Developmental Disturbances of the Jaws | Tongue | Thyroid

DEVELOPMENTAL DISTURBANCES OF THE JAW Agnathia Micrognathia Macrognathia Dental Arch Anomalies: Malocclusion

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DEVELOPMENTAL DISTURBANCES OF THE LIPS AND PALATE A. B. C. D. E. Labial Pits Cleft Lip and Palate Cheilitis Glandularis Cheilitis Granulomatosa Double Lip


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Microglossia and Macroglossia Ankyloglossia Scrotal Tongue (Fissured) Lingual Varicosities Lingual Tonsil


Psoriasiform Lesions: Benign Migratory Glossitis (Geographic Tongue, Erythema Migrans, Reiter's Syndrome)
Median Rhomboid Glossitis Fordyce Granules (Ectopic sebaceous glands) Ectodermal dysplasia

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A developmental defect, which is characterized by partial or complete absence of the maxilla or mandible. It is a suppressed gene expression with variation in clinical severity. It is not uncommon for the ear to be involved

A small mouth seen in association with: Pierre-Robin syndrome, Scleroderma, Infection or trauma to the temporomandibular joint during fetal development and congential heart disease Treatment: Reconstructive surgery.

Pierre Robin Sequence „ „ „ „ „ „ „ Congenital.possibly genetic – 10% to 20% if first degree relative affected Micrognathic Mandible Cleft Palate Posterior displacement of tongue Lack of support of tongue musculature Airway obstruction Treatment – Plastic Surgery .

Dental Arch Anomalies: Malocclusion occurs as a result of discrepancy in jaw bone and tooth size. 30% of the population will fit into a Class II or Class III type of malocclusion. According to Angle's classification. . with offspring following familial hereditary patterns from parents. Treatment: Orthodontic therapy/surgery.

Labial Pits: .„ „ Congenital lip pits are hereditary developmental defects which are found. clinically. as unilateral or bilateral depressions most commonly located on the lower lip vermilion border. Sometimes encountered with Von de Woude Syndrome which is associated with pits of lower lip. cleft lip/palate. Treatment: None.

Commissural Lip Pit .

Paramedial Bilateral Lip Pits .

Cleft Lip and Palate „ „ „ „ „ „ Etiology and Pathogenesis: Cleft lip and palate account for approximately 50% of all cases. Cleft lip with or without cleft palate is more common in males. with variable racial predilection. The incidence is 1-in-700 to 1. The multifactorial inheritance implies that many contributory genes interact with the environment and collectively determine whether a threshold of abnormality is breached.000 births. resulting in a defect in the . isolated cleft lip and isolated cleft palate each occur in about 25% of cases.

but does not involve the floor of the nose. Cleft lip may vary from a pit or small notch in the vermilion border to complete cleft extending into the floor of the nose.Cleft Lip „ „ „ „ „ „ „ Cleft lip. Any bilateral cleft lip is classified as Class IV. Class I cleft lip is a unilateral notching of the vermilion border that does not extend into the lip. generally. There are four (4) major categories with emphasis on degree of clefting. . Class III cleft lip are unilateral extending through the lip into the floor of the nose. Clinically. between the medial and lateral nasal processes to be penetrated by mesodermal cells. occurs at about the 6th to 7th week in utero. as a result of failure of the epithelial groove. Class II cleft lip involves the body of the lip. the Veau System of classification for cleft lip and palate is widely used.

Cleft Lip .

Cleft Lip .

Bilateral Cleft of Upper Lip .

leaving it free and mobile. Class IV clefts of the palate are bilateral complete clefts involving soft and hard palate on both sides of the premaxilla. . Class II extends no further than the incisive foramen. Class III involve complete unilateral clefts extending from the uvula to the incisive canal and the alveolar process. the Veau System of classification for cleft lip and palate is widely used. with ingrowth failure of mesodermal cells and lack of lateral palatal segment fusion. There are four (4) major categories with emphasis on degree of clefting Clefting of the palate limited to the soft palate is Class I. Clinically.Cleft Palate „ „ „ „ „ „ Cleft palate is a result of epithelial breakdown about the eight week of embryonic development.

Cleft Palate .

Cleft Palate communicating with the nose .

Bifid Uvula .

Submucosal Palate Cleft Bifid Uvula .

Speech is characterized by emission from the nose and has a hypernasal sound. .Complications of Cleft Palate „ „ „ „ „ „ Clefts of the palate are often associated with uvulopharyngeal incompetence or eustachian tube dysfunction. The lateral incisor is most often involved. Recurrent otitis media and hearing deficits are common complications. and eruption are seen. size. Abnormalities of tooth number. There is a high incidence of congenitally missing teeth. calcification. Palatal pharyngeal incompetence results from failure of the soft palate and pharyngeal walls to make contact during swallowing and speech thus preventing the necessary muscular seal between the nasal and oral pharynx. especially the maxillary lateral incisor. morphology.

