Occurrence
• Rare. Approximately one per 1000 births.
Clinical features
• The lingual frenulum is short, thick or thin, and fibrous (Figs. 2.7, 2.8).
• The malformation may cause partial or complete immobility of the tongue.
• Mild cases are asymptomatic, and may go unnoticed for a long time. Severe cases may cause problems with speaking, eating and breast-feeding.
Treatment
• Surgical clipping of the frenulum in severe cases.
Fig. 2.5 Bifid uvula
Fig. 2.6 Bifid tongue
Fig. 2.7 Ankyloglossia
Fig. 2.8 Ankyloglossia
Lip Frenulum Anomalies
Definition
• Lip frenulum is a normal connective tissue structure extending from the lips to the alveolar process of the teeth.
Clinical features
• Rarely, the central frenulum of the upper and lower lips may be thick, broad and long, with an adhesion to the marginal gingiva.
• In severe cases, a large gap between the central incisors, or gingival regression or tooth movement may occur (Figs. 2.9, 2.10).
Treatment
• Surgical correction.
Congenital Lip Pits
Definition
• Congenital lip pits or paramedian lip pits are developmental invaginations, which may occur alone or in combination with commissural pits, cleft lip, or cleft palate.
Etiology
• They may be inherited as an autosomal dominant trait.
• They develop through incomplete regression of the lateral sulci of the lower lip during embryonic development.
Occurrence
• Rare.
Localization
• A few millimeters from the midline of the vermilion border of the lower lip, usually bilateral.
• Labial commissures.
Clinical features
• Clinically, they present as bilateral or unilateral depressions (Fig. 2.11).
• The size varies from 1 mm to 10 mm, and the depth of blind sinuses may extend to 1 cm or more.
• A small amount of mucous secretion may accumulate at the depth of the pits, and the lip may be enlarged and swollen.
• 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
