Oral Pathology Flashcards by Edgar Lassance

Diagnosis and Treatment of the following condition

Usually affects children 2-10 years old
Short, thick lingual frenum
May impair breastfeeding
May cause localized Gingival Recession of a lower incisor
May cause speech difficulties

Ankyloglossia |Tongue-tie
- Frenuloplasty in case of Gingival recession
- Frenuloplasty at age 4-5 in case of speech problems
- Early Frenotomy in case of Breastfeed impairment

Etiopathogenesis: Developmental anomaly caused by a short lingual frenum that restricts tongue movement

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Diagnosis of the following condition

Acrobrachycephaly (tower skull), with severe cases causing cloverleaf skull. The occiput is flattened, and a tall forehead is observed.
Exophthalmos, Hypertelorism and downward-slanting lateral palpebral fissures
Syndactyly of the second, third, and fourth digits on hands and feet
Visual loss due to chronic eye exposure, increased intracranial pressure and optic nerve compression
There frequently is cognitive impairment
Midface hypoplasia, that may cause respiratory issues, mouth breathing, sleep apnea, and middle-ear infections
Class III Skeletal Relationship, causing Anterior Open Bite and Anterior Crossbite
V-shaped dental arch, causing Crowding despite Hypodontia
Shovel-shaped incisors
Trapezoid-shaped lips, cleft of the soft palate or Bifid Uvula
Gingival thickening potentially delaying tooth eruption
Increased digital markings, creating “beaten-metal” pattern in radiographs

Apert Syndrome | Acrocephalosyndactyly

Etipathogenesis: Craniosynostosis Syndrome (caused by the premature fusion of the fontanelles

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Diagnosis and Treatment of the following condition

Asymptomatic swelling in the lateral portion of the neck, anterior to the sternocleidomastoid muscle
May also form in the submandibular area, adjacent to the parotid gland, or around the sternocleidomastoid muscle

Branchial Cleft Cyst | Cervical Lymphoepithelial Cyst
Surgical Excision

Etiopathogenesis: Cystic development of remnants of the 2nd Branchial Arch or pouch

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Diagnosis of the following condition

Asymptomatic, white-yellow swelling in the floor of the mouth smaller than 1.5cm
Cystic cavity lined by stratified squamous epithelium without rete ridges
Parakeratinized Epithelium, which may contain mucous cells, with desquamated epithelial cells seen filling the cyst lumen
Lymphoid tissue in the cyst wall

Oral Lymphoepithelial Cyst

Etiopathogenesis: Cystic development of remnants of the 2nd Branchial Arch or pouch

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Diagnosis and Treatment of the following condition

Usually affects children <5
Lesions progress until puberty, when they stabilize and regress
Orbital wall lesions may tilt the eyeballs and cause “eyes upturned to heaven” and “puffy cheeks”
Usually affects the mandible, causing bilateral bony expansion
Intraorally, hard, non-tender swellings may be palpated
Tooth displacement and mobility, failure of tooth eruption, impaired mastication, speech difficulties
Bilateral, multilocular, expansile radiolucencies, creating Soap Bubble
Maxillary antrum obliteration
Numerous fibroblasts and multinucleated giant cells with prominent nuclei
Eosinophilic, cuff-like deposits of collagen surrounding small blood vessels

Cherubism
Enucleation of severe cases

Etiopathogenesis: Autosomal dominant inheritance leading to abnormal bone resorption and formation, causing lytic bone lesions

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Diagnosis of the following condition

Multiple Supernumerary Teeth, frequently affecting tooth eruption
Narrow and high-arched palate
Small or absent maxillary sinus, thin zygomatic arch
Abnormal spacing in mandibular incisor area, with patent mandibular symphysis
Mandibular prognathism, pointy coronoid process with distal curvature, narrow mandibular ramus
Increased prevalence of Cleft Palate
Hearing loss and recurrent ear infections
Delayed or impediment of cranial suture closure
Hypertelorism, broad-based nose and depressed nose bridge
Enlarged skull, specially with frontal and parietal bossing, brachycephaly and shortened skull
Short stature
Long neck and narrow shoulders
Missing or hypoplastic clavicles, unilaterally or bilaterally, with hypermobility of the shoulders

Cleidocranial Dysplasia| Cleidocranial Dysostosis

Etiopathogenesis: Genetic mutation of the RUNX2 gene, interfering with osteoblastic differentiation, chondrocyte maturation, and bone formation

