SQUAMOUS CELL CARCINOMA - ORAL CANCER
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This document discusses squamous cell carcinoma, a type of cancer. It was prepared by Dr. Amitha G, who has a BDS and MDS degree and works in the Department of Oral and Maxillofacial Pathology. The document includes a slide related to squamous cell carcinoma and expresses gratitude to the reader.
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Oral tuberculosis
Tuberculosis is a disease characterized by granulomatous lesions caused by Mycobacterium Tuberculosis. A German scientist Robert Koch discovered the causative organism of TB in 1882.
Since time immemorial, it has been a global health problem. TB has shown a decline in its prevalence globally; however, it is still highly prevalent in Asian countries.
TB is usually overlooked in the differential diagnosis of oral lesions as it is supposed to be a rare entity.
Oral manifestations of TB occur either due to infected sputum or due to hematogenous spread.
TB is an age old disease and has been known to mankind for thousands of years.
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Oral tuberculosis
Tuberculosis is a disease characterized by granulomatous lesions caused by Mycobacterium Tuberculosis. A German scientist Robert Koch discovered the causative organism of TB in 1882.
Since time immemorial, it has been a global health problem. TB has shown a decline in its prevalence globally; however, it is still highly prevalent in Asian countries.
TB is usually overlooked in the differential diagnosis of oral lesions as it is supposed to be a rare entity.
Oral manifestations of TB occur either due to infected sputum or due to hematogenous spread.
TB is an age old disease and has been known to mankind for thousands of years.
Juvenile Ossifying Fibroma
Juvenile Ossifying Fibroma
Two patterns
Trabecular
Psammomatoid,
Trabecular form
Seen in younger patients.
Mean age is approximately 11 years,
Psammomatoid form
Appears outside of the jaws
70% arising in the orbital and frontal bones and paranasal sinuses.
Clinical Features
Early to late childhood
Maxilla > Mandible
Singular, slow-growing, painless swelling
Overgrowth of tissue that occurs centrally in the jaws
May involve impacted or unerupted teeth disfiguring
Increased level of serum alkaline phosphatase
Severe maloccusion
Aggressive form:
Symptomatic if traumatized
Ulcerated
Maxilla lesion may interfere with sight and breathingHistologic Features:
Psammomatoid form
Abundant cellular fibrous connective tissue in a whorled pattern
Proliferating fibroblasts form spicules of bone and
Cementum at maturity the bone may be somewhat normal,
Areas of hemorrhage and small clusters of multinucleated giant cells,
Trabecular variant
shows irregular strands of highly cellular osteoid encasing plump and irregular osteocytes.
The psammomatoid pattern forms concentric lamellated and spherical ossicles that vary in shape and typically have basophilic centers with peripheral eosinophilic osteoid rims
Radiographic Features: Radiolucent or mixed radiolucent and radiopaque appearance (ground glass),
Lamina dura is usually obscured and the cortical plates thinned
Treatment and Prognosis:Management and prognosis are uncertain.
Smaller lesions, complete local excision or thorough curettage appears adequate,
Rapidly growing lesions, wider resection may be required
Recurrence rates of 30% to 58%
Malignant transformation has not been documented.
Fibro Osseous Lesions
Fibro-osseous lesions of the jaws
Fibrous dysplasia
Cemento-osseous dysplasia
Focal cemento-osseous dysplasia
Periapical cemento-osseous dysplasia
Florid cemento-osseous dysplasia
Ossifying fibroma
Juvenile aggressive ossifying fibroma
Cherubism
Fibro-osseous lesions (FOL) are characterized by replacement of normal bone architecture by collagen fibers and fibroblasts containing calcified tissue.
They include a wide variety of lesions of developmental, dysplastic and neoplastic origins with clinical and radiographic presentation and behavior.
