Chapter 1 Flashcards
When does upper lip formation begin?
Weeks 6-7 in utero
What structures contribute to the formation of the upper lip?
Medial nasal processes and the maxillary processes
What structures contribute to the formation of the primary palate?
Merging of the medial nasal processes
What structures contribute to the formation of the secondary palate?
Maxillary processes/Palatal shelves
What is cleft lip?
Failure of fusion of the medial nasal process with the maxillary process
What is cleft palate?
Failure of fusion of the palatal shelves
What is the treatment protocol for cleft lip?
Rule of 10 - 10 weeks, 10 pounds, 10 gm %HM
True or False: Most developmental cases of orofacial clefts are cleft palate and cleft lip
True, most cases are combined CL + CP
True or False: Most syndromic cases of orofacial clefts are cleft lip and cleft palate
False, syndromic cases most commonly present as cleft palate only
What are characteristics of Pierre Robin Sequence ?
Cleft palate, Mandibular micrognathia, glossoptosis
What are the 4 common environmental factors that can cause nonsyndromic orofacial clefts?
Maternal alcohol or cigarrette use, folic acid deficiency, corticosteroid use, and anticonvulsant therapy
What are the other more rare orofacial clefts?
Lateral facial cleft, oblique facial cleft, median cleft of the upper lip
In what populations are orofacial clefts most common?
Native American (1/250), Asians (1/300), Caucasians (1/700), African Americans (1/1500)
What is a submucous palatal cleft?
This occurs when the palatal shelves fail to fuse, but the surface is still intact. It appears as a notch in bone, and has a bluish discoloration at the midline.
Who is often involved in the management of orofacial clefts? (There are 9)
Pediatricians, OMFS, ENT, Plastic surgeon, Pediatric dentist, Orthodontist, Prosthodontist, Speech pathologist, Geneticist
What are lip pits?
Mucosal invaginations
When lip pits occur at the corners of the mouth, what are they called?
Commissural lip pits
True or False: Commissural lip pits are NOT associated with facial or palatal clefts
True, and no treatment is required
Congenital invaginations near the median of the lower lip are called ____________.
Paramedian lip pits
What syndrome is assoicated with Paramedian lip pits?
Van der Woude syndrome
What are the characteristics associated with Van der Woude syndrome?
Paramedian lip pits, autosomal dominant, cleft lip and cleft palate
Describe double lip.
A redundant fold of tissue on the mucosal side of lip
What causes double lip? Does is usually occur on the upper or lower lip?
It can be congenital or acquired (due to trauma or oral habits), and usually occurs on the upper lip.
What syndrome is associated with double lip?
Ascher syndrome
What are the characteristics of Ascher syndrome?
Double lip, Blepharochalasis (eyelid edema), Nontoxic thyroid enlargement (which messes with fluid retention)
What are Fordyce Granules?
“Ectopic” sebaceous glands
Where and when do fordyce granules appear?
Buccal and labial mucosa. They usually appear during puberty, so are more common in adults.
Describe Leukoedema.
Typically appear as dffuse gray-white, milky, opalescent lesions found bilaterally on buccal mucosa that do not wipe off.
What is a clinical test for leukoedema?
Stretching the tissue. The white appearance disappears when the cheek is stretched.
What is the term for an abnormally small tongue?
Microglossia
What is the term when there is no tongue?
Aglossia
What is aglossia frequently associated with?
Hypoplasia of the mandible (micrognathia)
What is the term that describe an abnormally large tongue?
Macroglossia
What most frequently causes macroglossia?
Vascular malformations (hemangiomas), muscular hypertrophy (associated with down syndrome), and tumors
What are some signs or macroglossia?
Noisy breathing, drooling, difficulty is eating or speaking
What syndrome is macroglossia associated with?
Beckwith-Wiedmann syndrome, where patients have increased risk for several childhood tumors
Describe ankyloglossia
A developmental tongue abnormality characterized by a short, thick lingual frenum resulting in limitation of tongue movement
When would you normally treat ankyloglossia?
