Fibro osseous lesions of jaw/ oral surgery courses

INDIAN DENTAL ACADEMY
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 Benign Fibro-osseous Lesions
A group of lesions in which normal bone is
replaced initially by fibrous connective tissue.
Over time, the lesion is infiltrated by
osteoidand cementoid tissue This is a benign
and idiopathic process

 The F.O. lesions are benign, slowly growing,
mesenchymal tumours/ malformations which
contain
1. Mineralized tissue
2. Blood vessels
3. Giant cells

 They either destroy the normal bone or replace it
( e.g. Fibrous dysplasia, Paget’s disease)
 Tumours are usually well circumscribed
 Dysplasias are diffuse
 The clinical behavior is variable
 The growth is related to age
 Self limiting
 Histopatholgical & Radiographic findings are
almost similar
 Biochemical findings are typical
 Clinicopathological correlation is needed for
diagnosis.

FACTORS TO BE CONSIDERED
Functional Disability
Neurologic Symptoms
Esthetic Problem
Defer until growth completion
Avoid Radiation

 Radiotherapy
 Medicinal
 Surgical
 Curative
 Cosmetic recontouring
Combination

 Monostotic
 Polyostotic
 Craniofacial

Zone 1: Frontal orbital,
nasal, ethmoid bones,
zygoma and the upper
maxilla
Zone 2: hair – bearing
cranium, including the
parietal bone and the
occipital bones
Zone 3: central cranial base
and temporal, petrous,
mastoid, and sphenoid
bones
Zone 4: teeth bearing
maxillary and mandibular
alveolar bones

Monostotic Or Polyostotic
1.Middle Cranial Fossa
2.Sphenoid Wing
3.Orbital Roof
4.Cribriform Plates
5.Skull Base
6.Nasal Cavity
7.Orbits

Pressure Effects
Limb Paralysis
2nd ,3rd ,4th ,6th ,7th cranial Nerves Most
Commonly Affected
Deafness, Deteriorating Vision, blindness

 Eye
Displacement
 Proptosis
 Diplopia
 Opthalmoplegia
 Blindness
Nasal Obstruction
Proptosis
Pain
ETHMOIDAL SINUSES

 Site
 Impingement of vital structures
 Respiratory obstructions
 Increased cellularity & vascularity on MR – ANGIO &
Technetium 99 Scans
 Age of the patient- more active in childhood, puberty &
pregnancy
 Clinical behavior
 Cosmetic demands
 Become quiescent & burn out in late teen age and
adulthood

 Medical – Mainstay Bisphosphonates
 Administration requires professional care.
 Results unpredictable
 Associated complications

 Amino biphosphonates (pamidronate)
 Controls the activity of osteoclasts
 IV 3 doses of 60 mg (1 mg /kg in children) at
intervals of 1 day to 1 week. Repeated every 6
months
 Serial biochemical markers of bone and ct
scans to asses the response to treatment

 Used in osteoporosis, multiple myeloma,
Paget’s disease, secondaries in bone, primary
hyperparathyroiism, osteogenesis imperfecta
 They bind to calcium ions in the bone and are
engulfed by osteoclasts
 Prevent boney destruction by inducing
apoptosis of osteoclasts
 Side effects- gastritis, oesophageal erosions
 Administered with due care in patients with
CVS disorders.

 Contour excision
 En bloc resection with or without bone
grafting.

CONTOUR EXCISION EN BLOC RESECTION
 Quiescent and non-
aggressive lesions
 No growth for at least 1
year
 Aesthetic deformities
 Functional problems, such
as paresthesia, trismus,
impairment of vision, and
pain.
 Aggressive lesions
 Rapid or extensive growth
 Cause airway obstruction
 Have recurred

ADDRESS IF
 Visual disturbances, hearing loss, deformity, or intractable
pain.
 Detection of a symptomatic, new cystic lesion in the pre
existing FD or other new findings
 Degeneration to a sarcoma

Zone 1: Frontal orbital, nasal,
ethmoid bones, zygoma and the
upper maxilla
Cosmetic re contouring
Zone 2: hair – bearing cranium,
including the parietal bone and the
occipital bones
Zone 2: not as cosmetically
important as Zone 1
Zone 3: central cranial base and
temporal, petrous, mastoid, and
sphenoid bones
Zone 3: most difficult or dangerous
for resection
Zone 4: teeth bearing maxillary and
mandibular alveolar bones
Zone 4: wide surgical resection
followed by microsurgical bone flap
reconstruction.

 Zone 1: sight and olfaction
• Management around the optic nerve:
– observation with regular ophthalmologic
examinations in asymptomatic patients
– prophylactic decompression of the optic nerve
• ‘‘Prophylactic decompression of the optic
nerve is not necessarily indicated on the
basis of the presence of FD on diagnostic
images alone”

 Preservation of key and unique functional abilities
related to the craniofacial region.
 Improved cosmesis
 Alleviation of painful symptoms related to bone
overgrowth
 Treatment of pathologic fractures

 Posterior extension
 Malignant transformation
 Involvement of vital structures
 Osteomyelitis

DIFFERENCE IN
NORMAL AND
AFFECTED SITE

PREOP POST OP
1 month POST OP

a. Purely genetic
b. Affects mandible & rarely maxilla & no other
bones.
c. Nasal obstruction
d. “Heavenly looking eyes”
e. Self limiting
f. Surgery not recommended unless symptoms
warrant it.
g. Curettage & not resection
h. Self limiting

 Surgical intervention must be based on
 To improve function,
 prevent debility, and
 Satisfy aesthetic considerations.
If necessary, conservative curettage of the lesion
with bone recontouring may be performed.

 The prognosis is relatively good, particularly if
the disease is limited to only one jaw especially
the mandible.
 After a rapid pace of bone expansion, the
disease is usually self limiting and regressive.
 Spontaneous regression begins at puberty, with
relatively good resolution by age 30.

 Primary indicator for therapeutic intervention
is patient discomfort.
 Elevation of alkaline phosphatase levels to
twice normal levels is also an indication for
treatment.
 Therapy is essentially symptomatic, with
analgesics used for pain control.
 The use of calcitonin or bisphosphonate as
parathormone antagonists has been effective.

 A 50% reduction in either index constitutes a good
therapeutic response.
 Heart failure may also be an important complication
of Paget's disease as a consequence of the
hypervascular bone.
 In the early vascular phase, bleeding following any
type of bone surgery (e.g., tooth extraction) can be
problematic.

 Surgical removal using curettage or
enucleation.
 Lesion can be easily shelled out from the
surrounding normal bone.
 Recurrence is described only rarely after
removal.

 PCD is a localized change in bone metabolism.
It occurs at the apices of lower anterior teeth
􀂃 Clinical Features
– Teeth are vital
– Usually an incidental radiographic finding

 Localized lesions/ tumours to be treated by
surgical excision
 Dysplasias are usually self limiting
 To be treated surgically only if symptomatic
 Recontouring to be done at growth maturity in
silent lesions.
 Medicinal treatment unpredictable
 Never irradiate

 A tumour?
 Malformation?
 Abnormal reparative phenomenon?
Destruction of bone
Reparative process
Uncontrolled/ exaggerated

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Fibro osseous lesions of jaw/ oral surgery courses

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