DEVELOPMENTAL DISTURBANCES OF

LIP,PALATE AND ORAL MUCOSA

BY:SNEHA SURAPALLI3RD YEAR BDS

ORAL PATHOLOGY PRESENTATION

LIP AND PALATE

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.

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:

TREATMENT: Surgical excision However it is harmless and seldom manifest complications

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

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

TREATMENT: Examination and genetic counseling by a

pediatric geneticist. Surgical repair of clept lip and palate

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.

ETIOLOGY: Heredity. Environmental factors Insufficent nutrition to pregnant womenOTHER FACTORS:o Defective vascular supplyo Size of the tongue prevent union of affected

partso Infections , certain alcohol ,drugs and toxinso Lack of inherent developmental force

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.

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

CLEFT LIP

CLEFT PALATE

RADIOGRAPH

ANATOMY OF CLEFT PALATE

CHELITIS GLANDULARIS

Characterized by progressive enlargement and eversion of the lower labial mucosa that results in obliteration of the mucosal-vermillion interface.

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.

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.

Differential diagnosis: Actinic keratosis Atopic dermatitis Cheilitis granulomatosa Sarcoidosis Sqamous cell carcinoma

Treatment: Antibiotic therapy.

CHEILITIS GRANULOMATOUS

Cheilitis granulomatosa is a chronic swelling of the lip due to granulomatous inflammation.

Etiology: Cause is unknown.

C/F:

Non-tender swelling and enlargement one or more lips and cheeks.

Enlarged lip appears cracked. Fissured with reddish brown discoloration

and scaling.

Differential diagnosis:

Insect bite Sarcoidosis Serum angiotensin-converting enzyme

test Chest radiography Gallium Positron emission tomography

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.

Treatment :

Intra lesional corticosteriods injections. Non steroidal anti-inflammatory agents . Mast cell stabilizers . Clofazimine. Tetracycline Surgery and radiation.

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

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

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

Histological feature:

o Normal stratified squamous epithelium with abundant melanin deposits within the keratinicytes of basal and parabasal layers.

TREATMENT: No treatment is required

ORAL MUCOSA

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

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.

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.

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.

Histological features:

o Focal acantosis of oral epitheliumo Spinous layer show both cytoplasm and

nuclei in cell

Treatment: Treatment is unnecessary. Conservative excisional biopsy for proper

diagnosis.

HISTOLOGICAL FEATURE