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321 Cards in this Set
- Front
- Back
What are the major salivary glands, what do they secrete?
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o Parotid – 100% serous
o Submandibular – mostly serous, some mucos o Sublingual – mostly mucus glands, some serous |
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• What are the minor salivary glands, what do they secrete?
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o Palate, 100% mucous
o Buccal mycosa, floor of mouth, labial mucosa: mucous and serous |
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o Etiology of a mucocele?
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Accidental trauma (bite lower lip) severance of MSG duct leakage of mucin into surrounding tissue walling off by granulation tissue
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o What is the morphology/color of a mucocele?
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Vesicle/bulla (> 5 mm) – fluctuant
Blue translucent, though may appear pink if mucin located deep |
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o How can you tell the difference between a fibroma and a mucocele?
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If it is able to be condensed upon touch, it is a mucocele
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o What is the most common site for a mucocele?
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Lower lip (due to the fact that most people have class I or II occlusion), especially halfway between midline and commissure
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o What is the most common population to have mucocele?
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Adolescents
Other common sites: buccal musoca, ventral tongue, floor of mouth |
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o Is a mucocele a cyst?
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Not a true cyst (no epithelial lining)
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o Will a mucocele go away after local excision of mucus?
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No, must also remove severed duct and gland
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o Why do mucoceles fluctuate?
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Because macrophages uptake a significant amount of the extravasated mucus
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Because macrophages uptake a significant amount of the extravasated mucus
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Ranula
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o What causes a ranula most commonly?
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The severance of a sublingual gland duct
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o What are differential diagnoses for a ranula?
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Dermoid cyst (will feel doughy)
Mucus duct cyst Epidermoid cyst |
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o This is a blue fluctuant vesicle/bulla on the floor of mouth that may elevate the tongue.
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Ranula
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o This extravasation of mucin dissects through the mylohyoid muscle into the neck (lateral or midline)
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Plunging ranula
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o Etiology of mucus duct cyst?
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Due to obstruction of salivary gland (minor or major) such as sialolith, bacterial plug
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o Is a mucus duct cyst a true cyst?
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Yes, epi-lined.
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o This is the formation of a calcified structure within the salivary duct system
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Sialolithiasis
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o When does pain occur with sialolithiasis?
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Classically upon salivation (just prior to meal)
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o Where is the most common site of a sialolith?
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80% - submandibular duct (Wharton’s duct) due to tortuous path and viscous mucus content
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o This is the term for inflammation of the salivary glands
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Sialadenitis
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o This lip lesion involving the minor salivary glands can undergo malignant transformation
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Cheilitis Glandularis
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o Which type of Cheilitis Glandularis causes the lower lip to be everted, extremely swollen and pus filled?
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Deep, suppurative type
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o What is the treatment of Cheilitis Glandularis?
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Vermillionectomy
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o Chronic, systemic, autoimmune disorder that affects the salivary and lacrimal glands
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Sjogren’s Syndrome
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o This is a subjective criteria, describing feeling a dry mouth.
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Xerostomia
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o This is an objective criteria, describing a declined salivary flow
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Salivary gland hypofunction
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o What differentiates Sjogren’s syndrome and Sicca syndrome?
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Sicca syndrome is a general term for dry eyes, mouth. Sjogren’s is an autoimmune disease with these symptoms.
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o What are the two types of Sjogren’s? What differentiates them?
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Primary: no other autoimmune disease
Secondary: Autoimmune disorder present, usually (rheumaroid arthritis, SLE) |
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o Which sex is more affected by sjogren’s?
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Female 80-90%, elderly
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o What are the intraoral findings of sjorgren’s?
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Xerostomia, dysphagia, predisposition to cervical caries, fissured tongue with atrophy of papillae, secondary candidiasis
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o What is a common extraoral finding of sjogren’s?
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Bilateral parotid swelling (33-50%)
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o What condition predisposes to a 40x higher risk of developing lymphoma?
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Sjogren’s
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o What diagnostic lab values indicate Sjogren’s?
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Positive rheumatoid factor (RF), Antinuclear antibodies (ANA)
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o What diagnostic test is used to measure tear secretion in Sjogren’s? What are the + and – values?
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Schirmer test. < 5 mm (suggests +), <2 mm (confirms +)
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o What condition will show a sialogram with a “fruit-laden, branchless tree” pattern?
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Sjogren’s syndrome
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o What sites are common for a biopsy to be performed for Sjogren’s?
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Labial mucosa biopsy or major gland (Parotid)
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o Pilocarpine hydrochloride (Sialogen) or another drug, Evoxac, is the most common treatment for what condition?
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Sjogren’s
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o How should you treat a patient with dry mouth?
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With sialologues, daily fluoride applications
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o This condition is an unusual non-inflammatory disorder causing salivary gland (parotid) enlargement
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Sialadenosis
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o This condition is when minor salivary glands on the palate shut down (possibly from ischemia), causing painful swelling, then forms a deep ulcer with sharply defined borders, will self-resolve.
