quiz 2 - developmental defects

Question 1

what are fordyce granules? where are they found and in whom are they most often seen?

Answer 1

appear as flat or elevated yellow plaques just beneath the mucosal surface. FG are ectopic sebaceous glands. most common site is the buccal mucosa followed by lips, although they may be found less commonly in other oral mucosa sites.

more than 80% of pop have these.

normal anatomic variation

more common seen in adults.

Question 2

What’s the treatment prognosis and differential diagnosis of fordyce granules?

Answer 2

none required.

good

the clinical appearance is characteristic

Question 3

what are complications of fordyce granules?

Answer 3

hyperplasia (15 or more sebaceous lobules)

keratin-filled pseudocyst - gland is plugged accumulating sebum

tumors: very rare

Question 4

what is leukoedema?

Answer 4

appears as a diffuse filmy, opaque, gray-white discoloration of mucosa, chiefly buccal.

common alteration of oral epithelium characterized by accumulation of fluid (edema) within the spinous layer, parakeratosis, and acanthosis.

unknown etiology

Question 5

what’s the prevalence, diagnosis and treatment of leukoedema?

Answer 5

70-90% in black adults
more common and severe in smokers
variation of normal

leukoedema is diagnosed clinically by stretching the cheek the white appearance greatly diminishes or disappears.

no treatment required. (just stop using tobacco and smoking!!)

good prognosis

Question 6

what is microglossia?

Answer 6

uncommon condition characterized by abnormal small tongue.

aglossia: absence of tongue, rare

mostly associated with syndromes (i.e. oromandibular-limb hypogenesis) but isolated cases may occur.

frequently associated w/ hypoplasia of the mandible and lower incisors may be missing and may be associated with constriction of maxillary arch.

Question 7

what is a syndrome?

Answer 7

a combination of signs and symptoms occurring commonly enough to constitute a distinct clinical entity.

Question 8

what is the treatment for microglossia?

Answer 8

depends on the nature and severity of the condition.
surgery and ortho may improve oral function.
Speech development is often quite goodbut depends on tongue size.

mandibular hypoplasia, often missing incisors.

Question 9

what is macroglossia?

Answer 9

uncommon condition characterized by enlargement of the tongue

several causes, most frequent:

• vascular malformations
• muscular hypertrophy

Question 10

what are congenital causes of macroglossia?

Answer 10

vascular malformations
hemihyperplasia
cretinism
down syndrome
mucopolysaccharidoses
neurofibromatosis
becwith-Wiedeman syndrome
MEN, type III

Question 11

what are the acquired causes of macroglossia?

Answer 11

edentulous patients
amyloidosis
myxedema
acromegaly
angioedema
carcinoma and other tumors

Question 12

who does macroglossia commonly occur with?

Answer 12

children ranging from mild to severe

n infants, noisy breathing, drooling and difficult eating may be the first manifestations of macroglossia

Question 13

what may macroglossia produce?

Answer 13

open bite
mandibular prognathism
eating problems
lisping speech
crenations of lateral border of tongue
tongue may ulcerate and become secondarily infected
if severe it can reduce airway obstruction

Question 14

what is treatment for macroglossia?

Answer 14

depends on cause and severity
in mild cases, treatment may not be necessary, although patients may benefit from speech therapy.
in symptomatic patients, reduction glossectomy may be needed.

Question 15

what is ankyloglossia (tongue-tie)?

Answer 15

developmental anomaly characterized by a short and thick lingual frenum
reported in 1.7% to 4.4% of neonates.
more common in boys than girls (4:1)
in adults mild forms are not unusual; severe form is a relative uncommon condition (in about 2-3 of every 10,000 people)

Question 16

what are possible complications of ankyloglossia?

Answer 16

speech problems
clefting of tongue tip
periodontal problems
breast-feeding problems

Question 17

what is the treamtnet for ankyloglossia?

Answer 17

treatment usually not necessary
condition is self-correcting in many cases because it is less common in adults
- frenectomy is the treatment when functional and periodontal problems are present
- in young children surgery is postponed until 4 or 5 years of age.

Question 18

what is lingual thyroid?

Answer 18

etiology: evelopmental
- this may represent remnants of thyroid tissue or an entire undescended thyroid
- of all ectopic thyroids, 90% are found in this region.

Clinical findings: detectable soft tissue mass between foramen cecum and epiglottis in midline posterior to the circumvallate papillae.

Question 19

what sex presents more with lingual thyroid? and what are the common symptoms?

Answer 19

females: male (4:1). Clinically evident or symptomatic lingual thyroids are much less common. Symptoms most often develops during puberty, adolescence, pregnancy or menopause.

common symptoms:

• Dysphagia - difficult swallowing
• dysphonia - difficult speech
• dyspnea - difficult breathing
• foreign body-like sensation

hypothyroidism in up to 33% of patients
in 70% of cases it is the patient’s only thyroid tissue!

Question 20

what is the diagnosis of lingual thyroid?

