Partial resection of the mandible for the treatment of diffuse sclerosing osteomyelitis: report of four cases.
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Adult↗
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Connective tissue nevus and osteopoikilosis in the hand: the Buschke-Ollendorff syndrome.
The Buschke-Ollendorff syndrome is a rare disorder of uncertain etiology characterized by osteopoikilosis and connective tissue nevi. An unusual presentation of this syndrome is described that involves both the cutaneous and skeletal manifestations affecting the hand. The bones of the hand and carpus are a common site for osteopoikilosis. Connective tissue nevi of the hand may require excision for diagnosis or mechanical impingement. Special elastin stains must be done on these cutaneous lesions to confirm the diagnosis. Routine hematoxylin-eosin stains may fail to show any pathologic change in mild cases.
Child↗
Imaging of renal osteodystrophy.
Chronic renal insufficiency, hemodialysis, peritoneal dialysis, renal transplantation and administration of different medications provoke complex biochemical disturbances of the calcium-phosphate metabolism with wide spectrum of bone and soft tissue abnormalities termed renal osteodystrophy. Clinically most important manifestation of renal bone disease includes secondary hyperparathyroidism, osteomalacia/rickets, osteoporosis, adynamic bone disease and soft tissue calcification. As a complication of long-term hemodialysis and renal transplantation amyloid deposition, destructive spondyloarthropathy, osteonecrosis, and musculoskeletal infections may occur. Due to more sophisticated diagnostic methods and more efficient treatment classical radiographic features of secondary hyperparathyroidism and osteomalacia/rickets are now less frequently seen. Radiological investigations play an important role in early diagnosis and follow-up of the renal bone disease. Although numerous new imaging modalities have been introduced in clinical practice (scintigraphy, CT, MRI, quantitative imaging), plain film radiography, especially fine quality hand radiograph, still represents most widely used examination.
Chronic Kidney Disease-Mineral and Bone Disorder↗
Dense bone around the sacroiliac joint: a radiological review of the differential diagnosis.
Solitary osteosclerotic bone lesions around the sacroiliac (SI) joints are described as seen on plain radiographs or conventional tomography, with the descriptive attributes ranging from round to ovoid over square and triangular to multiform. The etiology of the solitary osteosclerotic lesions around the SI joint can often be concluded from the radiographic appearance, sometimes complemented by the presentation on CT and/or scintigraphy.
Diagnosis, Differential↗
Skeletal benign bone-forming lesions.
The imaging features of benign osseous lesions of the bone are often characteristic and suggestive of a specific diagnosis. This is particularly true for skeletal benign bone-forming lesions such as enostosis, osteoma, osteoid osteoma and osteoblastoma. Enostosis or bone island is an incidental finding in the axial skeleton (pelvis, spine, ribs) of asymptomatic patients; it appears as a small (0.2-2 cm) round to oval sclerotic area with irregular, radiating ('thorny') spicules peripherally. Osteoma is a benign slow-growth tumor and usually an incidental finding in cranial sinuses, vault and mandible, and presenting as a homogeneous, sharply defined bone mass arising from bone surface; its signs and symptoms are rare and depend on the tumor size and location--e.g. sinusitis, headache, exophthalmos, diplopia. Osteoid osteoma is a painful highly vascularized benign tumor usually affecting the long bone diaphysis cortex of young patients; it generally appears as a small radiolucent nidus with or without central calcification and surrounding bone sclerosis on radiographs, and as a 'hot' spot on scintigraphy. CT is the method of choice for the definite location of the nidus especially in sites of complex anatomy, such as the spine, pelvis and hindfoot. Osteoblastoma is a rare tumor, histologically similar to osteoid osteoma but with a significantly different clinical potential because of the possibilities of postoperative recurrence, of its locally aggressive behavior or, rarer still, malignant transformation; the spine and long bones are affected in more than half the cases. Its radiologic appearance is not always distinctive and usually characterized by a lytic lesion with varying bone production and expansile behavior; CT and MRI are required for the diagnosis of spinal osteoblastomas. When a bone-producing tumor or tumor-like lesion is suspected but no specific diagnosis can be made, the knowledge of the range of the imaging findings of these lesions will allow a suitably ordered differential diagnosis. Radiography is the single most effective imaging method in this respect. CT is required for the tumors in complex anatomical sites, such as the spine, pelvis and hindfoot, as well as for the optimal assessment of the tumor matrix. MRI is specifically required to study the lesion effect on the spinal canal.
Bone Diseases↗
Dysosteosclerosis: clinicoradiologic findings including brain MRI.
Dysosteosclerosis is a very rare bone dysplasia associated with sclerosis and platyspondyly. This paper reports the clinicoradiologic and MR imaging findings in this rare condition. The primary brain MR imaging finding was retarded white matter matter myelination.