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Necrotizing Sialometaplasia
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o This ulcerative condition on the palate may be misdiagnosed as malignancy and overtreated.
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Necrotizing Sialometaplasia
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o What helps to differentiate between Necrotizing Sialometaplasia and malignancy?
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Necrotizing Sialometaplasia will happen very immediately (24-48 hours)
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o The most common site for salivary neoplasia?
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On the palate, off the midline
|
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o *Firm palatal swelling off the midline in an otherwise healthy mouth. What do you think?
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Salivary gland tumor
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o How do you distinguish between benign vs malignant salivary gland neoplasia?
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Perform biopsy
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o A rapid increase in growth of a palatal firm swelling after initial slow growth indicates what?
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Possibly malignant salivary neoplasm
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o What are 3 signs of possible malignancy for salivary neoplasms?
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Paresthesia, Fixation, Rapidly increased growth rate
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o What is the most common salivary gland neoplasm?
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Pleomorphic adenoma
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o Most common sites for salivary neoplasms?
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minor salivary gland site: palate
major salivary gland site: parotid |
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o Most common parotid gland tumor?
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Pleomorphic adenoma
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o Most common benign salivary gland tumor?
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Pleomorphic adenoma
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o Most common malignant salivary gland tumor?
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Mucoepidermoid carcinoma
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o What are the two types of monomorphic adenomas?
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Canalicular adenoma
Basal cell adenoma |
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o What is the most common site for a canalicular adenoma?
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Upper lip
|
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o What is the most common site for a basal cell adenoma?
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Parotid gland
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o What is the most likely site for Warthin’s tumor?
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The parotid (95%)
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o What is the most likely salivary gland tumor to be bilateral?
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Warthin’s tumor
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o What population is most commonly affected by Warthin’s tumor?
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Male > 40 yrs
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o What is the characteristic histology of Warthin’s tumor?
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Papillary, cystic, with lymphoid stroma in wall
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o What is the most common location for oncocytoma
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Parotid gland
|
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o What is characteristic of oncocytes?
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Cytoplasm has massive amounts of degenerating swollen mitochondria
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o What is the most common salivary gland malignancy?
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Mucoepidermoid cyst
|
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o What ages are affected by mucoepidermoid cysts?
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People in the 3rd and 6th decade of life (bimodal)
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o What is the most common childhood salivary gland malignancy?
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Mucoepidermoid Carcinoma
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o What malignant tumor is found more often in the submandibular gland than the parotid?
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Adenoid cystic carcinoma
|
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o What is the most common malignant salivary tumor IN the mouth?
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Adenoid Cystic Carcinoma
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o 50% of adenoid cystic carcinomas develop where?
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In the minor salivary glands (23% on the palate)
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o Most common malignancy on the palate?
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Adenoid cystic carcinoma
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o 25-33% of adenoid cystic carcinoma patients experience what symptoms?
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Pain and paresthesia
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o A radiographic finding of apical radiolucency with root resorption in a pointed “pencil tip” like root apearence indicated what salivary gland tumor?
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Adenoid Cystic Carcinoma
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o A biopsy report showing areas of swiss cheese pattern or cribiform pattern is indicative of what condition?
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Adenoid cystic carcinoma
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o Neurotropism is involved in 25-33% of occurrences of what salivary gland tumor?
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Adenoid cystic carcinoma
|
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o What are the most common sites of metastasis of adenoid carcinoma?
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Lung and bone
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o Is the prognosis more favorable with a parotid as opposed to a MSG adenoid cystic carcinoma?
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Parotid is more favorable
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o This salivary tumor is a slow growing and painless mass, more common in females, African americans, and occurs in the 6th and 8th decade.
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Polymorphous Low-grade Adenoma
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o This salivary gland tumor shows a histological pattern of ‘indian filing’ and neurotropism
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Polymorphous Low-grade Adenoma
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o Which malignant salivary gland tumor has the best prognosis?
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Polymorphous Low-Grade Adenoma
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• What does NOS mean?
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o Not otherwise Specified, can’t be identified exactly but is malignant
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• Which malignant salivary gland tumor has the worst prognosis?
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o Adenoid cystic carcinoma
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• Should you treat a benign salivary gland tumor with radiation therapy?
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o No, can create a malignant chance
|
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• What is the order of locations for prognoses, most to least favorable, for malignant salivary gland tumors?
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o MSG > palate > submandibular
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o What is the main difference between chronic and acute lymphoid hyperplasia?
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Chronic is non-tender
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o What is the name of the scattered aggregates of lymphoid tissue in the mouth?
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Waldeyer’s Ring
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o Hyperplastic Lymphoid tissue can appear what color?
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Pink, or yellow-orange
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o Bi-lateral pink papules on the posterior lateral border of the tongue, history of pneumonia.
