2 Developmental Anomalies Flashcards by Alexa Breaux

cleft lip vs cleft palate

Cleft lip- defective fusion of medial nasal and maxillary processes

Cleft palate- defective fusion of lateral palatal shelves

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prevalence of CL and CP

45% CL and CP (males 2:1 females)
30% CP (more common in females)
25% CL
1/700-1000 births in whites
1.5x more frequently in Asians
0.4/1000 in blacks
3.6/1000 in Native American Indians (highest rate)

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highest rate of CL/CP

Native American Indians

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tx for CL/CP

multidisciplinary approach (OMFS, ENT, plastic surgery, speech pathologist)

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another name for paramedian lip pits

van der Woude syndrome

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inherited autosomal dominant invaginations of the lower lip, in combo with CL and/or CP

paramedian lip pits

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most minimal manifestation of CP, more common than CP (1-2% of population)

bifid uvula

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mucosal invagination at commissure of lip, may result from failure of normal fusion of the embryonal maxillary and mandibular processes, 12-20% of the adult population

commissural lip pits

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male:female prevalence of commissural lip pits

males > females

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blind fistulas 1-4 mm, small amount of fluid expressed from pit when squeezed

commissural lip pits

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Are commissural lip pits unilateral or bilateral?

may be either

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excess fold of tissue on the mucosal surface of the lip, usually congenital but may be acquired

double lip

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Which lip is more commonly affected with double lip? Unilateral or bilateral?

upper lip > lower lip, but both lips may be affected

- may be uni- or bilateral

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Name the syndrome:

double lip
edema of upper eyelids
nontoxic thyroid enlargement

Ascher syndrome

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sebaceous glands found on the oral mucosa, affects 80% of the population

fordyce granules

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multiple whitish-yellow papules 1-3 mm found in the mouth or genital mucosa

fordyce granules

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most common sites for fordyce granules

buccal mucosa, upper lip, retromolar space, anterior tonsillar pillar

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asymptomatic anomaly, patient may note roughness, no tx needed

fordyce granules

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diffuse, grayish-white milky opalescent appearance, may look wrinkled, does not rub off, disappears when stretched, no tx needed

leukoedema

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70-90% of black adults
less common in white adults
more common in smokers of any race

leukoedema

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most common site of leukoedema

bilateral buccal mucosa

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histopathology: epithelium is thickened and exhibits intracellular edema (the clear spaces)

leukoedema

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abnormally small tongue, may be associated with different syndromes, speech is variable

microglossia

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associated with constricted maxillary and mandibular arches

microglossia

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tx for microglossia

speech therapy, ortho, surgery?

enlargement of the tongue, can be an acquired change or congenital

macroglossia

congenital (3) vs acquired (5) abnormalities associated with macroglossia

Congenital: - vascular growths - down syndrome - neurofibromatosis Acquired: - edentulism - amyloidosis - hypothyroidism in adults - acromegaly - benign or malignant tumors

crenated lateral border of the tongue, noisy breathing, drooling, difficulty eating, lisping speech, can lead to mandibular prognathism

macroglossia

tx for macroglossia

none, speech therapy, surgery depending on cause

short, thick lingual frenum causing limited tongue movement, mild to complete fusion to floor of mouth, causes minor speech difficulties

ankyloglossia

prevalence of ankyloglossia

males > females, affects 1.7-10.7% of neonates

tx for ankyloglossia

none, surgical release

Describe normal thyroid formation.

In the 3-4th week of fetal life, the thyroid starts to form in the pharyngeal gut. At the 7th week, it descends into the neck, its normal location via the thyroglossal tract.

If the thyroid does not descend, ectopic thyroid tissues may be found anywhere from the tongue to the epiglottis.

lingual thyroid

4-7x more common in women

lingual thyroid

In ___% of people who have lingual thyroid, this is their only thyroid.

70%

small to large, can result in dysphagia, dysphonia, or dyspnea

lingual thyroid

how to diagnose lingual thyroid

iodine isotope scan, technetium-99m scan, may hemorrhage with biopsy so avoid this

tx for lingual thyroid

- none if patient is asymptomatic - suppressive therapy with supplemental thyroid hormone to try to reduce lesion size - surgery or I131 if hormone therapy is unsuccessful - hormone replacement therapy may also be necessary if it is removed or treated with I131 (this may be the patient's only functioning thyroid tissue)

numerous grooves and fissures on the dorsal tongue, "variation of normal", hereditary link

fissured tongue

2-6 mm fissures or clefts on the dorsal tongue

fissured tongue

- affects 2-5% of the population - prevalence increases - 30% of older adults - unknown cause

fissured tongue

histopathology: hyperplasia of rete ridges of the filiform papillae and loss of keratin on the surface

fissured tongue

usually asymptomatic, may complain of mild burning, correlation between this anomaly and geographic tongue, no tx necessary

fissured tongue

layer of keratin on the dorsal tongue, gives it a white appearance

coated tongue

excess accumulation of keratin on filiform papillae on the dorsal tongue

hairy tongue

Causes of hairy tongue (2):

