J. Vasco. Castleton State College.
The ensuing telogen phase lasts an average of three months before a new anagen hair develops kamagra effervescent 100mg low cost homemade erectile dysfunction pump. In telogen order discount kamagra effervescent impotence at 52, the resting club root is situated at the “bulge” level cheap kamagra effervescent online amex erectile dysfunction doctor in kolkata, where the arrector pili muscle inserts into the hair follicle (15). The telogen hair is shed during washing and grooming referred to as “exogen phase. It is unclear whether this event requires molecular signaling or mechanical stimulus to dislodge the telogen club hair (16). Since there are approxi- mately 5% to 10% of scalp hairs in the resting phase, as many as 100 hairs per day may be lost. Local anes- thesia with lidocaine and epinephrine is suggested subject to patient hypersensitivity. The biopsy is angled in the direction of emerging hair fol- licles and should extend deep into subcutaneous tissue. Both halves are mounted in the block with cut surface downward, or one half is kept for additional studies such as immunoﬂuoresence techniques (Fig. The other 4-mm punch biopsy is bisected horizontally exactly parallel to the epidermis, 0. Sectioning progresses down toward the subcutaneous tis- sue in one half and up toward the epidermis in the other. Horizontal sections of scalp biopsies provide an accurate method for counting, typing, and sizing hair follicles (17). Horizontal versus Vertical Sections In the past, vertical sections of scalp biopsies have provided the traditional view of hair follicles. Most anatomical and histopathological features of hair follicles have been described using the vertical histologic sectioning technique. The concept of horizontal sectioning was introduced by Headington in 1984 and an increasing number of dermatopathologists are now interpreting horizontal sections (8). Horizontal sections generally demonstrate 20 to 30 follicles compared to the traditional four to six hair follicles seen in vertical sections (Figs. The horizontal sectioning technique readily allows quantiﬁcation and assessment of the follicle density, follicle diameter, and the proportion of follicles in various stages of the hair cycle, i. This technique also demonstrates normal ethnic variation in follicle size and density (7). Both halves of the specimens are mounted on a block with cut surfaces facing downward. Upper and mid-dermis with ﬁve terminal hairs and two vellus hairs (hematoxylin and eosin stain, 40x). Lower and mid dermis––terminal follicles and bulbs (hematoxylin and eosin stain, 40x). Lower dermis and subcutaneous fat––terminal follicles and bulbs (hematoxylin and eosin stain, 40x). However, a combination of both vertical and horizontal sections is recommended to maximize diagnostic yield (19). A thorough knowledge of the follicu- lar anatomy in both planes is essential to obtain maximum information from scalp biopsies. Hair Count in Scalp Biopsy There were numerous studies describing the physical differences in various ethnic hair groups, but comparison of histologic parameters among ethnic groups has only been elicited in the last decade (17,20–22). The data on the normal control histologic parameters were gathered primar- ily from the white male population (3,20,22). Subsequently the data for normal controls of scalp biopsy specimens were reported on male blacks and Asians (Koreans) (7,21). The average total hair count (vellus and terminal hairs) taken from a 4-mm punch biopsy specimen that is hori- zontally sectioned is somewhat different among the three ethnic groups (Table 1). Asians have the lowest hair density followed by blacks then Caucasians, who have the highest hair density, as shown by studies from Sperling and Whiting (7,20,22). Slightly higher hair follicular counts were observed in females of all ethnic groups (Fig. Familiarity with the differences in qualitative and quantitative information provided by the plane of the scalp biopsy specimen is important in the successful interpretation of horizontal sections. The terminal hair follicle penetrates deep into the dermis extending into the subcu- taneous tissue. In the vertical plane of section the terminal hair follicle consists of a permanent upper segment of follicular infundibulum and isthmus, and an impermanent lower segment of the hair follicle consisting of the lower follicle and root (bulb) (Fig. Infundibulum The infundibulum opens from the epidermal surface and ends at the entry of the sebaceous duct into the hair follicle. The infundibulum is lined with a keratinized skin surface epithelium that contains a granular layer and basket weave keratin (Fig. Hence proliferation of the infundibulum gives rise to the epidermoid inclusion cyst (folliculo-infundibular cyst). The hair shaft is contained within the infundibulum and has no attachment to the isthmus or the infun- dibulum, allowing freedom of movement. Isthmus The isthmus extends down from the opening of the sebaceous duct and ends at the “bulge” where the arrector pili muscle inserts into the follicle. It is lined by the trichilemmal keratin that is characterized by an eosinophilic compact keratin material, devoid of a granular layer. The inner root sheath crumbles and disappears in the mid-isthmus of the upper follicle (Fig. There it is replaced by trichilemmal keratin formed by the outer root sheath or trichilemma. The hair follicle consists of infundibulum that ends at the sebaceous duct, an isthmus