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    Developmental Defects

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    deenm
    This document provides information on various anatomical variations and developmental defects that can occur in the oral cavity. It describes conditions such as linea alba, lip pits, double lips, Fordyce granules, leukoedema, microglossia, macroglossia, ankyloglossia, lingual thyroid, fissured tongue, hairy tongue, varicosities, caliber-persistent artery, lateral soft palate fistulas, coronoid hyperplasia, condylar hyperplasia, bifid condyle, exostoses, torus palatinus, torus mandibularis, Eagle syndrome, Stafne defect, and geographic tongue. For each condition, it discusses characteristics, possible causes,

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    Developmental Defects

    Uploaded by

    deenm
    70 views16 pages
    This document provides information on various anatomical variations and developmental defects that can occur in the oral cavity. It describes conditions such as linea alba, lip pits, double lips, Fordyce granules, leukoedema, microglossia, macroglossia, ankyloglossia, lingual thyroid, fissured tongue, hairy tongue, varicosities, caliber-persistent artery, lateral soft palate fistulas, coronoid hyperplasia, condylar hyperplasia, bifid condyle, exostoses, torus palatinus, torus mandibularis, Eagle syndrome, Stafne defect, and geographic tongue. For each condition, it discusses characteristics, possible causes,

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    Developmental Defects

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    This document provides information on various anatomical variations and developmental defects that can occur in the oral cavity. It describes conditions such as linea alba, lip pits, double lips, Fordyce granules, leukoedema, microglossia, macroglossia, ankyloglossia, lingual thyroid, fissured tongue, hairy tongue, varicosities, caliber-persistent artery, lateral soft palate fistulas, coronoid hyperplasia, condylar hyperplasia, bifid condyle, exostoses, torus palatinus, torus mandibularis, Eagle syndrome, Stafne defect, and geographic tongue. For each condition, it discusses characteristics, possible causes,

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    © All Rights Reserved
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    Download as pdf or txt
    70 views16 pages

    Developmental Defects

    Uploaded by

    deenm
    This document provides information on various anatomical variations and developmental defects that can occur in the oral cavity. It describes conditions such as linea alba, lip pits, double lips, Fordyce granules, leukoedema, microglossia, macroglossia, ankyloglossia, lingual thyroid, fissured tongue, hairy tongue, varicosities, caliber-persistent artery, lateral soft palate fistulas, coronoid hyperplasia, condylar hyperplasia, bifid condyle, exostoses, torus palatinus, torus mandibularis, Eagle syndrome, Stafne defect, and geographic tongue. For each condition, it discusses characteristics, possible causes,

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    Linea Alba

    Developmental Defects and Variations


    Dr. John Koutlas
    Division of Oral Pathology

    Buccal mucosa, less common tongue


    Pressure, friction, sucking trauma
    Restricted to dentulous areas
    More prominent on posterior mucosa
    HistDx: Hyperkeratosis

    All pictures are intellectual property of the Division of Oral


    and Maxillofacial Pathology or its Faculty. Duplication or
    any unauthorized use is prohibited.

    Pits (Fistulas)
    Commissural lip pits
    12-20% of adults; 0.2-0.7% in children
    Males > Females
    Unilateral or bilateral
    Accentuated with age? or not developmental?
    Failure of processes to fuse
    Blind fistulas; sometimes saliva
    Infection can occur
    Associated with hearing loss, preauricular pits, rib
    anomalies
    Combination with paramedian (one case reported)

    Pits (Fistulas)
    Paramedian lip pits
    Blind ends
    Presence of salivary glands
    van der Woude syndrome (AD)
    Interferon regulatory factor 6 gene mutations (role in fusion of lip
    and palate); chr 1 long arm
    Pits and cleft lip and/or cleft palate
    Mental retardation; dental malformations (hypodontia)

    Popliteal pterigium syndrome

    Same gene
    Popliteal webs
    Cleft lip and/or cleft palate
    Syngnathia (webs connecting upper & lower jaw)

    Double Lip
    Redundant fold
    Congenital (persistence of the pars glabrosa and
    pars villosa) and acquired (trauma, habits)
    Ascher (Laffer-Ascher) syndrome
    Double lip
    Blepharochalasis (Fuchs 1896)
    Edema of the upper eyelid; vision interference
    Hyperplasia of lacrimal glands with prolapse of orbital fat

