Oral Pathology Flashcards
(169 cards)
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
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
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
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
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
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
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
Diagnosis of the following condition
Asymptomatic Imprints of teeth on the lateral surface of the tongue
Crenated Tongue | Scalloped tongue
Frequently associated to Macroglossia
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
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
How can a Dermoid Cyst and a Ranula be differentiated clinically?
Dermoid Cysts occur in the midline, whereas Ranulas occur off the midline
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
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
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
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
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
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
What are the acquired causes of Macroglossia?
- Edentulism
- Amyloidosis
- Myxedema
- Acromegaly
- Angioedema
- Myasthenia Gravis
- Amyotrophic lateral sclerosis
- Carcinoma and other tumors
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
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
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
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
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
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