Quiz 1 Flashcards
Describe the effect of the position of the tongue during the formation of the secondary palate
At first the tongue is up very high near the nasal septum
As the palate fuses together the tongue moves downward out of the way
Congenital/hereditary causes of macroglossia
Vascular malformations (hemangioma, lymphangioma)
Hemihyperplasia
Metabolic diseases (mucopolysaccharidoses)
Downs syndromes
Beckwith-Wiedemann Syndrome
Isolated CL is often (80% of the time)…
Unilateral
70% on left
CL + CP are related ____ + isolated CP is a separate entity
Etiologically
What are the 2 etiologies of clefts
Isolated (non syndromic)
Syndrome associated
Incidence of CL vs. CP vs CL+CP
CL least common (25% cleft pts)
CP (30%)
CL + CP most common (45%)
What is the most common congenital abnormality in humans?
Orofacial clefts
How are bifid condyles oriented in the glenoid fossa?
Most common = lateral/medial
Less common = anterior/posterior
Incidence of leukoedema
Blacks > whites
More prominent in smokers
Incidence of lingual thyroid
Very rare
Small remnants of tissue seen in 10% of ppl
Actual lingual thyroid less common
- females > men
In condylar hypoplasia the jaw deviates _____ from the affected side
Towards
Incidence of coronoid hyperplasia
Rare
Men 5x > women
Bilateral 5x > unilateral
Fordyce Granules
Sebaceous glands in oral mucosa (buccal mucosa + vermillion zone of upper lip)
Ectopic
NORMAL variation (80% ppl)
Varicosities
Dilated + tortuous vein(s)
Commonly in sublingual area
Develops because loss of connective tissue tone leads to a slowing of bloodflow
Median mandibular cleft
Failure of fusion of the mandibular processes
How common is Eagle Syndrome
18-40% of ppl
Ankyloglossia
Tongue tie
Short thick lingual frenum
Oblique facial cleft
Failure of fusion of lateral nasal process + maxillary process
Extends from upper lip to eye
ALWAYS associated with CP
Double lip is more common in which lip
Upper
Commissural + paramedian lip pits are _____ because saliva can be squeezed out of them
Blind fistulas
Acquired causes for condylar hypoplasia
1 trauma
Infection
Radiation
Arthritis
Isolated (non syndromic) clefts are caused by _____ inheritance
Heterogeneous
How is the lower lip formed
Fusion of the 2 mandibular processes
4 things to know about Ascher Syndrome
- AD
- Double lip
- Blepharochalasis (upper eyelid edema)
- Nontoxic goiter (50% cases)
Exostoses
Tori
Localized bony protuberances arising from cortical plate
Histologically = mass of non neoplastic bone w minimal marrow
Fissures + geographic tongue (migratory glossitis) histologically appears just like…
Psoriasis
Racial variation of bifid uvula
Most common in Asians + Native Americans (1/10)
Whites (1/80)
Blacks (1/250)
Paramedian lip pits
Congenital (AD) invaginations of lower lip
Arise from persistent lateral sulci on the embryonic mandibular arch (normally disappear by 6 wks)
Blind fistulas
Traumatic Eagle Syndrome
Symptoms following fracture of the mineralized stylohyoid ligament
How do you differentiate between a varicosity and a tumor?
If site blanches it is likely NOT a tumor
Leukoedema
Diffuse gray white look of mucosa Buccal mucosa to lips Thick epithelium Intracellular edema No tx
If you stretch cheek it goes away
Most minimal variation of CP
Bifid uvula
Acquired causes of macroglossia
Edentulous pts Amyloidosis Myxedema Acromegaly Tumors (most common)
Submucous Palatal Cleft
Variation of CP
Defect in underlying musculature only
Seen as notch in palate
No problems (incidental finding)
Hairy tongue
Marked hyperkeratinization of filiform papillae (only papillae that doesn’t have tastebuds)
Lateral facial cleft can be isolated or associated with ___
Mandibulofacial dysostosis
Causes of CLASSIC Eagle Syndrome
after tonsillectomy after scar tissue develops in area of mineralized stylohyoid ligament
3 things to know about Van der Woude Syndrome
- Paramedian lip pits assoc with CL + CP
- Hypodontia
- Mutations in interferon regulatory factor 6 (IRF6)
Clinical presentation of condylar hyperplasia
Facial asmmetry
Prognathism
OB
(Sometimes) compensatory Mx growth + tilting of the O plane
Are bifid condyles more often unilateral or bilateral?