Answer 20

thyroid scan using iodine isotyopes, thyroid nuclear scan show presence of thyroid tissue
biopsy is often avoided
may bt ehe patients only thyroid tissue and risk of hemorrhage
in some cases, incisional biopsy may be needed to confirm diagnosis or rule out malignant changes

Question 21

what is the treatment of lingual thyroid?

Answer 21

treatment:
- asymptomatic cases - no treatmnet except periodic follow-up
- symptomatic cases - exogenous thyroid hormone to correct the hypothyroidism and to induce shrinkage of the gland. When symptoms of obstruction or bleeding appear, surgical excision.

prognosis:

• carcinomas reportd in 1% of cases
• there is a male predilection
• some advocate prophylactic excision of lingual thyroids in men older than 30 years of age.

Question 22

what is fissured tongue (scrotal tongue)?

Answer 22

a relatively common (2-5% of the population) condition of the tongue characterized by numerous grooves or fissures present on the dorsal tongue surface.

etiology: the cause in uncertain but hereditary appears to play a significant role
- aging and local environmental factors may contribute to its development

Question 23

what is the prevalence like and treatment and prognosis for fissured tongue?

Answer 23

prevalence and severity increase with age
usually asymptomatic, however, some patients may have burning sensation or soreness
fissured tongue may be also associated with geographic tongue or Melkerson-Rosenthal syndrome

treatment and prognosis:

• benign condition and no specific treatment is indicated
• patients should be encouraged to brush their tongue, because food and debris can accumulate
• debris may produce irritation.

Question 24

what is hairy tongue?

Answer 24

a marked accumulation of keratin on the filiform papillae of the dorsal tongue resulting in a hair-like appearance.

hairy tongue is found in about 0.5% of adults

etiology: the cause is uncertain. It appears to represent an increase in keratin production or a decrease in normal keratin desquamation. Many affected people are heavy smokers.

other possible associated factors:
poor oral hygiene, general debilitation, history of radiation therapy to the ehad and neck, broad-spectrum antibiotic therapy, overgrowth of chromogenic organisms (fungal, bacteria), coffee, tea and tobacco stains, and medications containing bismuth (e.g. Pepto-Bismol).
-oxidizing mouth rinses, hydrogen peroxide, or medications containing bismuth (Pepto-Bismol).

Question 25

what is the diagnosis and treatment of hairy tongue?

Answer 25

diagnosis: usually made from the clinical appearance
treament: eliminate predisposing factos
- desquamination of the hyperkeratotic papillae can be promoted by periodic scraping/brushing with a toothbrush/tongue scraper.

Question 26

what is coated tongue?

Answer 26

in some individuals, bacteria and desquamated epithelial cells accumulated on dorsal tongue, but without the hair-like filiform projections and whitish appearance is called “coated tongue”.

Question 27

what is varix (plural: varices)? etiology?

Answer 27

a varicosity, or venous varix, is a type of acquired vascular malformation that represents focal dilation of a single vein.

it may be related to weakening of the vessel wall secondary to aging.

varices have not been associated with systemic hypertension or cardiopulmonary disease.

Question 28

what are clinical features of varix? complications?

Answer 28

multipl, bluish-purple elevated or papular bleds

most common: sublingual varices on ventral surface of tongue and lateral border of tongue.

less common: solitary varices on lip and buccal mucosa

complications: thrombosis, which is insignificant in these lesions, occasionally occurs, giving them a firm texture. Older thrombi may exhibit dystrophic calcifications resulting in formation of a phlebolith (which is like a stone in a vein).

Question 29

what is the treatment for a varix? and other acquired vascular malformations?

Answer 29

sublingual varicosities are usually asymptomatic; no treatment is required.

solitary varices of the lips and buccal mucosa may need biopsy:

1) to confirm the diagnosis
2) phlebolith or thrombus formation
3) esthetic purposes

other ones: represent a more complex network or proliferation of thin-walled vessels than simple varices.

• relative common in adults
• undetermined cause
• some may be associated with vessel trauma and subsequent abnormal repair

Question 30

what are exocytosis (plural exostoses)? etiology?

Answer 30

localized bony protuberances that arise from cortical plate.

etiology: probably multifactorial including both genetic and environmental influences.

most often in adults

Question 31

what types of exocytoses are there?

Answer 31

buccal exostoses: bilateral row of bony hard nodules along the facial aspect of the maxillary and/or mandibular alveolar ridge

palatal exostoses: bony protuberances in lingual aspect of maxillary tuberosities. Usually bilateral but may affect only one side.

solitary exostosis: may occur possibly in response to local irritation.

reactive subpontic exostosis: rarely occur under skin grafts to gingival and subjacent to pontics of fixed bridges.

torus palatinus and torus mandibularis are the most common exostoses

Question 32

what is the diagnosis and treatment of exostoses?

Answer 32

diag: biopsy is unnecessary unless the diagnosis is uncertain and the clinician needs to rule out other bony pathosis

treat: exostoses may be removed:
1) if frequent trauama occurs
2) for prosthetic reasons
3) to allow proper flap adaptation during periodontal surgery

• subpontic exostoses may be removed if they interfere with oral hygiene or are associated with adjacent periodontal disease

Question 33

what is torus palatinus? (torus: singular, tori: plural). etiology, occurrence?

