Chapter 15: Disease of the Oral Cavity Flashcards
Characterized by a nodular or lobular bony growth in the midline of the hard palate
Torus palatinus
Represented by single or multiple, unilateral or bilateral bony growths on the lingual aspect of the mandible in the region f the premolars
Torus mandibularis
- Diminution in size of either jaw
- Failure at the growth center in the condyle
- Congenital or acquired
- Associated with plethora of syndromes (craniofacial dysostosis, acrocephalosyndactyly, trisomy 2)
Micrognathia
Pierre Robin
- Micrognathia
- Glossoptosis (prevents adequate support of lingual of musculature, allowing the tongue to fall downward and backward
- Posterior cleft palate
Andy Gump facies
Maxilla development
10th-12th week: maxilla grows rapidly
4th-5th month: disparity between the upper and lower jaws is quite apparent
Treatment: Robin anomaly
- Keeping the infant in a prone position
2. Severe: tongue tip is sutured to the anterior mandible or lower lip
Enlargement or anterior placement of the lower jaw
Prognathism
Malocclusion
- Underdevelopment of the maxilla or mandible or overdevelopment of the mandible
- Incompatibility of tooth size and jaw size may result in spacing, crowding or irregularity of teeth
- Prolonged retention of primary teeth may result in delayed eruption of permanent teeth
- Neglected primary or permanent teeth may be lost prematurely
Most congenital cases of macroglossia are due to..
- Lymphagioma
2. Hemagiolymphangioma
Treatment of macroglossia
- Sclerosing agent
2. Corrective surgery
- Caused by embryonal failure of the tuberculum impar to submerge, covered by the lateral lingual tubercles
- Characterized by a smooth to nodular, elevated or depressed area void of papillae, located just anterior to the circumvallate papillae on the dorsum of the tongue
- No treatment
Median rhomboid glossitis
- Due to partial or complete embryologic failure of the thyroid gland to descend from the foramen cecum to its normal position in the neck
- Characterized by multiple nodules of thyroid tissue on the dorsum of the tongue in the area of the foramen cecum and within the body of the tongue
- No treatment is required for small lesion
- Larger lesion: surgery
No lingual thyroid tissue should be removed until the presence of thyroid tissue elsewhere is ascertained
Lingual thyroid
Inability to elevate the tongue tip above a line extending through the commissures of a congenitally short lingual frenulum
Ankyloglossia
Treatment for ankyloglossia
No treatment
Severe: frenulum should be clipped in infancy
Preferred treatment: Z-plasty
- Occurs in about 1 per 1000 white births
- As a result of declining postnatal mortality, decreasing operative mortality, steadily improving operative results and attendant increases in marriage and childbearing
Cleft lip, with or without cleft palate
- May be unilateral or bilateral
2. Unilateral: cleft is more common on the left side
Isolate cleft lip
Cleft lip-cleft palate is more common in…
Males
Complete clefts are more common in…
Females
Can be a sign of a submucosal cleft of the palate
Cleft uvula
Contraindicated in the presence of a submucosal cleft
Adenoidectomy
- Caused by failure of penetration of ectomesenchyme between the embryonic maxillary and mandibular processes
- Cleft may be unilateral (left side) or bilateral, partial or complete (rare)
- Extending from the angle of the mouth toward the ear
- Many cases: cleft extends above or below the tragus
- More common in males
Lateral facial cleft
May be found with 1st and 2nd branchial arch syndrome
- Hemifacial microsomia
- Oculoauriculovertebral dysplasia
- Mandibulofacial dysostosis
Lateral facial cleft
Hypoplasia of the ascending ramus and condyle of the mandible, ear tags and microtia
Hemifacial microsomia
Essential hemifacial microsomia with epibulbar dermoids and hemivertebra
Oculoauriculovertebral dysplasia
- Associated with cleft lip and extends to the inner canthus of the eye
- Some cases: cleft runs lateral to and does not involve the ala of the nose, passing near the outer canthus into the temporal region
