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Oral Pathology Lesson 1/2
Terms in this set (60)
Defective Fusion of medial nasal process with the maxillary process leads to cleft lip.
Failure of palatal shelves to fuse together.
Frequency of cleft lip and cleft palate together
45% (usually occur together)
Frequency of isolated cleft palate
Frequency of isolated cleft lip
_______ is a separate entity from CL (+/-) CP
isolated cleft palate
80% of these cases are unilateral
20% of these cases are bilateral
What side of the face do 70% of unilateral CL occur
Cleft or bifid uvula
the most minimal manifestation of Cleft Palate
Incomplete cleft lip
Cleft does not go up to nose
Etiology of Cleft Palate/Cleft lip
-Genetics: over 350 syndromes identified w/ CL +/- CP or CPO
-Deficiency of tissue
-Drugs (steroids and phenytoin)
-Alcohol and smoking
-Folic acid deficiency
-Treatment of Cleft Palate/Cleft Lip
First: Primary Lip closure
Second: Repair of the palate
Commissural Lip Pits
Small mucosal invaginations that occur at the corners of the mouth on the vermilion border.
-May be autosomal dominant.
Commissural Lip Pits Clinical Features
-Unilateral or bilateral...they present as blind fistulas
-NOT Associated with facial or palatal clefts.
-No treatment necessary.
Paramedian Lip Pits***
Rare congenital invaginations of the lower lip
Paramedian= along the midline
Paramedian Lip Pits clinical Features ***
-Present as bilateral and symmetric fistulas on either side of the midline of the vermilion of the lower lip.
-Inherited as autosomal dominant with cleft lip/cleft palate.
Treatment: labial pits may be excised for cosmetic reasons.
25 year old, white male presents with a complete unilateral cleft lip. He has lope ear and he also demonstrates bilateral fistulas on both sides of the midline of his lower lip. What are these fistulas called?
Paramedian Lip Pits
Rare redundant fold of tissue on the mucosal side of the lip. Congenital in nature but may be acquired later in life.
Ascher Syndrome is characterised by what three features and how is it treated
1) Double Lip
2) Blepharochalasis (+/-) drooping of eyelids
3) Nontoxic thyroid enlargement
Treatment: surgical excision of excess tissue may be performed.
Fordyce Granules Clinical Features and treatment***
-Sebaceous glands that occur on the oral mucosa.
-(Ectopic) not normally seen in a particular location (like the oral mucosa)
-Multiple yellow or yellow white papular lesions mostly in the buccal mucosa
Treatment: Clinical appearance is apparent and does not need a biopsy.
-Tumors arising from these glands are very rare.
Common oral mucosal condition of unknown cause
-Occurs more commonly in black individuals than in whites (90% of black adults).
-More common and severe in smokers
Leukoedema Clinical Features, diagnosis and treatment*****
-Diffuse, grayish-white milky opalescent appearance of the mucosa. Surface appears folded, resulting in wrinkles or whitish streaks.
-Histologically: Increased thickness of the epithelium with intracellular edema of the spinous cell layer.
-Diagnosis: pull on cheeks and white appearance disappears
Treatment: none required.
-Enlargement of the tongue
-Can be due to congenital malformations and acquired diseases
Examples of congenital/hereditary causes of macroglossia
1) Vascular malformations (MOST COMMON) (lymphangioma/hemangioma)
2) Hemihypertrophy (half your head gets bigger than the other half...half of tongue gets bigger than other half of tongue)
3) Cretinism (dwarf/retardation...have large tongues)
4) Beckwith-Wiedemann syndrome (large person with large tongue)
Examples of Acquired Macroglossia ***
1) Edentulous patients
2) Amyloidosis (abnormal proteins deposited)
3) Myxedema (edema due to CT)
4) Acromegaly (gigantism)
5) Angioedema (allergies & tongue swells)
Most frequent causes of Macroglossia
-vascular malformations and muscular hypertrophy
Excess of amyloid proteins deposited on tongue
-tongue 3 inches thick
Ankyloglossia (tongue tied)
Developmental anomaly of the tongue characterized by a short, thick lingual frenum.
-frenum attaching lip to gingiva (or) tongue to gingiva
-May cause people to have speech defects (rare)
-May cause gingival recession/gingival defects
-Treatment often unnecessary
Thyroid gland normal development
Thyroid gland begins as an epithelial proliferation in the floor of the pharyngeal gut.
-Thyroid bud normally descends into neck to its final resting position anterior to the trachea and larynx.
