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Developmental disturbances of LIP,PALATE and ORAL MUCOSA


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Developmental disturbances of LIP,PALATE and ORAL MUCOSA

  3. 3. Congenital lip and commissural pits and fistula  It is malformation of the lips ,often following a hereditary pattern.  It may occur alone or in association with other developmental anomalies such as various oral clefts.  75-80% of all cases of congenital labial fistulas ,there is an associated cleft lip or cleft palate.
  4. 4. ETIOLOGY:  Many theories have put up but none has been universally accepted.  Notching of the lip.  Fixation of the tissue at the base of the notch. C/F:
  5. 5. TREATMENT:  Surgical excision  However it is harmless and seldom manifest complications
  6. 6. VAN DER WOUDE SYNDROME  It is an autosomal dominant syndrome typically consisting of cleft lip or cleft palate and distinctive pits of the lower lip ETIOLOGY:  The most prominent feature is orofacial anomalies  Caused due to abnormal fusion of palate and lip , at days 30-50 postconception
  7. 7. C/F: • Occurences: affects about 1 in 100,000- 200,000. • Sex: no sex prediliction • Lesion: isolated ,usually medial • Site : on the vermilion portion of lower lip
  8. 8. TREATMENT:  Examination and genetic counseling by a pediatric geneticist.  Surgical repair of clept lip and palate
  9. 9. CLEFT LIP AND CLEFT PALATE  It is a common congenital malformation.  Failure in the fusion of the nasal and maxillary prosses leads to cleft of primary palate ,can be unilateral or bilateral.  Incidence of cleft of the lip and palate varies from 1 in 500 to 1 in 2500 depends on geographic origin.
  10. 10. ETIOLOGY:  Heredity.  Environmental factors  Insufficent nutrition to pregnant women OTHER FACTORS: o Defective vascular supply o Size of the tongue prevent union of affected parts o Infections , certain alcohol ,drugs and toxins o Lack of inherent developmental force
  11. 11. C/F: • Sex : male predilection • Lesion: unilateral or bilateral anomaly Types : i. The cleft anterior to the incisive foramen is defined as cleft of primary palate. ii. The cleft posterior to the incisive foramen is defined as a cleft of secondary palate.
  12. 12. CLINICAL SIGNIFICANCE:  Most cases can be surgically repaired with excellent cosmetic and functional results.  Eating and drinking are difficult because of regurgitation of food and liquid through the nose. TREATMENT:  Surgical treatment
  13. 13. CHELITIS GLANDULARIS Characterized by progressive enlargement and eversion of the lower labial mucosa that results in obliteration of the mucosal- vermillion interface.
  14. 14. Etiology :  Chronic irritation.  Lip enlargement is attributable to inflammation , hyperemia , edema and fibrosis.  Surface keratosis , erosion,self-inflicted biting , factitial trauma , excessive wetting from compulsive licking , drying  Chronic aggravating factor.
  15. 15. C/F: • Lesion :enlargement of lip and loss of elasticty , asymptomatic lip swelling , burning discomfort, sensation of rawness • Sex :male predilection. • Age :4th -6th decade. • Secretion: Mucopurulent exudates from ductal orifices of labial minor salivary glands.
  16. 16. Differential diagnosis:  Actinic keratosis  Atopic dermatitis  Cheilitis granulomatosa  Sarcoidosis  Sqamous cell carcinoma Treatment:  Antibiotic therapy.
  17. 17. CHEILITIS GRANULOMATOUS  Cheilitis granulomatosa is a chronic swelling of the lip due to granulomatous inflammation. Etiology:  Cause is unknown.
  18. 18. C/F:  Non-tender swelling and enlargement one or more lips and cheeks.  Enlarged lip appears cracked.  Fissured with reddish brown discoloration and scaling.
  19. 19. Differential diagnosis:  Insect bite  Sarcoidosis  Serum angiotensin-converting enzyme test  Chest radiography  Gallium  Positron emission tomography
  20. 20. Histological feature: o Chronic inflammatory cell infiltrate o Shows peri and para vascular aggregations of lymphocytes ,plasma cells and histiocytes. o Formation with epitheloid cells and Langhan’s type giant cells.
  21. 21. Treatment :  Intra lesional corticosteriods injections.  Non steroidal anti-inflammatory agents .  Mast cell stabilizers .  Clofazimine.  Tetracycline  Surgery and radiation.
  22. 22. Hereditory intestinal polyposis syndrome  It is an autosomal dominantly inheritant disorder characterized by intestinal hamaratomaous polyps in association with muco-cutaneous melanocytic macules. Etiology: The cause of the Peutz-Jeghers syndrome appears to be a germline mutation of the STK11 gene in most cases, located on band 19p13.3
  23. 23. Clinical feature: >Sex: M=F >Races: all races >Signs and symptoms: intestinal bleeding, menstrual irregularities, cutaneous pigmentation Histological features: >Extensive smooth muscle arborization throughout the polyp. Treatment: >surgical treatment
  24. 24. Labial and oral melanotic macule  It shows a focal area of melanin deposition C/F: • Sex:2:1 female predilection • Age :23years • Site: vermilion border of lip , buccal mucosa, gingiva and palate • Lesion: well demarcated, uniformly tan to dark brown, asymptomatic ,round shaped
  25. 25. Histological feature: o Normal stratified squamous epithelium with abundant melanin deposits within the keratinicytes of basal and parabasal layers. TREATMENT:  No treatment is required
  26. 26. ORAL MUCOSA
  27. 27. FORDYCE’S GRANULES  It is a developmental anomaly characterized by heterotropic collections of sebaceous glands at various sites in the oral cavity C/F: • Lesion :Small yellow spots. • Sex/race: No gender and races predilection. • Site: Tongue ,gingiva , frenum and palate
  28. 28. Histological feature: o Heterotopic collections of sebaceous gland. o The gland are usually superficial and may consist of only a few or a great many lobules o Shows keratin plugging. Treatment:  Requires no treatment.
  29. 29. FOCAL EPITHELIAL HYPERPLASIA  It is one of the most contagious of the oral papillary lesion.  It is able to produce extreme acantosis or hyperplasia of the prickle cell layer of epithelium.
  30. 30. C/F: • Age :children ,young and middle-aged. • Sex : no predilection • Site: labial , buccal and lingual mucosa , gingival. • Lesion: papillary in nature , smooth surfaced, flat-topped ,pale or rarely white.
  31. 31. Histological features: o Focal acantosis of oral epithelium o Spinous layer show both cytoplasm and nuclei in cell Treatment:  Treatment is unnecessary.  Conservative excisional biopsy for proper diagnosis.