Linea Alba

Developmental Defects and Variations
Dr. John Koutlas
Division of Oral Pathology

Buccal mucosa, less common tongue
Pressure, friction, sucking trauma
Restricted to dentulous areas
More prominent on posterior mucosa
HistDx: Hyperkeratosis

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Pits (Fistulas)
• Commissural lip pits
– 12-20% of adults; 0.2-0.7% in children
– Males > Females
– Unilateral or bilateral
– Accentuated with age? or not developmental?
– Failure of processes to fuse
– Blind fistulas; sometimes saliva
– Infection can occur
– Associated with hearing loss, preauricular pits, rib
– Combination with paramedian (one case reported)


chr 1 long arm • Pits and cleft lip and/or cleft palate • Mental retardation.Pits (Fistulas) • Paramedian lip pits – Blind ends – Presence of salivary glands – van der Woude syndrome (AD) • Interferon regulatory factor 6 gene mutations (role in fusion of lip and palate). dental malformations (hypodontia) – Popliteal pterigium syndrome • • • • Same gene Popliteal webs Cleft lip and/or cleft palate Syngnathia (webs connecting upper & lower jaw) 2 .

tumors (extremely rare) 3 . vision interference • Hyperplasia of lacrimal glands with prolapse of orbital fat – Nontoxic thyroid enlargement (50%) • DiffDx: angioedema.Double Lip • Redundant fold • Congenital (persistence of the pars glabrosa and pars villosa) and acquired (trauma. lips. no hair Hyperplasia. tonsillar pillar Adults > Children (puberty stimulates development) Glands with ducts. habits) • Ascher (Laffer-Ascher) syndrome – Double lip – Blepharochalasis (Fuchs 1896) • Edema of the upper eyelid. cystic transformation. tumor Fordyce Granules • • • • • • Sebaceous glands “Ectopic” or normal anatomic variation Buccal mucosa.

Duct Sebaceous glands Sebaceous gland Interesting note • Recent evidence indicates an increase in size and number of sebaceous glands following activation of the hedgehog pathway. • Unrecognized activation of the sebaceous glands system occurs in HNPCC Leukoedema • Diffuse grayish-white appearance of mucosa • Blacks > Whites (racial pigmentation may make this variation more prominent) • Variation. larynx • Hyperplastic epithelium. “poor” oral health • Buccal mucosa extending to the lips • Vagina. intracellular edema • No treatment • DiffDx: Lichen planus. dentifrice stomatitis (chemical burn) 4 . not a disease • More prominent in smokers. other leukoplakic lesions. a crucial signaling pathway for animal development that is aberrantly activated in several types of cancer.

Microglossia • Oromandibular-limb hypogenesis syndromes – Hypodactyly – Hypomelia – Underdeveloped organs – Some potential etiologic factors • Lithium during pregnancy • Chorionic villi sampling procedures 5 .

visceromegaly.Macroglossia • Congenital and hereditary – Vascular malformations – Hemihyperplasia – Cretinism – Beckwith-Wiedemann syndrome • Omphalocele. gigantism. Wilms tumor. hypoglycemia. adrenal or liver tumors (hepatoblastoma) – Down syndrome – NF 1 – MEN 2B Macroglossia • Acquired – Edentulous patients – Amyloidosis – Myxedema – Acromegaly – Angiedema – Tumors Ankyloglossia • NEVER FORGET THAT THE TONGUE IS SHORT AT BIRTH • Far more common in boys than girls • Complete ankyloglossia extremely rare • Relation to open bite ? • Relation to periodontal disease • Dyspnea (epiglottis comes forward) • Breast-feeding • Speech articulation • Mechanical tasks such as licking the lips and kissing 6 .

Graves’ disease have been described • Rare examples of thyroid carcinoma (MALES) • Lingual thyroid in a cat Fissured Tongue • Grooves and fissures • More prevalent in whites. less in Mexican Americas • Entire tongue or part • Usually asymptomatic • Prevalence increases with age • Strong association with geographic tongue and Melkersson-Rosenthal syndrome • Tongue brushing 7 . blacks.Lingual Thyroid • “Birth” of the thyroid & foramen cecum • Small remnants of thyroid can be found in the tongue • ~75% of pts with infantile hypothyroidism have lingual thyroid • 33% have hypothyroidism • Females >> males • Nodule of varying size – Dysphonia. dysphagia – Large nodules can cause sleep apnea • May be the only functioning thyroid tissue – Goiter.

