Osseous Dysplasia with Gross Jaw Expansion: A Review of 18 Lesions.

Fourteen cases with 18 grossly expansive lesions diagnosed over a period of 15 years as either "familial gigantiform cementoma" or "osseous dysplasia with jaw expansion" in an African population sample were reviewed. Eight lesions occurred in the anterior mandible, the maxilla was affected by four, three patients presented with more than one lesion and the most common associated pathologies were tooth displacement, conventional non expanding florid osseous dysplasia and simple bone cyst. No history of similar lesions in relatives of the diseased were recorded. The radiolucent fibrous component contained globular bone deposits and cellular osteoid with trabecular differentiation which matured into radiodense mineralized masses. Resorption of the cellular bone created cavities which are proposed to represent the early stage of simple bone cyst formation. It is recommended that "expansive osseous dysplasia" replace the out-dated term "familial gigantiform cementoma". The differential diagnoses of expansive osseous dysplasias are discussed.

Chronic kidney disease-mineral bone disorder: an update on the pathology and cranial manifestations.

Chronic kidney disease-mineral bone disorder (CKD-MBD) is a syndrome encompassing skeletal and extra skeletal changes associated with chronic kidney disease. It progresses silently until an advanced clinical stage when complications impact on the quality of life and survival rates of patients. The maxillofacial manifestations are unique and may play an important role in the early identification of changes which could influence the management of these patients. The goal of this review is to highlight the maxillofacial features, pathology, and principles of management of CKD-MBD.

Expansive jaw lesions in chronic kidney disease: review of the literature and a report of two cases.

Chronic kidney disease is an increasing public health problem, with a worldwide prevalence estimated to be between 8% and 16%. The metabolic alterations induce bone and soft tissue changes, and the encompassing term chronic kidney disease-mineral and bone disorder syndrome (CKD-MBD) is used to describe them. The cardinal manifestations of the syndrome are bone catabolism and soft tissue calcifications, which ultimately compromise the cardiovascular and skeletal systems. In rare cases, tumorous enlargement of the craniofacial bones occurs. This article provides a brief review of the pathogenesis and imaging of craniofacial changes in CKD-MBD and reports on two cases of expansive jaw lesions. The term expansive renal osteitis fibrosa is recommended to describe these lesions.

Recent developments in metabolic bone diseases: a gnathic perspective.

Metabolic bone diseases often are asymptomatic and progress sub clinically. Many patients present at a late stage with catastrophic skeletal and extra skeletal complications. In this article, we provide an overview of normal bone remodeling and a synopsis of recent developments in the following conditions: osteoporosis, rickets/osteomalacia, endocrine-induced bone disease, chronic kidney disease-mineral bone disorder and Paget's disease of bone. Our discussion will emphasize the clinical and microscopic manifestations of these diseases in the jaws.

Fibro-osseous disease: harmonizing terminology with biology.

Classification systems and associated terminology are inherently slow in reflecting rapidly unfolding scientific discoveries in the mechanism and presentation of diseases. Misleading concepts, which often have historical value only, may become entrenched in the literature, leading to confusion and inaccurate communication. The purpose of this communication is to stimulate discussion and debate on inappropriate terminology associated with fibro-osseous disease that continues to be perpetuated in the literature. Use of the terms "cementum," "aggressive," "active," "gigantiform," and "maturation" are questioned, and the criteria applied to the interpretation of secondary changes in fibro-osseous lesions critically are evaluated.

Peripheral odontogenic myxoma: a review of the literature and report of two cases.

Two cases of peripheral odontogenic myxoma with a verifiable location in gingival soft tissue and without bone involvement were compared with those reported in the literature. This study showed that they form a distinct albeit rare clinical entity with a potential to grow into large disfiguring lesions. The probability that small peripheral odontogenic myxomas are interpreted as edematous irritation fibromas may contribute to the small number of peripheral odontogenic myxomas recorded in the literature. The differential diagnosis of soft tissue myxoid proliferations is discussed.

Expansive osseous dysplasia: report of 9 lesions in an African population sample and a review of the literature.

