Developmental: Soft Tissue and Cysts Flashcards
Hereditary or Genetic
85% - unknown etiology
10% - inherited, any abnormality that is inherited is developmental
5% - known environmental cause (ETOH, thalidomide)
Familial
Runs in families
Congenital
Present at birth, doesn’t imply etiology
Developmental conditions often
A. Present at young age or congenitally
B. Bilaterally symmetrical
C. Asymptomatic
General considerations for developmental conditions
A. Sporadic vs Genetic
B. Isolated vs Generalized
Syndrome: A generalized condition characterized by multiple abnormalities
Agnathia
without jaw development (aplasia)
Micrognathia
Small underdeveloped jaw (hypoplasia)
Macrognathia
Large jaw
Agnathia, Micrognathia, Macrognathia Development
Primary - Developmental
Secondary or acquired - from another disease or condition, eg. tumors, acromegaly, Paget’s disease
Cleft lip and/or palate
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Lip pits
congential malformation often inherited and may be with other anomalies (eg. clefts)
Cheilitis glandularis
Not developmental, infection of minor salivary glands in lower lip, often outdoor workers which thins and drys lips promoting retrograde infection
Variable severity - from slight swelling with dilated, inflamed ductsto significant swelling, pain and deep abscesses ± sinus tracts
Premalignancy ??, shared etiology
Fordyce granules
“ectopic” sebaceous glands develop after puberty. > 80% of population. ↑↑buccal mucosa and often bilaterally symmetrical.
Asymptomatic, superficial yellowish “plaques”
No treatment, recognition only
Fibromatosis gingivae
Inherited, most autosomal dominant
Isolated or with syndromes
Clinically - Asymptomatic, generalized gingival hyperplasia
Treatment: Surgery ? recurrence
Aglossia
Microglossia
Macroglossia
Aglossia – Without tongue development (aplasia)
Microglossia - Small underdeveloped tongue (hypoplasia)
Macroglossia - Enlarged, overdeveloped tongue
Primary - Developmental
Secondary (Acquired) - Tumor, acromegaly etc.
Ankyloglossia
Fusion of tongue to FOM, “tongue tied”
Cleft tongue
bifid or midline fissure, failure of complete fusion of lateral halves of ant 2/3 tongue
Fissured tongue
unknown etiology but genetics may play role
Deep dorsal surface fissures, ↑ with age, ↑↑ xerostomia (dry mouth),
may retain plaque
Benign migratory glossitis
(Geographic tongue)
(Erythema migrans)
Not developmental
Common inflammatory condition (glossitis) of unknown etiology, 2:1 females,
dorsal and/or lateral borders of tongue, depapillated erythematous areas
surrounded by yellowish-white borders, single or multiple lesions, usually migrate,
asymptomatic (may burn or hurt) occasionally off tongue (erythema migrans)
Hairy tongue
Not developmental
Hypertrophy of filiform papillae
Unknown etiology, predisposing factors: drugs (antibiotics, H2O2),
smoking, radiation therapy
Extrinsic staining
Treatment: Physical debridement ± chlorhexidine
Varix
(varicose vein), varices
Superficial dilated veins
↑ calf, anus, orally - ventral tongue
color blanches with pressure (diascopy) - through glass
Treat only for esthetics
Varix - localized varicous vein
Lingual thyroid nodule
Thyroid gland develops from thyroglossal tract which is an endodermal invagination starting in base of tongue (foramen cecum)
A lesion that occurs back where the foramen cecum - r_emoval is a thyroid ecttomy_
Produces mass posterior, mid-dorsal tongue
May not have thyroid gland in neck
Radioactive I (Iodine) given to image gland
May treat surgically or with thyroid replacement therapy
Mass will shrink down and you can survive with therapy.
Lymphoid tissue
(lymphocytes, immune system)
- Lingual tonsil
- Lymphoepithelial cyst
Lingual tonsil - all lymphoid tissue in tongue, ↑↑ posterior-lateral and posterior dorsal surface
Normal (asymptomatic) or hyperplastic (often swollen and symptomatic, treat)
** Check for bilateral symmetry
Lymphoepithelial cyst - (true cyst) lymphoid tissue reacts and stimulates salivary ducts to proliferate producing a cyst or crypts around lymphoid tissue occlude
Common location: ↑↑ ventral tongue, FOM, soft palate
Asymptomatic, small yellowish nodules
Treatment: Excision
Developmental lingual mandibular salivary
gland depression
(Stafne’s bone cavity)
Submandibular salivary gland develops along lingual cortex producing an indentation
Asymptomatic radiolucency, often corticated, below inferior alveolar canal and from angle to midbody
No swelling
Unchanged with time
Is a clinical or radiographic diagnosis (sialography to confirm)
Incisive canal cyst
Most common, from cystic degeneration of nasopalatine ducts within the incisive canal
Any age, often asymptomatic (maybe pain & swelling)
Radiolucency > 6mm ant Mx (between roots of MxCeIs - teeth must be vital), often heart-shaped (normal incisive canal < 6mm)
Treatment: Surgical enucleation, results in anethesia of anterior Mx for months
Variant: Cyst of incisive papilla (outside bone)
Globulomaxillary cyst - Understand not on test
“Developmental cyst resulting from entrapped epithelium when premaxilla fuses with Mx”
Asymptomatic radiolucency between MxCu and LaI. Probably doesn’t exist
Lesions can usually be classified pathologically as other cysts or tumors
Most common lucency between MxLa-Cu - lateral radicular cyst (tooth non-vital)
Probably Never Existed - Usually other pathology not this.
Median palatal cyst
Cyst from entrapped epithelium during palatal closure
Radiolucency - midpalate - ± swelling
Treatment: Surgical removal
Nasoalveolar Cyst
(nasolabial cyst)
(Klestadt’s cyst)
Cyst from embryologic nasolacrimal duct producing upper lip cyst to R or L of midline
soft, fluctuant, often elevates ala
Often the only one that occurs in this area
3/4 in females, 10% bilateral
Treatment: Surgical removal
Thyroglossal duct (tract) cyst
Cyst from thyroglossal tract
Midline cyst from base of tongue to thyroid gland
soft, fluctuant, ↑ females
These classically move when patient swallows because thyroglossal tract goes through the hyoid bone
Treatment: Surgical removal, often with dissection of tract
Cervical lymphoepithelial cyst
(Branchial Cleft Cyst)
Cyst from entrapped salivary gland ducts in paraparotid lymph nodes
Cyst from branchial arch and pouch development
soft, fluctuant mass in lateral neck
Most common site, Md angle ant to sternocleidomastoid muscle
Treatment: Surgical removal
Epidermoid and Dermoid Cyst
Often midline cyst from entrapped epithelium during surface closure
Areas : ↑ young (children), ↑ FOM or ventral tongue, soft, fluctuant
Epidermoid - cyst lined by stratified squamous epithelium (epidermis)
Dermoid - cyst lined by stratified squamous epithelium but with dermal appendages, ie. sebaceous glands, sweat glands, hair follicles
Treatment: Surgical removal
