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Porotic hyperostosis and cribra orbitalia

Porotic hyperostosis (found on the cranial vault) and cribra orbitalia (found in the eye orbits) are two manifestations of a nonspecific nutritional disorder resulting in anemia (Walker et al. 2009). Anemia can potentially affect any bone of the skeleton that is involved in the production of red blood cells. The extent of the involvement of postcranial, as well as cranial bones, usually indicate how severe an anemia is and whether it is associated with genetic abnormalities of hemoglobin or with nutritionally induced anemia (Stuart-Macadam 1987). These lesions are produced by bone marrow proliferation that is diagnostic of anemia. The lesion, as the name implies, has a very porous (coral-like) appearance that develops when diploё (the trabecular portion of the cranial bone that separates the inner and outer surfaces) expands outward (Figure 2.6). With the expansion of the diploё, the outer layer of bone becomes thinner and may eventually disappear, exposing the trabecular bone (diploё), which is quite porous.

The lesions of porotic hyperostosis typically involve thinning and destruction of the outer tables of the cranial vault, accompanied by thickening and exposure of the deeper diploic tissue. Porotic hyperostosis is usually symmetrically distributed and presents as a tight cluster of small porous openings that are visible to the naked eye.

The scoring system distinguishes lesions by severity in expression, location, and amount of remodeling that had occurred. Remodeling in this case means the amount of new bone that has formed in response to the lesion because almost all bone destruction triggers new bone formation. If the disease persists, the effect of remodeling will not be seen because bone will be destroyed as quickly as it is formed. If the disease ceases or lessens, however, there will be a visible replacement of formerly diseased bone with newly mineralized bone. Thus, the amount of healing is subject to the length of time that the disease has been acting on bone, the severity of the disease response, the speed of new bone formation, and the overall health status of the individual.

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