Frenotomy or frenuloplasty at 4-5, unless it is interferring or causing a problem. Also, this condition could be “self correcting” i.e. patient falls down and tears frenum.
Describe lingual thyroid
Failure of migration of primitive thyroid gland during development
Where is the lingual thryoid usually found?
Between the foramen cecum and the epiglottis
Is lingual thyroid more common in males or females?
Females
Why should you avoid biopsy of the lingual thyroid?
In most cases, it is the patients only functioning thyroid tissue, and there is a risk of hemorrhage
What are some symptoms of lingual thyroid and when do they arise?
Dysphagia, dysphonia, dyspnea. Symptoms usually arise during puberty, adolescence, pregnancy, or menopause.
Desrcibe fissured tongue.
Dorsum of tongue exhibits multiple grooves/furrows that can measure from 2-6 mm in depth.
Why might patients with a fissured tongue experience mild burning?
Bacteria releasing acid.
What is the cause of fissured tongue?
Unknown
Fissured tongue is strongly associated with __________.
Geographic tongue
What syndrome is fissured tongue associated with?
Melkersson-Rosenthal syndrome
Geographic tongue is also known as ________ or ________.
Benign migratory glossitis or erythema migrans (when it is not on the tongue)
What causes geographic tongue?
It is a common inflammatory condition (an acute response) - so it is not developmental.
Describe hairy tongue
Marked accumulation of keratin on the filiform papilla that can be brown, black, blue or yellow (anything pigmented changes its color).
What causes hairy tongue?
Unknown etiology - many patients are heavy smokers, but could be due to poor oral hygiene, antibiotics or radiation therapy.
What is the term used to describe a white dorsal tongue without hairlike filiform projections?
Coated tongue
What causes coated tongue?
Bacterial and desquamated epithelial cells.
What term is used to describe superficial dilated veins?
Varicosities
Where can varicosites be found in the oral cavity?
The ventral tongue, or buccal/labial mucosa.
What is the most common type of oral varicosity?
Sublingual Varix
True or False: Lingual varices is common in children
False, lingual varices is common in adults and rare in children
True or False: Sublingual varicies are NOT associated with hypertension or cardiopulmonary disease
True
A thrombosed, calcified varix is called a _______.
Phlebolith
What term is used to describe a main arterial branch that extends up into the superficial submucosal tissues without a reduction is its diameter?
Caliber persistent artery
Where do caliber persistent arteries occur?
They most commmonly and exclusively occur on the labial mucosa
What is the unique characteristic of caliber persistent arteries?
Pulsation
Describe the characteristics of coronoid hyperplasia.
More commonly occurs in males, more commonly bilateral and the mandible will deviate towards the affected side.
Describe the characteristic of condylar hyperplasia.
Mandible deviation away from the affected side.
Describe exostoses.
Localized bony protuberances.
What are the 4 common types of exostoses?
Torus palatinus, torus mandibularis, buccal exostoses, palatal exostoses
Where do buccal exostoses occur?
Along the facial of the alveolar ridge, and more commonly occur on the maxilla.
Where do palatal exostoses occur?
Lingual aspect of the maxillary tuberosities.
Where does torus palatinus occur?
Midline of the hard palate.
Where does torus mandibularis occur?
Lingual aspect of the mandible
What term is used to describe a focal concavity of the cortical bone in the lingual surface of the mandible?
Stafne defect
What is another name for Stafne defect?
Lingual mandibular salivary gland depression
Where do Stafne defects commonly occur?
As well circumscribed radiolucencies below the mandibular canal in the posterior mandible. They are usually unilateral.
What term is used to describe a calcification of the stylohyoid ligament?
Eagle’s Syndrome; Stylohyoid syndrome; Carotid artery syndrome
What are the common symptoms of Eagle’s syndrome?
