
  giant cells woven bone

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1. Diseases of jaws

• 1a. Genetic diseases
• 1b. Metabolic diseases
• 1c. Diseases of unknown origin
• 1d. Inflammations
• 1e. Cysts
• 1f. Tumors

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1b. Metabolic diseases

• Rickets
• vitamin D deficiency during bone development
• infancy
• wide fontanels bossing of frontal and parietal
  eminences
• Gigantism and acromegaly
• ? mandibular condyle ? prognathism
• macroglossia

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1. Diseases of jaws

• 1a. Genetic diseases
• 1b. Metabolic diseases
• 1c. Diseases of unknown origin
• 1d. Inflammations
• 1e. Cysts
• 1f. Tumors

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1c. Diseases of unknown origin

• Pagets disease of bone
• Fibro-osseous lesions

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1c. Diseases of unknown origin

• Pagets disease of bone (osteitis deformans)
• past middle age
• common RTG finding x clinically silent
• ? ethiology (viral)
• axial skeleton
• skull vault maxilla
• symmetric enlargement of alveolar processes
  fusion of teeth to sclerotic bone ? difficult
  extraction

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1c. Diseases of unknown origin

• Pagets disease of bone (osteitis deformans)
• resorption (osteoclasts) ? irregular new bone
  formation (osteoblats)
• Mi irregular mosaic bone trabeculae
• ? osteoblasts and osteoclasts vascularity
• result thick spongy bone marrow fibrosis
• complication osteosarcoma (rare)

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1c. Diseases of unknown origin

• Fibro-osseous lesions
• Fibrous dysplasia
• monostotic
• polyostotic
• Cemento-osseous dysplasia
• periapical cemental dysplasia
• focal cemento-osseous dysplasia
• florid cemento-osseous dysplasia

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1c. Diseases of unknown origin

• Monostotic fibrous dysplasia
• painless, poorly circumscribed bone swelling
• in childhood
• self-limiting
• F M ... 11
• ? maxilla ? malocclusion

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1c. Diseases of unknown origin

• Polyostotic fibrous dysplasia
• several bones
• F M 31
• Albrights syndrome skin pigmentation
  sexual precocity
• Mi fibrous tissue woven bone trabeculae
  without osteoblasts lining

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1c. Diseases of unknown origin

• Cemento-osseous dysplasia
• of periodontal ligament origin, same process
• periapical cemental dysplasia
• F M 10 1
• asymptomatic lesion
• lower I

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1c. Diseases of unknown origin

• florid cemento-osseous dysplasia (gigantiform
  cementoma)
• florid form of PCD
• symmetric lesions in all quadrants
• focal cemento-osseous dysplasia
• Mi cellular fibrous tissue cementum-like
  tissue ? calcification

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1. Diseases of jaws

• 1a. Genetic diseases
• 1b. Metabolic diseases
• 1c. Diseases of unknown origin
• 1d. Inflammations
• 1e. Cysts
• 1f. Tumors

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1d. Inflammations

• acute osteomyelitis
• chronic osteomyelitis
• alveolar osteitis

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1d. Inflammations

• Acute osteomyelitis
• sources periapical infection, open fractures
• oral anaerobes, mixed infection
• adult males
• mandible
• clinically severe deep-seating pain, swelling,
  teeth tenderness, regional lymphadenopathy
• fever leucocytosis

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1d. Inflammations

• Acute osteomyelitis
• suppurative inflammation in marrow spaces ?
  compression of blood vessels ? bone necrosis ?
  sequestrum
• ? subperiostal area ? perforation ? fistulas to
  skin and oral mucosa
• complications fracture
• ? chronic osteomyelitis

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1d. Inflammations

• Chronic osteomyelitis
• de novo x low-grade infection
• Chronic focal sclerosing OM
• young people with carious lower 1. M
• Diffuse sclerosing OM
• old people, superinfection of florid COD

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1d. Inflammations

• Chronic osteomyelitis with productive periostitis
  (Garrés OM)
• young people, lower 1. M
• ? reactive new bone formation

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1d. Inflammations

• Alveolar osteitis (dry socket)
• sources excessive extraction trauma, low blood
  supply
• after extraction of 3. M
• ? females
• destruction of clot by fibrinolytic enzymes
  infection and food in contact with bone ?
  necrosis ? granulation tissue

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1. Diseases of jaws

• 1a. Genetic diseases
• 1b. Metabolic diseases
• 1c. Diseases of unknown origin
• 1d. Inflammations
• 1e. Cysts
• 1f. Tumors

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1e. Cysts

• Odontogenic
• Non-odontogenic
• Pseudocysts
• Solitary bone cyst
• Aneurysmal bone cyst

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1e. Pseudocysts

• Solitary bone cyst (simple, traumatic)
• ? ethiology
• F M 3 2
• lt 25 years
• painless swelling of mandible
• RTG cavity expands between teeth roots
• Mi NO epithelial lining wall fibrous tissue

