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