Oral Pathology | Developmental Conditions | INBDE, ADAT — Transcript

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1. 0:00hey guys it's Ryan welcome back sorry
2. 0:04it's been a while I got a new computer
3. 0:06and a new microphone so maybe you'll
4. 0:09notice a little bit of a change in the
5. 0:11audio quality hopefully for the better
6. 0:13this will be the first of many videos on
7. 0:16a really cool topic oral pathology this
8. 0:20is something that comes up on nbda part
9. 0:232 on the 8th at the seated ESC and even
10. 0:26part one of the boards and of course
11. 0:29this is something that will come in
12. 0:31handy when working with patients
13. 0:32recognizing when something seems off and
14. 0:35knowing when to biopsy but I'm hearing
15. 0:38these videos for preparing for the exams
16. 0:40I mentioned especially part to the
17. 0:42National boards
18. 0:43I'll be focusing on only the highest
19. 0:46yield things you should know for each
20. 0:48condition if you like this type of info
21. 0:51you may want to check out most ways
22. 0:53review for the NVDA part too much of the
23. 0:56info I'll be going over is adapted from
24. 0:58that book and I'll leave a link in the
25. 1:00description below for it for you to
26. 1:03check it out so these are all of the
27. 1:06categories we're going to be talking
28. 1:07about one video at a time and organized
29. 1:11by tissue type and then by the type of
30. 1:14lesion reactive infectious immuno logic
31. 1:17and so on basically you can kind of
32. 1:20think of it like we're starting with
33. 1:22developmental conditions things that are
34. 1:26either soft or hard tissue defects that
35. 1:28occur during the development of an
36. 1:30individual either before or after birth
37. 1:33then we go over basically going from
38. 1:36outside to inside from mucosa then we go
39. 1:40to submucosa and glands then we talk
40. 1:43about the teeth and then we talk about
41. 1:44bone and finally we'll go over
42. 1:46hereditary conditions that are passed on
43. 1:49through genes so let's begin so the
44. 1:53first one we're going to talk about is
45. 1:54cleft lip approximately one in 1,000
46. 1:58births so relatively rare unilateral is
47. 2:03about eighty percent of the time whereas
48. 2:06bilateral is only about twenty percent
49. 2:08of the time so you're gonna see
50. 2:09unilateral
51. 2:10often with cleft lip and most
52. 2:13importantly this is a lack of fusion
53. 2:15between the medial nasal process and the
54. 2:19maxillary process so if we look at this
55. 2:23image down here that's basically between
56. 2:27this philtrum area which is under the
57. 2:29middle of the nose and the lateral lip
58. 2:32cheek area so this is between the medial
59. 2:35nasal process and the maxillary process
60. 2:37or prominence which are embryologic
61. 2:40structures that will eventually fuse
62. 2:42together to form the face and this is a
63. 2:45lack of fusion of those embryo logical
64. 2:48structures and then cleft lip it's
65. 2:51approximately one in two thousand births
66. 2:53so a little bit more rare than cleft lip
67. 2:56and two lack of fusion between palpable
68. 2:58shelves which makes sense because it's
69. 3:01the cleft palate so then we can look at
70. 3:03this view over here this is looking at
71. 3:05the roof of the mouth and you can see
72. 3:08how a unilateral cleft will go off to
73. 3:11one side and kind of coalesce with one
74. 3:14of the nostrils and the bilateral cleft
75. 3:16will go and split the palate in two with
76. 3:20this inner maxillary segment separated
77. 3:23in a bilateral cleft because this again
78. 3:26involves middle nose the philtrum middle
79. 3:30of the lip and in a maxillary segment
80. 3:32which is part of the medial nasal
81. 3:35process so the two palatal shelves are
82. 3:37on either side of that cleft then lip
83. 3:44pits or imaginations at either the
84. 3:47common shares which are the corners of
85. 3:49the mouth or near the midline now all
86. 3:52the syndromes that I'm going to be
87. 3:53talking about in this oral pathology
88. 3:56video series I'll have them bolded and
89. 3:58I'll kind of list them as sort of a math
90. 4:00equation basically in addition the sum
91. 4:04of a certain amount of conditions that
92. 4:07need to be met for it to be considered a
93. 4:09syndrome so and I may not pronounce all
94. 4:13these correct so sorry about that but
95. 4:16the van der woodsen Jerome in valves
96. 4:18both a cleft either lip or palate or
97. 4:21both and the presence of lip
98. 4:24it's as seen in this picture now four
