• Stevens-Johnson Syndrome (SJS):

  • Characterized by ulcers with hemorrhagic crusts.

  • Typically has an acute onset following drug exposure (mainly sulfa group drugs).

• Biopsy for Vesiculobullous Pathology: Should be taken from the margin of the vesicle/bulla, including a significant amount of normal-appearing mucosa, to capture the pathological changes and adjacent healthy tissue for comparison.

• Linea Alba: A white, bilateral line on the buccal mucosa associated with pressure, frictional irritation, or sucking trauma from the facial surface of teeth.

• Morsicatio Buccarum: Chronic irritation seen on the buccal mucosa as a result of suction and glassblowers (chewing habits).

• Riga-Fede Disease: Sublingual ulcerations in infants resulting from chronic mucosal trauma from adjacent primary teeth (often natal/neonatal teeth).

• Bull Neck: Seen in Diphtheria and Ludwig's Angina.

• Bull's Eye Lesion / Target Lesions: Characteristic of Stevens-Johnson Syndrome and Erythema Multiforme.

• Bull's Teeth: Refers to Taurodontism.

• Circus Rubber Man: Clinical appearance associated with Ehlers-Danlos Syndrome (due to hypermobility and skin elasticity).

• Claw Hands: A physical deformity seen in advanced Scleroderma.

• Coup de Sabre: A linear depression or groove resembling a "saber cut" seen in Facial Hemiatrophy (Parry-Romberg Syndrome) and localized Scleroderma (linear scleroderma).

• CREST Syndrome: A limited form of Scleroderma, characterized by:

  • Calcinosis

  • Raynaud's phenomenon

  • Esophageal dysfunction

  • Sclerodactyly

  • Telangiectasias

• Crowe's Sign: Axillary or inguinal freckling seen in Neurofibromatosis Type 1.

• Frog Facies: A characteristic facial appearance seen in Crouzon Syndrome (due to midfacial hypoplasia and exophthalmos).

• Gorlin Sign: The ability to touch the tip of the nose with the tongue, seen in Ehlers-Danlos Syndrome (due to increased joint laxity).

• Hockey Stick Deformity of Femur and Shepherd's Crook Sign: Radiographic findings typically associated with Fibrous Dysplasia.

• Parrot's Beak Nose: A nasal deformity seen in Crouzon Syndrome.

• Red Strawberry Tongue and Pastia's Lines: Clinical signs characteristic of Scarlet Fever.

• Rodent Facies: A facial appearance often associated with Thalassemia.

• Simian Stance: A stooped posture, reminiscent of an ape, seen in Paget's Disease of Bone.

• Snail Track Ulcers: Serpiginous, grayish-white lesions on mucous membranes, characteristic of Syphilis (mucous patches in secondary syphilis).

• Socks Feet and Mitten Hands: Refers to syndactyly (fusion of digits) appearing like a sock or mitten, seen in Apert's Syndrome.

• Parrot Beak Shaped Nails: A nail deformity (onychogryphosis) seen in Congenital Syphilis.

• Bacteria adhere to acquired pellicle
• Coaggregation enables biofilm complexity
• Sucrose → lactic acid → pH drops → Hydroxyapatite dissolves

Key Enzymes Recap:

• Invertase → splits sucrose
• GTF → forms sticky glucans for adhesion
• FTF → synthesizes fructans for biofilm scaffolding

Garre’s Osteomyelitis (Chronic Osteomyelitis with Proliferative Perosteitis)

• Chronic Non Suppurative Sclerosing Osteitis/ Periostitis Ossificans.
• Non suppurative productive disease characterized by a hard swelling.
• Occurs due to low grade infection and irritation
• The infectious agent localizes in or beneath the periosteal covering of the cortex & spreads only slightly into the interior of the bone.
• Occurs primarily in young persons who possess great osteogenic activity of the periosteum.

Clinical Features

• Uncommonly encountered, described in tibia and in the head and neck region, in the mandible.
• Typically involves the posterior mandible & is usually unilateral.
• Patients present with an asymptomatic bony, hard swelling with normal appearing overlying skin and mucosa.
• On occasion slight tenderness may be noted
• pain is most constant feature
• The increase in the mass of bone may be due to mild toxic stimulation of periosteal osteoblasts by attenuated infection.

Radiographic features

• Laminations vary from 1 – 12 in number, radiolucent separations often are present between new bone and original cortex. (“onion skin appearance”)
• Trabeculae parallel to laminations may also be present.

Histologic Features

• Reactive new bone.
• Parallel rows of highly cellular & reactive woven bone in which the individual trabeculae are oriented perpendicular to surface.
• Osteoblasts predominate in this area.

D/D for Garre’s Osteomyelitis

• Ewing's sarcoma
• Caffey’s disease
• Fibrous dysplasia
• Osteosarcoma

Treatment

• Removal of the offending cause.
• Once inflammation resolves, layers of the bone consolidate in 6 – 12 months, as the overlying muscle helps to remodel.
• If no focus of infection evident, biopsy recommended.

• Pemphigus → Granular IgG intercellular
• Lichen Planus → Linear anti-fibrinogen at BM, with lamina propria extensions
• Cicatricial Pemphigoid → Patchy linear IgG/C3 at BM
• Bullous Pemphigoid → Patchy linear IgG at BMZ
• Erythema Multiforme → Patchy linear fluorescence
• Discoid Lupus (Lesional mucosa) → Speckled pattern (IgG, IgM, IgA, C3, fibrinogen)

📝 QUICK MEMORY AIDS

1. "Paget's Patients Prefer Tight Dentures" - Paget's disease causes denture tightening
2. "Fibrous Faces Feel Funny" - Fibrous dysplasia features (leontiasis, Chinese script, ground glass, hockey stick)
3. "Giant Cells Have Three Homes" - Hyperparathyroidism, Cherubism, Central Giant Cell Granuloma

⚡ HIGH-YIELD FACTS

• Chalk-stick fractures: Paget's disease & Osteopetrosis
• Leontiasis ossea: Paget's, Fibrous dysplasia, Cemento-ossifying fibroma
• Chinese script pattern: Fibrous dysplasia & COF
• Ground glass appearance: Fibrous dysplasia & Hyperparathyroidism
• Giant cells + vascular stroma + hemosiderin: Hyperparathyroidism, Cherubism, CGCG
• Triads to remember: Hutchinson's, Melkersson-Rosenthal, Ascher syndrome