Disease Of Bone Manifested In The Jaws And Fibro-Osseous Lesions

Question 1. Enumerate the fibro-osseous lesion. Discuss the etiology, clinical features, and complications of Paget’s disease.
Answer.

Fibro-osseous Lesions

Fibro-osseous Lesions of Medullary Bone Origin
- - Fibrous dysplasia
  - Fibro-osteoma
  - Cherubism
  - Juvenile ossifying fibroma
  - Giant cell tumor
  - Aneurysmal bone cyst
  - Jaw lesions in hyperparathyroidism
  - Paget’s disease.
Fibro-osseous Lesions of Periodontal Origin
- Periapical cemental dysplasia
- Florid osseous dysplasia
- Cemento-ossifying fibroma
- Ossifying fibroma.

Paget’s Disease

It is also called as osteitis deformans.

Paget’s disease is defined as abnormal resorption and apposition of bone in one or more bones.

Fibro-osseous Lesions Etiology

Circulatory disturbance: It is excessively vascular and vessels are similar to arteriovenous aneurysms
Genetic and environmental factors: It is transmitted as autosomal dominant trait.
Disorder of connective tissue biosynthesis.
Due to vasculitis, trauma, hormonal disorders, degenerative neurological disorders.

Fibro-osseous Lesions Clinical Features

It is seen in patient of 40 years of age with slight predilection of males.
It occurs in axial skeleton especially skull, femur, sacrum and pelvis.
Symptoms:
- Patient needs to buy a hat of large size because of skull enlargement.
- Bone pain is present, which is directed to weight bearing areas.
- Patient can have ill defined neuralgic pain due to restriction of both canals and foramina.
- Deafness due to enrolment of petrous part of temporal bone.
- Mental disturbance, dizziness.
Signs:
- Bowing of legs.
- Curvature of spine.
- Enlargement of skull.
- Involved bones are warm to touch because of increased vascularity and are prone to fracture.
Patient looks like a simian, this is because of grotesque facial appearance along with the presence of waddling gait and the short stature.
Because of broadening and flattening of chest as well as spinal curvature. Patient have waddling gait.

Fibro-osseous Lesions Oral Manifestation of Paget’s disease

Maxilla is more commonly involved and is bilaterally symmetrical.
There is presence of migration of the involved teeth. Since migration is seen, patient may have malocclusion. If patient is edentulous, his alveolar bone enlarges and because of this there is poor fit of the denture.
In maxilla there is increase in the alveolar width which is associated with the flattening of palate.
As disease enhances, mouth of the patient remains open which exposes the teeth, this is because lips of the patient are too small to cover the enlarged jaws.
Extracted tooth socket show slow healing and incidence of osteomyelitis is high. If lytic phase of Paget’s disease is going on, there can be excessive bleeding from highly vascular abnormal bones.

Fibro-osseous Lesions Complications of Paget’s disease

General complications
- Deformities of skeleton
- Limbs fracture
- Compression of spine
- Giant cell lesions occur
- Renal and salivary calculi
- Hypercalcemia.
Oral complications
- Osteogenic sarcoma
- Osteomyelitis
- Pathological bone fracture
- Facial paralysis.

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