Because of the histological similarities between diverse diseases, proper diagnosis requires correlation of history, clinical and radiographic findings.Fibrous Dysplasia
2. Reactive (dysplastic lesions arising in the tooth-bearing area (presumably of periodontal origin).
a. Periapical cemento-osseous dysplasia
b. Focal cemento-osseous dysplasia
c. Florid cemento-osseous dysplasia
3. Fibro-osseous neoplasms (widely designated as cementifying fibroma, ossifying fibroma or cemento-ossifying fibroma.Bone dysplasias
a. Fibrous dyspla i. Monostotic ii. Polyostotic
iii. Polyostotic with endocrinopathy (McCune-Albright)
iv Osteofibrous dysplasia
b. Osteitis deformans c. Pagetoid heritable bone dysplasias of childhood
d. Segmental odontomaxillary dysplasia
2. Cemento-osseous dysplasias
a. Focal cemento-osseous dysplasia b. Florid cemento-osseous dysplasia
3.Inflammatory/reactive processes
a. Focal sclerosing osteomyelitis b. Diffuse sclerosing osteomyelitis
c. Proliferative periostitis
4. Metabolic Disease: hyperparathyroidism
5. Neoplastic lesions (Ossifying fibromas)
a. Ossifying fibroma b. Hyperparathyroidism jaw lesion syndrome
c. Juvenile ossifying fibroma i. Trabecular type ii. Psammomatoid type
d. Gigantiform cementomas
Odontogenic cysts
A cyst is an epithelium-lined sac containing fluid or semisolid material. In the formation of a cyst, the epithelial cells first proliferate and later undergo degeneration and liquefaction. The liquefied material exerts equal pressure on the walls of the cyst from within. Cysts grow by expansion and thus displace the adjacent teeth by pressure. May can produce expansion of the cortical bone. On a radiograph, the radiolucency of a cyst is usually bordered by a radiopaque periphery of dense sclerotic bone. The radiolucency may be unilocular or multilocular. Odontogenic cysts are those which arise from the epithelium associated with the development of teeth. The source of epithelium is from the enamel organ, the reduced enamel epithelium, the cell rests of Malassez or the remnants of the dental lamina.
Saliva as a Diagnostic Tool
Definition
General properties
Composition
Function of saliva
Formation of saliva
Method for collecting saliva
Advantages
Limitations
Analysis of saliva done for the diagnosis of systemic disease
Definition:
by Stedmann’s & Lipincott medical dictionary.
A clear, tasteless, odourless, slightly acidic (pH 6.8) viscous fluid, consisting of the secretion from the parotid, sublingual, submandibular salivary glands and the mucous glands of the oral cavity.
General properties
Volume: 1000 to 1500 mL of saliva is secreted per day and, it is approximately about 1 ml/ minute.
Contribution by each major salivary gland is:
i. Parotid glands: 25%
ii. Submandibular glands: 70%
iii. Sublingual glands: 5%.
Reaction: Mixed saliva from all the glands is slightly acidic with pH of 6.35 to 6.85.
Specific gravity: It ranges between 1.002 and 1.012.
Tonicity: Saliva is hypotonSalivary flow
The average person produces approximately 0.5 L – 1.5 L per day
Unstimulated Flow (resting salivary flow―no external stimulus)
Typically 0.2 mL – 0.3 mL per minute
Stimulated Flow (response to a stimulus, usually taste, chewing, or medication [eg, at mealtime])
Typically 1.5 mL – 2 mL per minute
TONGUE ppt
INTRODUCTION
Tongue is a muscular organ
Situated in the floor of the mouth
FUNCTION
Taste
Speech
Mastication
Deglutition
EXTERNAL FEATURES
Tongue has
A Root
A tip
A body
ROOT
Is attached to the mandible and soft palate above and hyoid bone below.
These attachments prevent the swallowing of the tongue.
In between the 2 bones it is related to the geniohyoid and mylohyoid muscles.
TIP
Of the tongue forms the anterior free end which lies behind the upper incisor teeth.