Bone Diseases, Developmental↗
Spinous process fractures associated with Baastrup disease.
Patients with Baastrup disease may experience pain owing to irritation of the periosteum or adventitial bursae between abutting spinous processes. We are not aware of any reports in the literature that describe stress fractures of the spinous fractures in patients with Baastrup disease. In this case report, we present two cases of spinous process fractures in lumbar vertebrae associated with Baastrup disease and describe their appearance with conventional radiography, bone scintigraphy, computed tomography (CT) and magnetic resonance (MR) imaging.
Aged↗
Effect of marrow perforation on the sheep temporomandibular joint.
The effect of surgically perforating the mandibular condyle to allow synovial fluid to contact the marrow was examined in 5 sheep temporomandibular joints. The surgical defect showed replacement of the marrow with fibro-osseous tissue and subcortical cysts. A vertical, central osteophyte emerged from the perforation, causing attenuation or perforation of the disc and temporal surface proliferation. These changes were radiographically and histologically similar to advanced osteoarthritis. This supports the concept that intraarticular micro or macrofracture may result in osteoarthritis.
Animals↗
The effect of osteotomy and osteosynthesis in the mandibular condyle. A radiologic and histologic study in sheep.
Eighteen oblique osteotomies in sheep mandibular condylar necks were fixed with self-reinforced poly-L-lactide (SR-PLLA) (n = 9) or stainless steel (n = 9) screws (core diameters 2.4, 2.7, 3.0, or 3.5 mm). No intermaxillary fixation (IMF) was applied. The follow-up periods were 6, 12, and 24 weeks, respectively, after which the sheep were killed, and the status of the condylar head was assessed radiographically and histologically. The results showed that the fixation had been adequate. Bony destruction, osteophytes, and flattening of the condylar head, however, were frequently observed in both groups, as compared with the unoperated contralateral condyle. Histologic studies revealed that the thickness of the condylar head cartilage had increased and that the boundaries of the different cell layers were irregular, as was the junction of cartilage and bone. The diameter of the screw did not seem to have any influence on the occurrence of either radiologic or histologic signs of condylar degeneration. These findings indicate that screw fixation of condylar fractures in the mandible without IMF might result in degenerative joint disease.
Animals↗
Massive osteolysis (Gorham-Stout syndrome) in the maxillofacial region: an unusual manifestation.
An unusual case of massive osteolysis affecting the left side of the mandible, the maxilla, the zygoma, and the orbit is reported. The disease extended over a period of 25 years. The special feature of this case is that there were, before the osteolysis appeared, enlargement and sclerosis of the maxillofacial bones reaching up to the middle cranial fossa. Histopathologic examination of the affected mandible revealed that the bone was replaced by fibrous tissue.
Adult↗
Recurrent acromial bone spur after open subacromial decompression.
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Acromion↗
Results of treatment of 22 navicular stress fractures and a new proposed radiographic classification system.
Twenty-two navicular stress fractures sustained during athletic activity were retrospectively reviewed for return to activity time and the appearance of fracture pattern on computerized tomography. There were 10 females and nine males, with the average patient age being 27.2 years. Three patients sustained bilateral injuries at separate times. Average follow-up was 36.5 months. Nine patients underwent open reduction, internal fixation (some with bone grafting); this group's average return to activity (RTA) was 3.1 +/- 1.2 months (range, 1.5-5 months). Thirteen patients treated conservatively had an average return to activity of 4.3 +/- 2.8 months (range, 2-13 months). The difference between the two groups' RTA was significant (p = .02). Eleven patients utilized pulsed electromagnetic fields (PEMF) and had an average RTA of 4.2 +/- 3.4 months, 27.3% of those patients with PEMF also had surgery. Two conservatively treated fractures that took 5 and 8 months to RTA, respectively, re-fractured during the treatment process. Retrospective review showed CT fracture patterns in the frontal plane that were classified as: dorsal cortical break (type I), fracture propagation into the navicular body (type II), and fracture propagation into another cortex (type III). This is a proposed classification system. It includes modifiers "A" (avascular necrosis of a portion of the navicular); "C" (cystic changes of the fracture), and "S" (sclerosis of the margins of the fracture), the latter of which was most common in our series, particularly in continually symptomatic patients. Type I fractures were more likely to receive conservative treatment (p = .02) and type III fractures took significantly longer to heal than types I and II (p values .001 and .01, respectively). Type I and II injuries had an average RTA of 3.0 and 3.6 months, respectively. Type III injuries had an average RTA of 6.8 months. Based on our findings, we recommend surgery for patients with these modifiers, particularly with type II and III injuries. Conservative treatment may be prolonged, and requires at least 6 weeks of nonweightbearing in a below-knee cast/boot to be successful.
Adolescent↗
Enlargement of mandibular canal without hypesthesia caused by extranodal non-Hodgkin's lymphoma: a case report.
