• One side of the face, lips, tongue, maxilla, mandible, teeth.
Clinical features
• The affected side appears atrophic, and the skin is wrinkled, shriveled and often shows hyperpigmentation or hypopigmentation (Fig. 2.17). Rarely, bilateral facial atrophy may occur.
• Unilateral atrophy of the lips and tongue is the most common oral manifestation. Hypoplasia of the maxilla and mandible, delayed eruption of the teeth, and malocclusion may also occur.
• Enophthalmos, alopecia, sweat gland disorders, trigeminal neuralgia, facial paresthesia, and epilepsy may develop.
• The atrophic process progresses slowly for several years and then becomes stable.
• Diagnosis is based on clinical criteria.
Differential diagnosis
• Scleroderma
• Facial hemihypertrophy
• Lipodystrophy
Treatment
• Plastic reconstruction
• Orthodontic treatment, if there is malocclusion.
Fig. 2.16 Buccal exostoses of the maxilla
Fig. 2.17 Facial hemiatrophy. Atrophy of the right side of the face
3 Mechanical and Electrical Injuries
Traumatic Ulcer
Definition
• Traumatic ulcer is a form of acute or chronic mechanical injury to the oral mucosa leading to loss of all epithelial layers.
Etiology
• It can result from a sharp or broken tooth, an ill-fitting amalgam restoration, orthodontic materials, accidental biting during mastication, sharp foreign bodies and clumsy use of dental instruments.
Occurrence in children
• Common.
Localization
• Tongue, buccal mucosa, lips, gingiva, mucobuccal fold.
Clinical features
• Traumatic ulcer usually presents as a single, ill-defined painful ulceration, with a smooth surface and erythematous or whitish borders (Figs. 3.1–3.4).
• The size may range from a few millimeters to several centimeters.
• There is a close relationship between the ulcer and the irritating cause.
• The ulcer may persist for a long time, but usually heals within 7–10 days after elimination of the cause.
• The diagnosis is based on the history and clinical features.
Laboratory tests
• Biopsy and histopathological examination only to rule out malignancies or other specific ulcerations.
Differential diagnosis
• Aphthous ulcers
• Necrotizing ulcerative gingivitis and stomatitis
• Eosinophilic ulcer
• Squamous-cell carcinoma
• Necrotizing sialadenometaplasia
Treatment
• Removal of the etiological factors.
• Symptomatic.
Bite Injuries
Definition
• Bite injuries are common lesions caused by chronic manipulation of the oral mucosa.
Etiology
• Continuous mild chewing, sharp teeth.
• In children under stress, or in those with psychological problems.
Occurrence in children
• Common.
Localization
• Lateral borders and tip of the tongue.
• Buccal mucosa, lower lip.
Clinical features
• The lesions usually present as macerated, irregular thickened, shredded, painless, white areas with characteristic desquamation of the affected epithelium (Figs. 3.5–3.8).
• Superficial erosions may also be seen.
• The lesions may be unilateral or bilateral, localized or diffuse.
• Diagnosis is based on the history and the clinical features.
Differential diagnosis
• Candidiasis
• White sponge nevus
• Leukoedema
• Hairy leukoplakia
• Lichen planus
• Leukoplakia
Treatment
• No treatment is required.
• Elimination of the habit.
Fig. 3.1 Traumatic ulcer of the buccal mucosa
Fig. 3.2 Traumatic ulcer of the tongue
Fig. 3.3 Traumatic ulcer of the gingiva (first premolar area)
Fig. 3.4 Traumatic ulcer of the upper alveolar mucosa in an infant
Fig. 3.5 Chronic biting of the tip of the tongue
Fig. 3.6 Chronic biting of the right lateral border of the tongue
Fig. 3.7 Chronic biting, resulting in a tumor-like lesion on the left lateral border of the tongue