Maxillomandibular giant osteosclerotic lesions

Abstract Giant Osteosclerotic Lesions (GOLs) are a group of rarely reported intraosseous lesions. Their precise diagnosis is important since they can be confused with malignant neoplasms. Objective This retrospective study aimed to record and analyze the clinical and radiographic Giant Osteosclerotic Lesions (GOLs) detected in the maxillomandibular area of patients attending to our institution. Materials and Methods: Informed consent from the patients was obtained and those cases of 2.5 cm or larger lesions with radiopaque or mixed (radiolucid-radiopaque) appearance located in the maxillofacial bones were selected. Assessed parameters were: age, gender, radiographic aspect, shape, borders, size, location and relations to roots. Lesions were classified as radicular, apical, interradicular, interradicular-apical, radicular-apical or located in a previous teeth extraction area. Additionally, several osseous and dental developmental alterations (DDAs) were assessed. Results Seventeen radiopacities in 14 patients were found and were located almost exclusively in mandible and were two types: idiopathic osteosclerosis and condensing osteitis. GOLs were more frequent in females, and in the anterior and premolar zones. 94.2% of GOLs were qualified as idiopathic osteosclerosis and one case was condensing osteitis. All studied cases showed different osseous and dental developmental alterations (DDAs). The most common were: Microdontia, hypodontia, pulp stones, macrodontia and variations in the mental foramina. Conclusions GOLs must be differentiated from other radiopaque benign and malignant tumors. Condensing osteitis, was considered an anomalous osseous response induced by a chronic low-grade inflammatory stimulus. For development of idiopathic osteosclerosis, two possible mechanisms could be related. The first is modification of the normal turnover with excessive osseous deposition. The second mechanism will prevent the normal bone resorption, arresting the osseous breakdown process.

巨骨硬化性病变（Giant Osteosclerotic Lesions, GOLs）是一类罕有报道的骨内病变。由于其易与恶性肿瘤混淆，精准诊断具有重要临床意义。
研究目的：本回顾性研究旨在记录并分析就诊于本机构的患者上下颌骨区域检出的巨骨硬化性病变（GOLs）的临床与影像学特征。
材料与方法：本研究已获得患者知情同意，选取病灶直径≥2.5 cm、位于颌面骨内且呈放射阻射性或混合性（放射透射-放射阻射性）表现的病例作为研究对象。评估参数包括：年龄、性别、影像学表现、形态、边界、大小、位置以及与牙根的关系。根据病灶位置，将其分为根周型、根尖型、根间型、根间-根尖型、根周-根尖型，或位于既往拔牙区域。此外，本研究同时评估了多种骨与牙齿发育异常（osseous and dental developmental alterations, DDAs）。
结果：本研究共纳入14例患者的17处放射阻射性病灶，病灶几乎均位于下颌骨，分为两种类型：特发性骨硬化症与致密性骨炎。巨骨硬化性病变（GOLs）在女性群体及前牙区、前磨牙区更为多发。94.2%的病灶为特发性骨硬化症，仅1例为致密性骨炎。所有研究病例均存在不同程度的骨与牙齿发育异常（DDAs），其中最常见的类型包括：小牙症、先天缺牙、髓石、巨牙症以及颏孔形态变异。
结论：巨骨硬化性病变（GOLs）需与其他放射阻射性良、恶性肿瘤相鉴别。致密性骨炎被认为是慢性低度炎症刺激诱导的异常骨反应。关于特发性骨硬化症的发病机制，存在两种可能的机制：其一为正常骨代谢发生改变，出现过度骨沉积；其二为正常骨吸收过程受到抑制，阻滞了骨降解进程。