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Lingual tonsils
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• Excessive bleeding upon primary tooth extraction might suggest what condition?
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o Hemophilia A
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• Most common inherited bleeding disorder
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o Von Wilderbrand’s disease
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• What lab tests should be abnormal in vWD?
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o Abnormal von willebrand’s factor
o Abnormal platelets o Abnormal BT and prolonged PTT |
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• A slick, depapillated tongue that is light pink in coloration could be due to what condition?
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o Anemia
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• What condition is precipitated by hypoxia, infection, hypothermia, and dehydration?
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o Sickle-cell anemia
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• What is the most common cause of death in children affected by sickle-cell anemia?
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o Strep pneumonia
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• A radiographic pattern of a “step ladder” for the jaw bone, and “hair on end” skull, or reduced trebecular pattern appearance is indicative of what condition?
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o Sickle-cell anemia
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• What is causing the unique radiographic patterns shown in sickle-cell anemia?
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o Marrow areas are being recruited to make more red-blood cells
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• This a class of disorders affects hemoglobin
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o Thalassemia
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• What is Hydrops Fetalis?
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o A genetic disorder of alpha hemoglobins, (a thalassemic condition)
|
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• What condition experiences anemia, deficiency of WBC, and thrombocytopenia?
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o Aplastic Anemia
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• What are the oral symptoms of aplastic anemia?
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o Gingival hemorrhage (sometimes hyperplasia), petechiae, ecchymoses, ulcerations associated with infection.
|
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• What constitutes Neutropenia?
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o <1500 ANC count
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• Are infections associated with neutropenia likely to be bacterial, viral, or fungal?
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o Bacterial
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• Rare idiopathic hematologic disorder characterized by regular periodic reuctions in neutrophils
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o Cyclic neutropenia
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• How long is the usual cycle for cyclic neutropenia?
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o 21 days
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• What hematologic condition can cause severe periodontal bone loss and gingival recession?
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o Cyclic Neutropenia
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• How is Cyclic Neutropenia diagnosed?
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o 2-3 blood tests a week for 8 weeks (3 cycles)
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o What is the etiology of agranulocytosis?
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Usually induced by exposure to drugs (chemotherapeutic drugs)
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o The gingival appearance in agranulocytosis mimicks what condition?
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ANUG
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• Term for decreased number of circulatory blood platelets
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o Thrombocytopenia
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• What is Polycythemia Vera?
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o Too many red blood cells
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• What are the common clinical signs of polycythemia vera?
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o Ruddy complexion
o Pruritus with no rash o Epistaxis, ecchymoses, gingival hemorrhage |
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• What are the oral signs of leukemia?
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o Oral ulcers (deep punched out lesions with a gray white necrotic base)
o Oral herpetic infections o Oral candidiasis o Diffuse gingival enlargement o Gingival tumor like growth |
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• What type of leukemia most often has gingival enlargement?
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o Myelomonocytic type
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• What is Myelophthisic anemia? What conditions is it associated with?
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o Crowding out of normal hematopoietic stem cells by malignant proliferation
o Associated with leukemia and multiple myeloma |
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o What are the forms of langerhans cell disease?
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Acute Disseminated Form
Chronic, localized form Chromic, disseminated form |
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o Which form of langerhans cell disease shows an eosinophilic granuloma of bone?
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Chronic, localized form
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o Hand-Schuller-Christian disease exhibits what triad? Is another name for what disease?
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Triad: bone lesions, exophthalmos, diabetes insipidus. AKA chronic, disseminated form of langerhans cell disease
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o What is another name for the acute disseminated form of langerhans cell disease?
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Letterer-Siwe disease
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o What age distribution is often affected by Letterer-Siwe (acute disseminated langerhans)?
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Infants
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o In general, what are the most commonly affected sights of langerhans cell disease?
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Skull, ribs, vertebrae and mandible common
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o What is the radiographic appearance of langerhans cell disease?
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‘Tooth floating in air’ or severe periodontitis
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o Birbeck bodies will be seen in the cytoplasm of cells in what condition?
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Langerhans cell disease
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o What is the treatment for chronic localized langerhans cell disease?
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Solitary jaw lesions, curettage
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o Etiology of Hodgkin’s lymphoma?
|
It is thought to be from E-B virus
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o What is the classic cell seen in hodgkin’s lymphoma?
|
Reed-Sternberg cells (neoplastic, exhibit owl-eye nuclei) ***going to be on the exam
|
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o What is the age distribution for hodgkins lymphoma?
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Bimodal (15-35 and >50)
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o What are the clinical signs and symptoms of hodgkin’s lymphoma?
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Weight loss, fver, night sweats, generalized pruritus, enlarged lymphnodes
|
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o What two conditions (that are covered on the exam) have bimodal age distribution?
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Mucoepidermoid cysts and hodgkin’s lymphoma
|
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o Which has a better prognosis, Hodgkin’s or Non-Hodgkin’s lymphoma?
|
Hodgkin's
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o How does Hodgkin’s lymphoma affect nodes?
