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Epidermoid Cyst

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Epidermoid Cyst Oral Pathology Developmental defects of the soft tissue OROFACIAL CLEFTS: The formation of the face and oral cavity is complex in nature and involves the development of multiple tissue processes that must merge and fuse in a highly orchestrated fashion. Disturbances in the growth of these tissue processes or their fusion may result in the formation of orofacial clefts. CLEFTS OF THE LIP AND PALATE: Clefts can form in the lip or palate alone or in both. The aetiology is unknown but there is a genetic component in approximately 40% of cases. The risk of having such defects is greatly increased if one, and particularly if both, of the parents are affected. Classification: Generally, clefts of the lip and palate are classified into 4 major types: (1) Cleft lip. (2) Cleft palate. (3) Unilateral cleft lip and palate. (4) Bilateral cleft lip and palate. Nine environmental factors that have been postulated to plan accessory role in the development of cleft lip and palate include 1. Nutritional factors. 2. Physiologic, emotional, or traumatic stress. 3. Relative ischemia to the area. 4. Mechanical obstruction by an enlarged tongue. 5. Substances such as alcohol, drugs, or toxins. 6. Infections. 7. Maternal alcohol consumption. 8. Maternal cigarette smoking. 9. Anticoagulants therapy. Congenital lip pits: Congenital lip pits are developmental defects that may involve the paramedical portion of the vermillion of the lower and upper lip (paramedical lip pit) or the labial commissure area (commercial lip pit). Both types of lip pits appear to be inherited as autosomal dominant trait. The paramedical lower lip pit may occur as an isolated finding or may be associated with cleft lip or cleft palate (van der woude syndrome). The paramedical lip pits are occasionally excised for cosmetic reasons; commissural lip pits required no treatment. Double lip: A double lip is an anomaly characterized by a horizontal fold of redundant mucosal tissue that is usually located on the inner aspect of the upper lip, although the lower lip can also be occasionally involved. This redundant tissue can be congenital or acquired. The double lip is usually visible when the lip is tense but not when the lip is at rest. Fordyce’s Granules: Fordyce’s granules represent ectopic sebaceous glands or sebaceous choristomas (normal tissue in an abnormal location). This condition is regarded as developmental and can be considered a variation of normal. Fordyce’s granules are multiple and often are seen in aggregates or in confluent arrangements. Sites of predilection include the buccal mucosa and the vermilion of the upper lip. Lesions generally are symmetrically distributed and tend to become obvious after puberty, with maximal expression occurring between 20 and 30 years of age. Lesions are asymptomatic and often are discovered incidentally by the patient or by the practitioner during a routine oral examination. A large proportion of the population—more than 80% of individual is affected by this particular condition. Microscopically, lobules of sebaceous glands are aggregated around or adjacent to excretory ducts. The heterotopic glands are well formed and appear functional. No treatment is indicated for this particular condition because the glands are normal in character and do not cause any untoward effects. Leukoedema: Leukoedema is a generalized mild opacification of the buccal mucosa that is regarded as a variation of normal. It can be identified in the majority of the population. Clinical Features: Leukoedema is usually discovered as an incidental finding. It is asymptomatic and symmetrically distributed in the buccal mucosa and to a lesser extent over the labial mucosa. It appears as a gray-white, diffuse, filmy, or milky surface alteration. In exaggerated cases, a whitish cast with surface textural changes, including wrinkling or corrugation, may be seen. With stretching of the buccal mucosa, the opaque changes dissipate. It is more apparent in nonwhites, especially African Americans. Histopathology: In leukoedema, the epithelium is parakeratotic and acanthotic, with marked intracellular edema of spinous cells. The enlarged epithelial cells have small, pyknotic (condensed) nuclei in optically clear cytoplasm. Treatment and Prognosis: Treatment is not necessary because the changes are innocuous and no malignant potential exists. If the diagnosis is in doubt, a biopsy can be performed. White sponge nevus: Relatively uncommon, autosomal dominant hereditary disorder that manifests as a white lesion of the oral mucosa. The condition exhibits a variable penetrance; some patients exhibit lesion at birth, whereas in others, lesions may not appear until early childhood or even adolescence. Clinical features: Lesions