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Rosen AS, Sarmiento HL, Rosen PS, Peters SM. Multifocal mixed radiolucent-radiopaque lesions in an adult. J Am Dent Assoc 2024; 155:184-188. [PMID: 36543654 DOI: 10.1016/j.adaj.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 12/24/2022]
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Ali M, Farooq O, Rafique Z, Farooq H, Iftikhar F, Malik M. A rare case of asymptomatic Paget's disease of the skull in a 60-year-old Asian female. J Clin Transl Res 2023; 9:261-264. [PMID: 37593243 PMCID: PMC10431192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 01/22/2023] [Accepted: 05/30/2023] [Indexed: 08/19/2023] Open
Abstract
Background and Aim Paget's disease of the bone refers to a chronic cumulative disorder characterized by enhanced osteoclastic function followed by a secondary surge in osteoblastic activity. The condition can manifest as a polyostotic or monostotic bone disease with most patients having an asymptomatic presentation, although some may complain of pain localized to the affected bone while others express symptoms of nerve compression. A pagetic bone is predisposed to develop pathological fractures, bony deformities, and a rare yet detrimental transformation into osteosarcoma. Detection is often accidental when performing radiographic tests for other indications or when elevated blood levels of alkaline phosphatase (ALP) are detected. Treatment with third-generation bisphosphonates is helpful in preventing further bone resorption and, additionally, reduces bony pains that are believed to be caused by excessive metabolic activity. Here, we present a case of a middle-aged asymptomatic female with elevated serum ALP levels up to 1537 IU/L (reference range 40-150 U/L) during her pre-operative evaluation for elective cholecystectomy.99m Tc-methylene diphosphonate bone scintigraphy revealed diffuse uptake in the skull and, hence, was diagnosed as a case of isolated Paget's disease of the skull. Relevance for Patients The rarity of this disease in Southeast-Asians, its uncontrived detection, and the isolated skull involvement, imparts high clinical relevance on this case. Early detection and management of this disease can help prevent the development of life-threatening complications in affected patients, hence decreasing the morbidity.
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Affiliation(s)
- Muhammad Ali
- Department of Internal Medicine, Islamabad Medical Complex, NESCOM Hospital, Islamabad, Pakistan
| | - Omama Farooq
- Department of Internal Medicine, Islamabad Medical Complex, NESCOM Hospital, Islamabad, Pakistan
| | - Zahra Rafique
- Department of Internal Medicine, Islamabad Medical Complex, NESCOM Hospital, Islamabad, Pakistan
| | - Hajrah Farooq
- Department of Internal Medicine, Islamabad Medical Complex, NESCOM Hospital, Islamabad, Pakistan
| | - Fazeelat Iftikhar
- Department of Internal Medicine, Islamabad Medical Complex, NESCOM Hospital, Islamabad, Pakistan
| | - Muqadsa Malik
- Department of Internal Medicine, Fauji Foundation Medical College, Rawalpindi, Pakistan
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3
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Muthukumaran V, Kaliyaperumal S, Warrier A. Enlivening the radiographic features of Paget disease. BMJ Case Rep 2022; 15:e251006. [PMID: 36127032 PMCID: PMC9490631 DOI: 10.1136/bcr-2022-251006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Paget disease often presents as a rare asymptomatic lesion of the bone until it progresses into the advanced stages. A senile man was diagnosed with Paget disease of bone on routine dental radiographic analysis. His history of fractures, periodical ill-fitting dentures and frequent pain in the long bones were contributing to the diagnosis. The patient was referred to a general physician where whole body radiographs were taken, which showed several of the classic features of Paget disease. Biochemical analysis was also done in which serum alkaline phosphatase was elevated with all other values within normal limits, confirming the diagnosis. The patient was treated with single-infusion bisphosphonate followed by other required dental procedures. Early diagnosis and prompt management gave a good prognosis, preventing the potential complications.
