Median Rhomboid Glossitis

 Median Rhomboid Glossitis 

Definition 

     Central erythematous zone of the tongue due to a chronic fungal infection.

     The erythema is due to atrophy of the filiform papillae.

     In the   past   this was  thought to be a developmental  defect of the tongue  resulted from a failure of the tuberculum impar to be covered by the lateral processes of the tongue.

Clinical features 

     Ovoid or diamond, depapillated, erythematous zone.

     Smooth, raised, and asymptomatic.

     It  affects the midline of  posterior dorsal surface  of tongue   just   anterior   to   the foramen
       cecum.

Torus mandibularis and Ankyloglossia

 Torus mandibularis 

Definition 

     An exostosis that develops along the lingual surface of the mandible.

Clinically 

     Presents as a bilateral bony mass along the lingual surface of the mandible in the premolars

        region above the mylohyoid line.

Clinical significance 

     The thin overlying mucosa may become ulcerated secondary to trauma.

     It interferes with complete denture stability.

NB: 

The mylohyoid line is a ridge on the inner side of the bone of
the lower jaw extending in front to the last molar on each
side and giving attachment to the mylohyoid muscle.

Ankyloglossia (Tongue-tie) 

    Definition 

     Ankyloglossia is a congenital oral anomaly in which there is limitation of tongue movement.

     It is caused by an unusually short, thick lingual frenum, a membrane connecting the ventral

        surface of the tongue to the floor of the mouth.

    Clinical features and types 

     Partial ankyloglossia 

        This condition is characterized by a short, thick lingual frenum which is attached near the tip

        of the tongue.

     Complete ankyloglossia 

       A rare condition in which the tongue is fused to the floor of the mouth.

    Clinical significance 

     Ankyloglossia can affect feeding and speech.

Cleft palate and cleft lip

Cleft palate 

Etiology 

     Hereditary or environmental factor.

Pathogenesis 

     Failure of fusion between the two palatal shelves.

Types 

     1.  Cleft soft palate. 

    2.   Cleft soft and hard palate. 

    3.   Complete   unilateral   cleft   extending  from   the uvula  to   the  incisive  foramen  in   the   midline 

        then deviating to one side meeting the alveolar process in the area of the lateral incisor and 

        then into the lip. 

              Upper lateral incisor may be absent, may develop medial to or lateral to the cleft or 

                 may be doubled (supernumerary tooth). 

    4.   Complete bilateral cleft involving the soft and hard palate and extending forwards bilaterally 

         from the incisive foramen to the alveolus and lip. 

              The premaxilla and prolabium  (median portion of the lip) remain  suspended from 

                 the nasal septum

.

Cleft lip 

    Etiology 

         Hereditary or environmental factor.


    Pathogenesis 

         Failure of fusion between the medial nasal process and maxillary process.

Types Clinically

    Incomplete cleft : a small notch in the vermilion border (unilaterally or bilaterally).

    Complete cleft :  extending from lower border of the lip to the floor of the nose (unilaterally or

    bilaterally).
   

Oblique facial cleft 

         Oblique facial cleft extends from the upper lip to the inner canthus of the eye. 

         It occurs unilaterally.

Pathogenesis 

     Failure of fusion of the lateral nasal process with the maxillary process.

 Lateral facial cleft 

     This cleft extends from the angle of the mouth to the ear.

     May be unilateral or bilateral.

Pathogenesis 

     Failure of fusion between the maxillary and mandibular processes resulting in macrostomia

Torus palatinus

Torus palatinus 

Definition 

              Bony overgrowth (exostosis) in the midline of the hard palate.

Etiology 

              May be hereditary or acquired (as after surgery).

Clinically 

              Present as hard bony mass along the midline of the hard palate.

              May be spindle, nodular or lobulated mass.

Clinical significance 

               The thin overlying mucosa may become ulcerated secondary to trauma.

               Torus palatinus interfere with complete denture stability.

Congenital Lip pits

Congenital Lip pits 

Definition 

         They are  small  shallow depressions affecting the lip. They are of varying depths

            reaching to several millimeters.

Etiology 

         Hereditary disorder.


Clinical features and types 

         It is an epithelial-lined blind pits.

         lower lip is more commonly affected.

