Paget Disease of Bone — MFDS Part 1 MCQ

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ModerateOral PathologyPaget Disease of BoneMFDS Part 1

Which radiographic appearance is classically associated with Paget disease of bone affecting the jaws during its later mixed or sclerotic phase?

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Correct answer: A — Cotton-wool appearance

The correct answer is **A, cotton-wool appearance**. In the later mixed or sclerotic phase of Paget disease, disorganised bone resorption and formation produce patchy areas of radiolucency and sclerosis, creating the characteristic cotton-wool pattern. Jaw involvement may also be accompanied by enlargement and hypercementosis. A sunray pattern suggests an osteogenic periosteal reaction, classically osteosarcoma. Ground-glass change is associated particularly with fibrous dysplasia. A soap-bubble pattern occurs in multilocular lesions such as ameloblastoma, while onion-skin periosteal new bone is associated with conditions such as proliferative periostitis or Ewing sarcoma.

Reference: Fassio A, Idolazzi L, Rossini M, Viapiana O, Gatti D. A case of mandible Paget’s disease of the bone treated with intravenous neridronate. Reumatismo. 2016;68(3):154-158. https://pubmed.ncbi.nlm.nih.gov/27981818/