Radiology Of Dysplastic Disease1

Radiology of dysplastic disease (RDD) ‫ في البدايه حكى عن‬, ‫ طالب‬34 ‫طبعا في البدايه الدكتور كان معصب عشان الحضور لن كان قليل جدا مايقارب‬ ‫ سؤال للدكتورة‬20 ‫ و‬cyst ‫ اسئلة من المتحاان وهم العن ال‬10 ‫المتحان وكان لدكتور عبدال هزاع‬ .  ‫واكيد لن المادة صغيرة راح ندور لكم اسئلة من بين السطور‬,‫غيدا‬ ‫عندكم مشكلة في سؤال‬ -which of flowing is mostly associated with pathological resorption of something َQ giant cell granuloma ‫ من الطلب جاوبو صح وكان الجواب‬%16 ‫هذا السؤال‬ ‫ من الطلب‬%29 ‫وسؤال ثاني الي جاوبو‬ Q-The radiolucncy indicted by arrow oropharyngeal airway ‫والجواب كان‬ ‫وهنا احد اسئلتي)الدكتور( الصعبة في المحان‬ Q- a developing tooth under goes cystic degeneration is …… Keratocyst 46 ‫والي مجاوبينو‬% Q- the most common site for primordial cyst are ‫ الجواب‬upper canine , premolar and molar Q- the squstreum more opaque than normal bone ‫ الجواب‬true ‫بس اغلب الطلب مجاوبين خطأ وانا واحد منهم لن في المحاضرة انذكر‬ More opaque than the surrounding inflamed bone ‫ لن‬, final ‫وانا اعرف انه المادة مش سهلة لنها تجمع باثو واناتومي وسيرجري ومديسن يعني انتبهو في ال‬ ‫انا في الميد جبت الكم في الجوبه اشياء ما اخذتوها واشوف بعضكم يحطها هي الجابه بس في الفاينل راح يكون‬ ‫ سؤال مستحيل‬50 ‫كل اشي داخل ومراح تكون السئلة مباشرة يعني ركزو منيح والمادة مش سهله راح يكون‬ . ‫تكون مباشرة‬ I write what the DR said only for more information u have to go back for slides on alyaqyn website

Today we are going to talk about RDD mainly Fibro osseous disease .

Fibrous Dysplasia Most common of fibrous lesion is Fibrous Dysplasia. seen in young patient . no sex predilection in general , can seen in male as well as in female.

Type of Fibrous Dysplasia  

Monostotic Fibrous Dysplasia (70%) Polyostotic Fibrous Dysplasia (30%)

We know in monostotic involve one bone only while in polytstotic involve more than one bone Monostotic Fibrous Dysplasia  involves one bone  no extraskeletal involvement, no skull involvement at all except ,periphery , skin pigmentation  most frequent sites: ribs, femur, tibia, maxilla, mandible

Fibrous Dysplasia in Jaws  

maxilla: mandible said to be 2:1 bone lesion growth usually ends with somatic growth

Polyostotic Fibrous Dysplasia  involves multiple bones  can be seen in skull as well as the other bone  most frequently involved bones: femur, skull, tibia  increased skin pigmentation (café-au-lait spots) What's important for us the skull and café spots on the skin more pronounce in polystotic than monostotic.  skin and bone lesions usually unilateral  may cause fractures and severe deformities  bone lesion growth usually ends with somatic growth Again more maxilla than mandible In the late stage leads to anosmia, deafness or blindness if not treated.

