Developmental Disorders

Question 1

Commissural Lip Pits

Occur in 12-20%, fairly common in adults

unilateral or bilateral?’

1-4mm in depth

asymptomatic and innocuous

no treatment is generally necessary

Answer 1

fairly common

both - most of the time found bilaterally though

kind of develop later in life

salivary dcts sometimes empty into them

Question 2

Double Lip

rare anomaly

redundant fold of tissue on the _ side of the lip

congenital vs. acquired?

Answer 2

mucosal side

both - could be caused by biting and hyperplasia

usually unnoticeable when lips at rest, but becomes visible when patient smiles

Tx - may excise for aesthetic purposes

Question 3

Ectopic (normal structure, wrong location) SEBACEOUS glands that occur on the oral mucosa

extremely common (reported in more than 80% of the population)

Answer 3

fordyce granules

sebaceous glands normally occur on skin associated with hair structures

Question 4

Fordyce Granules - ectopic sebaceous glands

multiple small yellow or whitish-yellow papules, often clustered together

most common locations?

Answer 4

buccal mucosa, lip vermilion (exterior mucosa part of lip)

seen more frequently in adults than children (puberty may stimulate growth)

no treatment

Question 5

Diffuse grayish or milky white appearance to oral mucosa, with surface folds or wrinkles

Answer 5

leukoedema

buccal mucosa most common, often bilateral

overall very common - especially in people with more melanin content in their skin - black population 70-80%

Question 6

Histopathology - fluid accumulation within the epithelial cells of the spinous layer

whitish appearance disappears when the mucosa is stretched/distended (goes back to normal pink smooth surface)

Answer 6

leukoedema

buccal mucosa, bilateral

Question 7

uncommon condition
abnormally small tongue

may be a component of any one of several syndromes

ortho care to manage collapsed dental arches

Answer 7

microglossia

the tongue is very important to develop the arch form

aglossia = complete absence of tongue

Question 8

uncommon; enlargement of tongue may be caused by a wide variety of condition

congenital or acquired
down syndrome, Beckwith-Wiedemann, vascular malformations, lymphangioma, amyloidosis, hypothyroidism

Answer 8

macroglossia

Question 9

aka tongue-tie

abbreviated or absent lingual frenum

2-10% of neonates

speech problems are probably exaggerated

Answer 9

ankyloglossia

speech problems are probably exaggerated

frenectomy may be necessary if mucogingival stress is evident

Question 10

rare developmental problem due to failure of migration of thyroid anlage (base, embyro)

mass develops in foramen cecum area

females/males ?

Answer 10

lingual thyroid

could be only functioning thyroid gland!! biopsy often avoided

more common in females

consider excision in males - leads to thyroid cancer in males

dx - thyroid scan using radioactive iodine

Question 11

fissured tongue

common variation of normal

seen in 5% of population (children and adults)
30% of older adults

varies in severity, from midline fissure to extensive arborized pattern)

tx? symptoms?

Answer 11

no tx necessary

usually no symptoms - so if hurting or something we need to be thinking something else

epithelium is intact

strong association with geographic tongue

Question 12

20% of fissured tongue patients have this

yellowish whitish border that waxes and wanes in intensity, benign inflammatory condition

common condition - occurs 1-3% population

etiopathogenesis unknown; believed to be _ mediated

Answer 12

benign migratory glossitis
(geographic tongue, erythema migrans)

immune mediated

generally affects the tongue - but can also be in other spots

no tx

Question 13

Coated Tongue (Hairy Tongue)

common condition

Elongation of the _ papillae on dorsal tongue (accumulation of keratin)

papillae can become discolored (pigment-producing bacteria, staining from tobacco)

tx?

Answer 13

filiform papillae

increase production or decreased removal of keratin

often associated with smoking

tx = none or tongue scraper

it is excess keration

Question 14

abnormally dilated and tortuous veins

often seen in older adults

thought to be secondary to age-related degeneration or laxity in elastic support of vessel walls

Answer 14

varix

plural = varices

ventral and lateral tongue, buccal mucosa, labial mucosa, lip vermillion

sublingual varices - normal anatomy usually

buccal, labial, lip - pathology

may become secondarily thrombosed

no tx

Question 15

what is a diascopy

Answer 15

put pressure (clear glass or plastic) to lesion and observe color change

varices - work because can push blood out of vessel

if a thrombosed varix - clot forms, dilates and diascopy doesn’t work) - so we surgically excise

Question 16

if weren’t positive on Varix after diascopy- we excise because there are very similar looking clinically

DD may include

Answer 16

mucocele, salivary gland neoplasms (such as mucoepidermoid carcinoma), or melanotic macule

Question 17

soft non-tender, salivary gland lesion - under mucosal surface, duct becomes injured and can’t excrete saliva

80% on lower lip
vascular appearance - blue purpleish

Answer 17

mucocele

80% - lower lip

Question 18

common vascular anomaly
main arterial branch extends superficially, without reduction in its diameter

normally large diameter arteries are deep to surface

older adults - could be do to soft tissue relaxation

almost exclusively on lip mucosa - most common?