OBJECTIVES: The aim of this study was to report on the clinicopathologic features of osseous dysplasias (ODs) that manifest with gross expansion in a black South African hospital population sample. STUDY DESIGN: The files of 9 histology-verified expansive ODs in 8 patients were reviewed. The clinical records and radiographs were analyzed and compared with reports in the literature. RESULTS: The main complaint of all patients was related to expansion of the jaw. All except 1 were female, with ages between 26 and 71 years and sizes of the lesions ranging from 4 to 15 cm. No history of similar lesions in family members was obtained. All lesions occurred in the mandible and 6 crossed the midline. The expansive growth pattern was associated with persistence of radiolucent areas in the lesions which microscopically consisted of cellular fibro-osseous tissue. Resorption of mineralized deposits by osteoclasts was prominent in the radiolucent parts of the lesion. Maturation with enlargement of the radiodense component was associated with a decrease in osteoclast activity and the formation of lobular bone masses and confluent psammomatous mineralized deposits. CONCLUSION: We propose the term "expansive osseous dysplasia" for the rare albeit important clinical subcategory of ODs that manifest with progressive jaw expansion. Suspension of osteoclast activity plays an important role in the maturation of the lesions into dense mineralized masses.

Internal morphology of ameloblastomas: a study of 24 resected specimens.

OBJECTIVES: The objectives of this study were to describe the internal macroscopic architecture of resected specimens of ameloblastoma and to correlate the findings with radiographs and microscopic features. STUDY DESIGN: Resection specimens of 24 ameloblastomas were retrieved from the files of the Department of Oral Pathology at the University of Limpopo. The neoplasms were sectioned in parallel slices and the macroscopic features recorded and each slice was radiographed and sampled for microscopic examination. The macroscopic features were correlated with respective microscopic and radiological appearances. RESULTS: Twenty-three ameloblastomas affected the mandible and 1 the maxilla and measured between 3.3 and 20 cm in greatest diameter. Six cases were unicystic, 2 of which showed incomplete septae both of which presented multilocular on radiographs. Intracystic proliferations were present in 15 cases. These proliferations showed macroscopic features of either small or large nodules with or without the formation of confluent plaques, focal papillary lesions, or multinodular masses that protruded into the cystic cavities. Microscopically these proliferations were characterized by foci of inflammation or plexiform or solid epithelial proliferations, one of which showed a focus of carcinoma in situ, adenomatoid differentiation and another osteodentin deposits. Seven cases had foci of stromal desmoplastic change, one of which exhibited mineralized deposits resembling bone. CONCLUSIONS: The assessment of the cystic nature of ameloblastomas on 2-dimensional radiographs is inaccurate. Intraluminal proliferations, in situ carcinomatous change, adenoid differentiation, stromal osteodentin, and bone deposits and desmoplasia were found to be focal rather than generalized phenomena in resection specimen of ameloblastoma.

Odontogenic myxoma: review of the literature and report of 30 cases from South Africa.

OBJECTIVE: The purpose of the study was to analyze the clinical and radiographic features of central odontogenic myxomas (OM) of the jaws diagnosed over 23 years in a black South African patient sample. STUDY DESIGN: Records of 30 cases of OMs with radiographs of diagnostic quality were retrieved from 52 cases of histopathologically verified OMs from the archives of the Oral Health Center at the University of Limpopo, South Africa. The age, sex, size, location, and radiographic features were compared with the literature. RESULTS: The study consisted of 21 females and 9 males. The correlation between age and size of the tumor was found to be statistically significant (P = .004). Septa were shown to be either reorientated cortical bone or sheets of dense fibrous connective tissue. Indistinct borders mimicked malignancy. The most common radiographic feature was the tennis-racket appearance. CONCLUSIONS: Variations in radiographic presentation make a radiological differential interpretation of OM challenging because the radiographic features overlap with those of other benign and malignant neoplasms.

Central odontogenic fibroma-like tumors, hypodontia, and enamel dysplasia: review of the literature and report of a case.

A patient with multiple odontogenic fibroma-like tumors in the mandible and enamel dysplasia is presented, bringing the total number of cases reported in the literature to 3. In addition to these manifestations, this case had hypodontia. The absence of associated teeth, the size of the lesions, the lingual expansion, and the green-yellow polarization of collagen with Picrosirius stains supported the neoplastic nature of the central odontogenic fibroma-like tumors in the case presented. Laminated psammomatous deposits distinguished the tumors from the World Health Organization-type central odontogenic fibroma.