Now all the fibro osseous lesion have 3 stages 1-radiolucent stage 2-mix stage 3- radiopaque stage

Radiologic Features when we see radiopaque ‫ اما يكون‬ground glass or orange peel depend on type of radiograph , in the extra oral views we see ground glass while in the intra oral views we see orange peel . thumb print always similar to orange peel=== intra oral .  continuous with surrounding bone  situated within bone, not appositional  cortex thinned, displaced, but usually the outline continuous no distraction in lower border . so in the Fibro Dysplasia the clinical picture alone give us strong inductions , always an enlargement in bone on buccal direction causing deformation . now the DR show us on the slides how Fibro Dysplasia look like clinically and radio graphically. (now I don’t know what # of slide the DR talk about )but there is radiograph for Fibro Dysplasia look like ground glass, we said in the early stage the lesion is radiolucent , so difficult to differentiate the early stage unless you go for vitality test, Between the lateral and canine the pear shape globo maxillary cyst and now days we don’t call it globo maxillary cyst because it on of OKC . This is early stage we said what it look like (radiolucent ), in the 2nd stage when we see mix radiolucent area with radiopaque (slide 10, I guess) (Slide 11,) huge expansion bacclly while lingually we don’t see any changes at all. (Slide 13,I guess) This is the orange peel if u look be careful to the bone u can see the orange peel in the late stage ,‫ كمان شوي راح نشوف‬ground glass appearance trabeculation in the bone finer than this ‫يعني السواد يختفي تماما‬ .(Again we see thickening in the right maxillary sinus (slide 16 This how it looks in the PA skull (slide 17), where there's complete .obliteration of the maxillary sinuses This is the ground glass appearance. the trabeculation that we saw before completely disappeared, so its not shinny like the typical appearance for the ground glass should be but when you see a small thin spot within the

radiolucent area then that’s the ground glass appearance. (slide 24, I (!think it can also affect the maxilla and cause deformity in the maxilla. This is (another view to the same patient. (slides 21 and 22 Now we’re going to talk about the periapical cemento-dysplasia which the doctor thinks that all of us are familiar with. It’s mostly diagnosed at the age of 30 but it can be also be diagnosed earlier and also it can reach .up to 68 year old patients its mainly seen in females, doctor remembers coming across a clinical cause of a black female patient which was an indication, a black 37 year old female patient complaining of discomfortness in the lower anterior teeth came to our clinic, Radiographic examination showed a well defined radiolucent area associated with the lower anterior teeth so ?what’s you provisional diagnoses what’s your positive diagnoses Everyone thought that since it’s a well defined radiolucent area that that's a cyst or a periapical abscess while there's no history of restoration or caries. So that was their spot diagnoses according to the history and most !of your colleges missed this question Most of the time the lesion is associated with more than one tooth but it can be seen in a single tooth and the location mainly 91% in the mandible and usually in the anterior mandible. one or more teeth . The tooth may only be a remaining root or could be a whole tooth. it doesn’t cause resorption or displacement at all, the laminadura could be lost or intact .but mostly intact when it's lost it's lost only in the apical region only :As we said there are 3 stages .Radiolucent is stage 1 mixed is stage 2 and radio-opaque is stage 3 this is the typical radiographic appearance (slide 72) in the early stage it's radiolucent but it's not corticated so it's not a cyst unless the cyst is infected and if it's an abscess then the diameter should be more than 1 centemeter and the granuloma is more opaque than this so none of these .three is the case here If we don’t want to do a vitality test then based on the radiographic .appearance we go for periapical cemento-dysplasia This is in the mixed stage (slide 74) we start to see radio-opaque lesions in the radiolucent area later on it becomes totally opaque and there’s no resorption and the laminadura is still intact

