OMFPR 10 - Normal Anatomy and Anatomic Variants (Dr. Menon)

philtrum

What is A?

commissure

What is B?

vermillion

What is C (right)?

vermillion border

What is C (left)?

tonsillar fossa

What is A?

Uvula

What is B?

Anterior pillar

What is C?

posterior pillar

What is D?

circumvallate papilla

What is A?

fungiform papilla

What is B?

foliate papilla

What is C?

Fungiform papilla

What is at 1?

Palatine tonsil

What is at 2?

Lingual tonsil

What is at 3?

Epiglottis

What is at 4?

Foramen cecum

What is at 5?

Circumcallate papilla

What is at 6?

Foliate papilla

What is at 7?

Filiform papillae

ID the structure:

Filiform papillae

What are the only papillae that do not have taste buds?

incisive papilla

What is A?

rugae

What is B?

junction of hard and soft palate

What is C?

palatine fovea

What is D?

maxillary tuberosity

What is E?

Frenum

ID the structure at the blue arrow:

Gingiva

ID the structure at the white arrow:

Vestibule

ID the structure at the yellow arrow:

Anatomic variant

Define the following:

A non-pathologic anatomic structure that is different from the norm

- Tori

- Exostoses

What are two asymptomatic exophytic growths of normal compact bone?

midline of hard palate

in what location do torus palatinus MOST likely present?

mandible lingual to canine/pre-molars

in what location do tori mandibularis MOST likely present?

buccal aspect of maxilla and mandible

In what location do exostoses MOST likely present?

torus palatinus

ID the anatomic variant:

- Tissue-colored (pink)

- Multilobular

- Sessile (broad)

- Nodular

- Exophytic

How would you describe the torus palatinus?

torus palatinus

This is a histological section of what?

multifactorial (genetic and environmental)

Tori and exostoses are commonly what etiology?

Asian and Inuit populations

What populations are tori and exostoses higher in?

No biopsy/treatment is usually indicated for tori and exoses unless needed for dental prosthesis (remove/recontour to accomodate) or biopsy if irregular

Is a biopsy indicated for tori and exostoses?

no treatment

what is the treatment for tori/exostosis?

fordyce granules

ID the pathology:

- Normal sebaceous glands

- Usually located on buccal or lip mucosa

- Seen in >80% of adults after puberty

- No biopsy indicated, no treatment

buccal or lip mucosa

what is the most common location for fordyce granules?

fordyce granules

ID the anatomic variant:

- Yellowish

- Diffused

- Papules

- On the buccal mucosa

How would you describe the fordyce granules?

no treatment

what is the treatment for fordyce granules?

No

Is a biopsy indicated for fordyce granules?

fordyce granule

This is a histological section of what?

fordyce granule

This is a histological section of what?

Fordyce granules; no treatment indicated (normal anatomical variation)

During a routine oral exam, multiple small, yellowish-white papules are noted on the buccal mucosa and vermilion border of the lips. The patient is asymptomatic. What is the most likely diagnosis and required treatment?

Physiologic pigmentation

What has the following characteristics:

- Diffuse melanocytic pigmentation of the oral mucosa

- More common in dark-skinned individuals

- May be anywhere on the oral mucosa

- No biopsy indicated; no treatment

- Physiologic pigmentation

- Ulcer

ID the anatomic variant:

- Well-defined

- Yellow-ish

- Erythema

How would you describe the ulcer in the image?

- Diffuse

- Macular

- Dark brown pigmentation

- On the anterior maxillary gingiva

How would you describe the physiologic pigmentation in the image?

retrocuspid papilla

ID the anatomic variant:

- Sessile nodules on the lingual gingiva of the mandibular canines

- May disappear with age

- No biopsy indicated; no treatment

retrocuspid papilla

ID the anatomic variant:

retrocuspid papilla (fibroma-looking with fibroblasts)

What is this a histological slide of?

Yes

Are bilateral abnormal variants likely to be inherited/systemic?

No

Is a biopsy indicated for retrocuspid papilla?

varicosities

ID the anatomic variant:

- Prominent veins most often seen on the ventral and lateral tongue

- May also be seen on the buccal or labial mucosa

- Most common in individuals older than 60 years

adults age 60+

what patient population are Varicosities most common in?

ventral and lateral tongue

in what location do oral varicosities most commonly present?

No

Is a biopsy indicated for varicosisites?

no treatment (unless esthetic concerns or thrombosis)

what is the treatment for varicosities?

varicosities

ID the anatomic variant:

- Blue-ish

~ 6mm

- Macule

How would you describe the varicosity?

leukoedema

ID the pathology:

- Generalized gray opalescence of the mucosa

- Most commonly involves buccal mucosa

- More common in smokers

- More common in African-Americans

- Disappears when mucosa is stretched

- No biopsy indicated; no treatment

Leukoedema

A patient presents with a diffuse, gray-white opalescent lesion on the buccal mucosa. The lesion disappears when the mucosa is stretched. What is the diagnosis?

buccal mucosa

leukoedema most commonly affects what part of the mouth?

African Americans and smokers

what patient population is leukoedema more common in?

No

Is a biopsy indicated for leukoedema?

No treatment

What is the treatment for leukoedema?

leukoedema

ID the anatomic variant:

leukoedema

ID the anatomic variant:

fissured tongue

What has the following characteristics:

- Generalized cracked or grooved appearance of dorsal surface of tongue

- Asymptomatic

- No treatment is needed (Brush tongue more frequently)

fissured tongue

ID the anatomic variant:

fissured tongue

ID the anatomic variant:

ankyloglossia (tongue-tie)

ID the anatomic variant:

- Short, thick lingual frenum limiting tongue movement

- Developmental anomaly affecting 10% of neonates

- Male predilection (4:1)

treatment generally not necessary - if indicated due to functional or periodontal concerns, frenectomy should be delayed until at least age 4-5

What is the treatment for ankyloglossia?

ankyloglossia

ID the pathology:

linea alba

ID the pathology:

- Bilateral linear white plaque along buccal mucosa at the occlusal plane

- Related to clenching and bruxing habits

- Asymptomatic

- No treatment

No treatment

What is the treatment for linea alba?

linea alba

ID the pathology:

no treatment

what is the treatment for oral linea alba?

morsicatio

ID the pathology:

- Chronic cheek chewing

- Often bilateral

- Poorly-defined borders

No treatment

What is the treatment for morsicatio?

morsicatio

ID the anatomic variant:

morsicatio (linea alba also seen)

ID the anatomic variant:

morsicatio

ID the anatomic variant:

clinical diagnosis

how is morsicatio diagnosed?

no treatment

what is the treatment for morsicatio?

benign migratory glossitis/geographic tongue/erythema migrans

ID the pathology:

- One or more erythematous patches surrounded by a white-yellow, slightly elevated, scalloped border

- Involves tongue, may also affect other area of oral mucosa

- Sometimes accompanied by fissured tongue (33%)

- No treatment unless symptomatic

benign migratory glossitis/geographic tongue/erythema migrans

ID the pathology:

benign migratory glossitis/geographic tongue/erythema migrans

ID the pathology:

benign migratory glossitis/geographic tongue/erythema migrans

What pathology?

no treatment unless symptomatic

what is the treatment for the majority of benign migratory glossitis cases?

- Hairy leukoplakia

- Candidiasis

hairy tongue is sometimes confused for what other oral pathology?

hairy tongue

ID the pathology:

- Coated appearance of dorsal tongue due to keratin

- May appear white or discolored due to extrinsic staining

- Asymptomatic

Gentle brushing

What is a treatment for hairy tongue (coated tongue)?

hairy tongue

ID the pathology: