Lecture 1 - Normal Mucosa, Variants of Normal and Common Benign Conditions.pdf

ORAL MEDICINE 1. Variants of Normal and Common Benign Conditions Dr. Elif Özcan School of Dental Medicine Department of Oral and Maxillofacial Surgery Variants of Normal and Common Benign Conditions 1. Physiologic Pigmentation 2. Fordyce Granules 3. Gingival Grafts 4. Fissured Tongue 5. Geograp...

ORAL MEDICINE 1. Variants of Normal and Common Benign Conditions Dr. Elif Özcan School of Dental Medicine Department of Oral and Maxillofacial Surgery Variants of Normal and Common Benign Conditions 1. Physiologic Pigmentation 2. Fordyce Granules 3. Gingival Grafts 4. Fissured Tongue 5. Geographic Tongue 6. Fibroma 7. Tori and Exostoses 8. Ankyloglossia 9. Prominent Frenula Variants of Normal and Common Benign Conditions Variants of Normal and Common Benign Conditions Physiologic Pigmentation Melanocytes are a normal component of the basal cell layer of the oral epithelium. They cause varying degrees of mucosal pigmentation, ranging from light brown to black, due to the production of melanin. Variants of Normal and Common Benign Conditions Physiologic Pigmentation Focal, freckle-like melanotic macules are very common Melanotic macule of the lower lip with dark brown pigmentation and sharply defined borders. Variants of Normal and Common Benign Conditions Physiologic Pigmentation The keratinized mucosa, in particular the gingiva, is most commonly affected Physiologic pigmentation in an AfricanAmerican child. The interdental papillae are affected to a variable degree; the nonkeratinized mucosa is entirely unaffected Variants of Normal and Common Benign Conditions Physiologic Pigmentation Pigmentation may become more pronounced in areas of chronic trauma or inflammation, such as along the occlusal bite line of the buccal mucosa Postinflammatory pigmentation of the right buccal mucosa secondary to chronic cheek biting In most cases, the diagnosis can be made clinically but occasionally a biopsy is warranted to rule out melanoma; particularly if any changes are noted in size, shape, or degree of pigmentation, or if a flat lesion becomes raised. Intraoral melanoma, however, is exceedingly rare, representing less than 1 % of all melanom. Variants of Normal and Common Benign Conditions Fordyce Granules Sebaceous glands, Often be identified within the buccal mucosa Less commonly noted on the lip or the labial mucosa. Variants of Normal and Common Benign Conditions Fordyce Granules Fordyce granules appear; ü White to yellow in color ü Generally present in clusters ü May be slightly raised ü Asymptomatic Variants of Normal and Common Benign Conditions Gingival Grafts The donor tissue, which is harvested from the patient’s palate as an autograft, has a distinct appearance that is typically raised and more pale than the adjacent gingiva. Grafts are generally easily recognized, very sharply defined, and should not be mistaken for pathology If there is any doubt, the patient should be able to provide suitable history regarding whether such a procedure was performed Variants of Normal and Common Benign Conditions Fissured Tongue Most patients are universally asymptomatic; however, it is not uncommon for a patient to examine his or her tongue and become aware of fissuring following the onset of otherwise unrelated symptoms, such as burning mouth syndrome. Variants of Normal and Common Benign Conditions Geographic Tongue (Benign Migratory Glossitis) Common inflammatory condition of the tongue Geographic tongue is usually evident in early childhood and rarely causes symptoms Map-like appearance, thus the descriptive term “geographic.” The lesions demonstrate a wide variety of clinical patterns, ranging from irregularly shaped erythematous macules with surrounding elevated white borders to patchy areas of depapillation and smooth glossy mucosa Variants of Normal and Common Benign Conditions Geographic Tongue (Benign Migratory Glossitis) Presentation can change on a daily basis and therefore appear “migratory.” Although the clinical presentation can be striking, there are few if any other conditions that mimic geographic tongue (including oral lichen planus, erythematous candidiasis, and leukoplakia); with a good history and examination, lesions rarely warrant biopsy. Although rare, patients may describe sensitivity of the tongue There is a very well-defi ned area of depapillation on the right side of the tongue dorsum, while the rest of the surface is unaffected Variants of Normal and Common Benign Conditions