Cheiloplasty is often required later in life. Treatment is chronologically segmental and requires a multidisciplinary team including medical dental and surgical specialists.Treatment „ „ „ „ „ Treatment and prognosis depends on severity of clefting. when the child weighs at least 10 pounds and has a hemoglobin of 10 mg/dl. Aesthetic considerations and hearing and speech deficits often result in developmental problems. Cleft lip is repaired in early infancy. . Closure of soft palate defects with sliding or pharyngeal flaps is usually done by age one (1).

Preventive dental services are very important to allow for future orthodontic therapy. Chronic otitis media is related to improper orientation of the eustachian tubes.Treatment „ „ „ „ „ Palatal obturators may assist in feeding. Autogenous bone graft from the iliac crest can be used to re-establish maxillary arch continuity. . Early audiologic and speech evaluation is recommended.

. Treatment: Re-constructive surgery. Asher Syndrome: double lip.Double lip: „ Characterized by a fold of excessive tissue on the inner mucosal aspect of lip." Double lip cannot be seen when lips are at rest. blepharochalasis and nontoxic thyroid enlargement. When lip is tensed. the double lip resembles "cupid's bow.

Double lip .

Autosomal dominant inheritance „ .Asher Syndrome Asher Syndrome: double lip. blepharochalasis (recurring edema of the upper eyelids) and nontoxic thyroid enlargement (50%).

Also. palate. It explains occurrence of sebaceous neoplasms orally. lip and gingiva. Histology: Sebaceous gland lobules which are not associated with hair follicles. . present on tongue.Fordyce Granules „ „ „ „ Fordyce Granules (Fordyce's Spots): Etiology: Ectopic sebaceous glands. appearing as numerous ovoid discrete yellow spots. Treatment: None. Clinical: Located classically on buccal mucosa.

Fordyce Granules .

Fordyce Granules .

. Treatment: Re-constructive surgery. Beckwith's Hypoglycemia Syndrome: Macroglossia.e. Tumors. Amyloidosis. Hypothyroidism. Macroglossia may be congenital or secondary to systemic conditions (i. neonatal hypoglycemia. Sarcoidosis).Microglossia and Macroglossia „ Microglossia and Macroglossia are relatively an underdeveloped small tongue or an excessive large tongue. microcephaly. umbilical hernia. Acromegaly. visceromegaly and giantism.

Microglossia .

Microglossia .

Causes of Microglossia .

Macroglossia .

by a deficient lingual frenum. .• Ankyloglossia: „ Congenital defect with result from fusion of the tongue to the floor of the mouth. Treatment: Surgical excision. Consonants and diphthongs mostly affected.

Ankyloglossia .

„ .Lingual thyroid nodule: „ Lingual thyroid nodule: Posterior to foramen caecum.R/O adenoma or carcinoma. breathing. may effect voice. adolescence. May be only viable thyroid tissue. Treatment: Excision after confirmation of existence of thyroid tissue in neck via radioactive iodine uptake. pregnancy or menopause -. and swallowing. Associated with tightness in throat. Most arise in females during puberty.

Lingual Thyroid .

Lingual Thyroid .

Brush daily with soft toothbrush.. Treatment: None.Scrotal Tongue (fissured): Occurs as deep furrows and crevices on the dorsum. . unless inflammatory reaction to food. This condition is usually painless. This is a component of the Melkersson-Rosenthal Syndrome.

Fissured (Scrotal Tongue) .

Fissured Tongue .

Refer for medical examination. .Lingual Varicosities: Clinical presentation of engorged prominent blood vessels (veins) on the ventral tongue surface. Treatment: None. It is considered a part of the aging process and cardiovascular disorders (Hypertension).

Lingual Varicosities .

not to be mistaken for SCCa which will not regress with time. which undergo inflammation and enlargement. .Lingual Tonsils „ Lingual Tonsils are lymphoid aggregates located on the posterior lateral aspects of the tongue. Other lymphoid aggregates in the oral and para oral tissues undergo similar reactive hyperplasia. Treatment: Antibiotic if needed.

Etiology is unknown.Hairy tongue „ Hairy tongue: Hypertrophy of filiform papillae. cleans daily with soft tooth-brush. Treatment: None. . with lack of normal desquamation.

Hairy Tongue .

Hairy Tongue .

Hairy Tongue .

These patients. therefore. showing oligodontia (fewer teeth than normal). nails. Prognosis: Good. sweat glands. exhibit low tolerance to heat. defective development of hair.Ectodermal dysplasia: „ Ectodermal dysplasia: A X-linked recessive disorder. . Treatment: None.

Ectodermal Dysplasia .

Ectodermal Dysplasia .

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