99. 4:29nice granules are ectopic sebaceous
100. 4:31glands if you remember this it's
101. 4:33probably all you need to know they're
102. 4:36completely benign no treatment necessary
103. 4:38at all but that's sufficient to know and
104. 4:42sort of knowing this pretty classic
105. 4:44condition either on buccal mucosa or
106. 4:47labeled labial mucosa inside the lips
107. 4:50those are the characteristic locations
108. 4:53for these kind of things
109. 4:55Luco edema is another thing just to know
110. 4:58a couple of key buzz phrases for it it's
111. 5:02basically this white or in this picture
112. 5:05whitish grey ademma tiss which means
113. 5:07fluid the collection of fluid lesion of
114. 5:10buccal mucosa so again very common in
115. 5:13buccal mucosa and it dissipates when the
116. 5:16cheek is stretched so if you take two
117. 5:18fingers stretch this out the lesions
118. 5:21looks like it kind of goes away for a
119. 5:23brief moment and that's because of the
120. 5:25collection of this dimittis this fluid
121. 5:28in this area lingual thyroid is a
122. 5:32thyroid tissue mass at the midline base
123. 5:35of the tongue and importantly it's
124. 5:38located along the embryonic path of
125. 5:41thyroid ascend so if we look at this
126. 5:45diagram of thyroid ascent we don't need
127. 5:49to know all the specifics but it starts
128. 5:52out at the foramen cecum of the tongue
129. 5:55the midline base of the tongue and
130. 5:57during development it goes down it wraps
131. 6:01around the highway bone and goes down a
132. 6:03little bit further and eventually ends
133. 6:05up where the thyroid should be and that
134. 6:08is below the laryngeal cartilage area
135. 6:11around the trachea but it can get stuck
136. 6:14anywhere along this path of descent so
137. 6:18it could just not go anywhere and get
138. 6:20stuck in the back of the tongue like
139. 6:23this or it could end up somewhere along
140. 6:27that path at say the neck area and so a
141. 6:31thyroid thyroid glossa Luxus is an
142. 6:35example of this so this would be a
143. 6:38mid-line neck swelling and again located
144. 6:41along the embryonic path of thyroid
145. 6:43ascend so langral thought lingual
146. 6:46thyroid and thyroglossal duct cysts are
147. 6:48manifestations of an improper path of
148. 6:53the thyroid geographic tongue also goes
149. 7:00by two other names benign migratory
150. 7:02bless itis and erythema migrans and
151. 7:06sometimes the alternative names are sort
152. 7:09of cumbersome but in this case it
153. 7:11actually helps helps us remember what it
154. 7:14looks like and how it acts so this is a
155. 7:17pretty nice characteristic photo has
156. 7:20these white annular lesions which means
157. 7:23their white rings surrounding central
158. 7:26red islands that literally migrate over
159. 7:29time and they'll move around on the
160. 7:31tongue and this is how you get this
161. 7:33migratory migrants terminology and also
162. 7:38the ear athina referring to the redness
163. 7:40of the tongue
164. 7:41occasionally hurts and burns
165. 7:44unfortunately outside of a little bit of
166. 7:46symptomatic and dietary changes there
167. 7:49really is no treatment for this
168. 7:51condition fissure tongue is relatively
169. 7:57more common than some of the other ones
170. 7:59we talked about has a folds and furrows
171. 8:02of the tongue dorsum the the top surface
172. 8:06of the tongue here more important it's
173. 8:09involved in the syndrome called Mel
174. 8:11curse and Rosenthal syndrome and has
175. 8:14Fisher tongue granulomatous colitis
176. 8:17which is basically lip inflammation
177. 8:20involving granulomas granulation tissue
178. 8:23and facial paralysis how I remember this
179. 8:28is this is not an not an acronym but a
180. 8:37helpful way to think about this is Mel's
181. 8:42Mel's Belle's so you can think of Mel
182. 8:47Corson and Belle's referring to Belle's
183. 8:52which is another type of facial
184. 8:54paralysis involving the facial nerve and
185. 8:57you can think of rows or rosy-red and
186. 9:04that would be referring to the rosenthal
187. 9:08part of the syndrome and the redness
188. 9:10that's affecting the lips because this
189. 9:14granulomatous colitis is basically this
190. 9:17lip inflammation that involves red
191. 9:19swollen lips so if you think about the
192. 9:22bells Bell's palsy
193. 9:24facial paralysis rosy red red lips
194. 9:28colitis meaning lip inflammation you can
195. 9:31kind of put all this stuff together
196. 9:32maybe a little bit better so hopefully