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Mess with their architecture
|
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o What virus is thought to play a role in Burkitt’s lymphoma (a type of non-hodgkin’s lymphoma)?
|
Epstein Barr virus
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o What cell type does non-hodgkins lymphoma originate from most commonly?
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Most commonly originate from B-lymphocyte (~80%)
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o Which type of lymphoma more commonly occurs in the mouth?
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Non-hodgkins
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o What is the number of oral cavity and oropharyngeal cancer diagnoses a year?
|
35,000/yr (at least 7000 is in the oropharynx)
|
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o What autoimmune disease would predispose someone 40x to nonhodgkins lymphoma?
|
Sjorgrens
|
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o Which has a more organized classification scheme, non-hodgkins or hodgkins?
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Hodgkins lymphoma
|
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o What are the oral soft tissue lesion characteristics of non-hodgkins lymphoma?
|
Nontender, diffuse swelling, buccal vestibule, gingival, or posterior hard palate, boggy consistency, erythmatous or purplish, some ulcerated
|
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o What is the worst of the non-hodgkins lymphomas?
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Burkitt’s
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o What percent of African form Burkitt’s lymphomas form in the jaw?
|
50-70% form in the jaw (more in the posterior maxilla, common in young)
|
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o Where does Burkitt’s lymphoma most commonly occur in America?
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Usually in the abdominal region, only some in jaw
|
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o What are radiographic signs of Burkitt’s lymphoma in the jaw?
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Radiolucent bone, will ragged, ill defined margins,
Patchy loss of lamina dura is an early sign |
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o What is the histological pattern of Burkitt’s lymphoma?
|
Starry sky pattern
|
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• This condition is rare, aggressive, nonrelenting, destruction of palate and nasal fossa
|
o Extranodal NK/T-lymphoma
|
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• Where does Extranodal NK/T-lymphoma arise? In what age population?
|
o Intranasal in adults
|
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• This lymphoma can cause midline ulceration leading to palatal perforation
|
o Extranodal NK/T-lymphoma
|
|
• What are the complications of Extranodal NK/T-lymphoma?
|
o Secondary infection, hemorrhage
|
|
• What lymphoma begins with signs of epistaxis and nasal stuffiness/pain?
|
o Extranodal NK/T-lymphoma
|
|
• This is a malignancy of plasma cell origin; multicentric origin in bone
|
o Multiple myeloma
|
|
• This is the number one primary bone malignancy in the US
|
o Multiple myeloma
|
|
• What population, age and race, is most commonly affected by multiple myeloma?
|
o Ages 60-70, 2x more likely in Blacks vs whites
|
|
• What types of antibodies are usually formed by the malignant clone plasma cells in multiple myeloma?
|
o Most commonly IgG and IgM
|
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• What is the number one sign or symptom of multiple myeloma?
|
o Bone pain
|
|
• What is the etiology of petechiae of skin and oral mucosa in multiple myeloma?
|
o Lack of platelets due to myelophthisic anemia
|
|
• What is the significance of Bence-Jones proteinuria?
|
o Seen in renal failure caused by multiple myeloma
|
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• What lab exam finding in multiple myeloma?
|
o Monoclonal gammopathy with serum protein immunoelectrophoresis (which means the antibody produced by the malignant plasma cell will be the only one present)
|
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• What condition can lead to amyloid deposits in various soft tissue (ex. tongue) in some patients?
|
o Multiple myeloma
|
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• What condition will have a radiographic appearance of multiple well defined “punched out” radiolucencies common on skull films?
|
o Multiple myeloma
|
|
• What is the name for a solitary focal form of multiple myeloma?
|
o Plasmacytoma
|
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• This is the most commonly biopsied oral pathology lesion
|
o Fibroma
|
|
• This is a reactive fibrous hyperplasia, not a true neoplasm
|
o Fibroma
|
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• Most common locations of fibroma?
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o Commonly bitten areas (buccal mucosa, lip, tongue)
|
|
• What form of fibrous hyperplasia can occur in denture wearing patients?
|
o Epulis fissuratum
|
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• Raised areas or ridges of tissue on or near edentulous ridge caused from tissue trauma?
|
o Epulis Fissuratum
|
|
• What is the name for a pedunculated, pressed down fibrous hyperplasia under palatal part of removable denture?
|
o Fibroepithelial polyp
|
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• What is the treatment for epulis fissuratum?
|
o Local excision, reline denture or fabricate new, advise patient to remove denture at night
|
|
• What is the common patient to present with inflammatory papillary hyperplasia?
|
o Patients who wear dentures 24/7, ill-fitting dentures, poor denture hygiene
|
|
• Where are the common sites for inflammatory papillary hyperplasia?
|
o Palatal vault and alveolar ridge
|
|
• What is possible etiology of inflammatory papillary hyperplasia?