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Affiliation(s)
- Vaishnavi Muthukumaran
- Oral Medicine and Radiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Subadra Kaliyaperumal
- Oral Medicine and Radiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Aravind Warrier
- Oral Medicine and Radiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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Santana N, Mehazabin S, Sangeetha K, Kumari M. Osteodystrophies of jaws. J Oral Maxillofac Pathol 2021; 24:405. [PMID: 33456267 PMCID: PMC7802870 DOI: 10.4103/jomfp.jomfp_225_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 01/21/2020] [Accepted: 03/05/2020] [Indexed: 12/04/2022] Open
Abstract
Bone is a dense, semi rigid, porous, calcified connective tissue forming the major portion of the skeleton of most vertebrates. It consists of a dense organic matrix and an inorganic mineral component. Bone remodelling is a complex process by which old bone is continuously replaced by new tissue, which requires interaction between different cell phenotypes and is regulated by a variety of biochemical and mechanical factors. In a homeostatic equilibrium, the process of resorption and formation are balanced so that old bone is continuously replaced by new tissue and it adapts to mechanical load and strain. Several local and systematic factors which cause disturbances in bone resorption and deposition leads to abnormal or defective development of bone commonly termed as osteodystrophy - A defective ossification of bone usually is associated with disturbed calcium and phosphorus metabolism. The better understanding of molecular cellular biology and pathogenic mechanism aids to define the abnormalities in osteoblastic and osteoclastic lineages and to develop new therapeutic approaches.
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Affiliation(s)
- N Santana
- Department of Oral Medicine and Maxillofacial Radiology, Ragas Dental College and Hospital, Chennai, Tamil Nadu, India
| | - S Mehazabin
- Department of Oral Medicine and Maxillofacial Radiology, Ragas Dental College and Hospital, Chennai, Tamil Nadu, India
| | - K Sangeetha
- Department of Oral Medicine and Maxillofacial Radiology, Ragas Dental College and Hospital, Chennai, Tamil Nadu, India
| | - M Kumari
- Department of Oral Medicine and Maxillofacial Radiology, Ragas Dental College and Hospital, Chennai, Tamil Nadu, India
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Van de Voorde N, Mortier GR, Vanhoenacker FM. Fibrous Dysplasia, Paget's Disease of Bone, and Other Uncommon Sclerotic Bone Lesions of the Craniofacial Bones. Semin Musculoskelet Radiol 2020; 24:570-578. [PMID: 33036044 DOI: 10.1055/s-0039-3400292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Imaging studies of the brain, head and neck, sinuses, and dental computed tomography are among the most frequently performed procedures in radiologic departments. Systematic evaluation in the bone window may reveal common and uncommon sclerotic osseous abnormalities of the craniofacial skeleton.Most of these findings are incidental and unrelated to the initial clinical indications. Sporadically symptoms may arise due to lesional mass effect with compression on adjacent structures and neuroforaminal encroachment, resulting in proptosis, vision, or hearing loss. Other symptoms include craniofacial deformity, mandibular occlusion deformity, and local pain.This article reviews the most common disorders characterized by an increased bone density involving the craniofacial bones including fibrous dysplasia, Paget's disease of bone, meningioma with associated hyperostosis, and osteoma. Finally, typical examples of rarer sclerosing bone dysplasias are discussed as well.Emphasis is placed on imaging features and the differential diagnosis.