BODY
Has
A curved upper surface or dorsum
An inferior or ventral surface MUSCLES OF THE TONGUE
Middle fibrous septum divides the tongue into right and left halves.
Intrinsic muscles
Superior longitudinal
Inferior longitudinal
Transverse
Vertical
Extrinsic muscles
Genioglossus
Hyoglossus
Styloglossus
Palatoglossus
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Juvenile Ossifying Fibroma
Juvenile Ossifying Fibroma
Two patterns
Trabecular
Psammomatoid,
Trabecular form
Seen in younger patients.
Mean age is approximately 11 years,
Psammomatoid form
Appears outside of the jaws
70% arising in the orbital and frontal bones and paranasal sinuses.
Clinical Features
Early to late childhood
Maxilla > Mandible
Singular, slow-growing, painless swelling
Overgrowth of tissue that occurs centrally in the jaws
May involve impacted or unerupted teeth disfiguring
Increased level of serum alkaline phosphatase
Severe maloccusion
Aggressive form:
Symptomatic if traumatized
Ulcerated
Maxilla lesion may interfere with sight and breathingHistologic Features:
Psammomatoid form
Abundant cellular fibrous connective tissue in a whorled pattern
Proliferating fibroblasts form spicules of bone and
Cementum at maturity the bone may be somewhat normal,
Areas of hemorrhage and small clusters of multinucleated giant cells,
Trabecular variant
shows irregular strands of highly cellular osteoid encasing plump and irregular osteocytes.
The psammomatoid pattern forms concentric lamellated and spherical ossicles that vary in shape and typically have basophilic centers with peripheral eosinophilic osteoid rims
Radiographic Features: Radiolucent or mixed radiolucent and radiopaque appearance (ground glass),
Lamina dura is usually obscured and the cortical plates thinned
Treatment and Prognosis:Management and prognosis are uncertain.
Smaller lesions, complete local excision or thorough curettage appears adequate,
Rapidly growing lesions, wider resection may be required
Recurrence rates of 30% to 58%
Malignant transformation has not been documented.
Fibro Osseous Lesions
Fibro-osseous lesions of the jaws
Fibrous dysplasia
Cemento-osseous dysplasia
Focal cemento-osseous dysplasia
Periapical cemento-osseous dysplasia
Florid cemento-osseous dysplasia
Ossifying fibroma
Juvenile aggressive ossifying fibroma
Cherubism
Fibro-osseous lesions (FOL) are characterized by replacement of normal bone architecture by collagen fibers and fibroblasts containing calcified tissue.
They include a wide variety of lesions of developmental, dysplastic and neoplastic origins with clinical and radiographic presentation and behavior.
Because of the histological similarities between diverse diseases, proper diagnosis requires correlation of history, clinical and radiographic findings.Fibrous Dysplasia
2. Reactive (dysplastic lesions arising in the tooth-bearing area (presumably of periodontal origin).
a. Periapical cemento-osseous dysplasia
b. Focal cemento-osseous dysplasia
c. Florid cemento-osseous dysplasia
3. Fibro-osseous neoplasms (widely designated as cementifying fibroma, ossifying fibroma or cemento-ossifying fibroma.Bone dysplasias
a. Fibrous dyspla i. Monostotic ii. Polyostotic
iii. Polyostotic with endocrinopathy (McCune-Albright)
iv Osteofibrous dysplasia
b. Osteitis deformans c. Pagetoid heritable bone dysplasias of childhood
d. Segmental odontomaxillary dysplasia
2. Cemento-osseous dysplasias
a. Focal cemento-osseous dysplasia b. Florid cemento-osseous dysplasia
3.Inflammatory/reactive processes
a. Focal sclerosing osteomyelitis b. Diffuse sclerosing osteomyelitis
c. Proliferative periostitis
4. Metabolic Disease: hyperparathyroidism
5. Neoplastic lesions (Ossifying fibromas)
a. Ossifying fibroma b. Hyperparathyroidism jaw lesion syndrome
c. Juvenile ossifying fibroma i. Trabecular type ii. Psammomatoid type
d. Gigantiform cementomas
Odontogenic cysts
A cyst is an epithelium-lined sac containing fluid or semisolid material. In the formation of a cyst, the epithelial cells first proliferate and later undergo degeneration and liquefaction. The liquefied material exerts equal pressure on the walls of the cyst from within. Cysts grow by expansion and thus displace the adjacent teeth by pressure. May can produce expansion of the cortical bone. On a radiograph, the radiolucency of a cyst is usually bordered by a radiopaque periphery of dense sclerotic bone. The radiolucency may be unilocular or multilocular. Odontogenic cysts are those which arise from the epithelium associated with the development of teeth. The source of epithelium is from the enamel organ, the reduced enamel epithelium, the cell rests of Malassez or the remnants of the dental lamina.