|
o Candidiasis
|
|
• What benign condition, common in denture wearers, mimics the epithelial islands seen in squamous cell carcinoma? (psuedoepitheliomatous hyperplasia)
|
o Inflammatory papillary hyperplasia
|
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• Which condition can occur in NON-denture wearers, epulis fissuratum or inflammatory papillary hyperplasia?
|
o Inflammatory papillary hyperplasia
|
|
• What are the 3 conditions that start in the interpapillary gingival?
|
o PG – pyogenic granuloma
o PGCG – peripheral giant cell granuloma o POF – peripheral ossifying fibroma |
|
• This lesions have a female predilection, and can be due to hormonal changes
|
o Pyogenic granuloma
|
|
• What is the most common location from pyogenic granuloma?
|
o Gingival
|
|
• What is the classic appearance of pyogenic granuloma
|
o Red, rapid growth, bleeds easily, frequently secondarily ulcerated
|
|
• What is the treatment of a pyogenic granuloma?
|
o Conservative excision
o Eliminate the triggering factor or recurrence is likely |
|
• This is a gingival reactive lesion in response to local irritant histologically shows multinucleated giant cells
|
o Peripheral giant cell granuloma
|
|
• Which of the 3 P’s ONLY occurs on the gingival?
|
o Peripheral giant cell granuloma AND peripheral ossifying fibroma
|
|
• Which of the 3 P’s are true granulomatous inflammation?
|
o None of them
|
|
• What gingival condition may show radiographic bone resorption creating cupping or saucerization or resorption?
|
o Peripheral giant cell granuloma
|
|
• What is the most common mesenchymal tumor of the skin?
|
o Lipoma
|
|
• This is a smooth yellow nodule that happens 50% of the time on the buccal mucosa.
|
o Lipoma
|
|
• What must be ruled out with a possible lipoma on the buccal mucosa?
|
o Herniation of buccal fat pad
|
|
• True or false, lipoma is a reactive growth.
|
o False, it is a true benign neoplasm
|
|
• This is a tender nodule that has the appearance of a fibroma.
|
o Traumatic neuroma
|
|
• Is a traumatic neuroma a reactive or a true neoplastic lesion?
|
o Reactive
|
|
• What is the typical histology of a schwannoma?
|
o Antoni A with verocay bodies
o Antoni B tissue no associated verocay bodies |
|
• This neoplasm composed of neural tissue can present as a solitary or multiple lesions, and does not contain verocay bodies.
|
o Neurofibroma
|
|
• What are the stigmata with neurofibromatosis type 1 (von recklinghaus)?
|
o Crowe’s sign (axillary freckling)
o Café Au lait o Multiple neurofibromas o Lisch nodules (macules on the iris) |
|
• What is a major complication of neurofibromatosis?
|
o Neurosarcoma
|
|
• Neuromas of the oral mucosa are the first sign of what disease?
|
o MEN
|
|
• This condition often also presents with pheochromocytoma of the adrenal medulla
|
o MEN
|
|
• Medullary thyroid carcinoma is an VERY common complication (90%) of what condition?
|
o MEN
|
|
• What body type is often associated with MEN?
|
o Marfanoid
|
|
• Multiple NON-tender neuromas on the tongue or lips, are indicative of what condition?
|
o MEN
|
|
• What condition would be suspected with a teenager showing signs of hypertension from an over-secretion of catecholamines and nodules on the tongue?
|
o MEN
|
|
• What is the origin of neuroectodermal tumor of infancy?
|
o Neural crest cells
|
|
• This condition presents in infants as a melanotic lesion on the anterior maxillary alveolar ridge
|
o Neuroectodermal Tumor of Infancy
|
|
• This condition can cause bone destruction in the maxilla of an infant
|
o Neuroectodermal tumor of infancy
|
|
• This is a deep-seated nodule commonly on the tongue that is thought to originate from Schwann cells
|
o Granular cell tumor
|
|
• What nodular lesion commonly on the dorsum of the tongue commonly presents with a histology of pseudoepitheliomatous hyperplasia?
|
o Granular cell tumor
|
|
• What is the most common site in the body for a granular cell tumor?
|
o Tongue
|
|
• Is a granular cell tumor considered cancer?
|
o No, though it histologically appears very similar
|
|
• What is the gender and common site commonly affected by congenital epulis of the newborn?
|
o Maxillary alveolar ridge, 90% female
|
|
• What condition common in infants has a histology that appears similar to granular cell tumors but without neural tissue?
|
o Congenital Epulis of the Newborn
|
|
• This is the MOST common tumor of humans and infants
|
o Hemangioma
|
|
• This vesicle or bulla is compressible and blanches upon pressure
|
o Hemangioma
|
|
• What is the difference between vascular malformations and hemangiomas?
|
o A hemangioma arises within the 1st year of life and should resolve
o A vascular malformation is present at birth and will persist throughout life |
|
• What condition presents with a “port wine” stain and often follows the distribution of a branch of the trigeminal?
|
o Vascular malformation
|
|
• Most intrabony vascular malformations in the mandible are fed by what vessel?
|
o Carotid artery
|
|
• What vascular condition can appear as a radiographic radiolucency with trebeculi?
|
o Intrabony Vascular malformation
|
|
• What are the major components of sturge-weber syndrome?
|
o Vascular malformations involving face and brain and angiomatosis of leptomeninges
o Seizure disorders, mental retardation |
|
• This is a hamartoma growth rather than true neoplasm
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o Lymphangioma
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• What type of lymphangioma is very large, seen in newborns and often involves the neck?
