Oral pathology sheet # 1 - Mohammad Bader

by **Shadi Jarrar** 27/6/2011, 4:46 am

بسم الله الرحمن الرحيم
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http://www.mediafire.com/?62b02pa88w6dl58
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Hey everyone hopefully u had a great vacation :D, this lecture talks about Developmental Disturbances of soft tissue

1) Lip pits: there are two types of lip pits :

a) commissural lip pits: they are blind tracts (2-3mm dead end) which are found on the angle of the mouth, salivary glands may open in it, common (found in 10-20% of people) and more frequent in adults, some cases are congenital, can be unilateral or bilateral, there is NO clinical significance (no need for any management ), some might have also preauricular pits infront of ears.

b) Paramedian lip pits: less common, more clinical significance (have bad look so needs surgery for esthetic), if we saw them we have to think about syndromes like van der woude syndrome, associated with cleft lip or palate, in some cases this patient might have missing teeth (hypodontia). Another syndrome popliteal pterygium syndrome which is autosomal dominant can show paramedian lip pits and cleft lip or palate and extra skin in hands or feet connecting fingers with each other, skin webs and fibrous bands connecting the maxilla with the mandible and defect in the external genitalia.

2) Double lip: can be found in lower lip but mostly in upper, it is folded skin that appears like another lip, not esthetic so need surgery for correction , found in ascher's syndrome which is characterized by a double lip and euthyroid goiter (nontoxic goiter) and skin fold and edema in the upper eyelid.

3) Frenal Tag: extra mucosal fold in the upper labial frenum, no clinical significance, family history has a role.

4) Ankyloglossia “Tongue Tie”: the lingual frenum is short and thick, anteriorly positioned, connecting the tip of the tongue with the floor of the mouth and the lower lingual gingiva, there are variations: mild cases and severe cases (the tongue completely sticking with the floor of the mouth).

Complications: in mild cases it’s not that important, the patient can deal with it normally, but with the sever ones, the problems may arise directly after birth , difficult feeding, swallowing , mastication, phonetics, cant wet his lips, affects oral hygiene.

5) Microglossia: small tongue. Complications: collapse of teeth and palate because there is no support, problems in swallowing, mastication, phonetics. We have to check for other malformations like in hands, feet, clifting , hypodontia…

6) Macroglossia: large tongue, can be true large tongue or pseudomacroglossia. Different causes:

congenital causes: idiopathic, down syndrome, multiple endocrine neoplasia type 3.

acquired causes: hemartoma, hemangioma, lymphangioma, neurofibromatosis, amyloidosis, endocrine problems like acromegaly, growth hormone, critinism, allergy, angioedema, cancer.

Difficulty in breathing, snoring, drawling saliva, feeding, glossitis, anterior open bite, mandibular prognathism. Sometimes the size of the tongue is normal but it appears larger than normal (pseudomacroglossia), this person may have enlarged tonsils (adenoids) so pushing the tongue forward, low palate, small oral cavity (maxilla and mandible are small), hypotonia of the tongue.

7) Bifid tongue “Cleft Tongue”: can be associated with ankyloglossia, happens in incomplete fusion of the lateral parts of the tongue during development, correction using surgery.

8) Fordyce granules: collection of sebaceous glands in the oral cavity in 80% of people with no association with hair follicles, mostly bilateral in the buccal mucosa but can be found in other places and in vermilion zone of the upper lip. Most of it has no ducts that open to surface, unknown function, yellowish structures, mostly seen at puberty with increasing in number and size with age. Histologically it has superficial 1-5 lobules, no significance except in rare cases where there is hyperplasia in some of these lobules and have to be surgically removed.

9) Lingual thyroid nodule: it is thyroid tissue in the mid posterior dorsum of the tongue, caused by failure of migration of the thyroid gland completely or partially (thyroid gland might completely stay on the tongue and nothing in the neck (which is more common) or half on the tongue and half in the neck). Appears mostly after puberty because of the increased demand on thyroid gland. Complications depend on the size of the gland. Histologically, there are thyroid muscles superficially and thyroid tissue inside. We prefer not to remove it because 70% of the cases this is the only thyroid tissue. Diagnosis not by biopsy but by iodine isotopes or technetium or CT scan or MRI to see if the patient has normal thyroid gland in his neck or not then we decide to make management.

10) Oral tonsils: tonsils can be found at the floor of the mouth or in other places, small reddish region, normal lymphoid tissue. The problem is the hyperplasia of these tonsils like what happens with the normal ones. Some of these tonsils can be found under the foliate papillae (when inflamed it is called foliate papillitis) on the posterior lateral border of the tongue which is dangerous because it’s the most common place of the oral cancer.

11) Sublingual varices: dilated veins in the sublingual part of the tongue due to aging process, not congenital, common in people more than 60 years old.no need for biopsy. Can be confused with other vascular legions like hemangioma. Not associated with systemic diseases. Asymptomatic except when thrombosis happens. Can be found in the lips “venous lake”. No need for management except for cosmetic reasons.

12) Fissured tongue: deep fissures in the tongue, seen in children and adults with increasing in number and depth with age, 21% of people, clustering in families, no management, not esthetic, burning sensation, inflammation due to deposition of food and plaque. Strong association with geographic tongue. Some might come from syndromes like Melkersson-Rosenthal Syndrome which is fissure tongue, recurrent facial or labial swelling with facial paralysis. No reason so no treatment.

13) Geographic tongue “Benign migratory glossitis”: loss of the filiform papillae (the papillae that gives the tongue white color). Pink or reddish area surrounded by whitish border, single or multiple, mostly multiple and irregular in shape. The legion starts small then gets bigger then disappear to appear in other place on the tongue. Happens in 3% of people (less than fissure tongue). No age group, can be found in children and adults, clustering in families, asymptomatic, burning sensation in acidic and spicy foods.

Histologically, in center which is the red area, there is atrophy and chronic inflammatory cell infiltrate, the borders are yellow because of the parakeratosis, hyperplasia, dense acute inflammatory cell infiltrate. Can be associated with fissure tongue and psoriasis which is skin disease (10% of psoriasis has geographic tongue). Can be seen in other places than the tongue then it is called Migratory Stomatitis.

14) Median rhomboid glossitis: atrophic red area, found only in one place at the junction between the anterior 2 thirds and the posterior 1 third. Has a rhomboid shape, there are many theories for the origin, the 1^st one : persistence of the tuberculum impar during the emberyogenesis, the 2^nd one is : chronic candida infection specially if we found redness of the palate (kissing lesion).

15) Retrocuspid papilla: slightly raised area, similar to incisive papilla, found lingual to the lower canine, with a diameter of 2-4mm, usually bilateral. Histologically it is a fibrovascular tissue, surface parakeratinized epithelium, under it is the osseous foramen (blood vessels come from bone to this area), no nerves, no significance.

Done by: Mohammad Bader

Oral pathology lec. 1

26/6/2011