Vague facial pain while swallowing, turning the head or opening the mouth; dysphagia, dysphonia, headache, dizziness
What is a cyst?
A pathologic cavity lined by epithelium.
What term is used to describe palatal cysts that occur along the median palatal raphe in newborns?
Epstein’s pearls
What term is used to describe palatal cysts usually near the junction of the soft palate in newborns?
Bohn’s nodules
True or False: Epstein’s pearls and Bohn’s nodules require treatment.
False, Epstein’s pearls and Bohn’s nodules are usually self healing.
What term is used to describe a swelling of the upper lip resulting in elevation of the ala of the nose?
Nasolabial cyst
In what population are nasolabial cysts most common?
30-50 year old females.
True or False: Nasolabial cysts require surgical removal
True
What term is used to describe a well circumscribed radiolucency near the midline of the anterior maxilla, between and apical to the central incisors without root resorption?
Nasopalatine duct cyst
What is another name for nasopalatine duct cysts?
Incisive canal cyst
Nasopalatine duct cyst are the most common ___________ cyst of the oral cavity.
Non-odontogenic
How many millimeters can the incisive foramen be to be considered normal?
Up to 6 mm
Why is a biopsy of a nasopalatine duct cyst mandatory?
Becuase the lesion cannot be diagnosed radiographically.
How are nasopalatine duct cysts treated?
Surgical enucleation - which will take the nerve and the artery
What term is used to describe localized inflammation of the hair follicle?
Epidermoid cyst
What is a dermoid cyst?
Cyst that has adnexal involvement (sebaceous gland, hair follicle, erector pili muscle)
Where do dermoid cysts occur?
Occur at the midline as a submucosal, fluctuant swelling at the floor of the mouth
In what age group are dermoid cysts most common?
Children and young adults
How are dermoid cysts treated?
Surgical removal.
What term is used to describe cysts that occur from epithelial remnants of the thyroglossal tract?
Thyroglossal duct cyst
Where do thyroglossal duct cysts occur?
Painless, fluctuant, movable swelling at or near the midline, usually inferior to the hyoid bone
What term is used to describe cysts that occur within oral lymphoid tissue?
Lymphoepithelial cyst
What is the most common location of a lymphoepithelial cyst?
Floor of the mouth, but they can be found anywerhe along Waldeyer’s ring, ventral tongue or soft palate.
What do lymphoepithelial cysts present as?
White or yellow submucosal mass less than 1 cm. Usually asymptomatic.
In what age population are lymphoepithelial cysts most common?
Young adults.
What term is used to describe a cyst that occurs in the upper lateral neck along the anterior border of the SCM?
Branchial cleft cyst
What is another name for branchial cleft cysts?
Cervical lymphoepithelial cyst.
What term is used to describe an assymetric overgrowth of one or more body parts?
Hemihyperplasia
What syndromes are associated with hemihyperplasia?
Beckwith-Wiedmann syndrome, neurofibromatosis, proteus syndrome
What term is used to describe atrophy affecting one side of the face?
Progressive hemifacial atrophy
What might be the cause of progressive hemifacial atrophy?
Lyme disease caused a borelia spp infection
What does progressive hemifacial atrophy mimic?
Many features are similar to localized form of sclerodoma (strike of the sword)
What term is used to describe a painless, unilateral enlargement of the maxillary bone with overgrowht of the overlying gingiva?
Segmental odontomaxillary dysplasia
What are the characterisitcs of Crouzon syndrome?
Craniosynostosis, ocular proptosis, underdeveloped maxilla and in radiographs of the skill there is a beaten metal pattern
What are the characteristics of Apert syndrome?
Ocular proptosis, hypertelorism, downward slant of lateral palpebral fissures, syndactyly of hands and feet, mental retardation, trapezoid shape to lips, and they usually have cleft palate
What are the characteristics of Treacher-Collins syndrome?
Hypoplastic zygoma, coloboma (notch on outer portion of lower eyelid), underdeveloped mandible
