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PART 2:

Florid osseous dysplasia.


Aneurysmal bone cyst.
Done By :
Amal A.Ameer
20102050076

FLORID OSSEOUS DYSPLASIA (FOD):

Synonyms:
Florid cemento-osseous dysplasia.
Gigantiform cementoma.
Familial multiple cementomas.

Disease mechanism:
Widespread form of POD.
Normal cancellous bone replaced with DENSE ,
ACELLULARE AMORPHOUS BONE.
POD 3 or 4 Quadrants FOD.

FOD:

Clinical features:
Female, middle-aged (42ys).
African Americans and Asians.
No symptoms (found incidentally during radiographic examination),
extensive lesions often associated with bony swelling.
Simple bone cyst development within the lesion may induce
low grade intermittent poorly localized pain

Secondarily infected lesions:


Mucosal ulceration.
Fistulous tract with suppuration.
Pain.

Imaging features:

LOCATION:

Bilateral
Mandible > maxilla.
Epicenter apical to the tooth.
Usually post. to cuspid teeth.
Above inferior alveolar canal.

PERIPHERY:
Well defined with sclerotic border.
Mature lesions ST capsule may not appear.

INTERNAL STRUCTURE:

Vary from equal mixture to almost complete radiopacity.


Small oval and circular (cotton wool appearance) to large
irregular amorphous area.
prominent radiolucency represent development of
simple bone cyst.

EFFECTS ON SURROUNDING :

Displace Inferior alveolar nerve canal inferiorly.


Displace the floor of the antrum superiorly.
Displace the buccal and lingual cortical plates (causing
alveolar bone enlargement).

Differential diagnosis:

Pagets disease (effect entire mandible, polyostotic, involving other


bones as well as the jaws).

Chronic sclerosing osteomyelitis.(region of cementum-like masses)

CT image is essential for diagnosis

Management:
No required treatment.
Encourage the patient to maintain an effective OH
program to avoid secondary (odontogenic) infection.
It may be necessary to remove large areas of infected
amorphous bone. (if osteomylitis)

ANEURYSMAL BONE CYST (ABC):

ANOSTEOLYTICBONENEOPLASMCHARACTERIZED BY SEVERAL SPONGE-LIKE


BLOOD OR SERUM FILLED, GENERALLY NON-ENDOTHELIALIZEDSPACES OF
VARIOUS DIAMETERS.

Disease mechanism:
Reactive bone lesion.
Chromosomal translocation that led to activation of USP6
gene on chromosome 17p13.
ABCs usually develop in association with other primary
lesions like:
fibrous dysplasia.
Central hemangioma.
Giant cell granuloma.
Osteosarcoma.

Clinical features:

90% <30 years old.


Females > Males.
Firm expansile swelling causing facial deformity .
Occasionally painful.
Involved areas tendered to palpation.

Imaging features:

LOCATION :
Mandible > Maxilla.
Usually posterior part of the body of the
mandible and the ramus region.
PERIPHERY AND SHAPE:
Usually well defined.
Circular or hydraulic.

INTERNAL STRUCTURE:
Uni or Multilocular radiolucency.
Ballooned out appearance.
Wispy faint septa.
Law attenuation region representing fluid
density.

EFFECT ON SURROUNDING STUCTURES:


Extreme expansion of the outer cortical plate.
Displace and resorb teeth.
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Differential diagnosis:

Giant cell granuloma.


Ameloblastoma.
Cherubism.
Diagnosis based on biopsy results.

Management:
Surgical curettage. (19-50% recurrent rate)
Partial resection. (11% RR)
Careful follow up.