Pits (Fistulas)
Commissural lip pits
– 12-20% of adults; 0.2-0.7% in children
– Males > Females
– Unilateral or bilateral
– Accentuated with age? or not developmental?
– Failure of processes to fuse
– Blind fistulas; sometimes saliva
– Infection can occur
– Associated with hearing loss, preauricular pits, rib
– Combination with paramedian

Paramedian lip pits
– Blind ends
– Presence of salivary glands
– van derWoude syndrome (AD)
• Interferon regulatory factor 6 gene mutations (role in fusion of lip
and palate); chr 1 long arm
• Pits and cleft lip and/or cleft palate
• Mental retardation; dental malformations (hypodontia)
– Popliteal pterigium syndrome
• Same gene
• Popliteal webs
• Cleft lip and/or cleft palate
• Syngnathia (webs connecting upper & lower jaw)

Double Lip
Redundant fold
• Congenital (persistence of the pars glabrosa and
pars villosa) and acquired (trauma, habits)
• Ascher (Laffer-Ascher) syndrome
– Double lip
– Blepharochalasis (Fuchs 1896)
• Edema of the upper eyelid; vision interference
• Hyperplasia of lacrimal glands with prolapse of orbital fat
– Nontoxic thyroid enlargement (50%)
• DiffDx: angioedema, tumor

• Diffuse grayish-white appearance of mucosa
• Blacks > Whites (racial pigmentation may make this
variation more prominent)
• Variation, not a disease
• More prominent in smokers, “poor” oral health
• Buccal mucosa extending to the lips
• Vagina, larynx
• Hyperplastic epithelium; intracellular edema
• No treatment
• DiffDx: Lichen planus, other leukoplakic lesions,
dentifrice stomatitis (chemical burn)

• Oromandibular-limb hypogenesis syndromes
– Hypodactyly
– Hypomelia
– Underdeveloped organs
– Some potential etiologic factors
• Lithium during pregnancy
• Chorionic villi sampling procedures

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