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o Cystic Hygroma
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• This is the MOST common cause of macroglossia
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o Lymphangioma
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• What is the most common site for lymphangioma?
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o On the tongue
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• This is the term for a benign smooth muscle tumor
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o Leiomyoma
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• Leiomyomas are very common in what part of the body?
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o Uterus
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• What is the origin of a leiomyoma in the mouth?
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o Smooth muscle cells around blood vessels (vascular leiomyoma)
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• This benign tumor of skeletal muscle is most commonly seen on the tongue:
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o Rhabdomyoma
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• Which is more common, Rhabdomyoma or Rhabdomyosarcoma?
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o Rhabdomyosarcoma
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• What are the definitions of choristoma and hamartoma?
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o Hamartoma= tumor in normal tissue in a normal location
o Choristoma = tumor in normal tissue in an abnormal location |
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• What is the most common site for Choristoma?
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o Tongue
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• What are the most common components in Choristoma?
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o Bone or cartilage
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• What is the most common soft tissue sarcoma seen in the mouth?
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o Rhabdomyosarcoma
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• What is the most common soft tissue sarcoma in childhood (60%)?
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o Rhabdomyosarcoma
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• What is the tissue origin of rhabdomyosarcoma?
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o Skeletal muscle
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• What are the common head and neck sites of rhabdomyosarcoma
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o Orbit, nasopharynx, palate
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• What is the most common type of inherited bone disease?
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o Osteogenesis imperfecta
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• What is a systemic manifestation of dentinogenesis imperfect?
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o Osteogenesis imperfecta
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• This is a rare hereditary disease with increased bone density
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o Osteopetrosis
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• What are the two forms of osteopetrosis?
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o Infantile and adult
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• Which form of osteopetrosis is most deadly?
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o Infantile
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• In what disease is osteomyelitis common following tooth extraction?
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o Osteopetrosis
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• True or false, Osteopetrosis patients exhibit a deficiency in the numbers of osteoclasts
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o False, normal number of osteoclasts but functionally defective
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• What condition presents with globular amorphous bone deposited in marrow spaces?
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o Osteopetrosis
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• What sex and body site is most commonly affected by focal osteoporotic marrow defect?
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o 75% female and 70% posterior mandible
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• What is the condition that is non-pathologic and appears radiographically as a radiolucency with thin fine radiopaque trebeculae?
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o Focal osteoporotic marrow defect
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• This condition could be confused with condensing osteitis
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o Idiopathic osteosclerosis
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• Where is the most common location for idiopathic osteosclerosis?
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o 90% in mandible near 1st molar region
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• What is the radiographic appearance of idiopathic osteosclerosis?
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o Well-defined radiopaque mass
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• What is the required treatment for idiopathic osteosclerosis?
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o None!
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• This radiopaque bone lesion is associated with pulpitis or pulpal necrosis
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o Condensing Osteitis
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• This radiopaque bone lesion commonly occurs in children and young adults and exhibits no bony swelling
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o Condensing osteitis
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• What is the radiographic appearance of condensing osteitis?
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o Localized radiopacity at or adjacent to apex of tooth with inflammation, no radiolucent border (distinguishes it from focal cemento-osseous dysplasia)
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• What is the treatment for condensing osteitis?
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o No specific treatment for affected bone, associated tooth should be extracted or RCT
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• This abnormal resorption and deposition of bone affects older, generally Caucasian patients, who experience thickened distortion and weakening of bones
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o Paget’s disease of bone
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• What condition exhibits narrowing of foramina leading to vertigo, deafness, and visual disturbances?
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o Paget’s disease of bone
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• How often is the jaw affected in Paget’s disease of bone?
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o 17% of cases, bilaterally
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• What is the LATE radiographic appearance of paget’s bone disease?
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o “cotton wool” radiopacities similar to cement-osseous dysplasias
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• Elevation of what lab value is associated with paget’s disease of bone?
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o Serum alkaline phosphatase
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• What is the characteristic histology of paget’s disease of bone?
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o Jigsaw puzzle or mosaic pattern
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• What are two common complications of paget’s disease of bone?