         They may be unilateral or bilateral.

         May occur near the midline (paramedian lip pit) or,

         At the oral commissure (commissural lip pit).

Cheilitis Granulomatosa and Cheilitis Glandularis

Cheilitis Granulomatosa 

    Definition 

         Inflammation of the lip.


    Clinical picture 

         Chronic firm swelling, affecting usually
            one lip but sometimes both.

         Usually, the upper lip is affected.

    Etiology 

         It may occur due to  allergy to some factors as:

             Cosmetics.

             Food.

             Oral hygiene products (e.g. tooth paste, mouth rinses).

             Dental restorative materials.

       

     NB 

         When cheilitis granulomatosa is combined with facial paralysis  and fissured tongue it is

            called Melkersson -Rosenthal syndrome.

Cheilitis Glandularis 

  Definition 

     Rare inflammatory condition affecting minor salivary glands of the lower lip.

  Etiology 

     The etiology is uncertain although several etiologic factors have been suggested as:

         actinic damage (chronic sun exposure), infection, and tobacco irritation.

  Clinical Features 

     Cheilitis      glandularis   is  characterized   by   swelling   and  eversion   of   the   lower   lip   due   to

        hypertrophy and inflammation of the labial salivary glands.

     The orifices of the minor salivary ducts are dilated and inflamed giving the labial mucosa a

        red macular appearance. 

     Malignant transformation may occur  in the overlying epithelium of the lip.

Cheilitis Glandularis

Cheilitis Glandularis 

  Definition 

     Rare inflammatory condition affecting minor salivary glands of the lower lip.

  Etiology 

     The etiology is uncertain although several etiologic factors have been suggested as:

         actinic damage (chronic sun exposure), infection, and tobacco irritation.

  Clinical Features 

     Cheilitis      glandularis   is  characterized   by   swelling   and  eversion   of   the   lower   lip   due   to

        hypertrophy and inflammation of the labial salivary glands.

     The orifices of the minor salivary ducts are dilated and inflamed giving the labial mucosa a

        red macular appearance. 

     Malignant transformation may occur  in the overlying epithelium of the lip.

Hemifacial hyperplasia (hemifacial hypertrophy)

Hemifacial hyperplasia (hemifacial hypertrophy) 

Definition 

     Abnormal enlargement of one side of the face.

Etiology 

     Multiple     etiologic  factors  have  been    suggested    including vascular    or  lymphatic

        abnormalities, endocrine dysfunction, and chromosome abnormalities (heredity).


Clinically 



     Asymmetry often is noted at birth (congenital) and continues until         the patient's overall  growth ceases.

     The changes involve all the tissues on the affected side.

     Unilateral macroglossia.

     Enlargement of  oral soft tissues and jaws.

     The crowns and roots of the teeth on the affected side are                   larger.

.Treacher Collins Syndrome (Mandibulofacial Dysostosis)

Treacher Collins Syndrome (Mandibulofacial Dysostosis)

Introduction to Syndrome

     It is a rare syndrome that is characterized by defects of structures derived from the first and

        second branchial arches.

Etiology 

     It is an inherited disorder.

Clinical Features 

    facial bones 

     Hypoplasia or underdevelopment of the facial bones, especially  zygomatic bones

        (depressed cheeks), maxilla and mandible.

    Eye 

     Antimongoloid eyes (downward sloping of palpebral fissures).

     A coloboma or notch occurs on the outer third of the lower eyelid.

     Absence of eye lashes medial to the coloboma.

    Ear 

     A tongue-shaped extension of hair in front of ears (toward the cheeks).

     Deformed external ears.

     Oral findings include: 

     Macrostomia (due to lateral facial cleft) .

     Cleft palate.

     High arched palate.

     Malocclusion.

     The parotid glands may be hypoplastic or may be totally absent.

    Macrostomia 

Definition 

     An excessively large mouth.

Pathogenesis 

     Premature arrest of fusion between maxillary and mandibular processes bilaterally.

It is considered as: an incomplete form of lateral facial cleft. 

    Microstomia 

Definition 

     An abnormally small mouth.

Pathogenesis 

     Excessive fusion between maxillary and mandibular processes.