Head and Neck Development Disorders Flashcards
what do orofacial clefts result from
disturbances in growth of face and oral cavity
what is cleft lip
defective fusion with the medial nasal process and maxillary process
what is cleft palate
failure of palatal shelves to fuse
what is the prevalance of cases in orofacial clefts
- CL and CP: 45% of cases
- CP: 30% of cases
- CL: 25% of cases
what population are orofacial clefts most common in
native americans and asians
what are the causes and risk factors of orofacial clefts
- genetic factors, syndromic
- environmental factors
- maternal alcohol and tobacco
- anticonvulsant therapy - phenytoin 10x risk
what is the possible prevention of orofacial clefts
folic acid in prenantal vitamins
what are the clinical features of orofacial celfts
-complete CL: extends upwards into nostril
- incomplete CL: does not involve the nose
- CP: may involve hard and soft palate
- minimal manifestation: bifid uvula
- may interfere with teeth development
how can orofacial clefts interfere with teeth development
- hypodontia
- malformed teeth
- bony defects
- malocclusion `
what is the treatment for orofacial celfts
- multidisciplianry approach
-surgical treatment - prosthetic appliances
is there tx indicated for bifid uvula
no
what are paramedian lip pits
congenital invaginations of the lower lip
- autosomal dominant inheritance
what are the clinical features and tx of paramedian lip pits
- bilateral and symmetrical fistulas on either side of midline of lower lip
- subtle depression or prominent buldge
- tx: none except for cosmetic reasons
what is Van der Woude syndrome
lip pits with CL and/or CP
- most common form of syndromic clefting
what are fordyce granules
ectopic sebaceous glands in oral mucosa
what are the clinical features and tx of fordyce granules
- multiple yellow or yellow-white papules
- buccal mucosa, vermillion of upper lip, retromolar pad, tonsillar area
- tx: none
do fordyce granules require biopsy
no
what feature is necessary in histopath to identify fordyce granules
sebaceous lobules
what is the cause of leukoedema
unknown
what are the clinical feautres and tx of leukoedema
- diffuse, gray-white color
- folded, wrinkled mucosa
- bilateral buccal mucosa
- white appearance disappears when mucosa is stretched
-tx: none
what is the differential dx for leukoedema and how do you rule out
- lichen planus
- leukoplakia
-candidiasis - all ruled out when mucosa is stretched
is microglossia common
no
what are the clinical features and tx of microglossia
- abnormally small tongue
- may be associated with a syndrome
- tx: depends on nature and severity. surgery and ortho
what is macroglossia
- enlargement of tongue
- more common than microglossia
what are the congenital causes of macroglossia
- vascular malformations
- lymphangioma
- hemihyperlasia
- down syndrome
what are the acquired causes of macroglossia
- edentulous patients
- amyloidosis
- myxedema
what is ankyloglossia - tongue tie
developmental anomaly of the tongue
what are the clinical features and tx of ankyloglossia
- short, thick frenum
- may result in speech defects
- may result in breast feeding difficulties
- tx: frenectomy for functional problems
what is the lingual thyroid
normally the thyroid descends into neck anterior to trachea
- when the primitive gland does not descend normally, ectopic thyroid tissue may be found between foramen cecum and epiglottis
what are the clinical features of lingual thyroid
- Most common in females (4x) due to hormonal influences
- ectopic gland (70%) is often only thryoid tissue
- range in size: small, asymptomatic, large lesions may block airway and cause dysphagia or dyspnea
- hypothyroidism in 33%
how is lingual thyroid dx
- thyroid scan
- avoid excisional biopsy because may be patients only thyroid tissue
what is the tx for lingual thyroid
-periodic follow uo
- thyroid hormone replacement
how is lingual thyroid determined in biopsy
if there is iodine present
describe fissured tongue
often hereditary, may also be degenerative process
what are the clinical features of fissured tonuge and tx
- dorsal surface grooves, furrows
- 2-6mm in depth
- usually asymptomatic
- strong associated with geographic tongue
- tx: non, encourage good OH
what other finding is common with fissured tongue
geographic tongue
what is hairy tongue
marked elongations of filiform papilla due to keratin accumulation
what are the risk factors for hairy tongue
-smoking
- poor OH
- general debilitation
- radiation therapy
- medications
what are the clinical features and tx of hairy ongue
- dorsal tongue
- elongated papillae usually brown, yellow or black
- patients may complain of bad taste
- tx: eliminate predisposing factors such as tobacco
- oral hygiene
how is hairy tongue dx on histopath
layers of keratin over epithelium
what are varicosites
- abnormally dilated or tortuous veins
- age related degeneration
what are the clinical features and tx for varicosites
- sublingual varicosities - 2/3 of people above 60 years
- blue- purple, elevate papular blebs- ventral and lateral tongue
- may also occur on the lips, buccal mucosa
- usually asymptomatic
- tx: none for sublingual varicosites, solitary varicosities may need excision to confirm dx
what are exostosis
- localized bony protuberances arise from cortical plate
- may be related to stresses from teeth
what are the clinical features of tx of exostosis
- observed in adults
- buccal and palatal exostosis
- tx: distinctive clinically, bx usually unnecessary
- surgical removal for denture prosthesis
what are the clinical features and tx of torus palatinus