197. 9:35that helps you remember some of these
198. 9:37weirder name syndromes I'll try to throw
199. 9:39in some helpful things to kind of
200. 9:41they're silly things to help remember it
201. 9:45so next we're going to talk about
202. 9:46angiomas so this is a kind of it was
203. 9:49confusing for me is there a bunch of
204. 9:52different types of angiomas and I can't
205. 9:53really get a grasp on what they all were
206. 9:55is they're very different in
207. 9:57presentation but if we break this word
208. 10:00down Angie is a prefix meaning vessels
209. 10:04and oma is a suffix meaning a tumor so
210. 10:09literally it's translated to a tumor
211. 10:12composed of blood vessels or lymph
212. 10:14vessels there are two types of vessels
213. 10:17in the human body so any angioma is
214. 10:21either going to be a tumor of blood
215. 10:24vessels or lymph vessels a cherry
216. 10:27angioma is extremely common super benign
217. 10:30most of us have them somewhere and it's
218. 10:34basically a red mole so it an incredibly
219. 10:37really sounds silly to call it a tumor
220. 10:39but an incredibly small tumor of small
221. 10:43little capillaries and blood vessels
222. 10:45that accumulate and just form this small
223. 10:48little mole on our skin a hemangioma is
224. 10:52a congenital focal proliferation of
225. 10:55capillaries so again it's involving
226. 10:57blood vessels but a little bit larger
227. 10:59scale
228. 10:59now most undergo involution has an
229. 11:03infinite or child ages
230. 11:05but persistent lesions should be excised
231. 11:08mostly for aesthetic reasons so we have
232. 11:13cherry angioma hemangioma
233. 11:16and now lymph angioma so we talked about
234. 11:20the blood vessel proliferation and now
235. 11:23let's talk about congenital focal
236. 11:24proliferation of lymph vessels so oral
237. 11:28lymph angiomas are actually super rare
238. 11:30they manifested these little purple
239. 11:33spots on the tongue more common would
240. 11:36probably be when it occurs on the neck
241. 11:39it looks it's just basically a another
242. 11:42neck swelling and it's called a cystic
243. 11:44hygroma so that one's kind of a little
244. 11:48bit different nomenclature but cystic
245. 11:52hygroma is technically a lymph angioma
246. 11:54of the neck and again we have another
247. 11:59syndrome
248. 12:00this time sturge-weber syndrome and this
249. 12:03involves angiomas of the leptomeninges
250. 12:05which are the arachnoid and Pia mater
251. 12:08and just for reference to the two most
252. 12:12internal of the meninges and then they
253. 12:18also the syndrome also involves angiomas
254. 12:21of the skin along the distribution of
255. 12:24the trigeminal nerve so v1 v2 v3 the
256. 12:29angiomas of the syndrome can also be
257. 12:34referred to as an cephalo trigeminal
258. 12:37angio mitosis that's really it sounds
259. 12:41really complicated but encephalo
260. 12:43referring to brain trigeminal referring
261. 12:46to this nerve and angio mitosis just
262. 12:49referring to the presence of angiomas in
263. 12:52relation to those structures so
264. 12:55sturge-weber syndrome all about angiomas
265. 13:00next we have exostosis and tour eye and
266. 13:03this is the excessive cortical bone
267. 13:07growth seen in these pictures so this
268. 13:10they're basically named based on where
269. 13:12they occur this would be a buccal
270. 13:14exostosis
271. 13:16a very severe one in this case
272. 13:19and this would be a palatal Taurus again
273. 13:23pretty pretty severe they're usually not
274. 13:25quite this large but just for pictures
275. 13:29sake that's those are two examples next
276. 13:35we have a dermoid cyst and this is a
277. 13:38mass in the midline and it can be either
278. 13:40intraoral or extra oral it depends on a
279. 13:43location where the cyst originates so if
280. 13:47it originates above the mylohyoid muscle
281. 13:50it presents in the floor the mouth like
282. 13:53same here if it develops below the
283. 13:56mylohyoid then it would be a mass
284. 13:59another yet another mass in the upper
285. 14:02neck so as you can as you can see here
286. 14:04there are quite a few of these cysts and
287. 14:07developmental conditions that manifest
288. 14:10not only internally but also cervical e
289. 14:13in the neck so dermoid cyst is pretty
290. 14:16interesting it contains any variety of
291. 14:20adnexal structures which included like
292. 14:22hair sebaceous glands seminiferous
293. 14:35tubule
294. 14:36which is something we'll talk about in
