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 childhood, and girls are affected more frequently than boys (ratio 3:2).
Localization
• 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
