Micrognathia Small mandible (Figures 34-7 and 34-8) | Can occur in isolation or as part of syndrome Pierre Robin Sequence (PRS) occurs in about 1/8,500 births | | | Conservative—prone positioning or nasal airways Surgical treatment: tongue-lip adhesion, tracheostomy or mandibular distraction osteogenesis |
Ankyloglossia Short, fibrous lingual frenulum or a highly attached genioglossus muscle (Figure 34-9) | | “Tongue-tie” Feeding difficulties Speech articulation difficulties Tongue cannot contact the hard palate Cannot protrude more than 1–2 mm past the teeth | | |
Macroglossia Enlargement of the tongue | Associated with: | Difficulty feeding, stridor, airway obstruction Diffuse enlargement of the tongue | | |
Lingual thyroid Failure of the thyroid to descend from the foramen cecum8 | 1:4–10,000 Female:Male = 4:1 | Presents in early childhood, adolescence or menopause Airway obstruction Pink, firm mass at base of tongue Dysphagia, dysphonia or dyspnea | U/S to assess for other areas of ectopic thyroid (In 75% of patients, this is the only functioning gland) CT, MRI and technetium Tc-99m can also be used Thyroid function tests; 50 percent of patients will be hypothyroid | Debated - some authors argue for excision due to malignant potential. If asymptomatic, may choose to follow clinically Treat hormone dysfunction medically, as needed |
Natal Teeth Infant is born with a tooth or teeth9 | | Neonate will have normal appearing tooth Function and structure of the tooth may not be normal Can be either early eruption or supernumerary | | |
Congenital Epulis Granular cell tumor of the gingiva; benign mesenchymal tumor9,10 (Figure 34-10) | | Firm, mucosal covered lesion, more commonly along the maxillary gingival Airway obstruction Maxillary to mandibular ratio is 3:1 | CT demonstrates regular, prominent margins without associated bony tissue Consult to pediatric ENT or oral surgeon | |
Dermoid Cystic lesion of the floor of mouth comprised of skin appendages with a squamous epithelial lining11 (Figure 34-11) | | Midline slow growing mass Cystic lesion of the floor of the mouth, rarely in the tongue Can occur superior or inferior to the mylohyoid muscle | CT scan or ultrasound Consult pediatric ENT | |