- increased keratin production | - decreased keratin desquamation

tx for hairy tongue

none necessary, scraping/brushing

can have brown, yellow or black pigmentation on the tongue, results from pigment producing bacteria or staining from tobacco/food

hairy tongue

staining of the tongue after use of bismuth subsalicylate for upset stomach

bismuth staining

How does bismuth staining come about?

bismuth interacts with sulfur in saliva to form bismuth sulfide

abnormally dilated, tortuous veins, blue-purple elevated, soft

varicosities/varicies /varix

What causes varicosities/varicies/varix?

as we age, there is a loss of CT tone supporting the vessels

most common sites for varicosities/varicies/varix

lateral and ventral tongue, lips and buccal mucosa

age affected by varicosities/varicies/varix

2/3 of people over age 60

tx for varicosities

no tx necessary, may be removed for aesthetics

common vascular anomaly, main arterial branch extends into the superficial submucosal tissues, linear papular elevation, bluish, pulsation, no tx necessary

caliber persistent artery

bony protuberance arising from the cortical plate, 0.09-19% of adults

exostoses

3 locations of exostoses:

1) Buccal- bilateral row of bony hard nodules 2) Palatal- lingual aspect of the maxillary tuberosity 3) Subpontine

tx for exostoses

none or surgery (if interferers with appliance)

lingual mandibular alveolar ridge, affects 7-10% of US population

mandibular torus (tori) aka torus mandibularis

Mandibular tori --> unilateral or bilateral?

usually bilateral (90%), can be unilateral

Mandibular tori may correlate with _______.

bruxism

another name for maxillary torus

torus palatinus

location of maxillary torus (torus palatinus)

midline suture of the hard palate

4-60% of US population, females 2:1 males

maxillary torus (torus palatinus)

most are < 2 cm but can slowly get bigger, subject to trauma, composed of dense lamellar bone

maxillary torus (torus palatinus)

lingual mandibular salivary gland depression, corticated radiolucent lesion, normal salivary gland tissue, if diagnosis is in question on plain films can confirm with CT, no tx needed

Stafne defect (Stafne bone cyst)

location of Stafne defect

posterior mandible

80-90% in men

Stafne defect

Stafne defect --> unilateral or bilateral?

most are unilateral

radiolucent lesion seen in films below the inferior alveolar canal, asymptomatic, usually between molar region and angle of the ramus

Stafne defect

Styloid process is a bony projection that - Originates from? - Anterior and medial to? - Connected to ____ by _____? - What lies on either side?

- originated from the inferior aspect of the temporal bone - anterior and medial to the stylomastoid foramen - connected to the lesser cornu of the hyoid bone by the stylohyoid ligament - the external and internal carotid arteries lie on either side

Elongation of the styloid process or mineralization of the stylohyoid ligament complex --> unilateral or bilateral?

usually bilateral but can be unilateral

Most are asymptomatic, but a small number of patients with elongation of the styloid process or mineralization of the stylohyoid ligament complex experience symptoms. What is this syndrome called?

Eagle syndrome

impingement or compression of adjacent nerves or blood vessels, calcification can be seen on panoramic or lateral-jaw radiographs

Eagle syndrome

symptoms of eagle syndrome

- vague facial pain when swallowing, turning the head, or opening the mouth - dysphagia - dysphonia - otalgia - headache - dizziness - transient syncope

can be palpated in the tonsillar fossa area, may be painful

Eagle syndrome

Eagle syndrome can occur after this surgery:

tonsillectomy --> scar tissue in the area of a mineralized stylohyoid complex *some say you should only use the term Eagle syndrome when it develops following tonsillectomy or other neck trauma

results in cervicopharyngeal pain in the region of cranial nerves V, VII, and X (especially when swallowing)

Eagle syndrome

tx of Eagle syndrome (mild vs severe cases)

Mild cases = no tx, reassure patient Severe cases = partial surgical excision of the elongated sytloid process or mineralized stylohyoid ligament is required