This document describes several normal anatomical variants and developmental anomalies that can occur in the oral cavity. It discusses conditions like linea alba, leukoedema, oral pigmentation, lingual tonsils, and Fordyce's granules as normal variants. Developmental anomalies covered include ankyloglossia, cleft lip, cleft palate, bifid tongue, double lip, torus palatinus, torus mandibularis, multiple exostoses, and fibrous developmental malformation. Each condition is briefly described in terms of its clinical presentation, incidence, treatment if needed, and differential diagnosis.

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ORAL MEDICINE Dr. Ali Al-Ibrahemy
NORMAL ANATOMICAL VARIANTS
1. Linea Alba
Linea alba is a normal linear elevation of the buccal mucosa extending
from the corner of the mouth to the third molars at the occlusal line. Clinically,
it present as a bilateral linear elevationwith normal or slightly whitish color and
normal consistency on palpation. It occurs more often in obese persons,
habitually cheek biters. The oral mucosa is slightly compressed and adjusts to
the shape of the occlusal line of the teeth.
2. Leukoedema
Leukoedema is a normal anatomic variant of the oral mucosa due to
increase thickness of the epithelium and increase of intracellular edema. As a
rule, it occurs bilaterally and involves most of the buccal mucosa and rarely the
lips and tongue. Clinically, the mucosa has an opalescent or grayish-white color
with slight wrinkling, which disappears if the mucosa is distended by pulling or
stretching of the cheek. Leukoedema has normal consistencyonpalpation, and it
should not be confused with the leukoplakia or lichen planus.
3. Normal Oral Pigmentation
Melanin is a normal skin and oral mucosa pigment produced by
melanocytes. Increased melanin deposition in the oral mucosa may occur in
various diseases, however areas of dark discoloration may often be a normal
finding in black or dark-skinnedpersons. The degree ofpigmentation of the skin
and oral mucosa is not necessarily significant. In healthy persons there may be
clinically asymptomatic black or brown areas of varying size and distribution in
the oral cavity, usually on the gingiva, buccal mucosa, palate, and less often on
the tongue, floor of the mouth, and lips. The pigmentation is more prominent in
areas of pressure or friction and becomes more intense with aging. The
differential diagnosis includes Addison’s disease, pigmented nevus, melanoma,

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smoker’s melanosis, heavy metal deposition, pigmentation caused by drugs,
Peutz-Jeghers syndrome, and Albright’s syndrome.
4. Lingual Tonsils
Lingual tonsil is large foliate papilla on the side of the tongue which may
be mistaken for a lesion. This tonsil enlarged with viral infection and
occasionally noted by patient. It appear clinically as round smooth well defined
at the lateral side of the tongue covered by normal color mucosa.
DEVELOPMENTAL ANOMALIES
1. 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 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.
2. Congenital Lip Pits
Congenitallip pits representa 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 is surgical
excision for esthetic purposes.

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3. Ankyloglossia
Ankyloglossia, ortongue 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
casesthe 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. This malformation may cause speech difficulties. Treatment is surgical
cutting of the frenum corrects the problem.
4. 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.
5. 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 psychologicalproblems may occur. Treatmentis early surgical correction is
recommended.
6. 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

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the tip of the tongue. Usually, it is an asymptomatic disorder requiring no
therapy. It may coexist with the oral-facial digital syndrome.
7. 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
occuras a result of trauma. The abnormality becomes prominent during speech
or smiling. Frequently, it may be part of Ascher's syndrome. Treatment is
surgical correction may be attempted for esthetic reasons only.
8. 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
spindle like, lobular, nodular, or even completely irregular. The exostosis is
benign and consists of bony tissue covered with normal mucosa, although it may
become ulceratedif traumatized. Becauseofits slow growth, the lesioncauses no
symptoms, and it is usually an incidental finding during physical examination.
No treatment is needed, but problems may be anticipated if a total or partial
denture is required.
9. Torus mandibularis
Torus mandibularis is an exostosis covered with normal mucosa that
appears on the lingual surfaces of the mandible, usually in the area adjacent to
the bicuspids. The incidence of torus mandibularis is about 6%. Bilateral
exostoses occur in 80% of the cases. Clinically, it is an asymptomatic growth
that varies in size and shape. Treatment. Surgicalremoval of torus mandibularis
is not indicated, but difficulties may be encountered if a denture has to be
constructed.

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10. Multiple Exostoses
Multiple exostoses are rare and may occur on the buccal surface of the
maxilla and the mandible. Clinically, they appear as multiple asymptomatic
small nodular, bony elevations below the muccolabial fold covered with normal
mucosa. The cause is unknown and the lesions are benign, requiring no therapy.
Problems may be encountered during denture preparation.
11. Fibrous Developmental Malformation
Fibrous developmental malformation is a rare developmental disorder
consisting of fibrous overgrowth that usually occurs on the maxillary alveolar
tuberosity. It appears as a bilateral symmetrical painless mass with a smooth
surface , firm to palpation , and normal or pale color. Commonly , the
malformation develops during the eruption of the teeth and may cover their
crowns. The mass is firmly attachedto the underlying bone but on occasion may
be movable. The classic sites of development are the maxillary alveolar
tuberosity region, but rarely it may also appear in the retromolar region of the
mandible and on the entire attached gingiva. Treatment is surgical excision is
required if mechanical problems exist.