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More from oral and maxillofacial pathology
Saliva as a Diagnostic Tool
Definition
General properties
Composition
Function of saliva
Formation of saliva
Method for collecting saliva
Advantages
Limitations
Analysis of saliva done for the diagnosis of systemic disease
Definition:
by Stedmann’s & Lipincott medical dictionary.
A clear, tasteless, odourless, slightly acidic (pH 6.8) viscous fluid, consisting of the secretion from the parotid, sublingual, submandibular salivary glands and the mucous glands of the oral cavity.
General properties
Volume: 1000 to 1500 mL of saliva is secreted per day and, it is approximately about 1 ml/ minute.
Contribution by each major salivary gland is:
i. Parotid glands: 25%
ii. Submandibular glands: 70%
iii. Sublingual glands: 5%.
Reaction: Mixed saliva from all the glands is slightly acidic with pH of 6.35 to 6.85.
Specific gravity: It ranges between 1.002 and 1.012.
Tonicity: Saliva is hypotonSalivary flow
The average person produces approximately 0.5 L – 1.5 L per day
Unstimulated Flow (resting salivary flow―no external stimulus)
Typically 0.2 mL – 0.3 mL per minute
Stimulated Flow (response to a stimulus, usually taste, chewing, or medication [eg, at mealtime])
Typically 1.5 mL – 2 mL per minute
TONGUE ppt
INTRODUCTION
Tongue is a muscular organ
Situated in the floor of the mouth
FUNCTION
Taste
Speech
Mastication
Deglutition
EXTERNAL FEATURES
Tongue has
A Root
A tip
A body
ROOT
Is attached to the mandible and soft palate above and hyoid bone below.
These attachments prevent the swallowing of the tongue.
In between the 2 bones it is related to the geniohyoid and mylohyoid muscles.
TIP
Of the tongue forms the anterior free end which lies behind the upper incisor teeth.
BODY
Has
A curved upper surface or dorsum
An inferior or ventral surface MUSCLES OF THE TONGUE
Middle fibrous septum divides the tongue into right and left halves.
Intrinsic muscles
Superior longitudinal
Inferior longitudinal
Transverse
Vertical
Extrinsic muscles
Genioglossus
Hyoglossus
Styloglossus
Palatoglossus
Development of Palate and Tongue PPT
Central face begins to develop by 4th week, when olfactory placodes appear on both sides of the frontonasal process.
Gradually both placodes develop to form the median and lateral nasal process.
Upper lip is formed by 6th week by fusion of two median nasal processes in midline and the maxilllary process of the 1st branchial arch.
PRE-NATAL GROWTH AND DEVELOPMENT OF PALATEFormation of primary and secondary palate
Elevation of palatal shelves
Fusion of palatal shelves
SQUAMOUS CELL CARCINOMA - ORAL CANCER PPT
Introduction
Epidemiology
Etiology
Manifestations
TNM staging
Squamous cell carcinoma is defined as malignant epithelial neoplasm exhibiting squamous differentiation as characterised by the formation of keratin and/or the presence of intercellular bridges.
