Developmental Disturbances in Oral Cavity
Developmental Disturbances in Oral Cavity
Developmental Disturbances in Oral Cavity
JAWS
LIPS AND PALATE
ORAL MUCOSA
TONGUE
SALIVARY GLANDS
TEETH
JAWS
MACROGNATHIA
AGNATHIA FACIAL
MICROGNATHIA HEMIHYPERTROPHY
AGNATHIA
(OTOCEPHALY, HOLOPROSENCEPHALY AGNATHIA)
THIS LESION IS CHARACTERIZED BY THE ABSENCE OF MANDIBLE
CHARACTERSTICS FEATURES
EITIOLOGY
MICROGNATHIA
(SMALL JAW )
CHARACTERSTIC FEATURES
(CONGENTIAL) (ACQUIRED)
ETIOLOGY
CONGENITAL
1. Micrognathia or retrognathia
2. Glossoptosis (tongue downward and backward)
3. Cleft palate
ETIOLOGY
CLINICAL
MACROGNATHIA
(ABNORMALLY LARGE JAWS)
CHARACTERISTIC FEATURES
PAGET DISEASE :
Commonly :cranium and maxilla are involved.
Rarely : mandible
ARCOMEGALY: progressive enlargement of mandible -> hyperpituitarism
LEONTIASIS OSSEA: enlargement of maxilla(type of fibrous dysplasia)
ETIOLOGY
Unknown
GENERAL FACTORS
Increased Chin angle
Prominent Chin button
Increased Height of the ramus
Increased Mandible body length
Decreased maxillary length
Posterior positioning of the maxilla in realtion to cranium
TREATMENT
Surgical
OSTECTOMY : resection of a portion of mandible to decrease to its length.
FACIAL HEMIHYPERTROPHY
HEMI :HALF SIDE
HYPERTROPHY:OVERGROWTH
CHARATERISTIC FEATURES
COMPLEX HEMIHYPERPLASIA
simple hemihyperplasia
facial hemihyperplasia
ETIOLOGY
Unknown
CLINICAL FEATURES
Enlargement of one side of the body
Unilateral macroglossia
Premature development
Eruption as well as increased size of dentition
F>M
ORAL MANIFESTATIONS
Crown size
Root size and shape affected side is abnormal in three
Rate of development respects
HISTOLOGICAL FEATURES
Ture muscular hypertrophy is not found
DIFFERENTIAL DIAGNOSIS
Fibrous dysplasia
Neurofibroma
LIPS AND PALATE
Van der woude syndrome
Cleft lip and cleft palate
Cheilitis glandularis
Cheilitis granulomatosa
CHARATERISTIC FEATURES
Autosomal dominant syndrome
Cleft lip or palate
Can be lower lip pits alone ; missing teeth or isolated cleft lip and palate
ETIOLOGY
Orofacial anomalies
Abnormal fusion of lips and palate (30-50 days of postconception)
Due to deletion of chromosome band 1q32
CLINICAL FEATURES
Rare case
Only 1-2% patients with cleft lip have van der wounde syndrome
M=F
25% assymptomatic
DIFFERENTIAL FEATURE```````````````````: cleft lip or palate have
lower lip pits.
Can be unilateral or bilateral
CLUES OF DIAGNOSIS: hypernasal voice; cleft or bifid uvula
Lower lip pits:
1. medial ; on the vermillion border
2. infancy : small elevation
3. adult :simple depressions
4. rarely discharge
maxillary hypodontia
missing maxillary incisor or premolar
syngnathia
narrow ,high arched palate,
ankyloglossia(short glossal frenum)
EXTRAORAL MANIFESTATION
rare
limb anomalies
popliteal webs
brain abnormalities
accessory nipples and congential heart defects
TREATMENT
For cleft lip and palate : surgical
For lower lip pits: surgicall excision to alleviate discomfortor for cosmetic reasons.
Etiology
UNKNOWN
There are two theories which describe different etiology
FOGH-ANDERSEN
According this theory the lesion can be due to one gene or can be due to
different gene acting together. Although it states that this lesion is
because of heredity factor.
Acc. To bixler
Everyone carries some genes which affect the individual with this
syndrome. Whereas for the expression we need particular threshold
which is described as polygenic type. Second type is monogenic or
syndromic that related with variety of syndromes or anomalies .
OTHER FACTORS:
A defective vascular supply to the area involved
A mechanical disturbance in which the size of the tongue may
prevent the union palatine shelves.
Circulating substances , such as alcohol and certain drugs and
toxins.
Infections
Lack of inherent development force.
CLINICAL FEATURES
M>F
Two types
NON SYNDROMIC SYNDROMIC
No other physical and Additional birth defects like pits
developmental anomalies.
70% 30%
uncategorized
chromosomal
syndromic
teratogens
It can occur as unilateral or bilateral
It starts from lateral part of upper lip and continues through philtrum
to alveolous between the lateral incisor and canine tooth and when it
goes upto the incisive foramen we consider cleft lip along with cleft
palate.->CLP
TREATMENT
SURGICALLY BE CORRECTED
CHEILITIS GLANDULARIS
Uncommon and poorly understood inflammatory disorder of lip.
CHARACTERISTIC FEATURES
Progressive enlargement and eversion of lower lip that results in
obliteration of mucosal –vermillion interface. Due to this chronic
exposure to external environment leads to erosion, ulceration,
crusting that ultimately lead to squamous cell carcinoma.
ETIOLOGY
Unusual clinical manifestation
Lip enlargement -> inflammation->hyperaemia->oedema->fibrosis
CLASSIFICATION
cheilitis
glandularis
superficial deep
simple
suppurative suppurative
DIFFERNTIAL DIAGNOSIS
ACTINIC KERATOSIS
Atopic dermatitis
Cheilitis granulomatosa (MIESCHER-MELKERSSON-
ROSENTHAL SYNDROME)
SARCOIDOSIS
SQUAMOUS CELL CARCINOMA
TREATMENT
ANTIBIOTIC THERAPY
CHEILITIS GRANULOMATOSA
(miescher-melkersson-rosenthal syndrome)
CHARACTERISTIC FEATURES
Chronic swelling of lip
Meischer cheilitis term is used when lesion confined to lips only-
>monosymptomatic form of miescher-melkersson-rosenthal
syndrome
miescher-melkersson-rosenthal syndrome ->cheilitis
occurs with facial palsy and plicated tongue
occasionally a manifestation of CROHN DISEASE
EITIOLOGY
UNKNOWN
Genetic predisposition may exist
CLINICAL FEATURES
IT IS EPISODIC WITH NON TENDER SWELLING
Enlargement of one or both lips
Occasionally similar swelling on periocular region may also seen
First edema typically subsides completely in hours or days
After recurrent attack ,swelling may persist and slowly increase
and eventually becoming permanent
Attacks sometimes accompanied by fever and mild
constitutional symptoms
Earliest manifestation is sudden diffuse or occasionally nodular
Once chronically is established ,. The enlarged lip appears
cracked , fissured with reddish brown discolouration.
It may becomes painful
Regional lymph nodes are swelled in 50% cases
A fissured or plicated tongue is seen in 20-40%patients
Pt. may loose the sense of taste , Decreased salivary secretion
Facial palsy of lower motor neuron – 30% of cases
1. Can be unilateral or bilateral
2. Partial or complete
3. Poorly defined associated psychiatric and neurological
features are reported
4. Autonomic disturbances may occur