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Diagnosis and Treatment of the following condition

Affects most frequently males
Peak severity in late teenage years
Elongation of coronoid process
Usually bilateral, causing opening limitation
If unilaterally, causes mandibular deviation towards the affected side
Painless

Coronoid Hyperplasia
Surgical reduction of coronoid process

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Diagnosis of the following condition

Asymptomatic Imprints of teeth on the lateral surface of the tongue

Crenated Tongue | Scalloped tongue

Frequently associated to Macroglossia

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Diagnosis of the following condition

Underdevelopment of the midface, brachycephaly, calcified stylohyoid ligaments
Dental Crowding, Hypodontia, Angle’s Molar Class III and Posterior Crossbite
Exophthalmos, possibly leading to visual impairment or blindness
Hearing deficits, cognitive impairment
Increased intracranial pressure that may cause headaches
May be associated with Orofacial Clefts
Increased digital markings, creating “beaten-metal” pattern in radiographs

Crouzon’s Syndrome

Etiopathogenesis: Craniosynostosis Syndrome between the maxilla and the wall of the orbit

Risk Factors:
* Increased paternal age

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Diagnosis and Treatment of the following condition

Affects mostly children and young adults, some being congenital
Slow-growing, asymptomatic swelling in the midline of the floor of the mouth
Rubbery aspect, retaining pits after pressure application
Lesions above the geniohyoid muscle cause upwards the tongue displacement, causing trouble eating, speaking or breathing
Lesions below the geniohyoid muscle cause a double-chin appearance
Orthokeratinized stratified squamous epithelium lining with a prominent granular cell layer
Abundant keratin in the cystic lumen
Epithelial lining may contain areas of respiratory epithelium
Cystic wall consisting of fibrous connective tissue, with skin adnexal structures (hair, sweat glands, sebaceous glands)

Dermoid Cyst | Dysontogenic Cyst
- Supra geniohyoid lesions: surgical excision by intraoral approach
- Infra geniohyoid lesions: surgical excision by extraoral approach

Etiopathogenesis: Benign Teratoma of epidermis-like tissue

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How can a Dermoid Cyst and a Ranula be differentiated clinically?

Dermoid Cysts occur in the midline, whereas Ranulas occur off the midline

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Diagnosis and Treatment of the following condition

Vague facial pain, especially while swallowing, turning the head, or opening the mouth
Dysphagia, Dysphonia, otalgia, headache, dizziness
Severe manifestations: Vasodepressor Syncope and transient ischemic attacks
Mineralization of the stylohyoid ligament

Eagle Syndrome | Stylohyoid Syndrome |Carotid Artery Syndrome | Stylalgia
- Mild symptomatic cases benefit from local corticosteroid injection
- Severe cases can be treated with corrective surgery

Etiopathogenesis: - Development of scar tissue with elongation and mineralization of the stylohyoid complex after tonsillectomy, causing Impingement on adjacent nerves and blood vessels

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Diagnosis of the following condition

Incidence increases with aging
Affects most frequently males
Multiple grooves or fissures on the tongue surface
Usually asymptomatic, but may cause mild burning or soreness
Hyperplasia of rete ridges
Loss of keratin on filiform papillae
Varied papillae size, separated by deep grooves
Polymorphonuclear leukocytes migrating into epithelium, sometimes forming microabscesses
Mixed inflammatory cell infiltrate in the lamina propria

Fissured Tongue | Scrotal Tongue

Risk Factors:
- Geographic Tongue
- Melkersson-Rosenthal Syndrome

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Diagnosis of the following condition

Identified most frequently in adults
Multiple yellow or yellow-white Papules
Located most commonly on buccal mucosa and lateral portion of the upper lip’s vermilion
Sebaceous glands without hair follicles

Fordyce Granules

Etiopathogenesis: Anatomic variation characterized by ectopic presence of sebaceous glands on the oral and/or genital mucosa

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Diagnosis of the following condition

Midface hypoplasia, protuberant lips, flattened nose, prominent forehead
Conical teeth
Hypodontia, Oligodontia
Salivary Gland Aplasia or hypoplasia and Xerostomia
Wrinkling and hyperpigmentation of periocular skin, brittle nails
Hypotrichosis: Fine, sparse hair
Anhidrosis: Reduced number of sweat glands and heat intolerance
More common in males

Ectodermal Dysplasia | Christ-Siemens-Touraine Disease

Etiopathogenesis: X-linked recessive mutation that affects ectoderm-derived structures