Stomatitis erythema migrans Other oral mucosal sites can be affected less frequently Benign migratory glossitis of the ventral tongue and floor of mouth. subtle circular lesions with white borders of the right buccal mucosa and concurrent changes consistent with benign migratory glossitis Variants of Normal and Common Benign Conditions Fibroma Fibromas are probably the most encountered oral soft tissue lesions. commonly Frequently used terms include irritation fibroma and traumatic fibroma, indicating the underlying reactive etiology. These are initiated by trauma, typically a bite injury (that the patient may not recall) or secondary to friction from Variants of Normal and Common Benign Conditions Fibroma Fibromas present clinically as round or ovoid, firm, exophytic, smooth- surfaced masses that are the same color as, or slightly lighter than, the surrounding mucosa. Variants of Normal and Common Benign Conditions Fibroma Fibromas are generally asymptomatic and do not require treatment unless they are particularly bothersome to the patient. Depending on the size and location, lesions may simply be an annoyance or they may become quite uncomfortable due to repetitive trauma. Lesions may progressively enlarge with recurrent injury, thereby compounding the clinical situation. In such cases the surface mucosa often becomes ulcerated, characterized by a yellowish white pseudomembrane Variants of Normal and Common Benign Conditions Fibroma Treatment is surgical excision, after which lesions rarely recur. Histopathological examination demonstrates a dense collection of fibrous tissue with normal surface epithelium. Fibromas have no malignant potential; however, they should be excised and submitted for histopathological analysis if the clinical diagnosis is uncertain. Variants of Normal and Common Benign Conditions Tori and Exostoses These are benign, developmental bony growths Tori are more common and are specific to the midline hard palate and anterolateral lingual mandible Similar lesions involving the buccal aspect of the maxilla or mandible are called exostoses. These areas are covered by keratinized or nonkeratinized mucosa, depending on the anatomic location, and can be mistaken for mucosal growths. Maxillary torus with smooth surface and welldefined borders in the midline of the Variants of Normal and Common Benign Conditions Tori and Exostoses Maxillary tori occur in the midline of the hard palate and range from barely discernable dome-shaped smooth swellings to large multilobulated masses Multilobulated maxillary torus showing slight asymmetry Variants of Normal and Common Benign Conditions Tori and Exostoses Mandibular tori develop most commonly along the lingual aspect of the mandible inferior to the premolars bilaterally Exostoses appear clinically identical to mandibular tori on the buccal surface of the mandible or maxilla Mandibular tori in the premolar region with multiple lobules Variants of Normal and Common Benign Conditions Tori and Exostoses Tori and exostoses generally do not require any treatment. The covering mucosa may occasionally become irritated or ulcerated from trauma, and is managed symptomatically. Tori can be surgically removed in some situations may if denture fabrication is required in order to maximize retention of the prosthesis and minimize the risk of pressure-induced trauma. Variants of Normal and Common Benign Conditions Ankyloglossia Abnormal prominence of frenula (tissue attachments of the anterior tongue and labial mucosa), can result in a variety of complications. In the case of the lingual frenulum, this can lead to problems with infant feeding and speech development, and is referred to ankyloglossia or “tongue tie.” Variants of Normal and Common Benign Conditions Prominent Frenula High insertion of the maxillary frenulum onto the gingiva may lead to formation of a gap, or diastema, between the central incisors. These conditions are typically identified in young children by their dentist or pediatrician. If indicated, treatment is simple surgical repositioning or excision References Jean M. Bruch; Nathaniel Treister. Clinical Oral Medicine and Pathology: Springer. 2016. Joseph Regezi, James Sciubba, Richard Jordan. Oral Pathology Clinical Pathologic Correlations. 7th Edition. Saunders; 2016 George Laskaris. Color Atlas of Oral Diseases: Diagnosis and Treatment. Thieme Medical Publishers; 4th editon Edward W Odell. Cawson's Essentials of Oral Pathology and Oral Medicine E-Book (9th ed.). Elsevier Health Sciences; May 2017