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19. Bone diseases Tutorial 2026

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Bone Diseases Tutorial

Course Information1

  • Subject: Oral Medicine
  • Course Code: DENT5310
  • Instructor: A/Prof Omar Kujan

Case One: Maxillary Swelling In An Elderly Patient

Case Summary2

A 73-year-old female with dementia presented to a general dentist with swelling and purulence drainage involving the right posterior maxillary teeth (14, 15, 16, and 17), which were subsequently extracted.

Clinical Presentation And History

Past Medical History

The patient’s medical history is significant for:

  • Dementia
  • Hypertension
  • Liver disease

Clinical Examination And Activity34

Clinical exam

Clinical and Radiological Objectives5

  • Discuss the clinical and radiological presentations
  • Discuss the treatment and differential diagnosis

Clinical And Imaging Descriptions

Intraoral Findings6

  • The oral cavity exhibits a well-defined, smooth, dome-shaped lesion.
  • The lesion appears translucent and pinkish in color with an ulcerated surface.
  • There are no evident signs of inflammation, ulceration, or bleeding in the tissue surrounding the lesion.
  • The lesion is round to oval, smooth-surfaced, and protrudes significantly from the surrounding tissue.
  • The approximate size of the lesion is 1 cm.

Radiographic Findings7

  • A panoramic view of the CBCT imaging taken at the first clinical presentation demonstrates a large right maxillary sinus that appears cloudy.
  • In comparison, the contralateral left maxillary sinus is clear.
  • The alveolar ridge shows slight erosion, but there is no evidence of an intra-osseous lesion.

Differential Diagnosis And Biopsy891011

Potential Diagnoses12

  • Reactive Benign Lesion: Pyogenic granuloma
  • Malignant Tumors:
    • Squamous Cell Carcinoma (SCC)
    • Melanoma
    • Lymphoma

Incisional biopsy results

Microscopic Description And Diagnosis13

Histopathological Features14

  • Vascular Patterns: Lobular pattern of vascular proliferation with inflammation and edema resembling granulation tissue.
  • Surface Characteristics:
    • Thin epidermis at the top with variable ulceration.
    • Acanthosis and hyperkeratosis at the lateral aspects.
  • Vascular Structure: Central branching vessels (capillary or vascular lobules) surrounded by endothelial cells, containing no or rare red blood cells.
  • Deep Tissue Presentation: Deep lesions often lack the edema and inflammation seen in superficial areas.

Pyogenic granuloma

Treatment Plan

  • Surgical removal of the lesion.

Case Two: Mandibular Asymmetry In A Juvenile Patient

Patient Presentation16

A 17-year-old male presented with a chief complaint of right facial swelling and asymmetry that has persisted for six months.

History of Present Illness

The patient has maintained regular dental and medical care. Clinical evaluation revealed:

  • No evidence of pain
  • No neurological abnormalities
  • No malocclusion
  • No involvement of the condyle or coronoid processes

Case Summary And History17

Past Medical History

The patient’s medical history is significant for Type 1 diabetes.

Clinical Activity And Imaging

Clinical Discussion Points18

  • Discuss the clinical and radiological presentations
  • Discuss treatment options and differential diagnosis

Radiographic Findings19

Cone Beam CT (CBCT) at the first presentation demonstrates:

  • A large, unilocular, and expansile radiolucency
  • Generalized fine radiopacity within the lesion
  • Involvement of most of the right posterior mandible and part of the ramus
  • Sparing of the condyle and the coronoid processes

Differential Diagnosis202122

Clinical Considerations23

  • Aneurysmal bone cyst
  • Fibrous dysplasia
  • Brown tumour of hyperparathyroidism
  • Juvenile ossifying fibroma

Microscopic Examination And Diagnosis

Histopathological Features24

Multiple fragments of decalcified hard and soft tissue reveal a benign fibro-osseous lesion characterized by:

  • Irregularly shaped and woven-type bony trabeculae
  • Cellular fibrous connective tissue stroma surrounding the trabeculae
  • Bony trabeculae of variable shapes and sizes, with some exhibiting significant osteoblastic rimming
  • Focal areas within the connective tissue stroma containing clusters of multinucleated giant cells

Final Diagnosis25

  • Juvenile ossifying fibroma

Treatment Plan For Case Two

Footnotes

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Graph View