- Unilateral or bilateral
- Associated with cleft lip, cleft palate or lateral facial cleft
Oblique facial cleft
Due to failure of ectomesenchymal penetrance between the maxillary, median nasal and lateral nasal processes or failure of coverage of the nasolacrimal groove
Oblique facial cleft
Acrocephalosyndactylu
Apert syndrome
- Craniosyntosis leading to turribrachycephaly and syndactyly
- Progressive synostoses of hands, feet, spine
- Some mental retardation
- Case reports of conductive deafness
Apert syndrome
- Craniosynostosis
- Hypoplasia of midface
- Relative mandibular prognathism
- Ocular proptosis
- Hypertelorism
- Conductive hearing loss
Craniofacial dysostosis (Crouzon syndrome)
- Anomalies of the eye (antimongoloid obliquity of the lids and coloboma of the lower lids with lack of cilia)
- Abnormalities of the external and middle ears
- Hypoplasia of the mandible and malar bones
Mandibulofacial dysostosis (Treacher Collins syndrome)
Cavity lined by epithelium
True cyst
Derived form the proliferation and cystic degeneration
Odontogenic cyst
Derived from epithelial remnants of the tissue covering the embryonal processed that participate in the formation of the face and jaws
Nonodontogenic cysts
Odontogenic cyst
- Dentigerous cyst
- Eruption cyst
- Gingival cyst of newborn infants
- Radicular cyst
- Keratocyst
- Surrounds the crown of an unerupted tooth of either the regular or the supernumerary dentition
- Arises though alteration of the reduced enamel epithelium after the crown has been completely formed
- Teeth involved: mandibular 3rd molar, maxillary canine, maxillary 3rd molar and 2nd mandibular premolar
- Solitary
Dentigerous cyst
- Gingiva becomes swollen with associated salivation, fetor oris, dysphagia and painful lymphadenopathy
- Sites of round to oval, sharply demarcated, disseminated vesicles or erosions: gingiva and tongue
- Lesions are 2-4 mm, painful, covered by a yellowish pseudomembrane and surrounded by a red margin
- After about 10-14 days, the primary infection subsides without scar formation
Primary herpes simplex
Unilateral vesicles appear on the palate, uvula, maxillary gingiva and upper buccal and labial mucosa
Second trigeminal nerve
Unilateral vesicles appear on the palate, uvula, maxillary gingiva and upper buccal and labial mucosa
Second trigeminal nerve
- All human fetuses after their 4th month in utero and at least 80% of newborn infants have small nodules or cyst (Epstein’s pearls, Bohn’s nodules) at the junction of the hard and soft palates near the median raphe
- White to yellowish white small epithelial inclusion cyst
- Resulting from incorporation of epithelium during the embryonic process of palatal fusion
- Becomes superficial and rupture, within the 1st few weeks of life
Gingival and palatal cysts of newborn infants
- Uncommon type of dentigerous cyst
- Associated with erupting deciduous or rarely permanent teeth
- Represents the accumulation of tissue fluid or blood in a dilated follicular space about the crown of an erupting tooth
- Unilateral or bilateral, single or multiple, present at birth
Eruption cyst
Extremely painful for months or even years especially in elderly persons
Postzoster neuralgia
- Most common of oral cyst
- Inflammatory in origin
- Sequela of dental carries
- Symptomless and is diagnosed on routine dental radiographs
- Associated tooth is nonvital and usually manifests dental caries
- Remain small and does not produce jaw expansion
Radicular (periapical) cyst
- Basal cell carcinoma
- Multiple keratocysts
- Skeletal abnormalities
Nevoid basal cell carcinoma syndrome
- Bifurcated and splayed ribs
- Kyphoscoliosis
- Fusion of vertebrae
- Cervicothoracic spina bifida occulta
- Lamellear calcification of the falx cerebri
- Bilateral calcified fibromas of the ovary
- Medulloblastoma
- Meningioma
Nevoid basal cell carcinoma syndrome
- Lined by simple to thinly keratinized strafified squamous
- Appear as early as 7-8 years or as late as 30s
- Tendency to recur, possibly from adjacent microcyst, in spite of thorpugh cuerettement
Nevoid basal cell carcinoma syndrome