Diseases of jaws and maxillary sinus

Jan Laco, M.D., Ph.D.

Diseases of jaws and maxillary sinus

1. Jaws
2. Temporomandibular joint 3. Maxillary sinus

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

1a. Genetic diseases

Osteogenesis imperfecta Achondroplasia Cleidocranial dysplasia Cherubism

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

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

1a. Genetic diseases

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

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

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

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

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

1c. Diseases of unknown origin

Pagets disease of bone
Fibro-osseous lesions

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

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)

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

1c. Diseases of unknown origin

Monostotic fibrous dysplasia
painless, poorly circumscribed bone swelling in childhood self-limiting F : M ... 1:1 maxilla malocclusion

1c. Diseases of unknown origin

Polyostotic fibrous dysplasia
several bones F : M 3:1 Albrights syndrome: + skin pigmentation + sexual precocity

Mi: fibrous tissue + woven bone trabeculae without osteoblasts lining

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

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

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

1d. Inflammations
acute osteomyelitis
chronic osteomyelitis alveolar osteitis

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

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

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

1d. Inflammations
Chronic osteomyelitis with productive periostitis (Garrs OM)
young people, lower 1. M reactive new bone formation

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

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

1e. Cysts
Odontogenic
Non-odontogenic Pseudocysts
Solitary bone cyst Aneurysmal bone cyst

1e. Pseudocysts
Solitary bone cyst (simple, traumatic)
? ethiology F:M3:2 < 25 years painless swelling of mandible RTG: cavity expands between teeth roots Mi: NO epithelial lining + wall: fibrous tissue

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

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

1f. Tumors
Odontogenic
Non-odontogenic

Non-odontogenic tumors
Primary: benign x malignant
bone cartilage other

Secondary: metastases

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

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

Non-odontogenic tumors
Osteochondroma
cartilage-capped osteoma hard bony protuberance coronoid or condylar procces joint dysfunction

Non-odontogenic tumors
Giant cell granuloma
hyperplastic lesion, developmental ??? < 20 years F:M2:1 anterior mandible RTG: rounded cyst-like area Mi: vascular fibrous tissue + giant cells + bleeding + hemosiderin recurrency after incomplete removal

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

Non-odontogenic tumors
Osteosarcoma
rapid local growth + early metastases (lungs) 50% recurrency in 1st year 5-year survival: 40% ( 5 cm)

Non-odontogenic tumors
Chondrosarcoma
45 years anterior maxilla painfull irregular swelling Mi: cartilage tissue with pleomorphic, binucleated chondrocytes + mitoses locally aggressive + metastases (lungs)

Non-odontogenic tumors
Rare tumors
Ewings sarcoma Multiple myeloma Langerhanscell histiocytosis

Non-odontogenic tumors
Secondary tumors haematogenous metastases
breast lungs prostate thyroid kidney

Diseases of jaws and maxillary sinus

1. Jaws
2. Temporomandibular joint 3. Maxillary sinus

2. Temporomandibular joint
Trismus - inability to open mouth fully
inflammation injuries tetanus

Ankylosis - permanent limitation of movement

fibrosis congenital trauma arthritis tumors

2. Temporomandibular joint
Osteoarthritis
metabolic defect of art. cartilage - defective old people pain, minimal symptoms

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

Diseases of jaws and maxillary sinus

1. Jaws
2. Temporomandibular joint 3. Maxillary sinus

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

3. Maxillary sinus
Inflammation
Mi: respiratory epithelium squamous metaplasia thickened basal membrane infiltrate - acute - neutrophils - chronic - lymphocytes + plasma cells - hypersensitive - eosinophils

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

3. Maxillary sinus
Antral cysts
from mucous glands asymptomatic disappear spontaneously odontogenic cysts radicular, residual

3. Maxillary sinus
Tumors
squamous cell carcioma males > 50 years advanced stage local spread nose obstruction, nose bleeding paresthesia of infraorbital nerve visual disturbances poor prognosis