Patho

• Fordyce's granules


  Ectopic sebaceous glands present in the oral mucosa in at least 80% of adults, particularly in elderly people
• Fordyce's granules


  • Soft, symmetrically distributed, creamy spots a few millimetres in diameter
  • Main site is the buccal mucosa, but sometimes the lips and rarely, even the tongue is involved
• Fordyce's granules are sometimes mistaken for disease but patients can be reassured that they are of no significance
• Leukoedema


  Bilateral, diffuse, translucent greyish thickening, particularly of the buccal mucosa
• Leukoedema is a variation of normal, present in 90% of blacks and variable numbers of whites
• White sponge naevus


  A developmental anomaly inherited as an autosomal dominant trait
• White sponge naevus


  • The affected mucosa is white, soft and irregularly thickened
  • The abnormality is usually bilateral and sometimes involves the whole oral mucosa
  • There are no defined borders and the edges fade into normal tissue
  • The anus and vagina can also be affected
• Retrocuspid papilla


  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
• Retrocuspid papilla is commonly bilateral and has a very specific location, so it represents a normal anatomic structure
• Macroglossia


  An abnormally large tongue, it could be congenital or acquired
• Congenital macroglossia


  • Down's syndrome
  • Congenital haemangioma
  • Lymphangioma
• Microglossia


  An abnormally small tongue
• Hairy tongue


  The filliform papillae can become elongated and hair-like forming a thick fur on the dorsum of the tongue
• The discoloration of hairy tongue is probably caused by pigment-producing bacteria and fungi but not Candida albicans
• Treatment for hairy tongue


  Persuade the patient to scrape off the hyperplastic papillae and vigorously clean the dorsum of the tongue with a firm toothbrush
• Black tongue


  The dorsum of the tongue may sometimes become black without overgrowth of the papillae
• Causes of black tongue

  • Staining due to drugs such as iron compounds used for the treatment of anemia
  • Sucking of antiseptic lozenges
• Fissured tongue (scrotal tongue)


  Numerous grooves or fissures are present on the dorsal tongue surface
• The cause of fissured tongue is uncertain, but heredity appears to play a significant role, and aging or local environmental factors also may contribute to its development
• Furred tongue


  The tongue becomes coated with desquamating cells and debris
• Causes of furred tongue

  • Smoking heavily
  • Systemic upsets, especially of the gastrointestinal tract
  • Infections in which the mouth becomes dry and little food is taken
  • Childhood fevers, especially scarlet fever
• Lingual varicositis


  Dilated tortuous veins may be seen along the ventral surface of the tongue and tend to become more prominent with age
• Geographical tongue (erythema migrans linguae)


  The recurrent appearance and disappearance of red areas on the tongue
• Geographical tongue


  • An irregular, smooth, red area appears, usually with a sharply-defined edge
  • It extends for a few days, and then heals, only to appear again in another area
  • Sometimes the lesion is annular with a slightly raised pale margin, and several of these areas may coalesce to form a scalloped pattern
• Most patients with geographical tongue have no symptoms but some adults complain of soreness
• Ankyloglossia


  Characterized by a short, thick lingual frenum resulting limitation of tongue movement
• Ankyloglossia

  • The frenum sometime extends forward and attach to the tip of the tongue and there may be a slight clefting of the tongue
  • Occasionally, high mucogingival attachment of the lingual frenum may lead to local gingival and periodontal diseases in the regional frenal attachment
• Lingual thyroid nodule


  Accessory accumulation of thyroid tissue within the body of posterior tongue
• Lingual thyroid nodule


  • Represents a thyroid remnant in the region of the thyroid gland origin
  • More common in females apparent during puberty and adolescence
  • 2-3 cm, smooth, sessile mass on mid –posterior dorsum of the tongue in the region of foramen caecum
  • Symptoms include dysphagia, dysphonia and hypothyroidism
• Cleft tongue


  Disunion of tongue usually occurs due to failure of fusion of the two lateral part of the tongue (mainly anteriorly) and this will lead to bifid tongue or cleft tongue
• Orofacial clefts


  Clefts can form in the lip or palate alone or in both
• The aetiology of orofacial clefts is unknown but there is a genetic component in approximately 40% of cases
• Environmental factors contributing to orofacial clefts

  • Physiologic, emotional or traumatic stress
  • Nutritional deficiency or excess of vitamin A and Riboflavin
  • Mechanical obstruction by large tongue
  • Relative ischemia to the area
  • Substances like, alcohol, drugs and toxins
  • Infections
• Cleft lip (with or without a palatal cleft)


  • More common in males
  • Developing defect usually of the upper lip characterized by a wedge-shaped defect resulting from the failure of two parts of the lips to fuse into single structure
• Cleft palate alone


  • Approximately twice as common in females
• The incidence of cleft lip is about 1 per 1000 live births, while that of isolated palatal clefts is about 1 per 2000 live births
• In terms of relative frequencies, cleft lips form about 22%, combined defects of lip and palate form about 58% and isolated palatal clefts form about 20% of this group of defects
• The reason for the variations in the sites of clefts is that the lip and anterior palate (the primary palate) develop before the hard and soft palates (the secondary palate)
• Fusion of the secondary palate is from behind forwards
• Isolated cleft lip is the result of an early developmental disorder, while isolated cleft palate results from influences acting later, after the primary palate has closed