Facial cranial changes pagets disease
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Paget's disease of bone
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The Facial cranial changes pagets disease is often asymptomatic and commonly seen in pafets aging population. The chwnges 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. Rarely, skull involvement may lead to compression of the nerves that supply the eyeleading to vision loss.
Advanced Paget's cranail may lead to other medical conditions, including: Osteoarthritis may result from changes in bone shape that alter normal skeletal mechanics. For example, bowing of a femur affected by Paget's may distort overall leg alignment, subjecting the knee to abnormal mechanical forces and accelerating degenerative wear. No matter how realistic the description may seem to be, everyone, so the argument goes, knows that a year-old skull could not possibly have withstood the blow of Skapti's ax. Modern medical knowledge, however, suggests that we cannot treat this episode as a purely literary device intended to magnify heroic Viking qualities.
Egil's Saga precisely describes the skull as "ridged all over on the outside like a scallop shell. A "scalloped" bone surface, unique in descriptions of Viking heroes, closely matches medical portrayals of Paget's disease. Diagnoses repeatedly list irregularities of the outer skull surface, describing its appearance as corrugated and wavy. Such a feature appears in about one in 15 symptomatic cases. Physicians have also noted the exceptionally resilient, ivorylike hardness of the afflicted bones. Even the whitening of Egil's skull where Skapti's ax struck is a clear indication of Paget's disease. When subjected to a blow, the soft, pumicelike outer material of the enlarged Pagetic skull gives way to a white, hardened, highly resilient core.
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In the saga, Egil himself refers to his head in strange ways. In one poem, written in response to a pardon granted him by his sworn enemy, King Erik Blood-Axe, Egil composed this pagetz I am not opposed, Though I may be ugly, To accepting my helm's-rock of cganges head, From a ruler. Paget's disease may have been responsible for Egil's memorable facial appearance, a subject that over the years has engendered a great deal of creative literary interpretation. The saga offers a detailed description of Egil as he sits at a feast in England after battle. He faces King Athelstan, the ruler who he believes owes him compensation for the death of his brother, Thorolf.
Egil sat upright, but his head hung forward. Egil was marked by prominent features. He had a broad forehead and large eyebrows, a nose that was not long but enormously thick, and lips that, seen through his beard, were both wide and long. He had a remarkably broad chin, and this largeness continued throughout the jawbone.
Disease changes Facial cranial pagets
Facial cranial changes pagets disease He was thick-necked and broad-shouldered and, Fackal so than other men, hard-looking and fierce when angry. Well built and taller than others, he had thick wolf-gray hair but was early bald. While he sat as was written above, he jerked one eyebrow down to his chin and lifted the other one up into his hairline; Egil was black-eyed with eyebrows joined. He reported elevated alkaline changez activity in the patients' sera. Over time, Fcaial came to be appreciated that serum alkaline phosphatase activity could reach higher levels in Paget's disease Facia in any other disorder.
Estimates of the prevalence in individual British cities even suggest a striking variability within one country 5. Dosease of hospital vranial indicated prevalence ranging from 2. Paget's disease probably occurs diseade often in FFacial and women and clearly increases in prevalence with age The diagnosis is nearly always determined in individuals over the age of 50 years. The occurrence of Paget's disease in more than one member of a family was first reported in Analysis of numerous kindreds indicates an autosomal dominant mode of inheritance Gene analysis of Paget's disease kindreds will be discussed subsequently.
In patients with familial disease there may be somewhat more bones affected than in patients with sporadic disease Deformity A common feature of Paget's disease is skeletal deformity. This clearly evolves over a period of many years probably decades in most patients. The deformity is most visible in the skull and lower extremities. Asymmetric enlargement of the cranium may first come to attention in those individuals who notice an increase in hat size. An increase in the size of superficial scalp veins, best appreciated over the frontal and temporal bones, is not uncommon. In patients with cranial enlargement, hearing loss is a common complication. The hearing loss correlates with loss of bone mineral density in the cochlear capsule Inexplicably, despite the common skull involvement, Paget's disease is quite unusual in the facial bones.
One or, less often, two clavicles may become enlarged. An enlarged scapula is uncommonly appreciated perhaps because of its location. The spine is a common source of morbidity from Paget's disease. The lumbar vertebrae and sacrum are most frequently affected. A single vertebra or multiple vertebrae may be involved. Over time, the vertebrae generally enlarge, but in some instances, vertebral compression may produce significant kyphosis.
Figure 2Typical bowing of the leg due to Paget's disease involving the right tibia. Although Paget's disease is commonly found to affect the pelvis, only in its most severe form is it apparent on physical examination that the bone is thicker than normal. An increase in skin temperature is more readily detected over the tibia, a reflection of increased blood flow to the bone and surrounding soft tissue. Bowing of the upper extremity long bones is much less common than in the lower extremity, presumably because these are not weight-bearing bones. Typical bowing of the leg due to Paget's disease involving the right tibia. Pathological fractures in the lower extremity are most likely to occur in the femur and typically are transverse in nature Figure 3.
They are much more likely to result Facixl nonunion than are tibial fractures Figure 3Transverse fracture of the pagete femur. Pain Pain is a quite common symptom in the population of Paget's disease patients. It may pagehs of skeletal, joint, neurologic or muscle origin. Surprisingly, bone pain is usually absent even in patients with extensive disease or, when present, is mild to moderate in severity. The pain is usually dull in quality and often persists during the night. Weight bearing seldom produces a significant increase in bone pain. Severe pain in a patient with Paget's disease is most likely to be due to osteoarthritis. This commonly occurs in the hip Facoal.
Deterioration of the cartilage can occur when Paget's disease affects the acetabulum alone Figure 4but is likely to be more severe when both the acetabulum and head of the femur are affected by Paget's disease. If the femoral head is the only site of the disease, osteoarthritis is a less likely complication. A major feature of the pain in these patients is a significant increase in severity with weight bearing. In some patients, the combination of pain and impaired motion of the joint severely limits mobility. Knee pain and joint effusion may be prominent features in patients with bowing of the tibia.
Back pain due to osteoarthritis also occurs in association with Paget's disease Figure 5. Pain from osteoarthritis of the shoulder joint is relatively uncommon. Figure 4 Paget's disease involving the left hemipelvis and right femur. There is severe osteoarthritis of the left hip but a relatively normal joint space in the right hip. The most severe chronic pain in patients with Paget's disease is probably of neurologic origin. Pain from compression of the spinal cord or nerve roots may follow from enlargement of the vertebral bodies, pedicles, or laminae as well as from compression fractures.
Bone tissue is maintained by cells called osteoblasts and osteoclasts. The osteoblasts build new bone, while the osteoclasts help to dispose of old bone. The osteoblasts become overactive and too much bone tissue is produced, leading to enlargement. The abnormal growth means that the new bone tissue is weak and unstable. The new bone also contains more blood vessels than normal bone.