ending at the insertion of the arrector pili muscle, and lower follicle and hair root (bulb). The dilating follicular opening is surrounded by external root sheath lined by skin surface epidermis with granular layer and basket weave keratin (hematoxylin and eosin stain, 200x). External root sheath is lined with skin surface epidermis with a granular layer (hematoxylin and eosin stain, 400x). Trichilemmal keratin lines the upper isthmus extending to the level of entry of the sebaceous duct at the base of the infundibulum (Fig. The bulge area is located in the inferior portion of the isthmus near the insertion of the arrector pili muscle. The bulge contains stem cells that are slow cycling and when activated gives rise to transit amplifying cells that can differentiate into hair follicle (15). Hair Bulb The follicular root consists of the hair bulb, which is found in the deepest portion of the hair follicle and surrounds the dermal papilla (Figs. The bulb contains undifferentiated, actively dividing hair matrix cells that extend to the widest diameter of the hair bulb known as the critical line of Auber. Hair matrix cells around this central area produce elongated cortical cells, which stream upward to form the developing hair shaft.
The patellar buy 100mg kamagra effervescent mastercard erectile dysfunction herbal supplements, examination kamagra effervescent 100 mg for sale erectile dysfunction nervous, the presence of injected contrast within the quadriceps cheap 100 mg kamagra effervescent with mastercard erectile dysfunction statistics us, and semimembranosus tendons are most fre- substance of a repaired meniscus is diagnostic of a quently involved around the knee. Sonographically, a degen- a partial meniscectomy; in these cases both the meniscal erated tendon appears enlarged, with loss of the normal shape and internal signal are unreliable signs of recurrent parallel fiber architecture, and often with focal hypoe- meniscal tear. A gap between the tendon noninvasive test for recurrent meniscal tears following fibers indicates that the process has progressed to partial partial meniscectomy . In those cases in which T2-weighted images show a focus of high signal intensi- T2-weighted images demonstrate ruptures of the cruciate, ty, surgical excision of the abnormal focus can hasten collateral, and patellar ligaments. When macroscopic tearing is present, the radiolo- tion of the ligament fibers . While edema surround- gist should also examine the corresponding muscle belly ing a ligament is typically seen in acute tears, edema sur- for fatty atrophy (which indicates chronicity) or edema rounding an intact ligament is a nonspecific finding, (suggesting a more acute rupture). If the tear is complete, which can be seen in bursitis or other soft tissue injuries, the retracted stump should be located on the images as in addition to ligament tears . Synovium Secondary findings of ligament tears, such as bone con- tusions or subluxations, are useful when present, but do While radiographs can show medium and large knee ef- not supplant the primary findings, and do not reliably dis- fusions, other modalities better demonstrate specific syn- tinguish acute from chronic injuries, nor partial from ovial processes. In the knee, the anterior cruciate liga- hanced through-transmission on ultrasound images. At least 11 other named bursae occur around will be placed on the detection of clinically suspected or the knee. The most commonly diseased ones are proba- occult soft-tissue and bone abnormalities that could be bly the prepatellar, superficial infrapatellar, medial col- exacerbated by repeat trauma or could lead to chronic in- lateral ligament, and semimembranosus-tibial collateral stability and joint degeneration unless treated. Power Doppler ultrasound or the use of ultrasound contrast agent may in- Kinematic laws dictate normal joint motion and the bio- crease sensitivity for active synovitis . Although the knee moves pri- amination, thickening of the usually imperceptibly thin marily as a hinge joint in the sagittal plane, it is also de- synovial membrane and enhancement of the synovium signed for internal-external rotation and abduction-ad- following intravenous contrast administration indicates duction. The signal intensities of the bodies logical, but the menisci must shift with the contact points vary depending on their composition. Diffuse pigmented to avoid entrapment and crush injury by the femoral villonodular synovitis and focal nodular synovitis demon- condyles. Paired cruciate and collateral ligaments func- strate nodular, thickened synovium, which enhances fol- tion collectively with the menisci to maintain joint con- lowing contrast administration. In external rota- echo images – is an important, though inconstant, clue to tion, for example, the cruciate ligaments are lax whereas the diagnosis . Conversely, in internal rotation, the collateral lig- aments are lax whereas the cruciates become twisted Biomechanical Approach to Knee Trauma around each other, pulling the joint surfaces together and resisting varus or valgus rocking. Within the physiological Knee trauma often produces predictable groupings of lig- range of motion, the knee ligaments perform extremely amentous and meniscal injuries . In both contact and non-contact sports, ture is disrupted, synergistic structures are jeopardized. Valgus force is directed at and osseous injury all provide clues about the mechanism the lateral aspect of the joint, and varus force is