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o Hypercementosis 50% (difficult extractions) and Osteosarcoma (mostly in pelvis and long bones)
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• This bone disease that affects the anterior jaw and often crosses the midline is histologically indistinguishable from hyperparathyroidism, cherubism, and peripheral giant cell granuloma
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o Central Giant Cell Granuloma
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• This bone condition that often affects children has an early appearance of bilateral mandibular swelling
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o Cherubism
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• What condition has maxillary involvement stretching skin to expose more sclera of the eye?
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o Cherubism
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• What is the radiographic appearance of cherubism?
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o Multiple, multilocular radiolucencies
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• Is a simple bone cyst a true cyst?
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o No, no epi lining, therefore a pseudocyst
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• What is the presumed etiology of simple bone cyst?
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o Trauma, however >50% of cases report no history of trauma
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• What gender, body site, age group is mostly affected by simple bone cysts
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o Males 2:1, mandible most often, adolescents and young adults
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• This bone condition is usually asymptomatic and exhibits a radiographic appearance of scallop shape margins extending between roots of involved teeth without affecting them
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o Simple bone cyst
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• What does the surgeon usually encounter upon exploratory surgery of simple bone cyst?
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o An empty cavity, or more rarely one filled with seroanginous fluid
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• What are the clinical features (common age of pts, common location, symptoms) of aneurismal bone cysts?
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o Young adults, mandible molar region, and rapid facial swelling (pain)
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• What is the radiographic appearance of an aneurismal bone cyst?
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o Uni or multilocular radiolucency with a “blow-out” distension of bone contours
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• This is a diverse group of processes that replace normal bone with fibrous connective tissue and metaplastic bone
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o Benign Fibro-osseous lesions
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• What are three benign fibro-osseous lesions?
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o Fibrous dysplasia, cemento-osseous dysplasia, ossyfing cemetifying fibroma
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• What is the most common site for fibrous dysplasia?
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o The jaw
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• Does fibrous dysplasia more commonly affect one bone or multiple?
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o 80% of cases are monostotic
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• What are two syndromes that are characterized by polyostotic fibrous dysplasia?
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o Jaffe’s syndrome and McCune-Albright syndrome
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• When is the typical onset of fibrous dysplasia?
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o In children and teenagers typically before puberty
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• This is a painless, slow enlargement of the maxilla or mandible that commonly affects children before puberty.
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o Fibrous dysplasia
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• What are the radiographic appearances of immature and mature fibrous dysplasia lesions?
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o Early: mottled radiolucency
o Late: ground glass radiopaque bone with poorly defined margins |
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• This polyostotic disease presents with café au lait macules with irregular borders and precocious puberty
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o Albright’s syndrome
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• What is the characteristic histology of fibrous dysplasia?
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o Irregular trabeculae of immature (woven) bone shaped like Chinese writing characters
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• What is the treatment of large, diffuse maxillary fibrous dysplasia? What treatment should be avoided?
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o Delay treatment until growth ceases and hope the disease will stabilize
o Avoid radiation therapy since osteosarcomatous transformation has been seen |
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• What is the common population affected by periapical cemento-osseous dysplasia? (age, sex, race)
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o 30-50 yrs old
o Black predilection o Female predominance 14:1 |
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• What is the most commonly affected site with periapical cement-osseous dysplasia?
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o Mandibular anterior teeth (happens with vital teeth)
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• What is the radiographic appearance of periapical cemento-osseous dysplasia?
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o Asymptomatic periapical radiolucencies which transform into radiopacities
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• What is the treatment for periapical cemento-osseous dysplasia?
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o None
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• What is the most common benign fibro-osseous lesion?
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o Focal cemento-osseous dysplasia
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• What population is most often affected by focal cemento-osseous dysplasia?
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o 30-50 yrs old, whites, 90% women
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• Where is the most common site for focal cemento-osseous dysplasia?
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o Most often in posterious mandible and usually asymptomatic and solitary
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• Treatment of focal cemento-osseous dysplasia?
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o Observe after diagnosis (hemorrhagic, fragmented gritty tissue that is much more difficult to remove than ossifying fibroma)
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• What is the most commonly affected population for Florid Cemento-Osseous Dysplasia?
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o Middle aged, female, 90% black
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• What fibrous bone condition exhibits bilateral, symmetrical posterior jaw involvement that is multiquadrant and not tooth related?
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o Florid Cemento-osseous Dysplasia
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• What bone condition may become secondarily infected and mimic diffuse, chronic sclerosing osteomyelitis?
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o Florid Cemento-Osseous Dysplasia
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• What is the characteristic histology of Florid Cemento-Osseous Dysplasia?
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o Sequestrum/involcrum in advanced cases with secondary infection
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• What is the treatment of asymptomatic and symptomatic Florid Cemento-Osseous Dysplasia?
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o Asymptomatic: prevent or control Periodontitis, avoid biopsy or tooth extraction
o Symptomatic: antibiotics, sequestrectomy, chronic mgmt |
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• What is the age range, sex, and location most affected by Cementifying-Ossifying Fibroma?