Fissured tongue 2. radiation. Facial paralysis Hairy Tongue • • • • DO NOT CONFUSE IT WITH HAIRY LEUKOPLAKIA Marked hyperkeratinization of filiform papillae Less than 1% Causes – – – – – Smoking. POH. tobacco) Oxidizing mouthwashes or antacids Overgrowth of fungal or bacterial organisms Medications: olanzapine. antibiotics. fluoxetine hydrochloride. thiothixene hydrochloride. debilitated pts Staining (bacteria. Cheilitis granulomatosa 3. coffee. benztropine mesylate. and clonazepam (antipsychotic meds) • Asymptomatic • Treatment – Brushing – Shaving – DO NOT USE KERATOLYTIC AGENTS (If you do not know how) 8 .Melkersson-Rosenthal syndrome 1.

buccal mucosa) Phleboliths Caliber-Persistent Artery • • • • • • • • Uncommon Lower and less often upper lip Bilateral Pulsating (you feel it with bare fingers) Age-related Associated with ulceration. This unusual physical sign coincided with the patient's painful trigger zone and was attributed to hypertrophy of keratinized filiform papillae.“Bizarrities” • Unilateral hairlike discoloration of the tongue was described in a patient with ipsilateral mandibular division trigeminal neuralgia. where guarded avoidance of mechanical stimulation over time prevented normal desquamation. DiffDx: SCCa No tx necessary Arterial bleeding during surgery 9 . Varicosities • • • • • • • Dilated and tortuous vein Age-related (60% of older individuals) Loss of connective tissue tone No association with hypertension or CPD Sublingual area Multiple or solitary (lips.

endocrine or circulatory cause Part or not of hemifacial hyperplasia Facial asymmetry. J Ultrasound Med 2005 Coronoid Hyperplasia • • • • • • Rare 5M:F Unilateral or bilateral (5x) Restricted mouth opening Deviation towards the affected site Jacob’s disease (pseudojoints with the zygomatic arches. association with osteochondroma of the coronoid process) • CT better than panoramic • Tx is problematic – Fibrosis – Coronoid regrowth Condylar hyperplasia • • • • • Akan & Mehreliyeva Dentomaxillofac Radiol. preauricular defects Vazquez et al. hearing loss.Lateral Soft Palate Fistulas • • • • Congenital or the result of trauma or surgey Bilateral or unilateral Shallow or deep perforations Can be associated with anomalies such absence or hypoplasia of tonsils. open bite Occasional compensatory maxillary growth and tilting of the occlusal plane • Condylectomy 10 . 2006 Jan. prognathism.35(1):55-9 Uncommon. more common than coronoid Trauma.

Condylar hypoplasia • Congenital or acquired • Many syndromes – Treacher Collins – Oculoauricularvertebral – Hemifacial microsomia • During development – Trauma. radiation • Degenerative arthritis Bifid Condyle • Double head (lateral and medial. less often anterior-posterior) • Unilateral (less often bilateral) • Can be asymptomatic Exostoses • • • • • • • • Bony protuberance Palatinus and Mandibularis Buccal exostoses: facial Palatal exostoses: lingual aspect of tuberosity Solitary exostoses: trauma Subpontic osseous hyperplasia Mass of non-neoplastic bone with minimal marrow Can be ulcerated and painful 11 .

lobular Rarely show on PAs More women than men Surgical excision to accommodate prosthesis 12 . nodular.Torus Palatinus • • • • • • Midline of palatal vault Multifactorial. genetic predisposition Flat. spindle.

otalgia. dizziness. opening mouth) – Headache. transient syncope Eagle syndrome Treatment choices No treatment Cotricosteroid injection Surgical excision of the elongated process or mineralized ligament 13 . turning head.Torus Mandibularis • • • • • • • Lingual aspect of mandible Multifactorial Bilateral Single or multiple nodules PAs: Periapical opacities that can be confusing Not as common as torus palatinus Surgical excision to accommodate prosthesis Eagle syndrome • Stylohyoid syndrome • Elongation of the styloid process or mineralization of the stylohyoid ligament • Bilateral and less often unilateral • Most asymptomatic • After tonsillectomy • Clinical syndrome – Vague facial pain (swallowing.

sublingual. 2004 JOMFS 14 . parotid • • • • Asymptomatic Striking male predilection Developmental but not present from birth Sialogram Queiroz et al.Stafne Defect (Static Bone Cyst) • Radiolucency with sclerotic border • Near angle of mandible (below the canal) Anterior and upper ramus rarely • Usually normal salivary glands Submandibular.

? hormonal role Usually asymptomatic ? Association with psoriasis (HLA-Cw6) Patient reassurance. topical steroid. females twice more often Wandering patients ? Hypersensitivity reaction.Geographic Tongue • • • • • • • Migratory glossitis (stomatitis) 1-3% of population. zinc 15 .

16 .