Developmental Disturbances of the Oral and Maxillofacial Region
Double Lip
What:
- Linear fold of excess hyperplastic tissue along the mucosal surface of the lip
- Usually involved the upper lip bilaterally, but can be unilateral or affect lower
lip - Usually congenital, but doesn’t become evident clinically until after teeth
eruption - Can be associated with Asher Syndrome, oral habit or trauma
Symptoms:
- If bilateral, enlargements have “Cupid’s bow” appearance
Treatment:
- If problematic, either functionally or aesthetically, excision is indicated
Commissural Lip Pits
What:
- Congenital invaginations of the surface mucosa of the vermilion of the lip at
the commissure - May be unilateral or bilateral
- Seems to be inherited as an autosomal-dominate disorder
- Not rare
Symptoms:
- Invagination is usually 1 to 2mm in diameter, may be as deep as 4mm and
is lined by stratified squamous epithelium - Occasionally, minor salivary gland ducts empty into the pits and mucus can
be expressed from these invaginations - No adverse symptoms
Treatment:
• Not objectionable cosmetically • Require no therapy
Paramedian Lip Pits
What:
- Congenital invaginations of the vermilion of the lip that typically are
found on the lower lip either side of the midline - Rare
- Can be isolated finding but they are present in combination with cleft lip
or palate - Patients with isolated paramedian lip pits have 15-29% risk of having
child with cleft lip or palate
Symptoms:
- Pits very in size and may be as large as 3mm in diameter and 2.5 cm in
depth - Communication with the underlying minor salivary glands is seen, and
mucin may be present in the pits
Treatment:
• Aesthetically objectionable examples are treated by surgical excision with inclusion of the surrounding minor salivary glands
Cleft Lip
What:
- Birth defect, parts of the face that form upper lip remains split before
birth - Happens early in fetal development
Symptoms:
- Split in lip (can be small or large)
- Difficulty eating
- Speech difficulties
- Ear infections
- Misaligned teeth
- Hearing problems
Treatment:
• Surgery, usually between 3-6 months • Might need dental & orthodontic care • Might need speech therapy
Cleft Palate
What:
- Birth defect, opening or split of the palate (roof of mouth) that doesn’t
close completely during fetal development
Symptoms:
- Split in the palate (roof of mouth)
- Difficulty eating
- Difficulty swallowing
- Ear infections
- Hearing problems
Treatment:
- Surgery, usually between 3-6 months
- Might need dental & orthodontic care • Might need speech therapy
Bifid Uvula (Cleft Uvula)”
What:
- Division of the uvula into two lobes
- Represents mildest form of cleft palate
- Prevalence is greater in males and exhibits a familiar pattern similar to isolated cleft palate
Symptoms:
- Size of division may very from minimal to complete separation of the uvula into two halves
Treatment:
- No treatment is necessary
Lateral Palatal Fistula
What:
- Epithelial-lined channels through the soft plate that interconnect the
oral cavity and oropharynx or nasopharynx - Usually congenital, but also may be acquired secondary to rupture of a peritonsillar abscess or surgical complications
Symptoms:
- Most congenital examples are bilateral and symmetrical
Treatment:
- No treatment is required
Fordyce Granules
What:
- Sebaceous glands located on the oral mucosa and the vermilion of the
lips - Glands have been noted in the buccal mucosa and vestibules in around
80% of the adult population and should be considered normal
structures - May also occur on the anterior tonsillar pillar, the alveolar ridge, the
gingiva, the palate and the tongue, but are uncommon and should be
considered ectopic if discovered in these sites - The extent of involvement increases with age and is more pronounced
in males
Symptoms:
• Appear as multiple yellow maculopapular lesions typically smaller than 2mm
Treatment:
• Biopsy recommended for patients with abnormally large Fordyce granules or granules exhibiting continued growth otherwise they create no problems and require no therapy
“Leukoedema”
What:
- Variation of the oral mucosa in which the involved tissue appears white
or gray with a filmy, opalescent hue - Tissue may be thickened sufficiently to form prominent wrinkles
- Usually seen on the buccal mucosa bilaterally, but adjacent mucosa also
may be involved - Not rare in newborns
Symptoms:
- Usually asymptomatic
Treatment:
- No treatment is necessary
Common Lesions
Irritation Fibroma
What:
- Localized reactive hyperplasia of fibrous connective tissue
- Response to trauma or irritant (biting on cheek, lower lip or lateral side
of tongue
Symptoms:
- Smooth, dome shaped, mucosa colored
- Sizes are variable (small to large)
Treatment:
- Conservative excision
- Recurrence is rare
Canker Sore (aphthous ulcer)
What:
- Small white or gray lesion (sore) with a red border inside the mouth, on
tongue, soft palate (back portion of the roof of mouth), inside cheek - Not contagious
- Cause is not completely known, but immune system problems, bacteria
and viruses, and/or with trauma to soft tissue in mouth, stress, citrus or
acidic foods, allergies
Symptoms:
- Burning, tingling or burning sensation before the sore(s) appear
- Itching, stinging, painful, small white or gray round sores with red
border - Difficulty talking or eating
Treatment:
• They usually heal on their own after 1-2 weeks • Over-the-counter topical anesthetics • Anti-microbial mouthwash • Avoiding hot, spicy, acidic foods that irritate the sore(s)
Cold Sore (fever blister or herpes labialis)
What:
• Fluid filled blisters on slips and sometimes under the nose or around the chin • Caused by herpes simplex virus type 1 • Very contagious • Once a person is infected with herpes simplex virus type 1, the virus stays in the body and causes occasional attacks (outbreaks) • Ultraviolet light or trauma can trigger recurrences, stress, fatigue
Symptoms:
- Pain, burning, itching, tingling, localized warmth, erythema (redness) of
skin 6-24 hours before blisters develop - Multiple small erythematous papules that form clusters of fluid-filled
vesicles (blisters)
Treatment:
• Usually heal in a week by themselves • Over-the-counter topical anesthetics • Dr. Zaugg prescribe antiviral drug to reduce infection • Vesicles rupture and crust within 2 days
Leukoplakia-Hyperkeratosis
What:
- Increase in the amount of keratin due to trauma or irritant
Symptoms:
- Smooth to rough white area
- Superficial
- Not fixed to underlying mucosa
Treatment:
- If no obvious trauma or irritant can be identified, biopsy is needed
Leukoplakia-Dysplasia/Carcinoma”
What:
- White lesions which are thickened, indurated or ulcerated
Symptoms:
- May be clinically indistinguishable from hyperkeratosis (smooth to
rough white area, superficial, not fixed to underlying mucosa)
Treatment:
- If no obvious trauma or irritant can be identified, biopsy is needed