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o 20-40yrs old, females 5:1, Mandible 90% molar region
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• What lesion is radiographically a well-defined unilocular radiolucent to radiopaque lesion with centripetal expansion of the inferior border of the mandible?
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o Cementifying-Ossifying Fibroma
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• What is the treatment of Cementifying-Ossifying Fibroma?
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o Curettage – shell out from surrounding bone
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• This is a benign tumor of mature compact bone
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o Osteoma
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• What is the most common location for an osteoma to occur?
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o Mandibular angle is a frequent location
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• What condition presents with multiple osteomas of the jaw and other cranial bones at puberty?
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o Gardner Syndrome
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• What are 4 stigmata of Gardner Syndrome?
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o Multiple osteomas of jaw and cranium, supernumerary teeth/impacted teeth/odontomas, multiple epidermoid cysts of skin, multiple colon or rectal polyp
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• Colorectal polyps associated with Gardner syndrome increase the likely hood of the patient developing what?
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o Malignant transformation to invasive colorectal carcinoma (50% by age 30, chance increases to almost 100% with increasing age)
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• What prophylactic treatment is typically done after the discovery of oral lesions assoicaited with Gardner Syndrome?
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o Colonectomy due to the high risk of malignant transformation of polyps
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• The is a true neoplasm that is frequently classified as a bone lesion, although it is a tumor of the cementum
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o Cementoblastoma
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• A cementoblastoma most often occurs in what age group? What region of the mouth?
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o Young adults, mandibular first molar region
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• True or false, a tooth involved with a cementoblastoma must be non-vital.
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o False, involved tooth is vital
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• Is a cementoblastoma associated with pain and swelling?
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o 2/3rds of the time, yes
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• What is the radiographic appearance of a cementoblastoma?
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o Root anatomy and PDL obscured by dense radiopaque tumor with thin radiolucent border
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• What lesion presents as a jaw swelling with tooth mobility “pumping action” with pulsation or bruit present?
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o Central (Intrabony) Hemangioma
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• What gender and location is most commonly affected with central (intrabony) hemangioma?
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o Females, mandible
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• What are the 3 types of primary malignant tumors of the jaw?
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o Osteosarcoma
o Chrondrosarcoma o Ewing’s sarcoma |
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• This bone malignancy will occur on average 10-15 years later in the jaw than in the long bones
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o Osteosarcoma
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• What is the clinical presentation of osteosarcoma?
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o Bone pain, swelling, tooth mobility
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• What is the radiographic appearance of Osteosarcoma?
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o Ill-defined radiolucency or moth-eaten radiopacity, Codman’s triangle (tumor raises periosteum away from the bone)
o Symmetrical widening of PDL space o 25% have sunburst pattern |
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• What lesion presents radiographically with Codman’s triangle?
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o Osteosarcoma (tumor raises periosteum away from bone)
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• What is the prognosis of osteosarcoma with and without metastasis?
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o 30-70% without metastasis. 1 in 3 metastasize within 2 years (ave survival = 6 mo)
o maxilla, older age have worse prognosis |
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• To what locations is metastasis of osteosarcoma common?
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o Lung and brain
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• What is the average age for jaw osteosarcoma and chonrosarcoma?
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o 35 yrs
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• Does a chonrosarcoma occur more often in the maxilla or mandible?
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o Maxilla 4:1
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• What lesion looks similar radiographically to chondrosarcoma?
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o Osteosarcoma
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• This malignant bone lesion that can occur in the jaw most commonly affects white males, age 5-25 and presents most frequently in the mandible.
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o Ewing’s sarcoma
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• This malignant lesion, when occurring in the jaw, presents with pain, rapid jaw swelling, tooth mobility and parasthesia and can be misdiagnosed as a dental infection
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o Ewing’s sarcoma
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• This malignant lesion radiographically mimics Garre’s osteomyelitis in the onion skin periosteal appearance.
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o Ewing’s sarcoma
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• This bone malignancy is considered a small ‘blue dot’ tumor
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o Ewing’s sarcoma
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• Are most malignancies found in the jaw primary or secondary?
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o Secondary (eg. Multiple myeloma, osteosarcoma)
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• What are 6 common origin sites for metastatic tumors found in the jaw?
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o Lung, brest, kidney, colon, prostate, thyroid glands
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• What is the hypothesized route of metastasis for tumors from distant sites to the head and neck?
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o Paravertebral venous plexus of Batson (Batson’s plexus)
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• Where do metastatic tumors going to the jaw usually appear? Max or mandible?
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o Mandible 4:1
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• Bone swelling, pain or parasthesia, tooth mobility and post extraction extrusion from the socket in 50+ yr old adult might indicate what?
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o Metastatic jaw tumor
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• What are common radiographic appearances of metastatic tumors in the jaw?
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o Most are ill defined radiolucencies but some may be radiopaque since they produce calcifications
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