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1e. Pseudocysts

• Aneurysmal bone cyst
• rare in jaws
• between 10 20 years
• painless swelling of mandible
• Mi many blood-filled spaces without lining
  wall fibrous tissue

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1. Diseases of jaws

• 1a. Genetic diseases
• 1b. Metabolic diseases
• 1c. Diseases of unknown origin
• 1d. Inflammations
• 1e. Cysts
• 1f. Tumors

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1f. Tumors

• Odontogenic
• Non-odontogenic

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Non-odontogenic tumors

• Primary benign x malignant
• bone
• cartilage
• other
• Secondary metastases

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Non-odontogenic tumors

• Benign primary tumors
• osteoma
• osteochondroma
• central giant cell granuloma
• cemento-ossifying fibroma - rare
• haemangioma - rare

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Non-odontogenic tumors

• Osteoma x Exostosis
• torus palatinus posterior midline of hard palate
• torus mandibularis lingual aspect of mandible
  opposite to mental foramne, bilateral
• hard swelling
• Mi compact or cancellous bone
• Gardners syndrome - AD inheritance
• multiple osteomas polyposis coli ? malignancy

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Non-odontogenic tumors

• Osteochondroma
• cartilage-capped osteoma
• hard bony protuberance
• coronoid or condylar procces
• joint dysfunction

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Non-odontogenic tumors

• Giant cell granuloma
• hyperplastic lesion, developmental ???
• lt 20 years
• F M 2 1
• anterior mandible
• RTG rounded cyst-like area
• Mi vascular fibrous tissue giant cells
  bleeding hemosiderin
• recurrency after incomplete removal

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Non-odontogenic tumors

• Osteosarcoma
• ? malignant, ? common primary non-od. neoplasm
• irradiation, Pagets disease
• 30 - 40 years, males
• body of mandible
• irregular firm swelling ? painfull
• Mi osteoid formation atypical osteoblasts
  cartilage fibrous tissue

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Non-odontogenic tumors

• Osteosarcoma
• rapid local growth early metastases (lungs)
• 50 recurrency in 1st year
• 5-year survival 40 (? 5 cm)

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Non-odontogenic tumors

• Chondrosarcoma
• 45 years
• anterior maxilla
• painfull irregular swelling
• Mi cartilage tissue with pleomorphic,
  binucleated chondrocytes mitoses
• locally aggressive metastases (lungs)

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Non-odontogenic tumors

• Rare tumors
• Ewings sarcoma
• Multiple myeloma
• Langerhanscell histiocytosis

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Non-odontogenic tumors

• Secondary tumors haematogenous metastases
• breast
• lungs
• prostate
• thyroid
• kidney

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Diseases of jaws and maxillary sinus

• 1. Jaws
• 2. Temporomandibular joint
• 3. Maxillary sinus

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2. Temporomandibular joint

• Trismus - inability to open mouth fully
• inflammation
• injuries
• tetanus
• Ankylosis - permanent limitation of movement
• fibrosis
• congenital
• trauma
• arthritis
• tumors

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2. Temporomandibular joint

• Osteoarthritis
• metabolic defect of art. cartilage - defective
• old people
• pain, minimal symptoms

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2. Temporomandibular joint

• Rheumatoid arthitis - multisystemic disease
• antibodies (rheumatoid factors)
• females, 25 - 45 years
• symmetrical involvement of smaller joints
• crepitation, little pain
• inflammation of synovia - granulation tissue
  (pannus)
• Osteochondroma
• Condylar hyperplasia

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Diseases of jaws and maxillary sinus

• 1. Jaws
• 2. Temporomandibular joint
• 3. Maxillary sinus

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3. Maxillary sinus

• Inflammation - sinusitis
• acute x chronic x hypersensitive
• rhinogenic x odontogenic
• periapical inflammation of P or M
• long oro-antral communication
• pain percussion sensitivity

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3. Maxillary sinus

• Inflammation
• Mi respiratory epithelium ? squamous
  metaplasia
• thickened basal membrane
• infiltrate - acute - neutrophils
• - chronic - lymphocytes plasma
  cells
• - hypersensitive - eosinophils

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3. Maxillary sinus

• Oro-antral communication
• after extraction of P or M
• nose-blowing test
• root or tooth in sinus
• prolaps of antral mucosa

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3. Maxillary sinus

• Antral cysts
• from mucous glands
• asymptomatic
• disappear spontaneously
• odontogenic cysts
• radicular, residual

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3. Maxillary sinus

• Tumors
• squamous cell carcioma
• males gt 50 years
• advanced stage local spread
• nose obstruction, nose bleeding
• paresthesia of infraorbital nerve
• visual disturbances
• poor prognosis