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Questions and Answers
What characteristic is commonly associated with a fissured tongue?
What characteristic is commonly associated with a fissured tongue?
Which condition is characterized by retrognathia and possibly asphyxia?
Which condition is characterized by retrognathia and possibly asphyxia?
What is a typical clinical feature of fordyce granules?
What is a typical clinical feature of fordyce granules?
Which of the following conditions is specifically associated with a short lingual frenum?
Which of the following conditions is specifically associated with a short lingual frenum?
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Which of the following describes a lingual thyroid nodule?
Which of the following describes a lingual thyroid nodule?
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What is the primary cause of cleft lip formation during intrauterine life?
What is the primary cause of cleft lip formation during intrauterine life?
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Which class of Veau classification indicates a unilateral complete cleft involving the lip and floor of the nose?
Which class of Veau classification indicates a unilateral complete cleft involving the lip and floor of the nose?
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What is the common first sign of orofacial clefts in patients?
What is the common first sign of orofacial clefts in patients?
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Which type of cleft palate is characterized by a complete cleft that extends into soft and hard palate and passes through the incisive foramen unilaterally?
Which type of cleft palate is characterized by a complete cleft that extends into soft and hard palate and passes through the incisive foramen unilaterally?
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What is macroglossia and what are its potential causes?
What is macroglossia and what are its potential causes?
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Study Notes
Orofacial Clefts
- Cleft lip: Failure of fusion between medial nasal processes and maxillary processes during the 6th and 7th week of intrauterine life.
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Incidence:
- 45% cleft lip and palate together.
- 30% isolated cleft palate.
- 25% isolated cleft lip.
- 80% unilateral cleft lip.
- 20% bilateral cleft lip.
- 70% unilateral cleft lip on the left side.
- Cleft lip and palate more common in males.
- Isolated cleft palate is more common in females.
Clinical Picture
- Failure of contact between soft palate and pharyngeal wall.
- Feeding and swallowing problems.
- Speech: hypernasal voice.
- Respiratory difficulty: Asphyxia.
- Psychosocial difficulty.
- Dental abnormality: missing, supernumerary teeth, microdontia, macrodontia, hypoplasia of enamel, and malocclusion.
Veau's Classification of Cleft Lip
- Class I: Unilateral notching of the vermilion border doesn't extend into the lip.
- Class II: Unilateral notching involving the lip only, not extending to the base of the nose (incomplete cleft).
- Class III: Unilateral complete cleft involves the lip and floor of the nose.
- Class IV: Bilateral cleft notching or complete cleft.
Cleft Palate
- Medial nasal processes merge to form the primary palate.
- Palatine shelves fuse to form the secondary palate.
- Fusion between primary and secondary palate starts anteriorly (8 weeks) and progresses posteriorly to completion at 12 weeks.
Veau Classification of Cleft Palate
- Class I: Bifid uvula.
- Class II: Cleft in soft and hard palate not extending beyond the incisive foramen (incomplete).
- Class III: Complete cleft extending in soft and hard palate, passing unilaterally through the alveolar process.
- Class IV: Complete bilateral cleft involving soft and hard palate and alveolar processes on both sides of the premaxilla, leaving it free and mobile.
Double Lip
- A redundant fold of tissue partially covers the right anterior maxillary teeth.
- Types: Congenital or Acquired: may be a component of Ascher syndrome or result from trauma or oral habits.
Tongue Anomalies
Macroglossia
- Enlarged tongue.
- Causes: Congenital malformation or acquired disease.
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Clinical Picture:
- Noisy breathing, drooling of saliva, difficulty in eating and speaking.
- Crenated lateral border of the tongue, ulceration, and necrosis.
- Open bite, mandibular prognathism, and asphyxia in severe cases.
Congenital Causes of Macroglossia
- Lymphangioma and hemangioma.
- Down syndrome: papillary, fissured tongue.
- Neurofibromatosis: multinodular appearance.
- Beckwith-Wiedemann syndrome: Visceral tumors like adrenal carcinoma, hepatoblastoma, and kidney tumors.
Acquired Causes of Macroglossia
- Amyloidosis: Deposition of abnormal protein in tissues.
- Hemifacial hyperplasia: Unilateral tongue enlargement.
- Edentulous cases.
- Tumors.
Microglossia
- Isolated or syndrome-associated.
- Associated with cleft palate, micrognathia, and missing lower incisors.
- Abnormally small tongue associated with constricted mandibular and maxillary arch.
Ankyloglossia (Tongue Tie)
- Short lingual frenum.
Lingual Thyroid Nodule
- Asymptomatic to large mass at the dorsum of the tongue in the area of the foramen cecum.
- Primitive thyroid nodule.
- Diagnosed with thyroid scan, MRI, and CT scan.
- Incisional biopsy is avoided due to the risk of hemorrhage.
Fissured Tongue (Scrotal Tongue)
- Burning sensation and associated with Mekerson Rosenthial syndrome.
Geographic Tongue
- Areas of atrophy and hypertrophy of tongue papillae.
Hairy Tongue
- Marked elongation and brown staining of the filiform papillae, resulting in a hairlike appearance.
Varicosities (Sublingual Varix)
- Abnormal dilated, tortuous veins.
- Common in old age.
Fordyce Granules
- Sebaceous glands that occur on the oral mucosa.
- Incidence: More than 80% of the population.
- Considered normal anatomic variation or ectopic tissue.
Clinical Features of Fordyce Granules
- Multiple yellow or yellow-white papules.
- Site: Buccal mucosa (common) and lateral portion of the vermilion of the upper lip.
- Histopathology: Multiple sebaceous glands below the surface epithelium.
Exostoses
Torus Palatinus
- Localized bony protuberances arising from the cortical plate.
- Benign condition common in adults.
- Site: Palatal vault.
- Dental complication: Fitting of denture.
- Histopathology: Mass of dense lamellar bone with a small amount of fibro-fatty marrow.
Torus Mandibularis
- Bony protuberances arising from the inner aspect of the mandible.
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Description
This quiz covers the crucial aspects of orofacial clefts, including cleft lip and palate incidence, clinical features, and Veau's classification. Test your understanding of how these conditions affect feeding, speech, and psychosocial aspects. Dive into the specifics of patient presentation and management challenges.