( Pindborg et al, 1997).
Levels of Lymph Nodes
Occipital (2-4)
Superior nuchal line between sternocleidomastoid and trapezius
Occipital part of scalp
Superficial cervical lymph nodes
Accessary lymph nodes
Mastoid (1-3)
Superficial to sternocleidomastoid insertion
Posterior parietal scalp
Skin of ear, posterior external acoustic meatus
Superior deep cervical nodes Accessary lymph nodes
Preauricular (2-3)
Anterior to ear over parotid fascia
Drains areas supplied by superficial temporal artery
Anterior parietal scalp
Anterior surface of ear
Superior deep cervical lymph nodes
Parotid (up to 10 or more)
About parotid gland and under parotid fascia
Deep to parotid gland
External acoustic meatus
Skin of frontal and temporal regions
Eyelids, tympanic cavity
Cheek, nose (posterior palate)
Superior deep cervical lymph nodes
Facial
Superficial(up to 12)
Maxillary
Buccal
Mandibular
Distributed along course of facial artery and vein
Skin and mucous membranes of eyelids, nose, cheek
Submandibular nodes
Deep
Distributed along course of maxillary artery lateral to lateral pterygoid muscle
Temporal and infratemporal fossa
Nasal pharynx
Superior deep cervical lymph nodesSuperficial
Anterior jugular vein between superficial cervical fascia and infrahyoid fascia
Skin, muscles, and viscera of infrahyoid region of neck
Superior deep cervical lymph nodes
Deep
Between viscera of neck and investing layer of deep cervical fascia
Adjoining parts of trachea, larynx, thyroid gland
Superior deep cervical lymph nodes
Anterior cervical/Superficial
Submental (2-3)
Submental triangle
Chin
Medial part of lower lip
Lower incisor teeth and gingiva
Tip of tongue
Cheeks
Submandibular lymph node to jugulo-omohyoid lymph node and superior deep cervical lymph nodes
DEGLUTTITION (SWALLOWING)
Is a phenomenon of reflex sequence of muscle contractions that propels the ingested materials and pooled saliva from the mouth to the stomach.
PATTERNS
Infantile (visceral) swallow
Adult/mature swallow
ADULT SWALLOWING
Is composed of 4 stages
Voluntary
Preparatory phase
Oral or buccal
Involuntary: Controlled By Medulla and Lower Pons
Pharyngeal
b. Oesophageal
TONGUE
• Function
• External features
• Papillae of tongue
• Muscles of the tongue
• Arterial supply
• Venous drainage
• Lymphatic drainage
• Nerve supply
• Histology
• Development of tongue -
Intrinsic muscles
Superior longitudinal
Inferior longitudinal
Transverse
Vertical
- Extrinsic muscles
Genioglossus
Hyoglossus
Styloglossus
Palatoglossus
1. Vallate or circumvallate papillae
These are large in size 1-2mm in diameter and are 8-12 in number.
They are situated immediately in front of the sulcus terminalis.
Each papillae are cylindrical projection surrounded by a circular sulcus.
The walls of the papilla are raised above the surface.
2. Fungiform papillae
Are numerous
Near the tip and margins of the tongue, but some of them are scattered over the dorsum.
These are smaller than the vallate papillae but larger than the filliform papillae.
Each papilla consists of a narrow pedicle and a large rounded head.
They are distinguished by their bright red colour.
3. Filliform papillae
Conical papilla
Cover the presulcal area of the dorsum of the tongue and gives it a characteristic velvety appearance.
They are the smallest and most numerous of the lingual papillae.
Each are pointed and covered with keratin
The apex is often split into filamentous processes.
Trigeminal Nerve
Fifth cranial nerve
Have a large sensory root and a small motor root.
Motor root arises – arises from the lateral aspect of lower pons (cranially) the motor root cross the apex of the petrous temporal bone beneath the superior petrosal sinus, to enter the middle cranial fossa.
