Developmental: Soft Tissue and Cysts

Question 1

Hereditary or Genetic

Answer 1

85% - unknown etiology

10% - inherited, any abnormality that is inherited is developmental

5% - known environmental cause (ETOH, thalidomide)

Question 2

Familial

Answer 2

Runs in families

Question 3

Congenital

Answer 3

Present at birth, doesn’t imply etiology

Question 4

Developmental conditions often

Answer 4

A. Present at young age or congenitally

B. Bilaterally symmetrical

C. Asymptomatic

Question 5

General considerations for developmental conditions

Answer 5

A. Sporadic vs Genetic

B. Isolated vs Generalized

Syndrome: A generalized condition characterized by multiple abnormalities

Question 6

Agnathia

Answer 6

without jaw development (aplasia)

Question 7

Micrognathia

Answer 7

Small underdeveloped jaw (hypoplasia)

Question 8

Macrognathia

Answer 8

Large jaw

Question 9

Agnathia, Micrognathia, Macrognathia Development

Answer 9

Primary - Developmental

Secondary or acquired - from another disease or condition, eg. tumors, acromegaly, Paget’s disease

Question 10

Cleft lip and/or palate

Answer 10

Look at the Word Document

Question 11

Lip pits

Answer 11

congential malformation often inherited and may be with other anomalies (eg. clefts)

Question 12

Cheilitis glandularis

Answer 12

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

Question 13

Fordyce granules

Answer 13

“ectopic” sebaceous glands develop after puberty. > 80% of population. ↑↑buccal mucosa and often bilaterally symmetrical.

Asymptomatic, superficial yellowish “plaques”

No treatment, recognition only

Question 14

Fibromatosis gingivae

Answer 14

Inherited, most autosomal dominant

Isolated or with syndromes

Clinically - Asymptomatic, generalized gingival hyperplasia

Treatment: Surgery ? recurrence

Question 15

Aglossia

Microglossia

Macroglossia

Answer 15

Aglossia – Without tongue development (aplasia)

Microglossia - Small underdeveloped tongue (hypoplasia)

Macroglossia - Enlarged, overdeveloped tongue

Primary - Developmental

Secondary (Acquired) - Tumor, acromegaly etc.

Question 16

Ankyloglossia

Answer 16

Fusion of tongue to FOM, “tongue tied”

Question 17

Cleft tongue

Answer 17

bifid or midline fissure, failure of complete fusion of lateral halves of ant 2/3 tongue

Question 18

Fissured tongue

Answer 18

unknown etiology but genetics may play role

Deep dorsal surface fissures, ↑ with age, ↑↑ xerostomia (dry mouth),

may retain plaque

Question 19

Benign migratory glossitis

(Geographic tongue)

(Erythema migrans)

Answer 19

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)

Question 20

Hairy tongue

Answer 20

Not developmental

Hypertrophy of filiform papillae

Unknown etiology, predisposing factors: drugs (antibiotics, H2O2),

smoking, radiation therapy

Extrinsic staining

Treatment: Physical debridement ± chlorhexidine

Question 21

Varix

(varicose vein), varices

Answer 21

Superficial dilated veins

↑ calf, anus, orally - ventral tongue

color blanches with pressure (diascopy) - through glass

Treat only for esthetics

Varix - localized varicous vein

Question 22

Lingual thyroid nodule

Answer 22

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.

Question 23

Lymphoid tissue

(lymphocytes, immune system)

• Lingual tonsil
• Lymphoepithelial cyst

Answer 23

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

Question 24

Developmental lingual mandibular salivary

gland depression

(Stafne’s bone cavity)

Answer 24

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)

Question 25

Incisive canal cyst

Answer 25

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)

Question 26

Globulomaxillary cyst - Understand not on test

Answer 26

“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.

Question 27

Median palatal cyst

Answer 27

Cyst from entrapped epithelium during palatal closure

Radiolucency - midpalate - ± swelling

Treatment: Surgical removal

Question 28

Nasoalveolar Cyst

(nasolabial cyst)

(Klestadt’s cyst)

Answer 28

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

Question 29

Thyroglossal duct (tract) cyst

Answer 29

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

Question 30

Cervical lymphoepithelial cyst

(Branchial Cleft Cyst)

Answer 30

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

Question 31

Epidermoid and Dermoid Cyst

Answer 31

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