ORAL PATHOLOGY : Developmental Anomalies

Fordyce's Granules

Fordyce's granules are a developmental anomaly characterized by collections of heterotopic sebaceous glands in the oral mucosa. Clinically, there are many small, slightly raised whitish-yellow spots that are well circumscribed and rarely coalesce, forming plaques. 

They occur most often in the mucosal surface of the upper lip, commissures, and the buccal mucosa adjacent to the molar teeth in a symmetrical bilateral pattern.

They are a frequent finding in about 80% of persons of both sexes. These granules are asymptomatic and come to the patient's attention by chance. 


With advancing age, they may become more prominent but should not be a cause for concern. The differential diagnosis includes lichen planus, candidosis, and leukoplakia.

Treatment. No treatment is required.

Oral Hair

Hair and hair follicles are extremely unusual within the oral cavity. Only five cases have been reported so far. There is no satisfactory explanation for the occurrence of oral hair although a developmental anomaly is the most likely possibility. 

All reported patients have been white males. The buccal mucosa, gingiva, and tongue are the preferred areas of hair growth. Oral hair presents as an asymptomatic black hair 0.3-3.5 cm in length. 

The patients are usually anxious and nervous. The presence of oral hair and hair follicles may offer an explanation for the rare occurrence of keratoacanthoma intraorally. The differential diagnosis should be made from traumatically implanted hair and the presence of hair in skin grafts after surgical procedures in the oral cavity.

Laboratory test. Histopathologic examination supports the clinical diagnosis.

Treatment. Surgical removal is recommended.

Congenital Lip Pits

Congenital lip pits represent a rare developmental malformation that may occur alone or in combination with commissural pits, cleft lip, or cleft palate. Clinically, they present as bilateral or unilateral depressions at the vermilion border of the lower lip. A small amount of mucous secretion may accumulate at the depth of the pit.

The lip may be enlarged and swollen.

Treatment of choice is surgical excision, but only for esthetic purposes.


Ankyloglossia, or tongue-tie, is a rare developmental disturbance in which the lingual frenum is short or is attached close to the tip of the tongue. 

In these cases the frenum is often thick and fibrous. Rarely, the condition may occur as a result of fusion between the tongue and the floor of the mouth or the alveolar mucosa. The malformation may cause speech difficulties.

Treatment. Surgical clipping of the frenum corrects the problem.

Cleft Lip

Cleft lip is a developmental malformation that usually involves the upper lip and very rarely the lower lip . It frequently coexists with cleft palate and it rarely occurs alone. The incidence of cleft lip alone or in combination with cleft palate varies from 0.52 to 1.34 per 1000 births.

The disorder may be unilateral or bilateral, complete or incomplete.

Treatment. Plastic surgery as early as possible corrects the esthetic and functional problems.

Cleft Palate

Cleft palate is a developmental malformation due to failure of the two embryonic palatal processes to fuse. The cause remains unknown, although heredity may play a role. Clinically, the patients exhibit a defect at the midline of the palate that may vary in severity. 

Bifid uvula represents a minor expression of cleft palate and may be seen alone or in combination with more severe malformations.

Cleft palate may occur alone or in combination with cleft lip. The incidence of cleft palate alone varies between 0.29 and 0.56 per 1000 births. 

It may occur in the hard or soft palate or both. Serious speech, feeding, and psychologic problems may occur. Treatment. Early surgical correction is recommended.

Bifid Tongue

Bifid tongue is a rare developmental malformation that may appear in complete or incomplete form. The incomplete form is manifested as a deep furrow along the midline of the dorsum of the tongue or as a double ending of the tip of the tongue. 

Usually, it is an asymptomatic disorder requiring no therapy. It may coexist with the oro-facial digital syndrome.

Torus Palatinus

Torus palatinus is a developmental malformation of unknown cause. It is a bony exostosis occurring along the midline of the hard palate. The incidence of torus palatinus is about 20% and appears in the third decade of life, but it also may occur at any age. 

The size of the exostosis varies, and the shape may be spindlelike, lobular, nodular, or even completely irregular. The exostosis is benign and consists of bony tissue covered with normal mucosa, although it may become ulcerated if traumatized. 

Because of its slow growth, the lesion causes no symptoms, and it is usually an incidental finding during physical examination. 

Treatment. No treatment is needed, but problems may be anticipated if a total or partial denture is required.

Double Lip

Double lip is a malformation characterized by a protruding horizontal fold of the inner surface of the upper lip. It may be congenital, but it can also occur as a result of trauma. The abnormality becomes prominent during speech or smiling. Frequently, it may be part of Ascher's syndrome. 

Treatment. Surgical correction may be attempted for esthetic reasons only

°Color Atlas of Oral Diseases
°George Laskaris, D. D. S. , M. D.

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