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orofacial structures
Orofacial Clefts
Etiology
Genetic abnormalities
Inherited
Spontaneous mutation
Environmental factors
Nutritional Deficiency
Cigarette smoking
Drugs, radiation.
Amniotic bands
Frequency of Occurrence
In whites,CL CP occur in 1 of every 700-1000
births
In Asians,prevalence is 1.5 times higher.
In African Americans,less than 0.4 in 1000.
in Native Americans fequency is 3.6per 1000birth
Incidence of clefts is highest in Native American
population and lowest in African Americans
Frequency of occurrence
Location
Cleft Lip is more commonly unilateral
(80%)
70% of cleft lips on left side.
Complete CL extends upward into nostril.
CP may involve hard and soft palate or soft
palate alone.
Cleft or Bifid Uvula is more common.
Bifid Uvula:
Whites: 1 in 80
Asian and Native American: 1 in 10
African Americans: 1 in 250
Submucous palatal cleft : surface mucosa is
intact but underlying musculature of soft
palate is defective.
Bifid uvula
Bird facies
Esthetic disfigurement
Difficulty in breathing ,feeding and speech
Malocclusion.
Psychosocial problems.
Recurrent upper respiratory tract infections.
Treatment
Multidisciplinary approach
Plastic surgery,
Dentistry,Otolaryngology,Audiology,speech
pathology,Genetics and Pediatrics
SURGICAL REPAIR.
Distraction osteogenesis
Genetic counseling
In Non syndromic cases, risk of
Cleft development in a sibling or
offspring is 3-5% if no other first
degree relative is affected. It
increases to 10 20 % if another
first degree relative is affected
Double Lip
Double Lip
Rare
Redundant fold of
tissue on the mucosal
side of the lip.
May be Congenital or
acquired( from trauma
or oral habits such as
lip sucking)
Double lip
More common in
upper lip
Sometimes both
lips affected
Seen on smiling.
Feature of Aschers
syndrome
Aschers syndrome
Triad of :
Double lip
Blepharochalasis
Nontoxic enlargement of thyroid gland
Macroglossia
Microglossia
Ankyloglossia
Lingual Thyroid
Median Rhomboid glossitis
Benign Migratory glossitis
Hairy Tongue
Bifid tongue
Fissured tongue
Lingual Varices
Macroglossia
Causes
Congenital:
Acquired:
Haemangioma
Lymphangioma
Cretinism
Down syndrome
Beckwith Weidemann
Syndrome
Neurofibromatosis
Hemi hyperplasia
Amyloidosis
Myxoedema
Acromegaly
Angioedema
Carcinoma and other
tumours
Edentulous state
Differentiating features
Differentiating features
Down Syndrome:
Papillary fissured surface
Hemifacial Hyperplasia,
Neurofibromatosis:
Unilateral enlargement
Edentulous:
Lateral spreading of tongue.
Microglossia
Ankyloglossia
Anomaly characterized
by short thick lingual
frenum resulting in
restriction in tongue
movement.
Sever case tongue fused
to floor of mouth
Frenum some time
attached to tip of the
tongue
Ankyloglossia
Seen in 2-5 % of the
population
Males > Females
May be partial or
complete
May cause speech
defects.
Surgery if the
anomaly is severe
Lingual Thyroid-origin
Failure of primitive
thyroid gland to
descend into the neck
during development.
About 10 % of both
men and women may
show thyroid tissue if
biopsy is taken from
posterior part of
tongue.
Lingual Thyroid-Diagnosis
In 70% of cases this
ectopic gland is the
patients only thyroid
tissue.
Thyroid scans using
Iodine isotopes or
technetium 99m
CT and MRI to know
the size and extent
Lingual Thyroid-Treatment
Asymptomatic patients:
No treatment, Periodic follow up
Symptomatic patients:
Suppressive therapy with thyroid supplements
In case of airway obstruction,surgery with auto
transplantation to another body site.
In males over 30 years ,prophylactic surgical
excision as there is a risk of malignancy.
Hairy Tongue
Etiology
Antibiotic therapy
Poor oral hygiene
General debilitation
Radiation therapy
Use of oxidizing mouth wash or antacid
Overgrowth of fungus or bacterial organism
Histopathology- it is characterized by
marked elongation and hyper keratosis of
filiform papillae
Fissured Tongue
Lingual Varices
Abnormally dilated
and tortuous veins
Seen in 2/3rds of
people older than 60
years of age(indicating
age related
degeneration )
Asymptomatic
Mandibular Torus
Palatine Torus
Hemifacial Atrophy
Hemifacial hypertrophy
Condylar hypertrophy
Coronoid hypertrophy
Mandibular aplasia
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