Bone diseases Tutorial Oral Medicine DENT5310 A/Prof Omar Kujan #### Course Information - **Subject:** Oral Medicine - **Course Code:** DENT5310 - **Instructor:** A/Prof Omar Kujan Case 1 * Case summary: A 73-year-old female with dementia who was presented to a general dentist with a swelling and purulence drainage involving the right posterior maxillary teeth 14, 15, 16 and 17 which were extracted. * Past medical history The past medical history is significant for dementia, hypertension and liver disease. #### Case Summary 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. #### Past Medical History The patient's medical history is significant for: - Dementia - Hypertension - Liver disease Clinical exam  Clinical exam Clinical photograph of an oral lesion in the floor of the mouth, surrounded by lips and teeth. A wooden tongue depressor is visible on the left side, helping to expose the area for examination.  A radiographic image displaying a 3D segmented view of the mandible, showing extracted teeth holes and the remaining dental arch structure labeled 'R' and 'L' at the periphery. # Activity - Discuss the clinical and radiological presentations - Discuss your treatment and differential diagnosis #### Clinical and Radiological Objectives - Discuss the clinical and radiological presentations - Discuss the treatment and differential diagnosis # Clinical description * The image shows the oral cavity with a clearly visible, well-defined, smooth, dome-shaped lesion that appears translucent and pinkish in colour. The surface is ulcerated. * There are no evident signs of inflammation, ulceration, or bleeding surrounding the lesion. * The lesion is round to oval, smooth-surfaced, and protrudes significantly from the surrounding tissue with an approximate size of 1 CM. #### Intraoral Findings - 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. # Imaging description * This is a panoramic view of the CBCT imaging taken by the oral Surgeon’s office at first clinical presentation demonstrating a large right maxillary sinus which is appearing cloudy. Compare with the contralateral left maxillary sinus which is clear. * The alveolar ridge is slightly eroded but there is no intra-osseous lesion. #### Radiographic Findings - 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 * Reactive benign lesion; pyogenic granuloma * Malignant tumour: SCC, Melanoma, Lymphoma #### Potential Diagnoses - **Reactive Benign Lesion:** Pyogenic granuloma - **Malignant Tumors:** - Squamous Cell Carcinoma (SCC) - Melanoma - Lymphoma Incisional biopsy results Incisional biopsy results  Full-page histological micrograph showing a cross-section of tissue with extensive red necrosis at the top and central areas, transitioning to bluish-purple cellular inflammation at the bottom. The image reveals a distinct disruption in the tissue architecture.  A microscopic medical image showing cellular structures and tissue patterns, likely from a histopathological examination. # Microscopic description - Lobular pattern of vascular proliferation with inflammation and edema resembling granulation tissue - Thin epidermis at top with variable ulceration - Acanthosis and hyperkeratosis at sides - Central branching vessel is called capillary or vascular lobule, with no / rare red blood cells, surrounded by endothelial cells - Deep lesions often lack edema and inflammation #### Histopathological Features - **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. Diagnosis • Pyogenic granuloma Pyogenic granuloma # Treatment - Surgical removal of the lesion. #### Recommended Intervention - Surgical removal of the lesion. # Case 2 ## Case summary: A 17-year-old male whose chief complaint is of right facial swelling and asymmetry of six months’ duration. ## History of present illness The patient has had regular dental and medical care. There was no evidence of pain, neurological abnormalities or malocclusion. The condyle and coronoid processes were not affected. ## Past medical history The past medical history is significant for diabetes type 1. #### Patient Presentation 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 #### Past Medical History The patient's medical history is significant for Type 1 diabetes.  