Unilateral
Symptoms of coronoid hyperplasia
- restricted mouth opening
- deviation towards affected side
Commissural Lip Pits
Small mucosal invaginations @ corners of mouth on vermillion border
Abnormal fusion of the maxillary + mandibular processes
Carotid artery syndrome (stylohyoid syndrome)
Elongated mineralized complex (stylohyoid) impinges on internal + external carotid artery + assoc. sympathetic nerves —–> Eagle Syndrome
Lingual thyroid is associated with
Hypothyroidism (30% cases)
Rarely - carcinomas
- more common to develop in men so removal recommended for men >30 yrs)
Variation of CP happens where?
In the soft palate alone or in BOTH hard + soft palate
Orofacial clefting is most commonly of this etiology
Isolated (non syndromic)
Orofacial clefts are associated with malocclusion because
Collapse of the Mx arch
Most common acquired cause of macroglossia
Tumors
Congenital causes for condylar hypoplasia
Treacher Collins syndrome (most common)
Oculoaruicularvertebral syndromes
Heifacial microsomia
Lateral facial cleft
Lack of fusion of the maxillary + mandibular process
Isolated or assoc with mandibulofacial dystosis
Rare
Extends from commissures to ear
3 hallmarks of Melkersson Rosenthal syndrome
- Fissured tongue
- Orofacial granulomatosis
- Facial paralysis
Commissural lip pits are associated with a high incidence of __
Precauricular pits
Commissural and paramedian lip pits have what hereditary pattern
Autosomal dominant
What direction does the secondary palate form in
Front to back
Blepharochalasis
Edema of upper eyelid leading to sagging of eyelids at corners
Severe = vision interference
Happens in Ascher Syndrome
Causes of hairy tongue
Smoking Antibiotics POH Radiation General debilitation
Staining caused by bacteria, coffee, tobacco
Caliber persistent artery
Main arterial branch in superficial submucosal tissue without reduction in size
- ONLY in lip (can be both lips or bilateral)
- normal/blue color
- disappears when stretched
- pulsation
Condylar hyperplasia (uncommon) is _____ common than coronoid hyperplasia
More
Most common CP variation
Bifid uvula
Caliber persistent artery is associated with…
Age - probs bc of loss of CT tone
Tx for condylar hypoplasia
Rib graft
Osteotomy
Distraction osteogenesis
Causes of double lip
Congenital (MOST)
Trauma
Oral habits
Ascher syndrome
Varicosities are associated with age, but NOT associated with
Hypertension
Cardiopulmonary disease
Commissural lip pits incidence
Fairly common
More common in adults
Fissured tongue is strongly associated with…
Geographic tongue
Melkersson Rosenthal syndrome
How does mandibular micrognathia contribute to CP in Pierre Robin Sequence
Prevents descending of the tongue, causing CP
List the incidence of orofacial clefts in different racial groups
Black (least common)
White
Asian
Native Americans (3.6/1000)
How is CP different than normal in Pierre Robin Sequence?
Wider
U shaped
Ankyloglossia is associated with…
Open bite Perio disease (esp lingual anterior) Dyspnea (epiglottis comes forward) Breast feeding probs Speech articulation probs
Hairy tongue can easily be confused with…
Hairy leukoplakia
Oblique facial cleft is ALWAYS associated with ___
CP
Lingual thyroid
Thyroid tissue doesn’t migrate properly
Some/all of it is left @ foramen cecum of tongue (where it descends from initially)
Symptoms of Eagle Syndrome
Vague facial pain while swallowing, turning head, opening
Dysphagia
Dizziness
Transient syncope (faint)
Syndrome associated clefting makes up 3-8% of all clefts and is caused by:
250 developmental syndromes
- single gene mutations (AD, AR, or X linked)
- chromosomal abnormalities
- idiopathic
Does hairy tongue always present with staining?