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Affiliation(s)
- Nick Van de Voorde
- Department of Radiology, Antwerp University Hospital and Antwerp University, Edegem, Belgium
| | - Geert R Mortier
- Department of Medical Genetics, Antwerp University Hospital and Antwerp University, Edegem, Belgium
| | - Filip M Vanhoenacker
- Department of Radiology, Antwerp University Hospital and Antwerp University, Edegem, Belgium.,Department of Medical Genetics, Antwerp University Hospital and Antwerp University, Edegem, Belgium.,Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium.,Department of Radiology and Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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6
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Asirvatham AR, Kannan S, Mahadevan S, Balachandran K, Sampathkumar G, Sadacharan D, Balasubramanian SK. Is Paget Disease of Bone more Common in South India? Clinical Characteristics, Therapeutic Outcome and follow-up of 66 Patients from Tamil Nadu. Indian J Endocrinol Metab 2020; 24:306-311. [PMID: 33088752 PMCID: PMC7540825 DOI: 10.4103/ijem.ijem_209_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/16/2020] [Accepted: 06/19/2020] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Paget disease of bone (PDB) is a disorder of altered bone remodeling mainly characterized by increased osteoclastic activity. While the exact Indian prevalence remains unknown, a clustering of published cases suggests South Indian predominance. OBJECTIVE To study the clinico-biochemical profile and therapeutic response of patients with PDB and briefly review the epidemiology of PDB from an Indian perspective. MATERIALS AND METHODS Retrospective data was collected from the charts of patients who have been seen in endocrine out-patient clinics in Tamil Nadu over a 12-year period. Published literature on PDB from India was reviewed. RESULTS A total of 66 patients (71% males) predominantly from Tamil Nadu were studied. The mean age at presentation was 67 ± 8 years. Polyostotic involvement was seen in 89% and familial occurrence of PDB in 5 patients. Symptoms at presentation mainly included bone pain (51%) and skeletal deformities (18%). Scalp vein sign (21%) and sensorineural hearing loss (64%) were also noted. Incidental PDB detection by raised serum alkaline phosphatase (SAP) levels was observed in 17% and by abnormal fluorodeoxyglucose-positron emission tomography (FDG-PET) scan in 6% of cases. Mean SAP at presentation was 606 ± 438 IU/L (Normal, 76-140). Major skeletal site involvement includes pelvis (62.1%) and spine (34.8%). Mean (range) follow-up of the cohort was 3.4 yrs (1-12 yrs). In all, 64 subjects received zoledronate and two received alendronate, and mean (SD) SAP at 1-year was 73 ± 42 IU/L. All but two showed remission at the end of 1 year. Two had pathological fractures and two had sarcomas. A review of epidemiology of PDB in Indian literature clearly showed a South Indian predilection for unclear reasons. CONCLUSION In our cohort of PDB, male gender, polyostotic involvement, and hearing impairment were noted in more than two-thirds of patients and single-dose intravenous zoledronate was effective in normalizing SAP in almost all patients. PDB is intriguingly more common in South India and this needs more exploration.
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Affiliation(s)
- Adlyne R. Asirvatham
- Department of Endocrinology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
| | - Subramanian Kannan
- Department of Endocrinology, Mazumdar Shah Medical Centre, Bommasandra, Bengaluru, Karnataka, India
| | - Shriraam Mahadevan
- Department of Endocrinology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
| | - Karthik Balachandran
- Department of Endocrinology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
| | | | | | - Satish K. Balasubramanian
- Department of Endocrinology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, Tamil Nadu, India
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Siddiqui UM, Nieves CA, Valencia-Guerrero AL, Coyne C. Paget Disease of the Mandible. AACE Clin Case Rep 2018. [DOI: 10.4158/accr-2017-0264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Kumar SRR, Bagalad BS, Manohar CB, Kuberappa PH. Intermediate Type of Juvenile Paget's Disease: A Rare Case in Indian Population. Contemp Clin Dent 2017; 8:175-178. [PMID: 28566875 PMCID: PMC5426156 DOI: 10.4103/ccd.ccd_1097_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Juvenile Paget's disease (JPD), a rare genetic skeletal disorder characterized by accelerated bone turnover with elevated levels of serum alkaline phosphatase, presents in early childhood. We report a female patient with typical features of JPD with dental finding who remained undiagnosed until 18 years of age. Scarcity of this disease in the Indian literature and need for timely diagnosis to avert progression of disease thus incited us to report this case.