directed of injury. The lateral compartment normality in one structure should lead to a directed is distracted during varus stress, tearing the lateral collat- search for subtle abnormalities involving anatomically or eral ligament. In the weight-bearing knee, valgus force al- functionally related structures, thereby improving diag- so creates compressive load across the lateral compart- nostic confidence. The medial compartment is images are interpreted with an understanding that struc- compressed during varus stress, leading to impaction of tures with strong functional or anatomical relationships the medial femoral condyle against the tibia. By deducing the traumatic the most common traumatic mechanisms combine valgus mechanism, it is possible to improve diagnostic accuracy force with axial load. Therefore, compression with im- by taking a directed search for subtle, surgically relevant paction injury usually occurs in the lateral compartment, abnormalities that might otherwise go undetected. It may whereas tension with distraction injury occurs in the me- also be possible to communicate more knowledgeably dial compartment. Trauma-re- Acute ligamentous injuries are graded clinically into lated medial meniscal tears tend to be located at the pos- three degrees of severity. In mild sprain (stretch injury), teromedial corner (posterior to the medial collateral liga- the ligament is continuous but lax. The ligament can re- ment) because the capsule is more organized and thick- turn to normal function with appropriate conservative ened in this location, and its meniscal attachment is tight- treatment. In moderate sprain (partial tear), some but not all Although the posterior oblique ligament can be dissected fibers are discontinuous. Remaining intact fibers may not free in most cadaver knees, it is only rarely identified on be sufficient to stabilize the joint. Degenerative (attrition) tears of the medial bundles hang loosely, and intact fibers are overstretched meniscus also predominate posteromedially, but they in- with marked edematous swelling and ecchymosis. In severe sprain (rupture), the liga- a vertical orientation that can extend across the full thick- ment is incompetent. At operation, torn fiber bundles ness of the meniscus (from superior to inferior surface), hang loosely and can be moved easily. Once established, this vertical tear can propagate over time following the normal fiber architecture of the menis- cus. Propagation to the free margin creates a flap, or par- Meniscal Injury rot-beak, configuration. If the tear propagates longitudi- nally into the anterior and posterior meniscal thirds, the Why are most trauma-related medial meniscal tears pe- unstable inner fragment can become displaced into the in- ripheral in location and longitudinally orientated, where- tercondylar notch (bucket handle tear). When a distractive force sepa- dists recognize an association between longitudinal tears rates the femorotibial joint, tensile stress is transmitted and mechanical symptoms, and may decide to repair or across the joint capsule to the meniscocapsular junction, resect the inner meniscal fragment before it becomes dis- creating traction and causing peripheral tear. Compressive placed and causes locking or a decreased range of mo- force entraps, splays and splits the free margin of menis- tion. If an unstable fragment detaches anteriorly or pos- cus due to axial load across the joint compartment. Since teriorly, it can pivot around the remaining attachment site the most common traumatic mechanisms in the knee in- and rotate into an intraarticular recess or the weight-bear- volve valgus rather than varus load, the medial femorotib- ing compartment. The identification and localization of a ial compartment is distracted whereas the lateral compart- displaced meniscal fragment can be important in the pre- ment is compressed. Lateral compression means sile stress can avulse the capsule away from the menis- that the lateral meniscus is at risk for entrapment and tear cus (meniscocapsular separation), with or without a along the free margin. Meniscocapsular injury avulsed at sites where they are fixed, but can escape in- may be an important cause of disability that can be jury in regions where they are mobile. Compared to the treated surgically by primary reattachment of the cap- lateral meniscus, the medial meniscus is more firmly at- sule. Since the capsule stabilizes the medial meniscus, tached to the capsule along its peripheral border, and is meniscocapsular separation or peripheral meniscal avul- far less mobile. Normal knee motion involves greater sion can cause persistent pain and lead to posteromedi- translation of the femorotibial contact point in the lateral al instability with eventual degenerative change. In order to shift with the condyle and avoid images, meniscocapsular injury is more difficult to injury, the lateral meniscus requires a looser capsular at- identify than meniscal tear. Since with scarring and apparent reattachment of the capsule the medial meniscus is tightly secured by menis- to meniscus. Similarly, small avulsed corners of menis- cofemoral and meniscotibial ligaments along the joint cus may be difficult to identify unless a directed search line, it is subjected to greater tensile stress with lesser de- is made for them. Imaging of the Knee 33 The same valgus force that distracts the medial com- Therefore, depending on knee position and the direction partment also compresses the lateral compartment.