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Diagnosis and Treatment of the following condition

Affects most frequently females
Tissue-colored, vascular mass situated anywhere from the foramen cecum to the epiglottis
May growth enough to cause airway blockage
Frequently (70%) represents the only thyroid tissue in the patient
Dysphagia, Dysphonia, Dyspnea usually develop after puberty, pregnacy or menopause
1/3 of patients have Hypothyroidism
Thyroid scan will show hyperconcentration of iodine isotope in the mass

Lingual Thyroid
* Hormone therapy in symptomatic patients
- Surgical removal if hormone therapy is ineffective

Etiopathogenesis: Ectopic deposition of thyroid tissue between the foramen cecum and epiglottis

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What are the congenital causes of Macroglossia?

Vascular Malformations
Lymphangioma
Hemangioma
Cretinism
Neurofibromatosis Type I
Down Syndrome
Multiple Endocrine Neoplasia Type 2B
Hemihyperplasia
Beckwith-Wiedemann syndrome
Duchenne muscular dystrophy
Mucopolysaccharidoses

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What are the acquired causes of Macroglossia?

Edentulism
Amyloidosis
Myxedema
Acromegaly
Angioedema
Myasthenia Gravis
Amyotrophic lateral sclerosis
Carcinoma and other tumors

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Diagnosis and Treatment of the following condition

Affects most frequently older adults
Most common oral location is the sublingual area
Multiple asymptomatic, blue-purple, elevated blebs
If thrombosed, the varix appears as a firm, blue-purple nodule and contain lines of Zahn
Dilated vein with little smooth muscle and poorly developed elastic tissue
Older thrombi may show Dystrophic Calcification, leading to Phlebolith formation

Oral Varicosities
Surgical removal indicated in cases of: Esthetic concern or diagnostic confirmation needed

Etiopathogenesis: Age-related degeneration with loss of connective tissue tone supporting the vessels

Risk factors:
- Age
- Smoking
- Cardiovascular disease

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Diagnosis and Treatment of the following condition

Affects up to 85% of neonates
1-3mm wide white-yellow papules distributed along the median palatal raphe
Keratin-filled cyst
Squamous stratified epithelium lining

Epstein Pearls
Ruptures and heals spontaneously

It is a type of Palatal Cyst of the Newborn

Etiopathogenesis: Developmental cyst derived from epithelium entrapped along the line of fusion during secondary palate formation

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Diagnosis and Treatment of the following condition

1-3mm wide white-yellow papules distributed along the palate out of the midline
Affects up to 85% of neonates
Keratin-filled cyst with squamous stratified epithelium lining

Bohn’s Nodules
Ruptures and heals spontaneously

It is a type of Palatal Cyst of the Newborn

Etiopathogenesis: Developmental cyst derived from epithelium entrapped along the line of fusion during secondary palate formation

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Diagnosis and Treatment of the following condition

Usually bilateral and symmetric depressions on the lower lip
May vary from subtle depression to considerable hump
May express salivary fluid
May be transmitted to offspring as Orofacial Clefts

Paramedian Lip Pits | Congenital Fistulas of the Lower Lip
Surgical removal in cases of cosmetic concern

Etiopathogenesis: Congenital malformation that results from persistent lateral sulci from abnormal fusion of the maxillary and mandibular processes

Risk Factors:
- Genetic diseasesVan der Woude Syndrome
- Popliteal Pterygium Syndrome
- Kabuki Syndrome

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Diagnosis and Treatment of the following condition

Triad of: Cleft Palate, Mandibular micrognathia at birth and Glossoptosis
Respiratory difficulty at birth, specially in the supine position
Risk of asphyxiation
Cleft Palate usually in U shape, wider than isolated cases

Pierre-Robin Sequence

Etiopthogenesis: Intrauterine Molding syndrome due to decreased amniotic fluid volume and pressure of the head against the uterine wall

Risk factors
- Stickler Syndrome
- Velocardiofacial Syndrome

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Diagnosis and Treatment of the following condition

Effects frequently middle-aged men
Usually unilateral depression of the lingual surface of the mandible, inferior to the mandibular canal, between the angle of the mandible and the 1st molar
Asymptomatic
Usually contains normal salivary gland tissue, and may contain a mix of blood vessels, fat, connective tissue and lymphoid tissue, as well as may be totally empty
Round, unilocular, well-circumscribed radiolucency with sclerotic borders
May occur anteriorly in association with the sublingual gland, superimposing the apices of mandibular anterior teeth

Stafne Bone Defect | Stafne Bone Cyst

Etiopathogenesis: Development of ectopical tissue, frequently of salivary glands, in the mandible

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How can Stafne Bone Defect be differentiated from other radiolucencies in the same typical location?