The image is a panoramic dental radiograph (orthopantomogram) displaying the full upper and lower dental arches. It reveals the maxillary sinus cavities, the nasal airway, and both the mandible and maxilla bones, providing a comprehensive view of the patient's oral and craniofacial skeleton. Activity • Discuss the clinical and radiological presentations • Discuss your treatment and differential diagnosis #### Clinical Discussion Points - Discuss the clinical and radiological presentations - Discuss treatment options and differential diagnosis Imaging description * Cone Beam CT view at first presentation demonstrating large unilocular and expansile radiolucency with some generalized fine radiopacity involving most of the right posterior mandible and part of the ramus sparing the condyle and the coronoid processes. #### Radiographic Findings 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 diagnosis * Aneurysmal bone cyst * Fibrous dysplasia * Brown tumour of hyperparathyroidism * Juvenile ossifying fibroma #### Clinical Considerations - Aneurysmal bone cyst - Fibrous dysplasia - Brown tumour of hyperparathyroidism - Juvenile ossifying fibroma  A histology micrograph (photo) displaying a high-magnification view of tissue. The image shows a cellular, purple-stained interior (likely hematoxylin and eosin stain) with several pink, elongated fibrous bands running diagonally, representing connective tissue structures.  A full-page histological micrograph (H&E stain) showing a spindle cell neoplasm with scattered islands of squamous differentiation and keratin pearls.  A photomicrograph of a histological slide showing cells stained with Hematoxylin and Eosin. The image consists of a dense field of spindle-shaped cells with purple nuclei and pink cytoplasm, illustrating a tissue structure. Microscopic examination * Multiple fragments of decalcified hard and soft tissue made up of a benign fibro-osseous lesion. It is composed of irregularly shaped and woven-type bony trabeculae surrounded by cellular fibrous connective tissue stroma. The bony trabeculae are of variable shapes and sizes; some show significant osteoblastic rimming. In focal areas, the connective tissue stroma has clusters of multinucleated giant cells #### Histopathological Features 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 # Diagnosis • Juvenile ossifying fibroma #### Final Diagnosis - Juvenile ossifying fibroma # Treatment - Surgical enucleation [^1]: Original PDF page 1: [[19.Bone diseases Tutorial 2026.pdf#page=1|19.Bone diseases Tutorial 2026, p.1]] [^2]: Original PDF page 2: [[19.Bone diseases Tutorial 2026.pdf#page=2|19.Bone diseases Tutorial 2026, p.2]] [^3]: Original PDF page 3: [[19.Bone diseases Tutorial 2026.pdf#page=3|19.Bone diseases Tutorial 2026, p.3]] [^4]: Original PDF page 4: [[19.Bone diseases Tutorial 2026.pdf#page=4|19.Bone diseases Tutorial 2026, p.4]] [^5]: Original PDF page 5: [[19.Bone diseases Tutorial 2026.pdf#page=5|19.Bone diseases Tutorial 2026, p.5]] [^6]: Original PDF page 6: [[19.Bone diseases Tutorial 2026.pdf#page=6|19.Bone diseases Tutorial 2026, p.6]] [^7]: Original PDF page 7: [[19.Bone diseases Tutorial 2026.pdf#page=7|19.Bone diseases Tutorial 2026, p.7]] [^8]: Original PDF page 8: [[19.Bone diseases Tutorial 2026.pdf#page=8|19.Bone diseases Tutorial 2026, p.8]] [^9]: Original PDF page 9: [[19.Bone diseases Tutorial 2026.pdf#page=9|19.Bone diseases Tutorial 2026, p.9]] [^10]: Original PDF page 10: [[19.Bone diseases Tutorial 2026.pdf#page=10|19.Bone diseases Tutorial 2026, p.10]] [^11]: Original PDF page 11: [[19.Bone diseases Tutorial 2026.pdf#page=11|19.Bone diseases Tutorial 2026, p.11]] [^12]: Original PDF page 12: [[19.Bone diseases Tutorial 2026.pdf#page=12|19.Bone diseases Tutorial 2026, p.12]] [^13]: Original PDF page 13: [[19.Bone diseases Tutorial 2026.pdf#page=13|19.Bone diseases Tutorial 2026, p.13]] [^14]: Original PDF page 14: [[19.Bone diseases Tutorial 2026.pdf#page=14|19.Bone diseases Tutorial 2026, p.14]] [^15]: Original PDF page 15: [[19.Bone diseases Tutorial 2026.pdf#page=15|19.Bone diseases Tutorial 2026, p.15]] [^16]: Original PDF page 16: [[19.Bone diseases Tutorial 2026.pdf#page=16|19.Bone diseases Tutorial 2026, p.16]] [^17]: Original PDF page 17: [[19.Bone diseases Tutorial 2026.pdf#page=17|19.Bone diseases Tutorial 2026, p.17]] [^18]: Original PDF page 18: [[19.Bone diseases Tutorial 2026.pdf#page=18|19.Bone diseases Tutorial 2026, p.18]] [^19]: Original PDF page 19: [[19.Bone diseases Tutorial 2026.pdf#page=19|19.Bone diseases Tutorial 2026, p.19]] [^20]: Original PDF page 20: [[19.Bone diseases Tutorial 2026.pdf#page=20|19.Bone diseases Tutorial 2026, p.20]] [^21]: Original PDF page 21: [[19.Bone diseases Tutorial 2026.pdf#page=21|19.Bone diseases Tutorial 2026, p.21]] [^22]: Original PDF page 22: [[19.Bone diseases Tutorial 2026.pdf#page=22|19.Bone diseases Tutorial 2026, p.22]] [^23]: Original PDF page 23: [[19.Bone diseases Tutorial 2026.pdf#page=23|19.Bone diseases Tutorial 2026, p.23]] [^24]: Original PDF page 24: [[19.Bone diseases Tutorial 2026.pdf#page=24|19.Bone diseases Tutorial 2026, p.24]] [^25]: Original PDF page 25: [[19.Bone diseases Tutorial 2026.pdf#page=25|19.Bone diseases Tutorial 2026, p.25]]