A rare condition of enlargement of the mandibular canal caused by an extra-nodal non-Hodgkin's lymphoma in a 59-year-old Japanese woman was reported. The patient had a swelling of the hard palate and protrusion of both ocular bulbs, which had been present for 10 years. A panoramic radiograph revealed that the right mandibular canal was widely enlarged, extending from the mandibular foramen to the mental foramen, without bone destruction. The continuous dilation of the mandibular canal to an approximate 15-mm width was associated with peripheral bony sclerosis. Computed tomography and magnetic resonance imaging showed a soft tissue tumor inside the mandibular canal. The lesion demonstrated expansive growth in the orbits, extending to the skull base through the superior orbital fissures and cavernous sinus. The lymphoma was suspected to have grown so slowly that the adjacent mandibular canal and ocular bulbs enlarged without destroying the normal bone and nervous tissue.
Dilatation, Pathologic↗
Radiographic findings in Langerhans' cell disease affecting the mandible.
The radiographic features of histopathologically diagnosed mandibular Langerhans' cell disease are described for 29 cases of the condition. We divided the patients into two groups: adults (age 27 to 60 years) and juveniles (age 1.5 to 15 years). A characteristic sign in juveniles was an osteolytic lesion with an uneven margin and either a continuous or discontinuous periosteal reaction. Because of the wide variability in radiographic presentation in adults, it was very difficult to differentiate this from other lesions in adults on the basis of radiologic criteria.
Adolescent↗
Radiographic features of segmental odontomaxillary dysplasia: a study of 12 cases.
The purpose of the study was to analyze the radiographic features of segmental odontomaxillary dysplasia by studying the radiographs of 12 new cases. With a standard data collection form, the radiographic characteristics were assessed by the two principal investigators who studied available radiographs of all cases. As in previously reported cases, abnormal findings in all patients were confined to the posterior segment of one maxilla. The most common findings in the cases studied were sclerosis and thickening of bony trabeculae, missing permanent premolar teeth, abnormal spacing of primary molars vertical orientation of bony trabeculae, a smaller maxillary sinus, and delayed eruption of permanent posterior teeth. Less commonly observed features were enlarged crowns, roots, and pulps of primary molars, irregular resorption of primary molar roots, mediolateral expansion of the alveolar process, splayed roots of primary molars, and an abnormal medial position of the teeth.
Adolescent↗
Diffuse sclerosing osteomyelitis and florid osseous dysplasia.
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Diagnosis, Differential↗
Longitudinal radiographic assessment of dense bone islands of the jaws.
OBJECTIVES: This study assessed dense bone island (DBI) inception and growth in jaws. STUDY DESIGN: A population of 2991 patients (age range 5 to 35 years) was studied with at least two panoramic radiographs taken 1 to 10 years apart for each patient. Lesions were digitized and measured with computer measuring software. The size of the earliest DBI was compared with subsequent DBI measurements after the latter measurement was normalized with reference to the size of the nearest tooth. RESULTS: Sixty-nine patients with DBIs were identified. A total of 3.1% of the patients with DBI were found in the 5- to 10-year age range, with the first patient in the DBI group found at 9.4 years. A significantly higher proportion (p = 0.002) of the unaffected patients (26%) was found in the same 5-to 10-year age range. The proportions of patients in the DBI and unaffected groups in older age ranges were similar. Assessment of DBI size changes showed that 43% of the 53 DBIs detected between 9.4 and 19 years enlarged (mean change, 212%), and 17% diminished (mean change, 49%). In comparison, 29.4% of 17 DBIs detected between 20 and 35 years enlarged (mean change, 153%), and 5.9% diminished (mean change, 60%). CONCLUSION: Our results indicate that DBIs are labile lesions, develop during early adolescence, and retain a potential for enlargement, or to a lesser extent shrinkage, into adulthood.
Adolescent↗
Radiographic evaluation of possible etiology of diffuse sclerosing osteomyelitis of the mandible.
To examine the cause and site of origin of diffuse sclerosing osteomyelitis of the mandible, we compared various radiographic findings for the mandibular lesions in 20 patients with diffuse sclerosing osteomyelitis with those in 48 patients with osteomyelitis caused by bacterial infection. In osteomyelitis of infectious origin, a typical radiographic feature was a radiolucent lesion spreading in the cancellous bone, with cortical bone perforation and lamellated periosteal reaction. In diffuse sclerosing osteomyelitis, intermingled sclerotic and osteolytic lesions with solid periosteal reaction or external bone resorption were a common finding, and in some patients the cortical bone was initially affected by the fresh or recurrent lesion. Based on these distinct differences, we suggest that the cause of diffuse sclerosing osteomyelitis is not bacterial infection and that the site of origin is not in the bone but in the periosteum.
Bacterial Infections↗