Lingual Thyroid development
-When primitive gland does not normally descend into throat, the ectopic tissue remains between the foramen cecum and epiglottis.
Lingual Thyroid Clinical Features
-Four times more frequent in females (due to females having increased chances of hypothyroid disease)
-70% of cases, this ectopic gland is the only thyroid gland available.
-Most common clinical symptoms are :
1) dysphagia (difficulty in swallowing)
2) dysphonia (disorders of the voice)
3) dyspnea. ( shortness of breath)
Diagnosis of Lingual Thyroid
Thyroid scan using iodine isotypes.
-Biopsies avoided because they can cause hemorrhages and the thyroid tissue usually is the only thyroid tissue available.
Fissured tongue (scrotal tongue)
-fissures and grooves on tongue (red spots)
-common and hereditary
-appears as people age over 40. (degenerative process)
Fissured tongue clinical features and treatment
-multiple grooves on surface of tongue ranging from 2 to 6mm in depth.
-condition is asymptomatic
-2-5% of the overall population
-strong association between fissured tongue and geographic tongue
Treatment: brush tongue
1) Fissured tongue
2) Facial nerve paralysis
3) Cheilitis granulomatosis (+/-) granulomatous inflammation of the lower lip.
Hairy Tongue clinical features, causes and treatment ***
-Marked by accumulation of keratin on filiform papillae resulting in elongation around midline of tongue in front of circumvallate papillae.
-Brown/black/yellow as a result from growth of pigment producing bacteria or staining from tobacco and food.
2) Mouthwashes or antiacids
3) Smoking tobacco
4) poor oral hygiene
5) radiation therapy
6) general debilitation
7) overgrowth of fungal or bacterial organisms
treatment: stop use of products and scraping/brushing of tongue
Abnormally dilated and tortuous vein.
-correlated to age (commonly seen in older adults)
Most common type of oral varicosity is the sublingual varix which occurs in 2/3 of people over the age of 60 years old.
-Present as multiple bluish-purple, elevated or papular blebs on the ventral-lateral border of the tongue.
-dont hurt unless they clot.
treatment: none required.
-Occur in other areas of the mouth like the lips and buccal mucosa
-isolated and first noticed when they thrombose. They are firm, non-tender bluish-purple nodule.
Treatment: should be biopsied to rule out other pathology.
Localized bony protuberances that arise from the cortical plate.
-can get from grinding teeth or missing teeth
These benign growths affect the jaws.
Tori are common types of exostoses.
Bilateral and symmetrical
Occur as a bilateral row of bony hard nodules along the facial aspect of the maxillary and/or mandibular alveolar ridge.
Bony protuberances that develop from the lingual/palatal aspect of the maxillary tuberosities
Occur possibly in response to local irritation. Develop from the alveolar bone beneath free gingival grafts.
Subpontic exostoses (+/-) subpontic osseous proliferation; subpontic osseous hyperplasia.
develop from the alveolar crestal bone beneath the pontic of a posterior mandibular ridge.
Treatment of exostoses
-surgical removal may be required to accommodate a dental prosthesis.
Torus Palatinus Clinical Features and treatment
-Common exostosis (hard mass) that occurs in the midline suture of the hard palate.
-Cause is multifactorial including both genetic and environmental influences.
-Most are small, measuring less than 2cm.
-Asymptomatic, thin overlying mucosa may become ulcerated secondary to trauma.
-Prevalence of 20 to 35% in the US
-Females more common than males (2:1)
treatment: torus needs to be surgically removed for denture patients
Torus Mandibularis Clinical Features
-Common exostosis (bony protuberance) that develops on the lingual aspect of the mandible.
Etiology: genetic and environmental
-Bilateral involvement in over 90% of cases (premolar region)
-Prevalence from 5 - 40% of people and correlated to bruxism and number of teeth remaining present.
-Show surface ulceration due to trauma from brushing, foods, etc.
Treatment: surgical removal in edentulous patients to accomodate dentures.
-Focal concavity of the cortical bone on the lingual surface of the mandible.
-Radiolucency below the mandibular canal in the posterior mandible
-Contains normal salivary gland tissue
-most are unilateral
-size does not change.
-well circumscribed with sclerotic border
-instead of bone developing, salivary glands develop (+/- a submandibular gland)
Diagnosis: use staining to differentiate...if stain goes straight through hole you know its stafne defect and not tumor.
Treatment: none necessary.
A pathologic cavity (+/-) often fluid filled and is lined by epithelium.
