logging in or signing up fibro-osseous lesions of bones-FIBROUS DYSPLASIA khinsoe369 Download Post to : URL : Related Presentations : Let's Connect Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Copy embed code: Embed: Flash iPad Dynamic Copy Does not support media & animations Automatically changes to Flash or non-Flash embed WordPress Embed Customize Embed URL: Copy Thumbnail: Copy The presentation is successfully added In Your Favorites. Views: 1792 Category: Education License: All Rights Reserved Like it (0) Dislike it (0) Added: November 19, 2011 This Presentation is Public Favorites: 0 Presentation Description Clinical and microscopic features, management of fibrous dysplasia Comments Posting comment... Premium member Presentation Transcript FIBROUS DYSPLASIA: FIBROUS DYSPLASIA Dr Khin Soe B.D.S,M.D.Sc Assistant Lecturer, Department of Oral Medicine and Oral PathologyFibro-osseous lesions: Fibro-osseous lesions replacement of normal bone by cellular fibrous tissue within which varying amounts of predominantly woven bone and acellular islands of mineralized tissue developFibrous dysplasia: Fibrous dysplasiaPowerPoint Presentation: Benign fibro- osseous condition involving one or more bones of the cranial and extracranial skeleton, consists of non-encapsulated lesions which show replacement of normal bone by cellular fibrous tissues (Edwards 1984) Originally introduced by Lichtenstein in 1938 One of the most perplexing diseases of osseous tissues. A lesion of unknown aetiology, uncertain pathogenesis and diverse histopathologyFIBROUS DYSPLASIA: FIBROUS DYSPLASIAFibrous dysplasia: Fibrous dysplasia Non- neoplastic lesion of bone in which fibro-osseous lesions of bone replace the trabecular bone, altering its size and shapePowerPoint Presentation: Involving only one bone (A) Monostotic form Juvenile Adult (B) Polyostotic form (Involvement of two or more bones) Sub classified into (i) Jaffe-Lichtenstein syndrome - Bone involvement + café-au-lait pigmentation (ii) Mc Cune-Albright syndrome - Polyostotic F.D + café-au-lait pigmentation + multiple endocrinopathies such as sexual (precocity, pituitary adenoma; hyperthyroidism) (café-au-lait = coffee with milk; pale brown patches on the skin) (iii) Craniofacial form confined to bones of the craniofacial complex Clinical TypesFibrous dysplasia affecting the right side of mandible: Fibrous dysplasia affecting the right side of mandibleTypical buccal expansion: Typical buccal expansionSkin pigmentation in Albright’s syndrome: Skin pigmentation in Albright’s syndromePolyostotic form (i) Jaffe-Lichtenstein syndrome: Polyostotic form (i) Jaffe-Lichtenstein syndromeFIBROUS DYSPLASIA: FIBROUS DYSPLASIA(A) Monostotic Fibrous Dysplasia: (A) Monostotic Fibrous Dysplasia Less severe than polyostotic form AETIOLOGY Exact aetiology unknown Possible aetiologies (1) Aberrant actively in the forming mesenchymal tissues (2) Local infection (or) trauma (3) Reparative reaction on the part of the bone to any injuries (4) Autosomal recessive disorder Not related to polyostotic form (mostly accepted)PowerPoint Presentation: CLINICAL FEATURES More common in children and young adults Painless swelling (or) bulging of the jaw Buccal plate > Lingual plate Mandible → Protuberant excrescence of inferior border (abnormal outgrowth) → Due to progressive expansile nature → Tipping (or) displacement of teeth; malalignmentPowerPoint Presentation: Maxilla → Bulging of canine fossa (or) extreme prominence of zygomatic process causing marked facial deformity → Extension to maxillary sinus, zygomatic process, floor of the orbit and even towards base of the skull Mandible and maxilla → severe malocclusion (+)PowerPoint Presentation: Buccal expansion of maxillaFIBROUS DYSPLASIA: FIBROUS DYSPLASIAexpansive radiopacity in the left maxillary sinus in fibrous dysplasia: expansive radiopacity in the left maxillary sinus in fibrous dysplasiaWater’s view in same patient: Water’s view in same patientOrange peel appearance: Orange peel appearancePowerPoint Presentation: RADIOGRAPHIC FEATURES Three basic Patterns: Unilocular (or) multilocular radiolucency with well-circumscribed border