hey guys it's Ryan welcome back sorry it's been a while I got a new computer and a new microphone so maybe you'll notice a little bit of a change in the audio quality hopefully for the better this will be the first of many videos on a really cool topic oral pathology this is something that comes up on nbda part 2 on the 8th at the seated ESC and even part one of the boards and of course this is something that will come in handy when working with patients recognizing when something seems off and knowing when to biopsy but I'm hearing these videos for preparing for the exams I mentioned especially part to the National boards I'll be focusing on only the highest yield things you should know for each condition if you like this type of info you may want to check out most ways review for the NVDA part too much of the info I'll be going over is adapted from that book and I'll leave a link in the description below for it for you to check it out so these are all of the categories we're going to be talking about one video at a time and organized by tissue type and then by the type of lesion reactive infectious immuno logic and so on basically you can kind of think of it like we're starting with developmental conditions things that are either soft or hard tissue defects that occur during the development of an individual either before or after birth then we go over basically going from outside to inside from mucosa then we go to submucosa and glands then we talk about the teeth and then we talk about bone and finally we'll go over hereditary conditions that are passed on through genes so let's begin so the first one we're going to talk about is cleft lip approximately one in 1,000 births so relatively rare unilateral is about eighty percent of the time whereas bilateral is only about twenty percent of the time so you're gonna see unilateral often with cleft lip and most importantly this is a lack of fusion between the medial nasal process and the maxillary process so if we look at this image down here that's basically between this philtrum area which is under the middle of the nose and the lateral lip cheek area so this is between the medial nasal process and the maxillary process or prominence which are embryologic structures that will eventually fuse together to form the face and this is a lack of fusion of those embryo logical structures and then cleft lip it's approximately one in two thousand births so a little bit more rare than cleft lip and two lack of fusion between palpable shelves which makes sense because it's the cleft palate so then we can look at this view over here this is looking at the roof of the mouth and you can see how a unilateral cleft will go off to one side and kind of coalesce with one of the nostrils and the bilateral cleft will go and split the palate in two with this inner maxillary segment separated in a bilateral cleft because this again involves middle nose the philtrum middle of the lip and in a maxillary segment which is part of the medial nasal process so the two palatal shelves are on either side of that cleft then lip pits or imaginations at either the common shares which are the corners of the mouth or near the midline now all the syndromes that I'm going to be talking about in this oral pathology video series I'll have them bolded and I'll kind of list them as sort of a math equation basically in addition the sum of a certain amount of conditions that need to be met for it to be considered a syndrome so and I may not pronounce all these correct so sorry about that but the van der woodsen Jerome in valves both a cleft either lip or palate or both and the presence of lip it's as seen in this picture now four nice granules are ectopic sebaceous glands if you remember this it's probably all you need to know they're completely benign no treatment necessary at all but that's sufficient to know and sort of knowing this pretty classic condition either on buccal mucosa or labeled labial mucosa inside the lips those are the characteristic locations for these kind of things Luco edema is another thing just to know a couple of key buzz phrases for it it's basically this white or in this picture whitish grey ademma tiss which means fluid the collection of fluid lesion of buccal mucosa so again very common in buccal mucosa and it dissipates when the cheek is stretched so if you take two fingers stretch this out the lesions looks like it kind of goes away for a brief moment and that's because of the collection of this dimittis this fluid in this area lingual thyroid is a thyroid tissue mass at the midline base of the tongue and importantly it's located along the embryonic path of thyroid ascend so if we look at this diagram of thyroid ascent we don't need to know all the specifics but it starts out at the foramen cecum of the tongue the midline base of the tongue and during development it goes down it wraps around the highway bone and goes down a little bit further and eventually ends up where the thyroid should be and that is below the laryngeal cartilage area around the trachea but it can get stuck anywhere along this path of descent so it could just not go anywhere and get stuck in the back of the tongue like this or it could end up somewhere along that path at say the neck area and so a thyroid thyroid glossa Luxus is an example of this so this would be a mid-line neck swelling and again located along the embryonic path of thyroid ascend so langral thought lingual thyroid and thyroglossal duct cysts are manifestations of an improper path of the thyroid geographic tongue also goes by two other names benign migratory bless itis and erythema migrans and sometimes the alternative names are sort of cumbersome but in this case it actually helps helps us remember what it looks like and how it acts so this is a pretty nice characteristic photo has these white annular lesions which means their white rings surrounding central red islands that literally migrate over time and they'll move around on the tongue and this is how you get this migratory migrants terminology and also the ear athina referring to the redness of the tongue occasionally hurts and burns unfortunately outside of a little bit of symptomatic and dietary changes there really is no treatment for this condition fissure tongue is relatively more common than some of the other ones we talked about has a folds and furrows of the tongue dorsum the the top surface of the tongue here more important it's involved in the syndrome called Mel curse and Rosenthal syndrome and has Fisher tongue granulomatous colitis which is basically lip inflammation involving granulomas granulation tissue and facial paralysis how I remember this is this is not an not an acronym but a helpful way to think about this is Mel's Mel's Belle's so you can think of Mel Corson and Belle's referring to Belle's which is another type of facial paralysis involving the facial nerve and you can think of rows or rosy-red and that would be referring to the rosenthal part of the syndrome and the redness that's affecting the lips because this granulomatous colitis is basically this lip inflammation that involves red swollen lips so if you think about the bells Bell's palsy facial paralysis rosy red red lips colitis meaning lip