1. DEVELOPMENTAL
DISTURBANCES OF
LIP,PALATE AND ORAL
MUCOSA
BY:SNEHA SURAPALLI
3RD YEAR BDS
ORAL PATHOLOGY PRESENTATION

2. LIP AND PALATE

3. Congenital lip and
commissural pits and fistula
 It is malformation of the lips ,often following
a hereditary pattern.
 It may occur alone or in association with other
developmental anomalies such as various oral
clefts.
 75-80% of all cases of congenital labial fistulas
,there is an associated cleft lip or cleft palate.

4. ETIOLOGY:
 Many theories have put up but none has been
universally accepted.
 Notching of the lip.
 Fixation of the tissue at the base of the notch.
C/F:

5. TREATMENT:
 Surgical excision
 However it is harmless and seldom
manifest complications

6. VAN DER WOUDE SYNDROME
 It is an autosomal dominant syndrome
typically consisting of cleft lip or cleft palate
and distinctive pits of the lower lip
ETIOLOGY:
 The most prominent feature is orofacial
anomalies
 Caused due to abnormal fusion of palate
and lip , at days 30-50 postconception

7. C/F:
• Occurences: affects about 1 in 100,000-
200,000.
• Sex: no sex prediliction
• Lesion: isolated ,usually medial
• Site : on the vermilion portion of lower lip

8. TREATMENT:
 Examination and genetic counseling by a
pediatric geneticist.
 Surgical repair of clept lip and palate

9. CLEFT LIP AND CLEFT PALATE
 It is a common congenital malformation.
 Failure in the fusion of the nasal and
maxillary prosses leads to cleft of
primary palate ,can be unilateral or
bilateral.
 Incidence of cleft of the lip and palate
varies from 1 in 500 to 1 in 2500
depends on geographic origin.

10. ETIOLOGY:
 Heredity.
 Environmental factors
 Insufficent nutrition to pregnant women
OTHER FACTORS:
o Defective vascular supply
o Size of the tongue prevent union of affected
parts
o Infections , certain alcohol ,drugs and toxins
o Lack of inherent developmental force

11. C/F:
• Sex : male predilection
• Lesion: unilateral or bilateral anomaly
Types :
i. The cleft anterior to the incisive foramen is
defined as cleft of primary palate.
ii. The cleft posterior to the incisive foramen is
defined as a cleft of secondary palate.

12. CLINICAL SIGNIFICANCE:
 Most cases can be surgically repaired
with excellent cosmetic and functional
results.
 Eating and drinking are difficult because
of regurgitation of food and liquid
through the nose.
TREATMENT:
 Surgical treatment

17. CHELITIS GLANDULARIS
Characterized by progressive enlargement
and eversion of the lower labial mucosa that
results in obliteration of the mucosal-
vermillion interface.

18. Etiology :
 Chronic irritation.
 Lip enlargement is attributable to
inflammation , hyperemia , edema and
fibrosis.
 Surface keratosis , erosion,self-inflicted
biting , factitial trauma , excessive wetting
from compulsive licking , drying
 Chronic aggravating factor.

19. C/F:
• Lesion :enlargement of lip and loss of
elasticty , asymptomatic lip swelling ,
burning discomfort, sensation of rawness
• Sex :male predilection.
• Age :4th -6th decade.
• Secretion: Mucopurulent exudates from
ductal orifices of labial minor salivary
glands.

20. Differential diagnosis:
 Actinic keratosis
 Atopic dermatitis
 Cheilitis granulomatosa
 Sarcoidosis
 Sqamous cell carcinoma
Treatment:
 Antibiotic therapy.

22. CHEILITIS GRANULOMATOUS
 Cheilitis granulomatosa is a chronic swelling
of the lip due to granulomatous
inflammation.
Etiology:
 Cause is unknown.

23. C/F:
 Non-tender swelling and enlargement one
or more lips and cheeks.
 Enlarged lip appears cracked.
 Fissured with reddish brown discoloration
and scaling.

24. Differential diagnosis:
 Insect bite
 Sarcoidosis
 Serum angiotensin-converting enzyme
test
 Chest radiography
 Gallium
 Positron emission tomography

25. Histological feature:
o Chronic inflammatory cell infiltrate
o Shows peri and para vascular aggregations
of lymphocytes ,plasma cells and
histiocytes.
o Formation with epitheloid cells and
Langhan’s type giant cells.

26. Treatment :
 Intra lesional corticosteriods injections.
 Non steroidal anti-inflammatory agents .
 Mast cell stabilizers .
 Clofazimine.
 Tetracycline
 Surgery and radiation.

28. Hereditory intestinal polyposis
syndrome
 It is an autosomal dominantly inheritant disorder
characterized by intestinal hamaratomaous polyps
in association with muco-cutaneous melanocytic
macules.
Etiology:
The cause of the Peutz-Jeghers syndrome
appears to be a germline mutation of the
STK11 gene in most cases, located on band
19p13.3

29. Clinical feature:
>Sex: M=F
>Races: all races
>Signs and symptoms: intestinal bleeding, menstrual
irregularities, cutaneous pigmentation
Histological features:
>Extensive smooth muscle arborization throughout
the polyp.
Treatment:
>surgical treatment

32. Labial and oral melanotic
macule
 It shows a focal area of melanin deposition
C/F:
• Sex:2:1 female predilection
• Age :23years
• Site: vermilion border of lip , buccal mucosa,
gingiva and palate
• Lesion: well demarcated, uniformly tan to
dark brown, asymptomatic ,round shaped

33. Histological feature:
o Normal stratified squamous epithelium with
abundant melanin deposits within the
keratinicytes of basal and parabasal layers.
TREATMENT:
 No treatment is
required

35. ORAL
MUCOSA

36. FORDYCE’S GRANULES
 It is a developmental anomaly characterized by
heterotropic collections of sebaceous glands at
various sites in the oral cavity
C/F:
• Lesion :Small yellow spots.
• Sex/race: No gender and races predilection.
• Site: Tongue ,gingiva , frenum and palate

37. Histological feature:
o Heterotopic collections of sebaceous
gland.
o The gland are usually superficial and may
consist of only a few or a great many
lobules
o Shows keratin plugging.
Treatment:
 Requires no treatment.

39. FOCAL EPITHELIAL HYPERPLASIA
 It is one of the most contagious of the oral
papillary lesion.
 It is able to produce extreme acantosis or
hyperplasia of the prickle cell layer of
epithelium.

40. C/F:
• Age :children ,young and middle-aged.
• Sex : no predilection
• Site: labial , buccal and lingual mucosa ,
gingival.
• Lesion: papillary in nature , smooth
surfaced, flat-topped ,pale or rarely white.

41. Histological features:
o Focal acantosis of oral epithelium
o Spinous layer show both cytoplasm and
nuclei in cell
Treatment:
 Treatment is unnecessary.
 Conservative excisional biopsy for proper
diagnosis.