No - depends on pts diet
Condylar hypoplasia pts clinical findings
Small mandible
Class II
Significance of genetic counseling for cleft pts
3-5% Risk of cleft in sibling or offspring
Risk increases to 10-20% if there are affected first degree relatives
How is the upper lip formed
Middle upper lip = fusion of medial nasal processes (both sides) + frontonasal process
Lateral upper lip = fusion of maxillary processes (both sides) + medial nasal process
Causes of condylar hyperplasia
Trauma (most)
Endocrine
Circulatory
Hemifacial hyperplasia
Phleboliths can develop within…
Varicosities
Hairy tongue involves ____ papillae, the only papillae that doesn’t have tastebuds
Filiform
In condylar hyperplasia, the jaw deviates _____ from affected condyle
Away
3 hallmarks of Pierre Robin Sequence
- Mandibular micrognathia (small jaw)
- CP (wider + u shaped than normal CP)
- Glossoptosis (tongue falls back into airway)
Ankyloglossia incidence
Boys»_space;»> girls
Complete ankyloglossia = vv rare
Fordyce granules can become…
Hyperplastic
Form keratin filled cysts
Reactive subpontine exostoses (subpontic osseous hyperplasia)
Develop from alveolar crestal bone under pontic of a posterior bridge - comes up to meet pontic
Eagle syndrome
(Usually) asymptomatic elongation of styloid process or mineralization of stylohyoid process
Amloidosis
Acquired cause for macroglossia
Can be caused by multiple myeloma
Amyloid deposits on tongue
3 hallmarks of Melkersson-Rosenthal Syndrome
Fissured tongue
Orofacial granulomatosis
Facial paralysis
Stafne Defect (Static Bone Cyst/Defect) definition
Asymptomatic radiolucency with sclerotic border usually near angle of mandible (below canal)
*salivary glands normal
Stafne Defect is developmental but not ____
Present from birth
Stafne Defect incidence
Strikingly more common in men
80-90% of cases
Hemihyperplasia - definition
Asymmetric overgrowth (hyperplasia) of 1(+) body parts
- Involves ALL tissues of affected side (incl. bone)
- More pronounced @ puberty
- NOT hypertrophy
Complex hemihyperplasia involves…
Whole side of body
Simple hemihyperplasia involves…
Single limb
Hemifacial hyperplasia involves…
1 side of face
Incidence of Hemihyperplasia
Women 2x > men
Right 2x > left
2 dental clinical presentations of hemihyperplasia
Unilateral macroglossia
Increased crown
Romberg Syndrome
Progressive hemifacial atrophy
Affects dermatome of 1(+) branches of trigeminal N.
Romberg Syndrome Incidence
Women > men
Typical progression of Romberg Syndrome
Begins by 2nd decade
Stabilizes after 20yo
Clinical presentation of Romberg Syndrome (3)
- Sharp line of demarcation on forehead
- Osseous hypoplasia
- Dark pigmentation of overlying skin
8 features of Segmental odontomaxillary dysplasia (hemimaxillofacial dysplasia)
- Mistaken for fibrous dysplasia
- Childhood
- Unilateral Mx enlargement
- Gingival hyperplasia
- Missing Mx PMs
- Retained primaries w abnormal enamel
- Smaller Mx sinus
- Facial hypertrichosis, hyperpigmentation
7 benign epithelial lesions assoc. with HPV
- Squamous papilloma
- Verruca vulgaris
- Condyloma acuminatum
- Heck’s disease
- Sinonasal papillomas
- Molluscum contagiosum
- Verruciform xanthoma
Flat lesions =
Macule
Raised lesions =
Papule
Nodule
Irregular surfaced lesions =
Papillary
Which HPV strains are assoc. with squamous papilloma
HPV 6 + 11
Most common benign neoplasm?
Squamous papilloma