are asymptomatic, whitish and often folded (corrugated). They may exhibit a translucent opalescence similar to that seen in leukoedema. Lesions may be widespread and involve various sites including the buccal mucosa, gingiva, tongue, palate and floor of the mouth. Histopathology: a mild to moderate hyperpara keratosis, acanthosis , and intracellular edema of the spinous cells are shrunken (pyknotic). The associated connective tissue is usually free of inflammation. The diagnosis is generally reached by combining its histopathologic features, clinical appearance, and the patient's family history. Treatment: the condition requires no treatment, because it is entirely benign. Oral tonsil: Tonsillar lymphoid tissue is primarily disturbuted in a circular arrangement in the posterior region of the mouth. It consists of three main masses of lymphoid tissue, namely the paired palatine tonsils, the pharngeal tonsils, and the lingual tonsils located at the base of the tongue. The lingual tonsil often extends anteriorly along the postero lateral borders of the tongue and includes the region of the foliate papillae. Oral tonsils consist of lymphoid aggregate that exhibit germinal centers surfaced by nonkeratinized squamous epithelium, with or without occasional crypts. Reterocuspeid papilla: The retrocuuspid papilla is a 2 to 4 mm slightly raised area of mandibular alveolar mucosa located lingual to the cuspids, between the marginal gingiva and the mucogingival junction. It is commonly bilateral but can also be unilateral, and it is prominent in children. Because reterocuspid papilla is commonly bilateral and has a very specific location, it is logical to assume that it represents a normal anatomic structure. MICROGLOSSIA (HYPOGLOSSIA): Microglossia is an uncommon developmental condition of unknown cause that is characterized by an abnormally small tongue. In rare instances, virtually the entire tongue may be missing (aglossia). However, Most reported cases have been associated with one of a group of overlapping conditions known as oromandibular-limb hypogenesis syndromes. MACROGLOSSIA Macroglossia is an uncommon condition characterized by enlargement of the tongue. The enlargement may be caused by a wide variety of conditions including both congenital malformations and acquired diseases. The most frequent causes are vascular malformations and muscular hypertrophy. Causes of Macroglossia congenital and hereditary • Down syndrome • Vascular malformations • Neurofibromatosis • Lymphangioma • Multiple endocrine neoplasia type 2B • Hemangioma Acquired: • Acromegaly • Edentulous patients • Carcinoma and other tumors • Amyloidosis Clinical Features: Macroglossia most commonly occurs in children and can range from mild to severe in degree. macroglossia may be manifested first by noisy breathing, Drooling and difficulty in eating. The tongue enlargement may result in a lisping speech the pressure of the tongue against the mandible and teeth can produce a crenated lateral border to the tongue, open bite and mandibular prognathism. ANKYLOGLOSSIA (TONGUE-TIE): Ankyloglossia is a developmental anomaly of the tongue characterized by an abnormally short and anteriorly positioned lingual frenum that results in severely restricted tongue movements and impaired speech. Treatment and Prognosis: Treatment is often unnecessary. If there are functional or periodontal difficulties, a frenectomy may allow greater freedom of tongue movement. Lingual thyroid nodule: is a rare anomaly characterized by the development of a submucosal mass of thyroid tissue on the mid posterior dorsum of the tongue. Embryologically , the thyroid gland anlage arises at the site of the foramen caecum and migrates inferiorly along the thyroglossal tract to its ultimate destination in the anterior neck. If all or part of the thyroid anlage fails to migrate, remnant of thyroid tissue can develop along its path of migration; a lingual thyroid nodule represents a thyroid remnant in the region of the thyroid gland's origin. Clinical features: It presents as a 2 to 3 cm smooth sessile mass located on the mid posterior dorsum of the tongue, in the foramen caecum. The chief symptoms are dysphagia, dysphonia, dyspnea, and a feeling of tightness in the area. Histopathology: most cases are composed of normal mature thyroid tissue although embryonic or fetal thyroid tissue may be seen. Treatment: before excision of a lingual thyroid nodule is planned, it should be determined if the patient possesses a functioning thyroid gland in the anterior neck with sufficient secretion to support the daily requirement when the supplementary source in the tongue is removed. If a normal thyroid gland is present, then the lingual nodules can be excised. FISSURED TONGUE (SCROTAL TONGUE) Fissured tongue is relatively common numerous grooves
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