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Affiliation(s)
- S Ravi Raja Kumar
- Department of Oral Pathology and Microbiology, Saint Joseph Dental College, Eluru, Andhra Pradesh, India
| | - Bhavana S Bagalad
- Department of Oral Pathology and Microbiology, Saint Joseph Dental College, Eluru, Andhra Pradesh, India
| | - Ch Balakrishna Manohar
- Department of Oral Pathology and Microbiology, Saint Joseph Dental College, Eluru, Andhra Pradesh, India
| | - Puneeth H Kuberappa
- Department of Oral Pathology and Microbiology, Saint Joseph Dental College, Eluru, Andhra Pradesh, India
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A Giant-Cell Lesion with Cellular Cannibalism in the Mandible: Case Report and Review of Brown Tumors in Hyperparathyroidism. Case Rep Dent 2017; 2017:9604570. [PMID: 28280638 PMCID: PMC5322443 DOI: 10.1155/2017/9604570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/02/2017] [Accepted: 01/16/2017] [Indexed: 12/25/2022] Open
Abstract
A small radiolucent area in the mandible was discovered in a 58-year-old woman with no oral complaints. The patient's history included only hypertension. The lesion was considered as an inflammatory cyst and was enucleated. Three months later, a CT revealed the presence of a cyst-like lesion in the mandible with thin expanded buccal cortical plate, localized erosion, and a polylobate appearance on the lingual aspect of the cortical plate. The histological diagnosis of the lesion was central giant-cell granuloma (CGCG). The lesion was thoroughly enucleated. Nevertheless, another X-ray carried out six months later revealed multiple bilateral osteolytic areas throughout the jaw. In addition, widespread cortical plate erosion was observed, as well as signs of root resorption and periodontal enlargement. There was no sign of neurological involvement, although the nerves appeared to be dislocated. After full blood chemistry analysis and detailed collection of radiographs, the final diagnosis was brown tumors in primary hyperparathyroidism. This case report demonstrates how dental clinicians may be the first-line specialists who identify a complex systemic disease before other clinicians. Finally, it highlights the role of cellular cannibalism in predicting the clinical aggressiveness of brown tumors as well as in other giant-cell lesions.
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Dalirsani Z, Javadzade Bolouri A, Delavarian Z, Bidad S, Sanatkhani M, Amirchaghmaghi M. Human T-Lymphotropic Virus-1 Associated with Adult T-Cell Lymphoma/ Leukemia and Generalized Expansion of Palatal and Jaw Bones: A Rare Case Report. JOURNAL OF DENTISTRY (SHIRAZ, IRAN) 2015; 16:214-8. [PMID: 26331152 PMCID: PMC4554315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Human T-lymphotropic virus-1 (HTLV-1) can cause adult T-cell leukemia/ lymphoma (ATL/L), which is a rare and aggressive type of blood cancer. Herein, we report a case of ATL/L in a middle-aged man with unusual jaw presentations. The patient presented with mandibular, maxillary and palatal bony hard expansion, accompanied by generalized tooth mobility six months prior to admission to the Department of Oral Medicine. The panoramic radiograph showed generalized rarefaction of jaw bones. After laboratory examinations and bone marrow aspiration, ATL/L was diagnosed in association with HTLV-1. The patient underwent chemotherapy. Although the majority of infections associated with HTLV-1 are asymptomatic, some patients may develop blood diseases such as ATL/L and neurological disorders, mainly HTLV-1 associated myelopathy and tropical spastic paraparesis. ATL/L is a rare hematological malignancy in oral cavity that should be included in the differential diagnosis of cases with jaw swelling or generalized demineralization. Serum levels of anti-HTLV-1 antibodies should be examined in suspicious patients, particularly in endemic regions.
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Affiliation(s)
- Zohreh Dalirsani
- Dept. of Oral and Maxillofacial Medicine, Oral and Maxillofacial Diseases Research Center, Dept. of Oral Medicine, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Abbas Javadzade Bolouri
- Dept. of Oral and Maxillofacial Medicine, Dept. of Oral Medicine, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Zahra Delavarian
- Dept. of Oral and Maxillofacial Medicine, Oral and Maxillofacial Diseases Research Center, Dept. of Oral Medicine, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.
| | | | - Majid Sanatkhani
- Dept. of Oral and Maxillofacial Medicine, Oral and Maxillofacial Diseases Research Center, Dept. of Oral Medicine, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Maryam Amirchaghmaghi
- Dept. of Oral and Maxillofacial Medicine, Oral and Maxillofacial Diseases Research Center, Dept. of Oral Medicine, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.