    Nontoxic thyroid enlargement (50%)

    DiffDx: angioedema, tumor

    Fordyce Granules

    Sebaceous glands
    Ectopic or normal anatomic variation
    Buccal mucosa, lips, tonsillar pillar
    Adults > Children (puberty stimulates development)
    Glands with ducts; no hair
    Hyperplasia, cystic transformation, tumors (extremely
    rare)

    Duct

    Sebaceous glands

    Sebaceous gland

    Interesting note
    Recent evidence indicates an increase in
    size and number of sebaceous glands
    following activation of the hedgehog
    pathway, a crucial signaling pathway for
    animal development that is aberrantly
    activated in several types of cancer.
    Unrecognized activation of the sebaceous
    glands system occurs in HNPCC

    Leukoedema
    Diffuse grayish-white appearance of mucosa
    Blacks > Whites (racial pigmentation may make this
    variation more prominent)
    Variation, not a disease
    More prominent in smokers, poor oral health
    Buccal mucosa extending to the lips
    Vagina, larynx
    Hyperplastic epithelium; intracellular edema
    No treatment
    DiffDx: Lichen planus, other leukoplakic lesions,
    dentifrice stomatitis (chemical burn)

    Microglossia
    Oromandibular-limb hypogenesis syndromes
    Hypodactyly
    Hypomelia
    Underdeveloped organs
    Some potential etiologic factors
    Lithium during pregnancy
    Chorionic villi sampling procedures

    Macroglossia
    Congenital and hereditary
    Vascular malformations
    Hemihyperplasia
    Cretinism
    Beckwith-Wiedemann syndrome
    Omphalocele, visceromegaly, gigantism, hypoglycemia,
    Wilms tumor, adrenal or liver tumors (hepatoblastoma)

    Down syndrome
    NF 1
    MEN 2B

    Macroglossia
    Acquired
    Edentulous patients
    Amyloidosis
    Myxedema
    Acromegaly
    Angiedema
    Tumors

    Ankyloglossia
    NEVER FORGET THAT THE TONGUE IS SHORT
    AT BIRTH
    Far more common in boys than girls
    Complete ankyloglossia extremely rare
    Relation to open bite ?
    Relation to periodontal disease
    Dyspnea (epiglottis comes forward)
    Breast-feeding
    Speech articulation
    Mechanical tasks such as licking the lips and kissing

    Lingual Thyroid
    Birth of the thyroid & foramen cecum
    Small remnants of thyroid can be found in the tongue
    ~75% of pts with infantile hypothyroidism have
    lingual thyroid
    33% have hypothyroidism
    Females >> males
    Nodule of varying size
    Dysphonia, dysphagia
    Large nodules can cause sleep apnea

    May be the only functioning thyroid tissue


    Goiter, Graves disease have been described

    Rare examples of thyroid carcinoma (MALES)


    Lingual thyroid in a cat

    Fissured Tongue
    Grooves and fissures
    More prevalent in whites, blacks; less in Mexican
    Americas
    Entire tongue or part
    Usually asymptomatic
    Prevalence increases with age
    Strong association with geographic tongue and
    Melkersson-Rosenthal syndrome
    Tongue brushing

    Melkersson-Rosenthal syndrome
    1. Fissured tongue
    2. Cheilitis granulomatosa
    3. Facial paralysis

    Hairy Tongue

    DO NOT CONFUSE IT WITH HAIRY LEUKOPLAKIA


    Marked hyperkeratinization of filiform papillae
    Less than 1%
    Causes

    Smoking, antibiotics, POH, radiation, debilitated pts


    Staining (bacteria, coffee, tobacco)
    Oxidizing mouthwashes or antacids
    Overgrowth of fungal or bacterial organisms
    Medications: olanzapine, fluoxetine hydrochloride, thiothixene
    hydrochloride, benztropine mesylate, and clonazepam (antipsychotic
    meds)

    Asymptomatic
    Treatment
    Brushing
    Shaving
    DO NOT USE KERATOLYTIC AGENTS (If you do not know how)

    Bizarrities
    Unilateral hairlike discoloration of the
    tongue was described in a patient with
    ipsilateral mandibular division trigeminal
    neuralgia. This unusual physical sign
    coincided with the patient's painful trigger
    zone and was attributed to hypertrophy of
    keratinized filiform papillae, where guarded
    avoidance of mechanical stimulation over
    time prevented normal desquamation.