inflammation you can kind of put all this stuff together maybe a little bit better so hopefully that helps you remember some of these weirder name syndromes I'll try to throw in some helpful things to kind of they're silly things to help remember it so next we're going to talk about angiomas so this is a kind of it was confusing for me is there a bunch of different types of angiomas and I can't really get a grasp on what they all were is they're very different in presentation but if we break this word down Angie is a prefix meaning vessels and oma is a suffix meaning a tumor so literally it's translated to a tumor composed of blood vessels or lymph vessels there are two types of vessels in the human body so any angioma is either going to be a tumor of blood vessels or lymph vessels a cherry angioma is extremely common super benign most of us have them somewhere and it's basically a red mole so it an incredibly really sounds silly to call it a tumor but an incredibly small tumor of small little capillaries and blood vessels that accumulate and just form this small little mole on our skin a hemangioma is a congenital focal proliferation of capillaries so again it's involving blood vessels but a little bit larger scale now most undergo involution has an infinite or child ages but persistent lesions should be excised mostly for aesthetic reasons so we have cherry angioma hemangioma and now lymph angioma so we talked about the blood vessel proliferation and now let's talk about congenital focal proliferation of lymph vessels so oral lymph angiomas are actually super rare they manifested these little purple spots on the tongue more common would probably be when it occurs on the neck it looks it's just basically a another neck swelling and it's called a cystic hygroma so that one's kind of a little bit different nomenclature but cystic hygroma is technically a lymph angioma of the neck and again we have another syndrome this time sturge-weber syndrome and this involves angiomas of the leptomeninges which are the arachnoid and Pia mater and just for reference to the two most internal of the meninges and then they also the syndrome also involves angiomas of the skin along the distribution of the trigeminal nerve so v1 v2 v3 the angiomas of the syndrome can also be referred to as an cephalo trigeminal angio mitosis that's really it sounds really complicated but encephalo referring to brain trigeminal referring to this nerve and angio mitosis just referring to the presence of angiomas in relation to those structures so sturge-weber syndrome all about angiomas next we have exostosis and tour eye and this is the excessive cortical bone growth seen in these pictures so this they're basically named based on where they occur this would be a buccal exostosis a very severe one in this case and this would be a palatal Taurus again pretty pretty severe they're usually not quite this large but just for pictures sake that's those are two examples next we have a dermoid cyst and this is a mass in the midline and it can be either intraoral or extra oral it depends on a location where the cyst originates so if it originates above the mylohyoid muscle it presents in the floor the mouth like same here if it develops below the mylohyoid then it would be a mass another yet another mass in the upper neck so as you can as you can see here there are quite a few of these cysts and developmental conditions that manifest not only internally but also cervical e in the neck so dermoid cyst is pretty interesting it contains any variety of adnexal structures which included like hair sebaceous glands seminiferous tubule which is something we'll talk about in another video but this cyst in comparison to arraign yellow which also presents in the floor of the mouth has a doughy consistency and that's because of the things that it contains within it next we have the branchial cyst and this is also very often contradicted to the thyroglossal duct cyst which was the midline neck swelling this is a lateral neck swelling and it's because it's related to the branchial arches which are synonymous with the pharyngeal arches which are part of the head and neck embryology it's an epithelial cyst within a lymph node of the neck and you can think of when the doctor palpates around around your neck they're always running their fingers along the lateral aspect of the neck so that's why you can connect that to why the brachial this is on the lateral side also remember that all cysts by definition have an epithelial lining so all the since we've talked about have epithelial lining this one in this case is stratified squamous epithelium I don't think that's too important but just just for your own edification I guess and next we have oral lympho epithelial cyst which is basically the equivalent the intraoral equivalent of the bronchial assist because now it's also an epithelial assist within lymphoid tissue this time it's in oral mucosa not on the lateral neck so if you think of lymphoid tissue intra orally the paletine and lingual tonsils come to mind and so those are the most common regions that these little assists are found next is Stephanie bone defect which is a seems to be a really real favorite of test makers and it's a radial lucency and the posterior mandible below the mandibular canal and it looks like it could be a cyst it almost looks like it's coordinated in this image but it's not it's due to the lingual concavity of the jaw just being so severe that it appears on an x-ray this case in a panoramic and it just it seems like it's something that should be investigated but it's actually just a variation of normal Anatomy nasal Palatine duct cyst is a characteristically heart shaped radial lucency in the nasal palatine canal it's caused by syste fication of canal remnants treatment for this would be surgical excision globulin maxillary lesion is a fancy clinical term denoting any radial lucency between and this is very specific the maxillary canine and the maxillary lateral incisor that's very specific and this is not a diagnosis the other things we talked about our diagnosis this is just a clinical description of this exact manifestation and lastly we have traumatic bone cyst which is another favorite of test makers is also called simple bone cyst and idiopathic bone cavity which are important synonyms it's a large radial lucency and it's scalloped around roots that's probably the most important thing you need to know about this one it does not have an epithelial lining so like the other ones the other cysts I said they do have an epithelial lining this is technically a pseudocyst it's although it's named a cyst it's not technically by definition a cyst it's usually in the mandible of teenagers associated with some sort of jaw trauma by sports or something like that the treatment would be to aspirate first determine that it's fluid filled it has blood in it and then just monitor and this thing is they're typically nothing to worry too much about alright and that's it for developmental conditions I hope you enjoyed this video if you like what I do on this channel make sure to leave a like and subscribe for more oral pathology and other things dentistry thanks for watching guys and I'll see you all next time