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Chakravarthi PS, Peravali RK, Kattimani V. Paget's Disease in Mandible: A Rare Occurrence in an Indian Sub-Continent. J Clin Diagn Res 2015; 9:ZJ02-3. [PMID: 25954722 DOI: 10.7860/jcdr/2015/11468.5708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 01/06/2015] [Indexed: 11/24/2022]
Affiliation(s)
- P Srinivas Chakravarthi
- Professor, Department of Oral and Maxillofacial Surgery, SIBAR Institute of Dental Sciences , Guntur, Andhra Pradesh, India
| | - Ranjit Kumar Peravali
- Reader, Department of Oral and Maxillofacial Surgery, SIBAR Institute of Dental Sciences , Guntur, Andhra Pradesh, India
| | - Vivekanand Kattimani
- Assistant Professor, Department of Oral and Maxillofacial Surgery, SIBAR Institute of Dental Sciences , Guntur, Andhra Pradesh, India
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Rai H, Pai SM, Dayakar A, Javagal V. A rare incident of Paget's disease of bone in early adult life. J Oral Maxillofac Pathol 2014; 18:S147-50. [PMID: 25364167 PMCID: PMC4211226 DOI: 10.4103/0973-029x.141373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 09/01/2014] [Indexed: 11/09/2022] Open
Abstract
Paget's disease of bone (PDB) is characterized by a focal alteration of bone remodeling, which leads to bone with anomalous structure and altered mechanical properties associated with pain and complications. It is more common in Western Europe where as rare in Africa and Asia. The disease is more common in men of older adults and mean age of occurrence is 59 ± 14 years. But it is rarely encountered in patients younger than 40 years of age.
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Affiliation(s)
- Harishchandra Rai
- Department of Oral Pathology and Microbiology, KVG Dental College and Hospital, Sullia, Karnataka, India
| | - Shaila M Pai
- Department of Oral Pathology and Microbiology, KVG Dental College and Hospital, Sullia, Karnataka, India
| | - Anitha Dayakar
- Department of Oral Pathology and Microbiology, KVG Dental College and Hospital, Sullia, Karnataka, India
| | - Vivek Javagal
- Department of Oral Pathology and Microbiology, KVG Dental College and Hospital, Sullia, Karnataka, India
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An SY, Shin HI, Choi KS, Park JW, Kim YG, Benavides E, Kim JW, An CH. Unusual osteoid osteoma of the mandible: report of case and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 116:e134-40. [PMID: 23849381 DOI: 10.1016/j.oooo.2013.04.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 04/06/2013] [Accepted: 04/08/2013] [Indexed: 11/20/2022]
Abstract
A 10-year-old boy presented with a swelling on the right side of the jaw. He had undergone excision of the lesion about 10 months ago at a private dental clinic and the swelling began to regrow 4 months after surgery. A panoramic radiograph revealed 4 sclerotic round masses with radiolucent rims surrounded by sclerosis of the right posterior mandible. Computed tomography scan showed 4 round bony masses centered on the buccal cortex and bone marrow space, sclerosis of the adjacent bone and periosteal reaction. He underwent a marginal resection under general anesthesia and the final histopathological report confirmed the diagnosis of osteoid osteoma. Postoperative course was uneventful, and there was no evidence of recurrence at the 5.5-year follow-up. In the review of the literature, 20 osteoid ostemas were found in the jaw and to the best of our knowledge, the present case is the only one showing multifocal nidi.
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Affiliation(s)
- Seo-Young An
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Kyungpook National University, Daegu, South Korea
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Cakir Karabas H, Kose TE, Hatipoglu E, Dincer O, Erdem TL, Ozcan İ. Paget's disease of maxilla: A case report. Indian J Dent 2013. [DOI: 10.1016/j.ijd.2013.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
Paget disease of bone (PDB) is a chronic progressive disease of the bone of uncertain etiology, characterized initially by an increase in bone resorption, followed by a disorganized and excessive formation of bone, leading to pain, fractures, and deformities. It can manifest as a monostotic or polyostotic disease. The prevalence of PDB is common in the Anglo-Saxon population, but relatively rare in India. The disease is often asymptomatic and commonly seen in an aging population. The diagnosis of the disease is mostly based on radiological examination and on biochemical markers of bone turnover. Markedly elevated serum alkaline phosphatase (SAP) is a constant feature while calcium and phosphate levels are typically within normal limits. It is being successfully treated by biphosphonates, a group of anti-resorptive drugs, thereby decreasing the morbidity and mortality associated with the disease. We report a classic case of PDB with craniofacial involvement resulting in Leontiasis Ossea (lion like face), cotton wool appearance of the skull and elevated SAP.
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Affiliation(s)
- Y Uday Shankar
- Department of Oral Medicine and Radiology, G. Pulla Reddy Dental College and Hospital, Kurnool, Andhra Pradesh, India
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