DEVELOPMENTAL DISTURBANCES AFFECTING LIP AND PALATE.pptx

This presentation contains developmental disturbances affecting lip and palate.

1. DEVELOPMENTAL DISTURBANCES AFFECTING LIP AND PALATE Dr. Reshma M Assistant Professor Dept of Oral and Maxillofacial Pathology

2. Congenital lips and commissural pits and fistulas Malformations of the lip with hereditary pattern Van der Woude’s syndrome: pits of lower lip with cleft lip and/or cleft palate. Commissural pits: related to lip pits but occurs in commissures lateral to typical lip pits Etiology : in early stages of development fixation of tissue to the base of notch or from failure of complete union of the embryonic lateral sulci of the lip.

3. Bilateral lip pits Commissural lip pits

4. CLINICAL FEATURES Unilateral /bilateral Vermilion surface of either lip Common in lower lip Some times appears swollen accentuating appearance of lips Commissural pits are unilateral or bilateral TREATMENT Surgical excision

5. Van der Woude’s syndrome Autosomal dominant Cleft lip/cleft palate+ pits of lower lips Etiology : deletions in chromosome band 1q32 Clinical features : Unilateral/ bilateral Hyper nasal voice and cleft or bifid uvula Syngnathia(congenital adhesion of the jaws) N arrow high arched palate Ankyloglossia

6. EXTRA ORAL MANIFESTATION L imb abnormalities Popliteal webs Brain abnormalities Congenital heart defects TREATMENT S urgical repair of cleft lip and palate Surgical removal of lip pits

7. Cleft lip and cleft palate Two types of malformation : cleft lip with or without cleft palate and cleft palate Etiology : Hereditary By single gene/ by number of genes (polygenic inheritance) Polygenic : Most common type , low risk Monogenic : Associated with congenital abnormalities Other factors : Defective vascular supply Size of the tongue A lcohol and certain drugs Infections and lack of inherent developmental force

8. Clinical features Males Syndromic and non syndromic Unilateral or bilateral Median cleft face syndrome: hypertelorism, median cleft of premaxilla and palate and cranium bifidum occultum. Clinical significance : Esthetic, physical and psychological effects Treatment : cosmetic and functional, 10 s

9. Chelitis glandularis Uncommon poorly understood inflammatory disease of the lip Progressive enlargement and eversion of lower lip Altered by environmental influences, leading to erosion, ulceration and crusting. Etiology : chronic irritation Clinical features : Distinct deeply suppurative chronic inflammatory condition of lower lip Equal gender predilection classification : simple type- multiple,painless, papular surface lesions with central depressions and dilated canals

10. Superficial suppurative type( baelz disease) : painless indurated swelling of the lower lip with shallow ulceration and crusting. Deep suppurative type: deep seated infection with formation of abscesses, sinus tracts and fistulas Histological features: lip biopsy is indicated Differential diagnosis: actinic keratosis, chelitis granulamatosa , sarcoidosis and squamous cell carcinoma Treatment : aetiology to be rule out and attempts to alleviate and e radicate the cause.

11. Chelitis granulomatosa( miescher-melkersson –Rosenthal syndrome) Swelling of lip due to granulomatous inflammation Melkersson Rosenthal when chelitis with facial palsy and plicated tongue Etiology : Genetic predisposition Clinical features : Episodic nontender swelling and enlargement of one or both lips Prodromal symptoms Regional lymph nodes are enlarged

12. Differential diagnosis: insect bites and sarcoidosis Histological features: chronic inflammatory cell infiltration ;peri and para vascular aggregations of lymphocytes, plasma cells and histiocytes, non caseating granuloma formation and Langhans type of giant cells Treatment : corticosteroid, NSAIDS,Surgery radiation

13. Thank you