Answer 33

a common exostosis in the midline of the vault of hard palate.

etiology: multifactorial etiology, including both genetic and environmental factos, e.g. masticatory stress.
occurrence: the prevalence varies in a number of populations (9-60%) and peaks during early adult life, tapering off in later years.

higher prevalence in Asian and Inuit populations

more common in females (2:1)

Question 34

what are the clinical features of torus palatinus?

Answer 34

a bony hard mass that arises along the midline suture of the hard palate
usually asymptomatic, but in the overlying mucosa may become ulcerated secondary to trauma.

Diagnosis: most are easily diagnosed based on clinical presentation.

Question 35

what is the treatment of torus palatinus?

Answer 35

no treatment is necessary
surgical removal may be indicated
1) for prosthetic considerations
2) when it becomes frequently ulcerated
3) if interfere with oral function

Question 36

what is torus mandibularis? etiology and occurrence?

Answer 36

a common exostosis that develops along the lingual aspect of the mandible (above the mylohyoid line in the premolar area).

etiology: multifactorial etiology, including both genetic and environmental influences
occurrence: the prevalence ranges from 5 to 40%, and peaks in early adult life, tapering slightly in later years.

higher prevalence has been correlated with both bruxism and the number of teeth remaining present.

slight male predilection.

Question 37

what are the clinical features of torus mandibularis?

Answer 37

presents as a single bony protuberance or multiple lobules along the lingual aspect of the mandible above the mylohyoid line in the premolar area.

bilateral involvement in 90% of cases

may appear in radiographs as a radiopacity superimposed on the roots of the teeth

Diagnosis: most are easily diagnosed based on clinical presentation.

Question 38

what is the treatment for torus mandibularis?

Answer 38

surgical removal may be required for prosthetic considerations

occasionally, tori may recur if teeth are still present.

Question 39

what are other names for the stafne defect and what is it?

Answer 39

other names: stafne bone cyst, lingual mandibular salivary gland depression, static bone cyst.

description: a focal concavity of the cortical bone on the lingual surface of the mandible

Question 40

what causes the stafne defect?

Answer 40

although it is believed to be developmental, most cases appear in adult particularly in men.
the cause is unknown, but some have suggested that the lesion is due to entrapment of salivary gland tissue or other soft tissue (muscle tissue, fibrous tissue, blood vessels, fat or lymphoid tissue) during the development of mandible.

Question 41

what is the occurrence of the stafne defect?

Answer 41

posterior defects are not rare and are reported in 0.3% of panoramic radiographs. Similar defects have been noted in anterior mandible in incisors, canine or premolar teeth.

Question 42

what are the clinical features of the stafne defect?

Answer 42

most cases have been reported in adult males (80-90% of all cases).
Asymptomatic and most defects are unilateral, although bilateral cases may be seen. It may interrupt continuity of inferior border of mandible with palpable noth in this area.
Radiographically, a well-circumscribed radiolucency with sclerotic border, below the mandibular canal between the molar teeth and the angle of the mandible. Anterior defects present as well-defined radiolucency that may appear superimposed ocer the apices of the anterior teeth.

Question 43

What is the diagnosis of the stafne defect? what is treatment?

Answer 43

based on typical radiographic findings and lack of symptoms. If the clinical diagnosis is in doubt, then it can be confirmed by CT scan, MRI or sialography. Usually biopsy is not necessary except for anterior defects that may be difficult to recognize.

no treatment is necessary and prognosis is excellent.

Question 44

what is hemihyperplasia?

Answer 44

a rare developmental anomaly characterized by unilateral enlargement of the body and can be an isolated finding but it also may be associated with a variety of malformation syndromes.

Question 45

what is the etiology and occurrence of hemihyperplasia?

Answer 45

unknown etiology. several theories: vascular or lymphatic abnormalities, CNS disturbance, endocrine dysfunction, and chromosomal anomalies.

occurrence: more often in the right side of the body. Female to male ratio (2:1).

Question 46

what are the clinical types of hemihyperplasia?

Answer 46

complex hyperplasia - one whole side of the body
simple hyperplasia - single digit
segmental hyperplasia - (a limb)
hemifacial hyperplasia - one side of the face

Question 47

what is hemifacial hyperplasia?

Answer 47

• changes may involve all the tissues on the affected side, including the underlying bone
• asymmetry often noted at birth but more acentuated with age.
• increase incidence of abdominal tumors.
• 20% have mental retardation
• skin often shows hyperpigmentation, hypertrichosis, and telangiectasias

Question 48

what are oral features of hemifacial hyperplasia?

Answer 48

(enlargement of oral soft tissues and bone can occur)

• unilateral macroglossia
• mandibular canal and teeth (crowns and roots) can be larger
• malocculsion with open bit
• premature development of the affected teeth along with precocious eruption

Question 49

what is the treatment for hemifacial hyperplasia?

Answer 49

complete workout to rule out other causes of unilateral growth e.g. neurofibromatosis

• follow up to R/O abdominal tumors
• after growth has ceased, cosmetic and orthognathic surgery
• there are some malformation syndromes associated with hemihyperplasia