1. Diseases of jaws and maxillary sinus
Jan Laco, M.D., Ph.D.

2. Diseases of jaws and maxillary sinus
2. Temporomandibular joint
3. Maxillary sinus

3. 1. Diseases of jaws 1a. Genetic diseases 1b. Metabolic diseases
1c. Diseases of unknown origin
1d. Inflammations
1e. Cysts
1f. Tumors

4. 1a. Genetic diseases Osteogenesis imperfecta Achondroplasia
Cleidocranial dysplasia
Cherubism

5. 1a. Genetic diseases Osteogenesis imperfecta (brittle bone d.)
AD inheritance
defect of biosynthesis of collagen I
thin bones without cortex -  fragile
 multiple fractures  dwarfism
+ blue sclera + deafness

6. 1a. Genetic diseases Achondroplasia
most common genetic skeletal disease
short-limbed dwarf with normal trunk and head
failure of cartilage proliferation in epiphyses
protrusive mandible  malocclusion

7. 1a. Genetic diseases Cleidocranial dysplasia
defective formation of clavicles
retrusion of maxilla
delayed eruption of permanent teeth

8. 1a. Genetic diseases Cherubism AD inheritance,  boys
painless symmetrical swelling of mandible angle
at 2-4 years
rapid growth until puberty  regression
Mi: fibrous tissue + haemorrhage + multinucleated giant cells + woven bone

9. 1. Diseases of jaws 1a. Genetic diseases 1b. Metabolic diseases
1c. Diseases of unknown origin
1d. Inflammations
1e. Cysts
1f. Tumors

10. 1b. Metabolic diseases Rickets Gigantism and acromegaly
vitamin D deficiency during bone development
infancy
wide fontanels + bossing of frontal and parietal eminences
Gigantism and acromegaly
 mandibular condyle  prognathism
+ macroglossia

11. 1. Diseases of jaws 1a. Genetic diseases 1b. Metabolic diseases
1c. Diseases of unknown origin
1d. Inflammations
1e. Cysts
1f. Tumors

12. 1c. Diseases of unknown origin
Paget´s disease of bone
Fibro-osseous lesions

13. 1c. Diseases of unknown origin
Paget´s disease of bone (osteitis deformans)
past middle age
common RTG finding x clinically silent
? ethiology (viral)
axial skeleton
skull – vault + maxilla
symmetric enlargement of alveolar processes + fusion of teeth to sclerotic bone  difficult extraction

14. 1c. Diseases of unknown origin
Paget´s disease of bone (osteitis deformans)
resorption (osteoclasts)  irregular new bone formation (osteoblats)
Mi: irregular mosaic bone trabeculae +
 osteoblasts and osteoclasts + vascularity
result: thick spongy bone + marrow fibrosis
complication: osteosarcoma (rare)

15. 1c. Diseases of unknown origin
Fibro-osseous lesions
Fibrous dysplasia
monostotic
polyostotic
Cemento-osseous dysplasia
periapical cemental dysplasia
focal cemento-osseous dysplasia
florid cemento-osseous dysplasia

16. 1c. Diseases of unknown origin
Monostotic fibrous dysplasia
painless, poorly circumscribed bone swelling
in childhood
self-limiting
F : M ... 1:1
 maxilla  malocclusion

17. 1c. Diseases of unknown origin
Polyostotic fibrous dysplasia
several bones
F : M … 3:1
Albright´s syndrome: + skin pigmentation + sexual precocity
Mi: fibrous tissue + woven bone trabeculae without osteoblasts lining

18. 1c. Diseases of unknown origin
Cemento-osseous dysplasia
of periodontal ligament origin, same process
periapical cemental dysplasia
F : M … 10 : 1
asymptomatic lesion
lower I

19. 1c. Diseases of unknown origin
florid cemento-osseous dysplasia (gigantiform cementoma)
florid form of PCD
symmetric lesions in all quadrants
focal cemento-osseous dysplasia
Mi: cellular fibrous tissue + cementum-like tissue  calcification

20. 1. Diseases of jaws 1a. Genetic diseases 1b. Metabolic diseases
1c. Diseases of unknown origin
1d. Inflammations
1e. Cysts
1f. Tumors

21. 1d. Inflammations acute osteomyelitis chronic osteomyelitis
alveolar osteitis

22. 1d. Inflammations Acute osteomyelitis
sources – periapical infection, open fractures
oral anaerobes, mixed infection
adult males
mandible
clinically: severe deep-seating pain, swelling, teeth tenderness, regional lymphadenopathy
fever + leucocytosis

23. 1d. Inflammations Acute osteomyelitis
suppurative inflammation in marrow spaces  compression of blood vessels  bone necrosis  sequestrum
 subperiostal area  perforation  fistulas to skin and oral mucosa
complications: fracture
 chronic osteomyelitis

24. 1d. Inflammations Chronic osteomyelitis de novo x low-grade infection
Chronic focal sclerosing OM
young people with carious lower 1. M
Diffuse sclerosing OM
old people, superinfection of florid COD

25. 1d. Inflammations
Chronic osteomyelitis with productive periostitis (Garré´s OM)
young people, lower 1. M
 reactive new bone formation

