The face

and mouth
Development : from 5 process

1. The frontal nasal

2. Two maxillary
3. Two mandibular
Congenital anomalis

– Facial cleft : failure of union at the site of the nose

– Cleft lip ( hare-lip) , cleft palate
– Macrostoma , microstoma
– Prearicular sinus
– Dermoid cysts
Dermoid cyst ( 4 types )

1. Sequestration ( congenital )
A piece of epithelium which dips in the subcutaneous tissue
at the lines of fusion of the body at :
A. Middle line anteriorly and posteriorly
B. In lines of fusion in the face

N.B in the limbs there are no lines of fusion

– Small cyst lined by squamous epithelium contains
sebaceous material , covered by outer layer of fibrous
tissue
– May have :
– Infection abscess
– Ext. angular dermoid in the face may have
connection to the inside of the cranium ( hour – glass
dermoid ) may cause cerebral compression
Most common sites in the face

– External angular dermoid

– Internal angular dermoid
– Around the auricle ( behind – front )
– In the neck in the upper , lower part, sublingual ,
suprasternal .
Small ( up to one inch painless
swelling )

– Well defined , smooth , oval , cystic , no

tender , mobile , not comprisable or
translucent
– Treated by excision
2. Implantation dermoid cyst

– In workers who sew or work with fine

pointed tools
– Commoner in the thumb
3. Tubulodermoid

– Thyroglossal cyst , branchial cyst , cysts of

process vaginalis
4. Tertatomatous cysts

– Teratoma of internal organs like : ovary , testes ,

mesentery, mediastinum
5. Inclusion dermoid

– During closure of a cavity due to inclusion of the

epidermis
Acute infection of the face

– Boil ( furuncle ) , abscess , carbuncle

– Dangerous area of the face , because the facial veins are
connected to intracranial venous sinuses ( cavernous
sinus ) by the emissary veins cavernous sinus
thrombosis
 Sebaceous cyst (epidermal cyst )

– Disease of the sebaceous gland by dried sebaceous material

or scaring retention cyst commoner at the scalp , face ,
back of the neck , anywhere except palms and soles
– The duct is obliterated and attached to the skin by one point
(black ) called the punctum
– Complications :
Infection , ulceration (cock’s peculiar tumour ) , sebaceous horn , scalp
area of boldness
Treatment : excision
Tumours of the face

Benign :
1. Heamngioma : face is a very commoner site
Vascular malformation may be capillary , cavernous ,
arterial
2. Lipoma of the face

A. Subcutaneous type
Give rise to well defined lobulated painless swelling with slippery
edge , and attached to overlying skin by stands

B. The subfascial type

Commoner in the forehead and lies under the epicranial aponeurosis

Treatment of both is excision

3. Papiloma

– Commoner on the mucous membrane of the lip and tongue , may

be in the skin
– Pedunculated , lined by squamous epithelium , soft , mobile liable
to turn to malignant , vascular
– Treatment is excision with a wide base by surgery or diathermy )
– commoner in the tongue predisposed by chronic irritation , in tip ,
sides or dorsum
4. Rodent ulcer (basal cell carcinoma)

– Locally malignant tumour

– The face is a commoner site for it and it’s the commoner tumour of
the face
– However it can occur where squamous epithelium is present . Occurs
at old age , males more than females
– It predisposed by irritation of the actinic sun rays especially in fair skin
– Started as small papule , pink , covered by epithelium scratched
by the patient crust and so on small ulcer grows
slow but continuous eat up any tissue in its way, may open in the
nasal , maxillary cavities , orbit , cranial cavity
– It’s commoner in the inner , the outer canthus of the eye
then nasolabial fold , in general it occurs commonly in
the face above a line drawn from the angle of the mouth
to the lobule of the ear
– May be small , moderate , large , rounded , oval or
irregular , growing form one side and healing in another
side ( false healing )
– Edge rolled in and beaded due to some fibrosis and feels
indurated
– Floor covered by scabs , crusts , areas of heamorrhage
and suppuration
– Base is indurated
– Discharge , bloody and necrotic tissue
– Lymph nodes : never affected by secondaries but may
enlarged due to secondary infection or the ulcer turns
malignant
– Solid rounded masses with intervening stroma of fibrous
tissue , single peripheral layer of columnar cell the inner
cells are smaller and arranged in polyhedral shape , no
cell nests
– Complications : spread , transformation to epithlioma ,
infection ,heamorrahge
– Types : superficial , deep or excavating , hypertrophic or
fungating type
– Treatment excision with safety margin , radiation or both
5. Epithelioma

– Usually in old age

– The true cause is unknown
– In lips , tongue , inside mouth sepsis , spices , smoking , syphilis
and spirits
– In the skin of the face , chronic irritation specially by sun rays
– Papilloma , chronic ulcers , scars of burns , radiations , lupus
vulgaries , rodent ulcer
– Commoner site in the face is lower lip , cheek , pinna of ear
Epithelioma of the lip

– Begin at the junction of the outer and middle third of the lower lip
– May be in the upper lip
– May be malignant ulcer or fissure , nodule , cauliflower mass or
diffuse infiltration (woody lip)
– Presented as malignant ulcer
– Surgical excision with lymph nodes or irradiation
Lesions of the lips

– Wounds , cracks , ulcers , malignancy ,

macrochilia ,
Lesions of the cheek

– Ulcers similar to those of the lip and tongue

– Carcinoma : like that of the lip but more
malignant
Lesions of floor of the mouth

– Mucous cyst : obstruction of the ducts of the small mucous

glands which are scaled under the mucous membrane ,
translucent , painless
– Treatment : excision
– ranula : from the scattered mucous glands in floor of the
mouth
– Treatment : excision

– Sublingual dermoid : excision

Lesion of the tounge

1. Congenital
– Bifid tongue
– Tongue tie
– Congenital of fissures

2. Macroglossia : congenital , inflammatory , neoplastic ,

endocrinal .
 3. Wounds of the tounge

– Trauma , epilepsy , after anasethia , dental instruments

– Wounds may be small , large , any shape and extend , even a
part may be completely separated or hanging severe
heamorrhage
1. First aid : tongue pulled forward to kink the lingual vessels
against the jaw the jaw so stop the heamorrahge
2. Sutures
3. Post operative mouth washes
Benign tumours of the tongue

– Papilloma , haemangiomas ,
lymphangioma , lipoma , neurofibroma