Sensory root – arises from the lateral aspect of lower pons (caudally).
RELATIONS
Medially
(a) internal carotid artery
(b) posterior part of cavernous sinus
Laterally - middle meningeal artery
Superiorly - parahippocampal gyrus
Inferiorly
motor root of trigeminal nerve
(b) greater petrosal nerve
(c) apex of the petrous temporal bone
(d) foramen lacerum.OPTHALIMIC DIVISION
Terminal branches of Ophthalmic division of trigeminal nerve, are
1. Frontal
Supratrochlear
Supraorbital
2. Nasociliary
Branch of ciliray ganglion
2-3 long ciliary nerves
Posterior ethmoidal
Infratrochlear
Anterior ethmoidal
3. Lacrimal
Branches
From main trunk
Meningeal branch
Nerve to medial pterygoid
From the anterior trunk
Sensory branch
Buccal nerve
Motor branch
Masseteric
Deep temporal nerve
Nerve to lateral pterygoid
From the posterior trunk
Auriculotemporal
Lingual
Inferior alveolar nerves
PAGETS DISEASE
COTTON-WOOL APPEARANCE
Active phase showing disorganised bone architecture with numerous, large, multinucleated osteoclasts. The stroma is vascular and fibrous
The late phase features thick trabeculae with a prominent mosaic pattern of prominent, hematoxyphilic, cement lines at the interfaces of episodes of resorption followed by deposition.
Paget disease showing very prominent blue cement lines. The lamellae are arranged haphazardly giving an overall effect of a jigsaw puzzle.
Dental Caries
Hume- “caries is essentially a progressive loss by acid dissolution of the apatite component of the enamel then the dentin or of the cementum then dentin.”
According to location:
Pit or Fissure caries
Smooth Surface caries
According to rapidity:
Acute
Chronic
Arrested
According to occurrence:
Primary (Virgin) caries
Secondary (Recurrent) caries
According to the site of occurrence:
Enamel caries
Cemental caries.
Acidogenic [ Miller’s Chemico-parasitic] theory.
Proteolytic theory.
Proteolysis- chelation theory.
Lymph Nodes
The lymphatic system has three functions:
Fluid recovery.
Immunity
Lipid absorption
The lymphatic vessels of the small intestine receive the special designation of lacteals or chyliferous vessels.
The components of the lymphatic system are :-
lymph, the recovered fluid;
Lymphatic vessels, which transport the lymph;
Lymphatic tissue, composed of aggregates of lymphocytes and macrophages that populate many organs of the body; and
Lymphatic organs, in which these cells are especially concentrated and which are set off from surrounding organs by connective tissue capsules.
Research Microscopes
A Magnified Microscopic Image Is Worth More Than A Thousand Words.
DARK FIELD MICROSCOPE
PHASE CONTRAST MICROSCOPY
POLARIZED LIGHT MICROSCOPY
FLUORESCENT MICROSCOPY
STEREO MICROSCOPE
ELECTRON MICROSCOPY
Maxillary Second Premolar
Maxillary Second Premolar
the maxillary first premolar in function
Less angular ,rounded crown in all aspects.