Again this is another radiograph with mixed stage (slide 75) we said that it’s mostly in the anterior region but it could be in the posterior region in .the mandible as well (This radiograph is in the late stages. (slide 76 This is another radiograph (slide 77) you can see that part of the root is .still there The florid cement-osseous dysplasia is common at the age of 50 (in the slides it’s 38) but it can be up to 68 and it can be in 20 years old as well. More common in females and also it's more common in black patients so it's like in the periapical cemento-dysplasia female>male Black>white but in cemento-dysplasia it's either one tooth or a couple of teeth but here it involves at least two quadrants! So it's not about teeth here. it can be in both right and left sides of the mandible, it can be in the maxilla and mandible lateral right, left etc.. But it should always be in at least two quadrants it can be in all four quadrants! And that's the most :common case that we see. There’s three stages Stage one is Radiolucent, stage two is mixed radiolucent with radio.opaque and radio-opaque which is stage three This is the patches of florosis that we see here, bilateral in the mandible ((slide 81 And again this is another view in the mandible this is the lesion again ((slide 82 This is also in the maxilla, so four quadrants are involved (I couldn’t find (!the next slides And again in all four quadrants in the late stage In the PA, again bilateral And in the maxilla, in the occlussal radiograph usually in the premolars if we look carefully here we can see the florosis this is closest to the orange .peal appearance

Now we’re going to talk about :Paget’s disease paget’s disease it’s most commonly seen in central Europe then followed by UK, Australia, New-Zealand and less common in the US and .Scandinavia So in the clinic when we say Scandinavian it’s less common, it’s rarely found in those countries

But when we talk about English patients then it’s more common to have this disease It’s frequency in the US is 2.5 million cases but only 5% are serious enough to require treatment so that doesn’t mean that if a patient has paget’s disease that he’ll automatically require treatment so only small .percentage of the patients might require treatment Radio graphically we see the cotton-wool appearance which is specific for this disease. It doesn’t affect the sinus it stays in it’s original size and ,in the extra oral radiograph we see the ground glass appearance Also the orange peal appearance is seen in the intraoral radiograph like .the fibro-osseous Hyper-cementosis is common in paget’s disease so when we see hypercementosis in one of our patients it’s good to take a skull radiograph to .see if it’s paget’s disease Also periapical cemento-osseous dysplasia is common in this disease so it’s also good to take a skull radiograph usually we go for either PA or .lateral radiograph in order to see the skull In the early stage what we usually see is demineralization in the anterior and posterior parts of the skull so when we see a patient with hypercementosis we should look at the anterior and posterior parts of the skull and as soon as we see demineralization then we start suspecting paget’s .disease In the intermediate stage we see the driven snow appearance which is a (continuous thin radio-opaque line (slide 54 In this lateral skull radiograph we can see maxillary expansion and we start to see the cotton-wool calcification either in the anterior or posterior (region. (slide 57 This is a mixed radio-lucent with radio-opaque which we see in the (intermediate stage (slide 58 Here it affects the whole jaw so we can surly see this deformity clinically and when we take a radiograph we see that the expansion is in the right (maxilla. (slide 59 We can also see in the water’s view total obliteration in the sinuses that is .if it affected the sinuses The most important thing that the doctor wants us to know is the terms that we use to describe the radiographic appearance, like cotton wool, ..orange peal, driven snow etc .

Florosis can be seen in the late stage also hyper-cementosis is associated (with this disease as we can see. (slide 62 (Early stage of hyper-cementosis here in the central. (66 Here we see generalized hyper-cementosis involving all the teeth that we (can see in this panoramic radiograph. (I think slide 64 Also external root resorption is one of the features that are associated with this disease

Now we’re going to talk about

Cherubism As we said it’s a rare inherited disease limited to the jaws and it’s usually .seen in early childhood We see bilateral involvement in the mandible it could be unilateral but it’s not common it’s just written in the literature, the doctor never came .across a unilateral lesion Also we could see it in the maxilla but only following the mandible that means that it doesn’t start in the maxilla, it starts in the mandible then continues to the maxilla, so if we see this lesion in the maxilla we have to .look carefully at the mandible to locate this lesion It’s a cystic like lesion; it either looks like a well defined radiolucent area or a multilocular area which we will see next. And it usually appears in the ramus in the 3rd molar area it can also be in the sigmoid notch and the .condyle might be affected also We always see enlargement in the jaws and the cortex remains intact, total obliteration to the maxillary sinus and displacement of the .developing teeth as well as early loss of the deciduous teeth is common This is a radiograph that was confusing in the exam, there was a history of extraction and the same complain was in the other side and most of us answered ameloblastoma and forgot that it wasn’t included but the (correct answer was OKC. (slide 38 Always when we see a bilateral involvement we should suspect .cherubism (PA skull (slide 40 This is in the late stage (slide 41), multilocular, we see involvement of the .whole mandible