-pathogenesis is still uncertain
-once cysts develop, slowly increase in size due to elevated hydrostatic luminal pressure.
1) Inflammatory ( bacteria infection...cause abcess in tooth with cyst around it)
2) developmental ( occur after birth)
3) odontogenic (erupting tooth may be impacted and cyst forms on top of it)
Palatal cyst of the newborn
-Distinguishes them from gingival cysts of newborn
-Common (65-85% of neonates)
-Cysts are 1-3mm white keratin filled, epithelial lined papules. (white bumps)
-Near the midline near the junction of the soft and hard palates
-can be popped to get rid of them
Incisive canal cyst (nasopalatine duct cyst)
-Most common non-odontogenic cyst (NOT RELATED TO TEETH) of the oral cavity
-1% of the population
-Cyst arises from remnants of the nasopalatine duct.
(nasopalatine duct is an embryologic structure which connects the oral and nasal cavities in the area of the incisive canal)
Incisive Canal (Nasopalatine Duct Cyst) Clinical Features
-Swelling of the anterior palate, drainage and pain (if cyst enlarges).
-lesions are asymptomatic
-well circumscribed, inverted pear on radiograph, radiolucency in or near the midline of the anterior maxilla between and apical to the central incisor teeth.
-difficult to distinguish between a small nasopalatine duct cyst from a large incisive foramen. Diameter of 6 mm is upper limit of a normal size for the incisive foramen (+/-) most cysts range from 1.0-2.5cm diameter.
-Epithelial lining consisting of stratifed squamous epithelium or pseudostratified columnar epithelium. Fibrous connective tissue exhibits numerous prominent nerves and blood vessels. (normally seen within the incisive canal)
Treatment: surgical excision
Epidermoid cyst of skin
-common cyst, arises from hair follicle
-"sebaceous cyst" mistakenly used as synonym
-most common in acne-prone areas
-unusual before puberty unless associated with Gardner Syndrome.
-Appear as subcutaneous swellings
4 regions of the neck
-Parotid region of neck
-Submandibular region of neck
40 year old man presents a double chin.
Clinical investigators found a benign cyst below the geniohyoid muscle in the midline of the mouth that produced this submental swelling. Cyst is lined by epidermis-like epithelium and contains dermal adnexal structures in the cyst wall. This type of cyst is called
Dermoid cyst clinical features and treatment
-uncommon developmental cyst containing adnexal structures in cyst wall.
-cyst wall contains skin appendages
-Benign cystic form of teratoma (developmental tumor consisting of tissue from all three germ layers: ectoderm, mesoderm and endoderm)
-commonly occur in the midline floor of the mouth
-Above the geniohyoid sublingual swelling displaces the tongue toward the roof of the mouth
-Below the geniohyoid produces submental swelling "double chin appearance.
-slow-growing, painless, rubbery
-most often in young adults
treatment: surgical removal
Thyroglossal Cyst Duct
-Remnants of thyroglossal duct may persist and give rise to cysts
-Develop in midline anywhere from the foramen cecum to suprasternal notch.
-painless and movable swelling. (movable if cyst maintains an attachment to the hyoid bone or tongue) It will move vertically during swallowing or protrusion of tongue.
-Lined by columnar or stratified squamous epithelium
-Develops below the hyoid bone 60 to 80%
-50% of people develop it before the age of 20.
Treatment: Sistrunk procedure
Cervical Lymphoepithelial Cyst Clinical Description and Treatment
-1st theory: Developmental cyst of the lateral neck that develops from brachial clefts
-Second theory: Arises from cystic changes in parotid gland epithelium that becomes entrapped in the upper cervical lymph nodes during embryonic life.
-Occurs in the upper lateral neck along the anterior border of the SCM muscle.
-Affects young adults between the ages of 20 and 40.
-More than 90% lined by stratified squamous epithelium
-Wall of cyst contains lymphoid tissue germinal center formation.
-AIDS related bilateral partoid lymphoepithelial cysts have been reported.
Treatment: surgical excision
Oral Lymphoepithelial Cyst
-Uncommon lesions within oral lymphoid tissue
-Similar to cerival lymphoepithelial cyst except alot smaller.
-Small , submucosal mass that is less than 1 cm in diameter.
-white or yellow
-common in young adults, in the floor of the mouth.
-cystic cavity lined by stratified squamous epithelium without rete ridges.
-the most striking feature is the presence of lymphoid tissue in the cyst wall.
Treatment: surgical excision and generally doesn't occur. (unlike the neck..these cysts dont have to be removed)
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