    Varicosities

    Dilated and tortuous vein


    Age-related (60% of older individuals)
    Loss of connective tissue tone
    No association with hypertension or CPD
    Sublingual area
    Multiple or solitary (lips, buccal mucosa)
    Phleboliths

    Caliber-Persistent Artery

    Uncommon
    Lower and less often upper lip
    Bilateral
    Pulsating (you feel it with bare fingers)
    Age-related
    Associated with ulceration; DiffDx: SCCa
    No tx necessary
    Arterial bleeding during surgery

    Lateral Soft Palate Fistulas

    Congenital or the result of trauma or surgey


    Bilateral or unilateral
    Shallow or deep perforations
    Can be associated with anomalies such
    absence or hypoplasia of tonsils, hearing
    loss, preauricular defects

    Vazquez et al. J Ultrasound Med 2005

    Coronoid Hyperplasia

    Rare
    5M:F
    Unilateral or bilateral (5x)
    Restricted mouth opening
    Deviation towards the affected site
    Jacobs disease (pseudojoints with the zygomatic
    arches; association with osteochondroma of the
    coronoid process)
    CT better than panoramic
    Tx is problematic
    Fibrosis
    Coronoid regrowth

    Condylar hyperplasia

    Akan & Mehreliyeva

    Dentomaxillofac Radiol. 2006 Jan;35(1):55-9

    Uncommon; more common than coronoid


    Trauma, endocrine or circulatory cause
    Part or not of hemifacial hyperplasia
    Facial asymmetry, prognathism, open bite
    Occasional compensatory maxillary growth
    and tilting of the occlusal plane
    Condylectomy

    10

    Condylar hypoplasia
    Congenital or acquired
    Many syndromes
    Treacher Collins
    Oculoauricularvertebral
    Hemifacial microsomia

    During development
    Trauma, radiation

    Degenerative arthritis

    Bifid Condyle
    Double head (lateral and medial; less often
    anterior-posterior)
    Unilateral (less often bilateral)
    Can be asymptomatic

    Exostoses

    Bony protuberance
    Palatinus and Mandibularis
    Buccal exostoses: facial
    Palatal exostoses: lingual aspect of tuberosity
    Solitary exostoses: trauma
    Subpontic osseous hyperplasia
    Mass of non-neoplastic bone with minimal marrow
    Can be ulcerated and painful

    11

    Torus Palatinus

    Midline of palatal vault


    Multifactorial, genetic predisposition
    Flat, spindle, nodular, lobular
    Rarely show on PAs
    More women than men
    Surgical excision to accommodate prosthesis

    12

    Torus Mandibularis

    Lingual aspect of mandible


    Multifactorial
    Bilateral
    Single or multiple nodules
    PAs: Periapical opacities that can be confusing
    Not as common as torus palatinus
    Surgical excision to accommodate prosthesis

    Eagle syndrome
    Stylohyoid syndrome
    Elongation of the styloid process or
    mineralization of the stylohyoid ligament
    Bilateral and less often unilateral
    Most asymptomatic
    After tonsillectomy
    Clinical syndrome
    Vague facial pain (swallowing, turning head,
    opening mouth)
    Headache, dizziness, otalgia, transient syncope

    Eagle syndrome
    Treatment choices
    No treatment
    Cotricosteroid injection
    Surgical excision of the elongated process or
    mineralized ligament

    13

    Stafne Defect (Static Bone Cyst)


    Radiolucency with sclerotic border
    Near angle of mandible (below the canal)
    Anterior and upper ramus rarely

    Usually normal salivary glands


    Submandibular, sublingual, parotid

    Asymptomatic
    Striking male predilection
    Developmental but not present from birth
    Sialogram

    Queiroz et al, 2004 JOMFS

    14

    Geographic Tongue

    Migratory glossitis (stomatitis)


    1-3% of population; females twice more often
    Wandering patients
    ? Hypersensitivity reaction; ? hormonal role
    Usually asymptomatic
    ? Association with psoriasis (HLA-Cw6)
    Patient reassurance; topical steroid; zinc

    15

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