295. 14:38another video but this cyst in
296. 14:40comparison to arraign yellow which also
297. 14:42presents in the floor of the mouth has a
298. 14:44doughy consistency and that's because of
299. 14:47the things that it contains within it
300. 14:50next we have the branchial cyst and this
301. 14:53is also very often contradicted to the
302. 14:58thyroglossal duct cyst which was the
303. 15:00midline neck swelling this is a lateral
304. 15:02neck swelling and it's because it's
305. 15:04related to the branchial arches which
306. 15:09are synonymous with the pharyngeal
307. 15:10arches which are part of the head and
308. 15:13neck
309. 15:13embryology it's an epithelial cyst
310. 15:17within a lymph node of the neck and you
311. 15:20can think of when the doctor palpates
312. 15:22around around your neck they're always
313. 15:25running their fingers along the lateral
314. 15:27aspect of the neck so that's why you can
315. 15:31connect that to why the brachial
316. 15:32this is on the lateral side also
317. 15:35remember that all cysts by definition
318. 15:37have an epithelial lining so all the
319. 15:40since we've talked about have epithelial
320. 15:42lining this one in this case is
321. 15:44stratified squamous epithelium I don't
322. 15:47think that's too important but just just
323. 15:51for your own edification I guess and
324. 15:54next we have oral lympho epithelial cyst
325. 15:57which is basically the equivalent the
326. 16:00intraoral equivalent of the bronchial
327. 16:02assist because now it's also an
328. 16:04epithelial assist within lymphoid tissue
329. 16:07this time it's in oral mucosa not on the
330. 16:10lateral neck so if you think of lymphoid
331. 16:14tissue intra orally the paletine and
332. 16:17lingual tonsils come to mind and so
333. 16:19those are the most common regions that
334. 16:22these little assists are found next is
335. 16:27Stephanie bone defect which is a seems
336. 16:30to be a really real favorite of test
337. 16:32makers and it's a radial lucency and the
338. 16:36posterior mandible below the mandibular
339. 16:39canal and it looks like it could be a
340. 16:42cyst it almost looks like it's
341. 16:43coordinated in this image but it's not
342. 16:46it's due to the lingual concavity of the
343. 16:48jaw just being so severe that it appears
344. 16:51on an x-ray this case in a panoramic and
345. 16:56it just it seems like it's something
346. 16:59that should be investigated but it's
347. 17:01actually just a variation of normal
348. 17:04Anatomy nasal Palatine duct cyst is a
349. 17:09characteristically heart shaped
350. 17:11radial lucency in the nasal palatine
351. 17:14canal it's caused by syste fication of
352. 17:17canal remnants treatment for this would
353. 17:20be surgical excision globulin maxillary
354. 17:25lesion is a fancy clinical term denoting
355. 17:29any radial lucency
356. 17:30between and this is very specific the
357. 17:33maxillary canine and the maxillary
358. 17:35lateral incisor
359. 17:38that's very specific and this is not a
360. 17:41diagnosis the other things we talked
361. 17:43about our diagnosis this is just a
362. 17:45clinical description of this exact
363. 17:49manifestation and lastly we have
364. 17:54traumatic bone cyst which is another
365. 17:56favorite of test makers is also called
366. 17:59simple bone cyst and idiopathic bone
367. 18:02cavity which are important synonyms it's
368. 18:05a large radial lucency and it's
369. 18:07scalloped around roots that's probably
370. 18:10the most important thing you need to
371. 18:11know about this one
372. 18:13it does not have an epithelial lining so
373. 18:17like the other ones the other cysts I
374. 18:19said they do have an epithelial lining
375. 18:21this is technically a pseudocyst it's
376. 18:24although it's named a cyst it's not
377. 18:26technically by definition a cyst it's
378. 18:30usually in the mandible of teenagers
379. 18:32associated with some sort of jaw trauma
380. 18:34by sports or something like that the
381. 18:38treatment would be to aspirate first
382. 18:40determine that it's fluid filled it has
383. 18:43blood in it and then just monitor and
384. 18:46this thing is they're typically nothing
385. 18:49to worry too much about alright and
386. 18:53that's it for developmental conditions I
387. 18:55hope you enjoyed this video if you like
388. 18:58what I do on this channel make sure to
389. 19:00leave a like and subscribe for more oral
390. 19:02pathology and other things dentistry
391. 19:04thanks for watching guys and I'll see
392. 19:06you all next time