Answer 18

Caliber-Persistent Artery

upper>lower

midline upper lip most common

Question 19

linear, arcuate, or papular lesion (seagull in flight)

normal to bluish in color

pulsation - unique feature

no tx

Answer 19

caliber-persistent artery

midline upper lip

Question 20

benign bony protruberance

debated pathogeneis; genetic vs. environemtnal
it is multifactorial

asymptomaticm unless secondarily traumatized

Answer 20

Exostoses

buccal exostoses, torus palatinus, torus mandibularis

no tx generally necessary
surgical removal if repeatedly exposed to trauma or if getting removable prosthesis

can biopsy to confirm homogeneity in the bone

Question 21

Adults, male predilection

asymptomatic, discovered on routine panoramic radiograph

well-demarcated radiolucency below the mandibular canal, posterior mandbile - houses salivary tissue

asymptomatic

Ct scan helps confirm the dx

Answer 21

Stafne Defect (Stafne cyst and lingual mandibular salivary gland depression) - not a true cyst

occasinally examples in the anterior mandible have been identified ( if here we are probably going to biospy)

these typically are not suspected clinically and are usually explored surgically

Question 22

cavity or space lined by epithelium

Answer 22

cyst

Question 23

rare soft tissue cyst, no radiographic change

adults; 3:1 female to male ratio

upper lip, lateral to midline, along nasolabial groove, 10% bilateral

the ala of the nose may be elevated

Answer 23

nasolabial cyst

soft tissue cyst - no hard tissue

lateral aspect of ala nost to commissure

Question 24

Nasolabial Cyst

Tx - Biopsy, surgical removal, recurrence?

variable histopathology - pseudostratified ciliated columnar epithelial lining, cuboidal epithelium and squamous metaplasia not uncommon

Answer 24

recurrence is rare

Question 25

most common non-odontogenic developmental cyst of the jaws

sometimtes pear or heart shaped

Answer 25

Incisive Canal Cyst, Nasopalatine duct cyst

from epithelial remnants of the nasopalatine duct

occurs at the apices of usually vital maxillary central incisors

6mm or less - prob just incisive foramen

6mm or more we are thinking incisice canal cyst

Question 26

incisive canal cyst

tx?

histopathology? - highly variable cyst lining

cyst wall contains _

Answer 26

simple curettage is curative

cyst wall contains contents of the incisive canal neurovascular bundle

Question 27

epidermoid cyst

common, arise from the _

usually affect facial skin, neck or back

rare examples intraorally

Answer 27

arise from hair follicle - fill doughy upon palpation

intraorally - epidermal inclusion cyst

milia - are simply very small epidermoid cysts

Question 28

tx - simple excision - recurrence is uncommon

histopathology - cystic lining that resembles the epidermis with production of orthokeratin

the lining of the cyst looks identical to the lining of the skin

Answer 28

epidermoid cyst/milia

no inflammation just tissue

orthokeratin inside

Question 29

very small epidermoid cysts
often occur in clisters/multiple

periorbital location most common

resolve spontaneously by self marsupialization

Answer 29

milia

singular - milium

Question 30

_ cyst

uncommon

lined by epidermis-like epithelium

cyst wall contains adnexal skin structures (hair follicles, sebaceous glands, sweat glands)

may be classified as “benign cystic form of teratoma” (composed of tissue derived from multiple germ layers)

Answer 30

dermoid Cyst

most commonly occur as fluctuant swelling midline floor of mouth

above geniohyoid-displaces tongue superiorly intraoral swelling

below geniohyoid - submental swelling , extraoral swelling

tx - surgical excision (rare malignant transformation)

Question 31

_ cyst

rare, 50% develop before 20 years old

midline, foramen cecum to suprasternal notch

if attached to hyoid bone or tongue, may elevate on swallowing

Answer 31

thyroglossal duct cyst

once thyroid tissue descends - tissue shoudl dissapear - but if it doesn’t - it is a thryoglossal duct cyst

Question 32

thyroglasssal duct cyst

high recurrence rate unless treated by a _ procedure but still 10% recurrence

1% malignant transformation

Answer 32

sistrunk procedure

surgical excision with portion of hyoid bone and muscular tissue along thyroglossal tract

Question 33

_

lined by columnar or stratified squamous epi with thyroid tissue in cyst wall

Answer 33

thyroglossal duct cyst

Question 34

Branchial cleft cyst

cervical variant of _

Answer 34

variant of lymphoepithelial cyst

its called branchial clst cyst if lateral to neck

if in oral it is lympoepithial cyst

Question 35

Branchial Cleft cyst (cervical variant of lymphoepi cyst)

arised from remnants of the branchial arches, usualy _ arch

fluctuant swelling of upper lateral neck

usually anterior/posterior? to SCM

_ of cases may develop fistula tract (oozing purulence)

Answer 35

usually 2nd arch

usually anterior to the SCM

Question 36

Branchial cleft cyst tx

histo - lined by stratified squamous epi with lymphoid tissue in cyst wall

Answer 36

surgical removal

FNA (fine needle) prior to surgery

minimal recurrence

questional malignant transformation

Question 37

oral counterpart to branchial cleft cyst

arised from _ trapped in oral lymphoid tissue (Waldeyer’s ring or accessory lymphoid aggregates)

Answer 37

oral lymphoepithelial cyst

arised from epithelial rests trapped in oral lymph tissue

Question 38

floor of mouth 50%, ventro-lateral tongye, tonsillar pillar

soft to firm, yellowish-white nodule

usually less than 1cm and asymptomatic - small

tx - surgical excision is curative

histo -lined by stratified squamous epi with lymphoid tissue in cyst wall

Answer 38

oral lymphoepitheoail cyst