‫‪Differential diagnoses could be either bilateral dentigerous cyst or nevoid‬‬ ‫‪.basal cell carcinoma syndrome‬‬ ‫‪If there is more than one sign then it’s not OKC anymore then it becomes‬‬ ‫‪.a syndrome‬‬ ‫‪.The END‬‬

‫‪M-rsuh2‬‬ ‫بما انه هذي اخر محاضرة احب اوجه تحياتي لــ‬ ‫في البدايه ننننن )غلبتك كثير معاي ( وعوضي شكرا على الفلش )كلها فايرس (‬ ‫علي الثاني ‪,‬محمد شعبان ‪,‬حسين الشيخ‪ ,‬محسن‪ ,‬انور الشمري ‪ ,‬محمد الشمري ناصر العنزي‬ ‫‪,‬احمد الجهني ‪,‬محمد العنزي ‪,‬طلل ‪,‬ابو الوليد‪ ,‬عبدال القحطاني ‪,‬عبد الرحمن‪,‬صالح اليافعي‬ ‫‪,‬نعيم ‪,‬علي كاظم‪,‬انس ربحي ‪ ,‬منتصر ‪,‬زين العابدين‪ ,‬صالح القاضي ‪ ,‬عبد الرحمن‪,‬اوس‬ ‫الديناري‪,‬عمار ‪,‬هيثم ‪,‬شريف ‪ ,‬ادهم ‪ ,‬معاذ ‪ ,‬حلحولي ‪,‬خالد القصري ‪,‬اياس‪,‬باسل‪,‬امين‬ ‫رونالدينهو ‪,‬امين مدلج‪ ,‬مصطفى ‪ ,‬زين )الدكتور حسين الحيص ( ‪,‬روان ‪,‬اسراء ‪,‬سناء )شكرا‬ ‫على ‪ ,( RCT‬سكينة‪,‬داليا ‪,‬هدى ‪,‬هالة ‪,‬جمانه‪ :‬الصاحب وابو درويش وحسن ‪ ,‬شهد‪ ,‬فس فس ‪,‬‬ ‫ريهام‪,‬رونزا‪ ,‬ايمان الراس ‪.‬‬ ‫نبذة عامة عن الحساء‬ ‫السم الحساء وهو مدلول طبيعي حيث يجمع المؤرخون عل ان الحساء جمع )حسي( وهو‬ ‫الرض الصخريه المغطاة بطبقة رملية تختزن مياه المطار ‪.‬وتشتهر بالنخيل والزراعة‬ ‫بحيث يمكن الحصول عليها نقيه عذبه بحفر عنق بسيط جدًا ‪ .‬ولكثرة الحسية في هذا الموقع‬ ‫عرفت المنطقة بالحساء في سنة ‪ 314‬هـ‪ .‬أسست مدينة عرفت بالحساء ‪.‬‬ ‫وكانت تعرف في زمن سابق بأحساء بني سعد وكان لها تاريخ طويل إذ عرفت قبل ذلك باسم‬ ‫هجر والبحرين وقامت في ربوعها عدة حكومات وممالك ‪ .‬ومنها إمارة الجرهاء التي قامت هنا‬ ‫في الفتره )‪ 500‬ق‪.‬م إلى ‪ (300‬ميلدي ‪.‬وكانت لهذه الماره شهرة في الوساط التجارية بين‬ ‫المم حيث اكتنز أهلها الذهب والفضة والحجار الكريمة ‪.‬تقع الحساء في شرق المملكة السعودية‬

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