Oral Pathology Exam 1- Developmental Defects and Variations
Linea alba is restricted to (Dentulous/adentulous) areas
Dentulous areas
Describe the appearance of leukoedema
Diffuse grayish-white appearance of mucosa
Unrecognized activation of the sebaceous glands system occurs in what kind of cancer?
HNPCC- hereditary non-polyposis colon cancer
Do not confuse hairy tongue with ___________
Hairy leukoplakia
Recent evidence indicates an increase in SIZE and NUMBER of sebaceous glands following activation of which pathway?
Hedgehog
What is Van der Woude syndrome?
Interferon regulatory factor 6 gene mutation (role in fusion of lip and palate) chromosome 1 long arm
What disease is coronoid hyperplasia associated with?
Jacob's disease
Fissured tongue is strongly associated with geographic tongue and _________?
Melkersson-Rosenthal syndrome
Where is torus palatines located?
Midline of the palatal vault
Name a syndrome that is associated with double lip.
Ascher syndrome: -double lip -Blepharochalasis (edema of the upper eyelid, vision interference; hyperplasia of lacrimal glands with prolapse of orbital fat) -Nontoxic thyroid enlargement
What is jacob's disease?
Associated with coronoid hyperplasia, pseudo joints with the zygomatic arches, association with osteochondroma of the coronoid process.
What are commissural lip pits associated with?
Associated with hearing loss, pre auricular pits and rib anomalies
Are patients with fissured tongue asymptomatic or symptomatic?
Asymptomatic
Are patients with hairy tongue symptomatic or asymptomatic?
Asymptomatic
Name a syndrome that macroglossia is associated with
Beckwith-Wiedemann syndrome (omphalocele, visceromegaly, gigantism, hypoglycemia, Wilms tumor, adrenal or liver tumors
Is leukoeema more commonly seen in blacks or whites?
Blacks-racial pigmentation may make this variation more prominent
Ascher syndrome may result in nontoxic ______?________ enlargement.
thyroid
Eagle syndrome can occur after what?
tonsillectomy
How do solitary exostoses come about?
trauma
Is treatment necessary for caliber persistent artery?
No
What are the treatment choices for Eagle syndrome?
No treatment, corticosteroid injections, surgical excision of the elongated process or mineralized ligament
Do fordyce granules have hair?
No, no hair
Linea alba is prominent on (anterior/posterior) mucosa?
POSTERIOR mucosa
Is Van der Woude syndrome associated with paramedian or commissural lip pits?
Paramedian lip pits
In coronoid hyperplasia, which side does the mouth deviate toward?
The affected site
Where is Linea alba most commonly found?
The buccal mucosa
Name the two areas of the mouth in which Linea alba is found
The buccal mucosa and the tongue
What does it mean if a patient's double lip is acquired?
The double lip is a result of trauma or habits
Never forget that _____ is short at birth!!
The tongue
Of the two places in the mouth that Linea alba is found, which location is 'less common'
The tongue
Which is more common, torus palatinus or mandibularis
Torus palatinus
What causes condylar hyperplasia?
Trauma, endocrine and/or circulatory cause.
What during development may cause condylar hypoplasia?
Trauma, radiation
Name the three syndromes associated with condylar hypoplasia.
Treacher collins, oculoauricularvertebral, hemifacial microsomia
(T/F) A stafne defect is developmental, but not present from birth
True
(T/F) Ankyloglossia is related to dyspnea
True
(T/F) Ankyloglossia is related to periodontal disease
True
(T/F) Arterial bleeding may occur during surgery in caliber persistent artery
True
(T/F) Caliber-persistent arteries are uncommon
True
(T/F) Commissural lip pits may be unilateral or bilateral
True
(T/F) Fordyce granules may be described as ectopic or as a normal anatomic variation
True
(T/F) Hyperplasia, cystic transformation and tumors (extremely rare) are associated with fordyce granules
True
(T/F) Leukoedema is more prominent in smokers or those with poor oral health status
True
(T/F) Phleboliths are associated with varicosities
True
(T/F) Pits and cleft lip and/or cleft palate are associated with van der woude?
True
(T/F) Saliva can accumulate in fistulas.
True
(T/F) Salivary glands may be present in paramedian lip pits
True
(T/F) Sialograms are associated with stafne defects
True
(T/F) coronoid hyperplasia is rare
True
(T/F) hyperplastic epithelium and intracellular edema are associated with leukoedema
True
(T/F) there are rare examples of thyroid carcinoma in males from lingual thyroid
True
(T/F) varicosities can me either multiple or solitary on the lips or buccal mucosa
True
Name two other places besides the buccal mucosa in which leukoedema may present.
Vagina larynx
Describe the clinical syndromes of Eagle syndrome
Vague facial pain (swallowing, turning head, opening mouth), headache, dizziness, otalgia, transient syncope
Is leukoedema a variation or a disease?
Variation
What kind of patients are oftentimes seen with geographic tongue?
Wandering patients
Who is fissured tongue most prevalent in (whites, blacks, or mexican americans)
Whites and blacks
Is geographic tongue more common in men or women?
Women
Torus palatinus are more common in (women/men)
Women
Do commissural lip pits have a male or female predilection? If so, which?
YES, commissural lip pits present more frequently in males over females.
Does torus palatines have a genetic predisposition?
Yes
Are varicosities age-related?
Yes, 60% of older adults have this
If a patient presents with paramedian lip pits and van der woude syndrome, are there any other dental or mental concerns that may be associated with paramedian lip pits?
Yes, pits and cleft lip and cleft palate, mental retardation and dental malformations (hypodontia)
Do fordyce granules have ducts?