- bony hard nodule of midline suture of hard palate
- 2:1 female
- most common in asian and inuit
- tx: similar to exostoses, may leave if. not causing any issue
when would you need to remove tori or exostosis
when fabricating dentures
what are the clinical and radiographic features of torus mandibularis
- bony hard nodule on lingual aspect of mandible
- 90% bilateral involvement
- most common in premolar regino
- most common in asian and inuit
- radiograpj: bony nodule superimposed on teeth
what is the tx for torus mandibularis
similar to exostosis
what is stafne defect
-developmental defect in mandibular alveolar bone
- may contain normal salivary gland tissue
- 80-90% of males
- reported in adults
what are the radiographic features in stafne defect
- radiolucency below the mandibular canal, lingual cortical defect
- occasionally may occur anteriorly
- well defined, with sclerotic border
- usually remains static over time
- asymptomatic
what is the tx for stafne defect
none
what is a palatal cyst of the newborn and how is it formed
- small developmental cysts on palate of newborn
- may result from trapped epithelium during palatal fusion in embryogenesis
what are the clinical features of palatal cyst of the newborn
- common, may occur in 55-85% of newborns
- most along the midline of hard or soft palate
- appear as small white or yellow-white papules on palate
- cysts are 1-3mm keratin filled cysts
what is the tx for palatal cyst of newborn
none- they usually regress on their own after a few weeks
describe nasopalatine duct cysts
- most common developmental non-odontogenic cyst
- arises from remnants of nasopalatine duct
- most common in 4-6th decade of life
- male predilection
what are the clinical features of nasopalatine duct cyst
- may exhibit swelling of anterior palate, drainage
- occasionally painful
- 1-2.5cm in diameterw
what are the radiographic features of nasopalatine duct cyst
- well defined RL near midline of anterior maxilla apical to central incisors
- may be difficult to distinguish small cyst from large incisive foramen
what is the tx for nasopalatine duct cyst
surgical enucleation
what is the normal upper limit size of the incisive foramen
6mm
what is the histopath presentation of nasopalatine duct cysts
- classic cyst lining
- cilia
- glandular tissue
- inflammation with lymphocytes
what is an epidermoid cyst of the skin
- common skin cyst, arises from the hair follicle
- accounts for 80% of follicular cysts of the skin
what are the clinical features of epidermoid cysts of the skin
- common in acne prone regions
- common areas: scalp, face, back
- nodular, fluctuant subcutaneous swelling
- unusualy before puberty unless associated with gardner syndrome
what is the tx for epidermoid cyst of the skin
conservative enucleation
what is the histopath presentation of epidermoid cyst of skin
cyst lining filled with keratin
what is a dermoid cyst
- developmental cystic malformation
- lined by epidermis, with dermal adnexal structures within cyst wall
- benign cystic form of a teratoma
- most common in ovaries and testes
what is a teratoma
developmental tumor composed of more than one germ layer - ectoderm, mesoderm or endoderm
what is the tx for dermoid cyst
surgical removal because it has small chance of malignant transformation
what are the clinical features of a dermoid cyst
- most common in children and young adults
- most common midline FOM
- soft, doughy mass
- may produce submental swelling
what is the tx for a dermoid cyst
surgical excision
what is the differential for a dermoid cyst
-lipoma
- salivary gland tumor
- soft tissue tumors
what is the histopath for a dermoid cyst
- keratin in lumen
what differentiates a dermoid cyst from an epidermoid cyst
dermal adnexal structures and sebaceous glands and immature hair follicles in histopath
what does the thyroglossal duct cyst arise from
thyroglossal duct remnants that normally undergo atrophyw
what are the clinical features of thyroglossal duct cyst
- develops from foramen cecum to suprasternal notch
- 60-80% develop adjacent to hyoid bone
- dx in 1-2nd decade of life, 50% by age of 20
- fluctuant, movable swelling
- usually asymptomatic
what is the tx for thyroglossal duct cyst
surgical excision
what is the histopath for thyroglossal duct cyst
cyst lining and presence of thyroid follices
what is a branchial cleft cyst
developmental cyst that develops from branchical arch remnants- usually the second
what are the clinical features of branchial cleft cysts
- upper lateral neck anterior or deep to SCM
- develop in children and young adults
- soft, fluctuant mass, 1-10cm in diameter
what is the tx for branchial cleft cyst
surgical excision
what is the differentail for branchial cleft cyst
- thyroglossal duct cyst- however would be in midline
- dermal cyst
- lipoma
- dermal and CT lesions
what is a lymphoepithelial cyst
- lesion that develops from oral lymphoid tissuew
what are the clincial features of lympepithelial cysts
- small, submucosal mass, usually <1 cm
- common on posterior lateral tongue, anterior tonsillar pillar
- firm or soft to palpation
- often white or yellow, keratin in lumen
- usually asymptomatic
what is the tx for lymphoepithelial cyst
-surgical excision, should not recur
- if distinctive, biopsy is not necessary
what is the histopath for lymphoepithelial cyst
entire cyst structure is retained - no breach in wall
- lymphoid aggregate in wall
what is the differential for lymphoepithelial cysts
- lipoma: wouldnt be this small though
- salivary stone- but this would feel hard