Fine-needle Aspiration Biopsy

# Diagnosis and Treatment of the following condition - Typically affects young adults - Asymptomatic, movable and fluctuant swelling at the midline from the foramen cecum of the tongue to the suprasternal notch, often adjacent to the hyoid bone - May attach to the hyoid bone or tongue and move along with swallowing and tongue movement - May cause laryngeal obstruction - Columnar, stratified squamous, cuboidal, or even small intestine epithelium lining - May contain thyroid tissue in the cystic wall

**Thyroglossal Duct Cyst** Surgical removal of cyst, hyoid bone segment and muscle tissue associated ## Footnote Etiopathogenesis: Developmental cyst that results from the proliferation of endodermal cells in the embryonic pharynx

# Diagnosis and Treatment of the following condition - Usually affects females under 10 - Multiple bones are affected - Irregular Café-au-lait pigmentation that resembles the coast of Maine - Endocrine abnormalities, such as sexual precocity in females, Hyperthyroidism, Hyperparathyroidism, hypercortisolism, excess Growth Hormone - Craniofacial involvement may lead to vision and hearing problems, nasal and sinus congestion and airway obstruction - Tends to slows or cease with puberty - Coxa Vara, bone pain, pathologic fracture, leg length discrepancy, bowing deformity, etc. - Painless, slow-growing, unilateral swelling causing facial asymmetry - Increased risk of malignant transformation - Some lesions may be a mix of radiolucent and radiopaque - Ground-glass Opacification with poorly defined margins - Hypophosphatemia due to renal phosphate waste - Increased Alkaline Phosphatase **Oral Manifestations** - Same as Monostotic Fibrous Dysplasia - Tooth displacement, retained deciduous teeth, Oligodontia - Enamel Hypoplasia, Enamel Hypomineralization - Taurodontism

**McCune-Albright Syndrome | Albright Syndrome** - Symptomatic management - Hormonal therapy - Surgical intervention for deformities - Bisphosphonates for bone pain | Type of **Polyostotic Fibrous Dysplasia** ## Footnote Etiopathogenesis: Mutation of the GNAS gene, altering multiple cell types related to bone metabolism, resulting in replacement of bone with fibro-osseous tissue

# Diagnosis and Treatment of the following condition - Hypoplastic zygomas, narrow face, depressed cheeks, and downward-slanting palpebral fissures - Coloboma of the lower eyelid, lack of eyelashes - Ear anomalies that often lead to hearing loss - Marked hypoplasia of the condylar and coronoid processes, antegonial notching, retruded chin - Downturned mouth, Lateral Facial Cleft, Cleft Palate - Salivary Gland Aplasia of the Parotid Gland - Hypoplasia of the airways may cause difficulty breathing

**Treacher-Collins Syndrome | Mandibular Dysostosis | Franceschetti-Zwahlen-Klein Syndrome** ## Footnote Etiopathogenesis: Malformation involving the 1st Branchial Arch and the 2nd Branchial Arch Risk Factor: Increased paternal age

# Diagnosis of the following condition - High tendency to have sunburns - Atrophied, freckled skin - Early actinic keratosis - Early development of squamous cell carcinoma and Basal Cell Carcinoma - Squamous cell carcinoma of lower lip and tip of tongue - Neurologic degeneration (20-30% of patients): subnormal intelligence, ataxia, sensorineural deafness, impaired eyesight

**Xeroderma Pigmentosum** ## Footnote Etiopathogenesis: Genetic Impairment of DNA repair, allowing free mutagenic effect of UV light in epithelial cells

# Diagnosis and Treatment of the following condition - Affects most frequently individuals of black descent - Bilateral white-translucent wrinkles and streaks that do not rub off - Disappears during mucosal stretch - Parakeratosis, Acanthosis - Intracellular epithelial edema in the stratum spinosum, resulting in large cells with pyknotic nuclei - Broad and elongated rete ridges

