Macroglossia

• Feature: Crenated (scalloped) lateral tongue borders

Lymphangioma of Tongue

• Appearance: Tapioca pudding/Frog's egg

Geographic Tongue

• Associated With: Fissured tongue
• Histopathology: Similar to psoriasis
• Key Feature: Munro's abscesses

Median Rhomboid Glossitis

• Unique Sign: "Kissing lesion" on soft palate due to tongue contact

Hairy Tongue

• Misnomer: Elongated filiform papillae—not actual hair

1. Nasopalatine cyst is the most common non-odontogenic cyst
2. Globulomaxillary cyst entity is controversial - many consider it a variant of lateral periodontal cyst
3. Median mandibular cyst is extremely rare - always consider other diagnoses first
4. Nasolabial cyst is the only one with no radiographic features
5. All these cysts are developmental in origin

Quick Facts for MCQs:

• Oval + Maxillary midline = Nasopalatine cyst
• Pear-shaped + Between teeth = Globulomaxillary cyst
• Soft tissue swelling + No X-ray changes = Nasolabial cyst
• Mandibular midline + Rare = Median mandibular cyst

MEMORY AIDS

"NASAL" for Nasopalatine Cyst:

• Non-odontogenic (most common)
• Anterior maxilla
• Spacing of centrals
• Above/between central incisors
• Location: incisive canal

"PEAR" for Globulomaxillary:

• Pear-shaped (inverted)
• Enlarges slowly
• Adjacent to lateral incisor & canine
• Root divergence

"SOFT" for Nasolabial:

• Soft tissue cyst
• Obstruction of nose
• Fold involvement (nasolabial)
• Tissue only (no bone involvement)

Osteoradionecrosis

Clinical features

A reduction in vascularity, secondary to endarteritis obliterans, and damage to osteocytes as a consequence of ionising

Radiotherapy can result in radiation-associated osteomyelitis or Osteoradionecrosis. The mandible is much more  commonly affected than the maxilla, because it is less vascular. Pain may be severe and there may be pyrexia. The overlying oral mucosa often appears pale because of radiation damage. Osteoradionecrosis in the jaws arises most often following radiotherapy for squamous cell carcinoma.
 

Scar tissue will also be present at the tumour site, often in close relation to the necrotic bone.

Radiology
 

Osteoradionecrosis appears as rarefying osteitis within which islands of opacity (sequestra) are seen. Pathological

fracture may be visible in the mandible.

Pathology
The affected bone shows features similar to those of chronic osteomyelitis. Grossly, the bone may be cavitated

And discoloured, with formation of sequestra.
Acute inflammatory infiltrate may be present on a background of chronic inflammation, characterized by formation

Of granulation tissue around the non-vital trabeculae.

Blood vessels show areas of endothelial denudation and obliteration of their lumina by fibrosis.

Small telangiectatic vessels lacking precapillary sphincters may be present.

Fibroblasts in the irradiated tissues lose the capacity to divide and often become binucleated and enlarged.

Management

Prevention of Osteoradionecrosis is vital. Patients who  require radiotherapy for the management of head and

neck malignancy should ideally have teeth of doubtful prognosis extracted at least 6 weeks prior to treatment.

The dose of radiation,
The area of the mandible irradiated and
the surgical trauma involved in the dental extractions.
Surgical management of Osteoradionecrosis is similar to osteomyelitis.

• Radicular Cysts: Derived from Rests of Malassez.

• Impacted Canine Associations:

  • Most common odontogenic cyst: Dentigerous cyst.

  • Most common odontogenic tumor: Adenomatoid Odontogenic Tumor (AOT).

• Eruption Cyst: Considered an extra-alveolar dentigerous cyst (soft tissue counterpart).

Infective osteomyelitis

• Tuberculous osteomyelitis
• Syphilitic osteomyelitis
• Actinomycotic osteomyelitis

Tuberculous osteomyelitis

• Non healing sinus tract formation
• Age group affected is around 15 – 40 years.
• Commonly seen in phalanges and dorsal and lumbar vertebrae.
• Usually occurs secondary to tuberculosis of lungs.
• Cases have been reported where mandibular lesions were not associated with pulmonary disease.
• Another common entrance is through a carious tooth via open pulp.
• Usually affects long bones and rare in jaws.
• Results when blood borne bacilli lodge in cancellous bone. Usually in ramus , body of mandible. may mimic parotid swelling or submassetric abscess.

Syphilitic osteomyelitis

• Difficult to distinguish syphilitic osteomyelitis of the jaws from pyogenic osteomyelitis on clinical & radiographic examination.
• Main features are progressive course & failure to improve with usual treatment for pyogenic osteomyelitis.
• Massive sequestration may occur resulting in pathologic fracture.
• If unchecked, eventually causes perforation of the cortex.

Actinomycotic Osteomyelitis

• The organisms thrive in the oral cavity, especially tissues adjacent to mandible.
• May enter the bone through a fresh wound, carious tooth or a periodontal pocket at the gingival margin of erupting tooth.
• Soft or firm tissue masses on skin, which have purplish, dark red, oily areas with occasional zones of fluctuation.
• Spontaneous drainage of serous fluid containing granular material.
• Regional lymph nodes occasionally enlarged.
• Mimics parotitis / parotid tumors