26. 1d. Inflammations Alveolar osteitis (dry socket)
sources: excessive extraction trauma, low blood supply…
after extraction of 3. M
 females
destruction of clot by fibrinolytic enzymes – infection and food in contact with bone  necrosis  granulation tissue

27. 1. Diseases of jaws 1a. Genetic diseases 1b. Metabolic diseases
1c. Diseases of unknown origin
1d. Inflammations
1e. Cysts
1f. Tumors

28. 1e. Cysts Odontogenic Non-odontogenic Pseudocysts Solitary bone „cyst“
Aneurysmal bone „cyst“

29. 1e. Pseudocysts Solitary bone „cyst“ (simple, traumatic) ? ethiology
F : M … 3 : 2
< 25 years
painless swelling of mandible
RTG: cavity expands between teeth roots
Mi: NO epithelial lining + wall: fibrous tissue

30. 1e. Pseudocysts Aneurysmal bone „cyst“ rare in jaws
between 10 – 20 years
painless swelling of mandible
Mi: many blood-filled spaces without lining + wall: fibrous tissue

31. 1. Diseases of jaws 1a. Genetic diseases 1b. Metabolic diseases
1c. Diseases of unknown origin
1d. Inflammations
1e. Cysts
1f. Tumors

32. 1f. Tumors
Odontogenic
Non-odontogenic

33. Non-odontogenic tumors
Primary: benign x malignant
bone
cartilage
other
Secondary: metastases

34. Non-odontogenic tumors
Benign primary tumors
osteoma
osteochondroma
central giant cell granuloma
cemento-ossifying fibroma - rare
haemangioma - rare

35. Non-odontogenic tumors
Osteoma x Exostosis
torus palatinus: posterior midline of hard palate
torus mandibularis: lingual aspect of mandible opposite to mental foramne, bilateral
hard swelling
Mi: compact or cancellous bone
Gardner´s syndrome - AD inheritance
multiple osteomas + polyposis coli  malignancy

36. Non-odontogenic tumors
Osteochondroma
cartilage-capped osteoma
hard bony protuberance
coronoid or condylar procces
joint dysfunction

37. Non-odontogenic tumors
Giant cell granuloma
hyperplastic lesion, developmental ???
< 20 years
F : M … 2 : 1
anterior mandible
RTG: rounded cyst-like area
Mi: vascular fibrous tissue + giant cells + bleeding + hemosiderin
recurrency after incomplete removal

38. Non-odontogenic tumors
Osteosarcoma
 malignant,  common primary non-od. neoplasm
irradiation, Paget´s disease
years, males
body of mandible
irregular firm swelling  painfull
Mi: osteoid formation + atypical osteoblasts + cartilage + fibrous tissue

39. Non-odontogenic tumors
Osteosarcoma
rapid local growth + early metastases (lungs)
50% recurrency in 1st year
5-year survival: 40% ( 5 cm)

40. Non-odontogenic tumors
Chondrosarcoma
45 years
anterior maxilla
painfull irregular swelling
Mi: cartilage tissue with pleomorphic, binucleated chondrocytes + mitoses
locally aggressive + metastases (lungs)

41. Non-odontogenic tumors
Rare tumors
Ewing´s sarcoma
Multiple myeloma
Langerhans´cell histiocytosis

42. Non-odontogenic tumors
Secondary tumors – haematogenous metastases
breast
lungs
prostate
thyroid
kidney

43. Diseases of jaws and maxillary sinus
2. Temporomandibular joint
3. Maxillary sinus

44. 2. Temporomandibular joint
Trismus - inability to open mouth fully
inflammation
injuries
tetanus
Ankylosis - permanent limitation of movement
fibrosis
congenital
trauma
arthritis
tumors

45. 2. Temporomandibular joint
Osteoarthritis
metabolic defect of art. cartilage - defective
old people
pain, minimal symptoms

46. 2. Temporomandibular joint
Rheumatoid arthitis - multisystemic disease
antibodies (rheumatoid factors)
females, years
symmetrical involvement of smaller joints
crepitation, little pain
inflammation of synovia - granulation tissue (pannus)
Osteochondroma
Condylar hyperplasia

47. Diseases of jaws and maxillary sinus
2. Temporomandibular joint
3. Maxillary sinus

48. 3. Maxillary sinus Inflammation - sinusitis
acute x chronic x hypersensitive
rhinogenic x odontogenic
periapical inflammation of P or M
long oro-antral communication
pain + percussion sensitivity

49. 3. Maxillary sinus Inflammation
Mi: respiratory epithelium  squamous metaplasia
thickened basal membrane
infiltrate - acute - neutrophils
- chronic - lymphocytes + plasma cells
- hypersensitive - eosinophils

50. 3. Maxillary sinus Oro-antral communication after extraction of P or M
nose-blowing test
root or tooth in sinus
prolaps of antral mucosa

51. 3. Maxillary sinus Antral cysts from mucous glands asymptomatic
disappear spontaneously
odontogenic cysts
radicular, residual

52. 3. Maxillary sinus Tumors squamous cell carcioma males > 50 years
advanced stage – local spread
nose obstruction, nose bleeding
paresthesia of infraorbital nerve
visual disturbances
poor prognosis