Yes, they are glands with ducts
What anomalies are lateral soft palate fistulas associated with?
absence or hypoplasia of tonsils, hearing loss, and pre auricular defects
Do fordyce granules present more frequently in adults or children?
adults
Name two things that should be included in a differential diagnosis for double lip
angioedema, tumor
Where may a dentist find fordyce granules?
buccal mucosa, lips, tonsillar pillars
(T/F) facial assymetry, prognathism and an open bite are all associated with (condylar or coronoid) hyperplasia
condylar
Which is more common, condylar hyperplasia or coronoid hyperplasia?
condylar hyperplasia
Degeneritive arthritis is associated with condylar hyper or hypoplasia?
condylar hypoplasia
What are varicosities
dilated and tortuous veins
What oral defect is Ascher syndrome associated with?
double lip
Name a few complications from the nodules of lingual thyroid?
dysphonia, dysphagia, sleep apnea
Name a few things that are associated with acquired Macroglossia
edentulism amyloidosis myxedema acromegaly angioedema tumors
Where are buccal protuberances located?
facial
Is lingual thyroid more common in females or males?
females
Why is treatment of coronoid hyperplasia problematic?
fibrosis or coronoid regrowth
Which type of papilla undergoes marked hyperkeratinization in hairy tongue
filiform
~33% of patients with lingual thyroid have __________
hypothyroidism
~75% of patients with ____________ have lingual thyroid
infantile hypothyroidism
Where are palatal exostoses located?
lingual aspect of tuberosity
Where are caliber-persistent arteries normally found?
lower and less often upper lips. They are bilateral age-related and may be pulsating
Is there any treatment for leukoedema?
no
What kind of glands are fordyce granules?
sebaceous
Name some of the causes of hairy tongue
smoking, antibiotics, POH, radiation, debilitated patients, staining (bacteria, coffee, tobacco), oxidizing mouthwashes or antacids, overgrowth of fungal or bacterial organisms, medications
What is another way to describe a double lip?
redundant fold
Geographic tongue is associated with ____?
psoriasis (HLA-Cw6)
What stimulates the development of fordyce granules?
puberty
Torus palatinus (rarely/commonly) show on pas
rarely
What percentage of children present with commissural lip pits?
0.2-0.7%
Name 3 treatments for Hairy tongue
1. Brushing 2. Shaving 3. Keratolytic agents **However, do not use Keratolytic agents if you do not know how
Name the two types of Pits (fistulas) that we learned about
1. Commissural lip pits 2. Paramedian lip pits
Lateral soft palate fistulas can be the result of 3 different things. Name them.
1. Congential 2. Trauma 3. Surgery
Name the three things associated with Melkersson Rosenthal syndrome
1. Facial paralysis 2. Cheilitis granulomatosa 3 Fissured tongue
Name three things that should be included in a differential diagnosis for a patient with leukoedema.
1. Lichen planus 2. Other leukoplastic lesions 3. dentrifice stomatitis (chemical burn)
Name two potential etiologic factors involved with microglossia.
1. Lithium during pregnancy 2. Chorionic villi sampling procedures
Name three syndromes involved in microglossia
1. hypodactyly 2. hypomyelia 3. underdeveloped organs
What percentage of ADULTS present with commissural lip pits?
12-20%
What is the hedgehog pathway?
A crucial signaling pathway for animal development that is aberrantly activated in several types of cancer
What is a stapne defect?
A radiolucency with a sclerotic border. It is commonly near the angle of the mandible
What is Eagle syndrome?
A stylohyoid syndrome. Can involve the elongation of the styloid process or mineralization of the stylohyoid ligament
What is Blepharochalasis?
Blepharochalasis is defined as edema of the upper eyelid and may cause vision interference. It may also result in hyperplasia of lacrimal glands with prolapse of orbital fat. Bepharochalasis is associated with Ascher syndrome which is also associated with double lip.
What is an exostosis?
Bony protuberance
A double lip can be the result of congenital causes, acquired causes, or both?
Both congenital or acquired
Is ankyloglossia more common in boys or girls?
Boys
Where is leukoedema seen in the mouth?
Buccal mucosa extending to the lips
Is a CT or panoramic better for coronoid hyperplasia?
CT
Macroglossia overview
Congenital or hereditary: -vascular malformations -hemihyperplasia -cretinism -Beckwith-Wiedemann syndrome -Down syndrome -NF 1 -MEN 2B
Varicosities may result in loss of _________ ?
Connective tissue tone
What causes commissural lip pits?
Due to a failure of processes to fuse
(T/F) Varicosities are associated with hypertension or CPD
False, varicosities are NOT associated with hypertension or CPD
What is the histologic diagnosis for Linea alba?
Hyperkeratosis
What is a concern for a patient with commissural lip pits?
Infection
Is a stafne defect more common in males or females?
MALES, MALES, MALES
Is coronoid hypoplasia more common in males or females?
Males
What does it mean if a patient's double lip is congenital?
Persistence of the pars glabrosa and pars villosa
Besides Van der Woude syndrome, name another syndrome that is associated with Paramedian lip pits
Popliteal pterygium syndrome: 1. same gene 2. popliteal webs 3. Cleft lip and/or cleft palate 4. Syngnathia
What causes Linea alba?
Pressure, friction, sucking trauma
Name one differential diagnosis for caliber persistent artery
Squamous Cell Carcinoma
Where are varicosities found?
Sublingual areas
Exostoses are masses of ___________ with minimal marrow
non-neoplastic bone
Caliber-persistent arteries are associated with ____________?
ulceration