Single root
Smaller crown cervico occlusally
Root length is as great or greater
BUCCAL ASPECT
Not as long as that of the first premolar
Less pointed
Mesial slope is
shorter than the distal slope
Buccal ridge of the crown may not be so prominent whencompared with the first premolarLINGUAL ASPECT
Lingual cusp is longer making the crown longer on the lingual sideMESIAL ASPECT
Cusps of second premolar are shorter with the buccal and lingual cusps more nearly the same length
Greater distance between cusp tips-that widens the occlusal surface buccolingually
No developmental depression on the mesial surface of the crown as on the first premolar
Crown surface is convex instead
No deep dev. Groove crossing the mesial marginal ridgeOCCLUSAL ASPECT
Outline of the crown is more rounded or oval rather than angular
Central dev. groove is shorter and more irregular
Tendency toward multiple supplementary grooves radiating from the central groove that may extend out to the cusp ridges
Makes for an irregular occlusal surface and gives a very wrinkled appearance
Mandibular Canine
First evidence of calcification : 4-5 months
Enamel completed : 6-7 yr
Eruption : 9-10yrs
Root completed : 12-14yrs
Maxillary Central Incisor
Centered in the maxilla, one on either side of median line, with mesial surface of each in contact with mesial surface of other
Two in number
Larger than the lateral incisor
These teeth supplement each other in function, and they are similar anatomically
Shearing or cutting teeth
Major function is to punch and cut food material during the process of mastication
These teeth have incisal ridges or edges rather than
cusps such as are found on canines & posterior teeth
First evidence of calcification
Crown completion
Eruption
Root completion
3-4 months
4-5 years
7-8 years
10-11 years
ENAMEL
PHYSICAL PROPERTIES
CHEMICAL PROPERTIES
STRUCTURE OF ENAMEL
DEVELOPMENT OF ENAMEL
EPITHELIAL ENAMEL ORGAN
AMELOGENESIS
LIFE CYCLE OF AMELOBLASTS
AGE CHANGES IN ENAMEL
DEFECTS OF AMELOGENESIS
CLINICAL IMPLICATIONS
Developmental Of The Mandible
PRENATAL GROWTH OF MANDIBLE
Occurs between the 4th and 7th week of intrauterine life.
4th week of intrauterine life
Formation of the head fold
Following which the developing brain and the pericardium form 2 prominent bulges on the ventral aspect of the embryo.
The 2 bulges are separated from each other by a shallow depression called stomatoedum (corresponding to the primitive mouth).
Floor of the stomatodeum is formed by the Buccopharyngeal membrane, which separates the stomatodeum from the foregut.Soon, mesoderm covering the developing forebrain proliferates, and forms a downward projection that overlaps the upper part of the stomatodeum – this downward projection is called frontonasal process.
Developmental Disturbances of The Face
Since the formation of various parts of the face involves fusion of diverse components.
Occasionally this fusion can be incomplete give rise to various anomalies
MANDIBULOFACIAL DYSOSTOSIS OR FIRST ARCH SYNDROME
- Entire first arch may remain underdeveloped on one or both sides, affecting
Lower eyelid
Maxilla
Mandible
External ear.
- Prominence of the cheek is absent
- Ear is displaced ventrally and caudally
Development of Face
Face develops in humans between 4th – 10th week of intrauterine life.
prenatal growth of the maxilla
DEVELOPMENT OF UPPER LIP
Development of lower lip
Development of nose
hare lip
OBLIQUE FACIAL CLEFT
macrostomia
lateral facial cleft
microstomia
TMJ- 3
INFLAMMATORY DISTURBANCES
Arthritis
Infectious arthritis (bacterial, viral and fungal)
Rheumatoid arthritis
Osteoarthritis or degenerative joint disease
NEOPLASTIC DISTURBANCES
Benign : osteoma, chondroma
Malignant : primary, metastatic
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In this book, we use conservation of energy techniques on a fluid element to derive the Modified Bernoulli equation of flow with viscous or friction effects. We derive the general equation of flow/ velocity and then from this we derive the Pouiselle flow equation, the transition flow equation and the turbulent flow equation. In the situations where there are no viscous effects , the equation reduces to the Bernoulli equation. From experimental results, we are able to include other terms in the Bernoulli equation. We also look at cases where pressure gradients exist. We use the Modified Bernoulli equation to derive equations of flow rate for pipes of different cross sectional areas connected together. We also extend our techniques of energy conservation to a sphere falling in a viscous medium under the effect of gravity. We demonstrate Stokes equation of terminal velocity and turbulent flow equation. We look at a way of calculating the time taken for a body to fall in a viscous medium. We also look at the general equation of terminal velocity.
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