Bone Swellings

Bone Swellings

1. Developmental lesions

   • Torus palatinus
     • Bony hard swelling in palate
     • Often design denture around torus
     • May have surgical reduction to aid denture fit
   • Mandibular torii
     • Bony prominence in mandible (from lingual aspect)

2. Reactive lesions

   • Reactive exostosis
   • Cause = chronic trauma
   • Treatment = eliminate cause & remove surgically
   • Very hard, may have ulceration

3. Fibro-osseous lesions

   • Pathologic term for group of intra-osseous lesions
   • Fibroblastic background with bone formation (irregular trabeculae arrangement)
   • Histopathology of all are indistinguishable
   • Fibrous dysplasia
     • Painless bone expansions
     • Children
     • Slow growth
       • Usually stops when child stops growing
     • No tooth displacement
     • No systemic abnormality
     • Radiographically
       • Lesion merges into normal bone
       • Begins radiolucent -> ossifies over time -> radiopaque
     • Forms
       • Monostotic (solitary)
       • Multiple (cranio-facial)
       • Polyostotic = McCune-Albright syndrome
     • Management
       • Wait until growth stops (18yrs)
       • Jaw recontoured (lesion not removed)
   • Ossifying fibroma
   • Cemento-osseous dysplasia
     • Female, Asian/Black
     • Radiographically
       • Radiolucent -> ossify over time -> Radiopaque
       • Usually mandible & above IAN canal
     • Teeth vital
     • Types
       • Localised = periapical
       • Generalised = florid
     • Treatment = leave & monitor
   • Cherubism
     • Radiographically
       • Bilateral, multilocular radioluncencies
       • Buccal expansion
     • Facial deformity
       • 'chubby face'
     • Treatment
       • Facial recontour when stopped growing (18yrs)
     • Exclude hyperparathyroidism

4. Neoplasms

   • Benign
     • Ossifying fibroma
       • Rare
       • Slow growing
       • Radiographically
         • More defined outline (circumscribed)
         • Mixed radiopaque centre with radiolucent outline
       • Treatment = surgical removal with small margin
     • Osteoma
       • Radiographically
         • Well-circumscribed outline
         • Radiopaque
       • Histologically
         • Cancellous
         • Compact
       • Clinical types
         • Solitary
         • Multiple
           • Gardner syndrome
             • Multiple odontomes
             • Multiple intestinal polyps
               • High malignant potential
             • APC gene mutation
       • Maxilla, mandible, sinuses
       • Treatment = surgical removal
   • Malignant
     • 3) Marrow neoplasms
       • Ewing's tumour = primary bone marrow tumour
       • Myeloma, lymphoma
     • 1) Metastatic bone tumour
       • Most common
       • Neurological sign e.g. numb lip
       • From e.g. breast, lung, prostate
     • 4) Primary bone tumour
       • Osteosarcoma
         • Malignant osteoblasts depositing malignant bone
         • Central or juxtacortical (most common)
         • Radiograph
           • Sun ray spicule on CT scan
         • 8-15yrs or >50yrs
       • Chrondosarcoma, Mesenchymal chondrosarcoma
     • 2) SCC (spread to bone)