containing bony trabeculae network Similar to (A) except ↑ ed trabeculation leading to more opaque and typically "mottled' appearance Area of reduced radiopacity with fine orange-peel (or) thumb-print (or) ground glass appearance with egg-shell thin cortex of expanded bone (not circumscribed and blends into adjacent normal bone)FIBROUS DYSPLASIA: FIBROUS DYSPLASIAPowerPoint Presentation: Key feature Margins merge imperceptibly with surrounding normal bone and that limits of lesions difficult to define Severe resorption of rootsPowerPoint Presentation: HISTOLOGICAL FEATURES Loose cellular fibrous connective tissues stroma with proliferating fibroblasts Scattered irregular slender trabeculae ( C-shaped or Chinese character-shaped ) Loose foci of giant cellsPowerPoint Presentation: TREATMENT AND PROGNOSIS Self-limiting Surgical removal → Conservative removal rather than radical approach (most of the cases) Not well-circumscribed lesions → Block resected if treated by radiation → Malignant transformation (+) (Osteosarcoma) (Mock and Rosen 1986)(B) Polyostotic Fibrous Dysplasia: (B) Polyostotic Fibrous Dysplasia Firstly recognized by Weil in 1922 and specifically described by Albright CLINICAL FEATURES ♀ > ♂ (3:1) 50% of the cases → head and neck involvement (+) Aching recurrent bone pain (+) Bones of face and skull involved → Facial asymmetry (+) Clavicles, pelvic bone, scapulae, long bones, meta carpals and meta tarsals (+)PowerPoint Presentation: Leg length discrepancy is very common as a result of involvement of upper portion of the femur ( Hockey stick deformity ) Skin (trunk and thighs) → Café-au-lait pigmentation (+) ♀ → precocious puberty (sometimes beginning at the age of 2 (or) 3 years (or) even younger and vaginal bleeding is common manifestation) Mandible > Maxilla Due to endocrine disturbance → Time of eruption altered Pituitary, thyroid, parathyroid and ovary → Disturbance (+)PowerPoint Presentation: RADIOGRAPHIC FEATURES Rarefication (decrease in density) of medullary portion of bone Irregular trabeculation with expanded, thin cortical boneLate stage of fibrous dysplasia: Late stage of fibrous dysplasiaPowerPoint Presentation: LABORATORY FINDING Moderately elevated BMR Premature secretion of pituitary FSH (Follicle Stimulating Hormone)PowerPoint Presentation: HISTOLOGY FEATURES Fibrous connective tissues stroma within which numerous trabeculae of woven bone Large multinucleated giant cellsFIBROUS DYSPLASIA: FIBROUS DYSPLASIAPowerPoint Presentation: TREATMENT AND PROGNOSIS Mild case → Surgery Prognosis → depend upon degree of involvement of skeleton Radiation → Subsequent development of radiation-included sarcoma [Craniofacial F.D (involvement of zygoma, sphenoid, occiput) → Long term follow up] Careful correlation between clinical, histopathological and radiographic features Rule out serum calcium, alkaline phosphatase and parathyroid hormonebehaviour: behaviour A few cases of malignant transformation of fibrous dysplasia have been reported, usually to fibrosarcoma , some of which have followed radiotherapy. However, the lesions of fibrous dysplasia are not radiosensitive and radiotherapy, which may increase the risk of malignant change, is not an acceptable treatment.PowerPoint Presentation: The majority of cases are treated by conservative surgical removal of sufficient of the lesion to reduce deformity. The lesions tend to expand mainly during the period of active skeletal growth and become quiescent in adult life.Key points - Fibrous dysplasia of the jaws: Key points - Fibrous dysplasia of the jaws · more common in maxilla than mandible · fusiform bony expansion; maxillary lesions also expand into sinus · radiographic features vary depending on amount of bone formed within lesionfusiform expansion: fusiform expansionPowerPoint Presentation: · margins of lesion merge with surrounding normal bone · delicate trabeculae of woven bone in cellular or collagenous fibrous tissue · expansion usually stops with skeletal maturation · remodelling of woven to lamellar bone may occur with increasing agePowerPoint Presentation: Thank you You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.