**Leukoedema** ## Footnote Etiopathogenesis: Anatomic variation

# Diagnosis and Treatment of the following condition - Most common in the posterior third of the tongue, just anterior to the circumvallate papillae, in the midline - Elongated, hair-like papillae of the tongue that may be stained dark due to drinks, foods, smoking or bacteria - May lead to esthetic discomfort, gagging and bad taste in the mouth - Histological elongation and hyperparakeratosis of the filiform papillae, with numerous bacterial growth sites

**Hairy Tongue** - Reduction or elimination of predisposing factors (ie: smoking, alcohol, antibiotics, etc.) - Scraping of the elongated papillae - Improvement of oral hygiene ## Footnote Etiopathogenesis: Idiopathic increase in keratin production or a decrease in keratin desquamation Risk Factors: - Systemic Antimicrobials therapy - Smoking, Alcohol consumption - General debilitation - Poor oral hygiene - Drugs that may induce Xerostomia - Radiation Therapy - Prolonged use of Chlorhexidine or Hydrogen Peroxide mouthwashes

# Diagnosis and Treatment of the following condition - Abnormally small mandibular condyle - If bilateral, will result in a small mandible in Class II Skeletal Relationship - If unilateral, will result in depression of the face and midline deviation towards the affected side

**Condylar Hypoplasia** ## Footnote Risk Factors: - Trauma - Infection - Congenital malformation

# Diagnosis and Treatment of the following condition - Affects most frequently young adult females - Excessive growth of one mandibular condyle that may involve the body of the mandible - Contralateral deviation on opening - Facial asymmetry, prognathism, Posterior Crossbite, and Posterior Open Bite - May lead to compensatory maxillary growth and tilting of the occlusal plane

**Condylar Hyperplasia** Ortho-surgical treatment in cases of severe functional or esthetic compromise ## Footnote Risk Factors - Local circulatory problems - Endocrine disturbance - Trauma

How to differentiate Condylar Hyperplasia from Hemifacial Hyperplasia?

Soft tissue and teeth are not enlarged in Condylar Hyperplasia

How to differentiate Condylar Hyperplasia from Osteoma of the mandibular condyle?

Condylar shape is maintained in Condylar Hyperplasia, wheras it is altered in Osteoma of the condyle

# Diagnosis and Treatment of the following condition - Usually affects middle-aged females - No bone involvement, occurring exclusively in soft tissue - Unilateral, asymptomatic swelling in the upper lip lateral to the midline, causing elevation of the ala of the nose - Elevation of the mucosa of the nasal vestibule and obliterates the maxillary mucolabial fold - May result in nasal obstruction or may interfere with the wearing of a denture - Pseudostratified columnar epithelial lining - Cyst wall is composed of fibrous connective tissue with adjacent skeletal muscle

**Nasolabial Cyst | Nasolalveolar Cyst | Klestadt Cyst** Enucleation ## Footnote Etiopathogenesis: Cystic development of epithelial remnants of nasolacrimal duct

# Diagnosis and Treatment of the following condition - Usually occurs in the mandibular 1st molar area - Adjacent teeth are vital - Asymptomatic, non-expansile, well-defined radiopacity

How to differentiate a Dense Bone Island from Condensing Osteitis?

It is not caused by odontogenic inflammation, so the associated teeth are usually asymptomatic and show no decay

# Diagnosis of the following condition - Usually affects females - Usually affects the posterior mandible in edentulous areas - Asymptomatic, non-expansile, well-defined radiolucency - Hematopoietic cells and fatty marrow in histological examination

**Focal Osteoporotic Marrow Defect** ## Footnote Etiopathogenesis: Enlarged bone marrow that is sufficient to produce a radiolucency Risk Factors: Exodontia

# Diagnosis of the following condition - Usually affects children and young adults - Spontaneous and progressive destruction of one or more bones - Bone pain - Risk of pathologic fracture - Increased risk for sleep apnea - Gnathic lesions usually affect the mandible - Teeth respond normally to vitality tests - Mobile teeth, malocclusion, deviation of the mandible, and clinically obvious deformity - Ill-defined radiolucency - Loss of lamina dura and thinning of cortices - Loose, highly vascular connective tissue with a diffuse chronic inflammatory cell infiltrate

**Phantom Bone Disease | Massive Osteolysis | Gorham Disease** ## Footnote Etiopathogenesis: Bone destruction followed by vascular, then fibrous tissue replacement Risk Factors: Trauma

# Diagnosis and Treatment of the following condition

Oral Pathology Flashcards

(169 cards)