• Occasionally, a fistula may coexist.
• The diagnosis is based on clinical criteria.
Treatment
• Surgical correction for cosmetic purposes.
Double Lip
Definition
• Double lip is a malformation that may be present at birth or later in life.
Etiology
• It may be congenital due to the failure of the pars glabrosa and the pars villosa to fuse along the horizontal sulcus during lip formation.
• Acquired double lip is one of the main components of Ascher’s syndrome (double lip, blepharochalasis and goiter).
Occurrence
• Rare.
Localization
• Often the upper lip, and less frequently the lower lip.
Clinical features
• Clinically, it is characterized by an asymptomatic, protruding horizontal fold on the mucosal surface of the lip.
• Typically, the double lip is visible during speech or smiling, or when the lips are tensed (Figs. 2.12, 2.13).
• The diagnosis is based on clinical criteria.
Treatment
• Mild cases require no treatment.
• Severe cases require surgical correction for cosmetic purposes.
Fig. 2.9 Thick and long central frenulum of the upper lip
Fig. 2.10 Thin and long central frenulum of the lower lip
Fig. 2.11 Bilateral congenital lip pits
Fordyce’s Granules
Definition
• Fordyce’s granules are a normal anatomical variation, characterized by the presence of ectopic sebaceous glands in the oral mucosa.
Etiology
• Developmental.
Occurrence
• They present in about 20–30% of children and adolescents.
• About 80% of adults have Fordyce’s granules.
Localization
• Upper lip, buccal mucosa, retromolar area, anterior tonsillar pillar.
Clinical features
• Clinically, Fordyce’s granules present as multiple yellow or whitish-yellow, slightly raised, tiny pinhead-sized spots that are well circumscribed (Fig. 2.14).
• Solitary enlarged Fordyce’s granules may also be seen (Fig. 2.15).
• The granules are asymptomatic, and come to the patient’s attention by chance.
• The diagnosis is usually based on clinical criteria.
Laboratory tests
• Histopathological examination reveals normal collections of sebaceous glands without hair follicles.
Differential diagnosis
• Candidiasis
• Lichen planus
• Leukoplakia
Treatment
• No treatment is required.
Exostoses
Definition
• Exostoses are developmental harmless bony overgrowths that may affect the jaws.
Etiology
• Unknown. Genetic and environmental factors may be involved in their development.
Occurrence in children
• Rare. The lesions are usually first noticed after 20 years of age.
Localization
• Midline of the hard palate (torus palatinus).
• Lingual surfaces of the mandible, usually in the premolar region (torus mandibularis).
• Buccal surface of the maxillary and/or mandibular alveolar ridge (buccal exostoses).
Clinical features
• Clinically, exostoses present as bony, hard nodules covered by normal mucosa (Fig. 2.16).
• The number and size of the lesions vary considerably.
• Rarely, the overlying mucosa may be ulcerated due to mechanical trauma.
• The lesions grow slowly, and are asymptomatic.
• The diagnosis is based on clinical criteria.
Treatment
• No treatment is required. Surgical excision is indicated only when it is necessary to fit a prosthesis.
Fig. 2.12 Double upper lip
Fig. 2.13 Double lower lip
Fig. 2.14 Multiple Fordyce’s granules on the buccal mucosa and retromolar area
Fig. 2.15 Solitary hypertrophic Fordyce’s granules on the buccal mucosa
Facial Hemiatrophy
Definition
• Facial hemiatrophy, or Parry–Romberg syndrome, is a degenerative disorder characterized by atrophic changes of the deeper structures (e.g. fat, muscle, cartilage, and bone) involving one side of the face.
Etiology
• Unknown.
Occurrence
• Rare. The disease usually starts in