And to stay out of the workshop until the asbestos- containing belt had been replaced and the furniture painting had been moved to a different building cheap kamagra effervescent express drugs for treating erectile dysfunction. High Blood Pressure High blood pressure is one of the easiest problems to correct without resorting to drugs purchase kamagra effervescent on line amex wellbutrin xl impotence. The most important change to make is to stop using caffeine as in coffee order kamagra effervescent 100 mg on-line erectile dysfunction humor, tea, or carbonated beverages. Switch to hot milk or hot water if a hot beverage is desired, or any of the beverages given in the recipe section. If being without caffeine leaves you fatigued, take an arginine tablet in the morning (500 mg). Blood pressure is mainly controlled by the adrenal glands which sit like little caps on top of the kidneys. You could do your search in the kidneys since kidney tissue is available in grocery stores. Conducting or storing drinking water in containers of metal is as foolish a practice as eating food off the floor. You may not see what it picked up any more than you can see if it has picked up sugar or salt. If you find cadmium in your hot or cold water, you will never be able to filter it out. The amount of cadmium in your clothing from doing laundry with this water is already too much for your adrenals and kidneys. If you believe you already have plastic pipes or all copper (which leads to leu- kemia, schizophrenia and fertility problems) you will need to search every inch of plumbing for a very short piece of galva- nized pipe left in the system! The toxicity of cadmium, in fact, the high blood pressure connection, has been known a long time. All (100%) cases of high blood pressure I have seen could be easily cured by eliminating cadmium and other pollutants, followed by cleansing the kidneys. To test whether you still need your blood pressure medicine, wait until your pressure is down to 140/90 or better. If it has climbed back up you are not ready; go back to ¾ or a full dose of medicine. If your blood pressure stays down, cut your medicine in half again (you are now down to ¼ the regular dose) and see if your blood pressure stays improved. Better yet, make a salt that is a mixture of sodium and potassium chlorides (see Sources). The sodium portion could be sterilized sea salt (test and make sure it has no alumi- num silicate in it first). Rinse these thoroughly first, throw away shriveled ones, and add vitamin C to the cooking water. Bala Cuzmin, age 72, had high blood pressure for ten years but the upper (systolic) pressure remained high in spite of various medi- cines that were tried. She stopped using caffeine, switching to arginine tablets to get over the let-down. Her diet was changed to reduce phosphate and add calcium, and she took magnesium and Vitamin B6 to assist the kidneys. She killed parasites, cleansed kidneys but saw no drop in blood pressure which stayed at 150 to 170 systolic. She had all the metal in her mouth replaced and promptly saw a blood pressure drop to 145-1 50. She had phosphate crystals in her kidneys and was started on kidney herbs and a diet change to include milk and exclude soda pop. She was feeling so much better after the kidney cleanse that she decided to remove her last fillings and replace her bridge, too, since it was shedding ruthenium. On her way home from the dentist, her ears stopped ringing and soon her blood pressure was down to 126/68. She was still on half a dose of drugs because she was too afraid to go off entirely. This gave her the energy she wanted to play basketball with the grandchildren again. Then he could cut back on his medicines, measuring his blood pressure daily to guide him. After seven weeks it was down to 140/85, so he decided to do without medicine, a bit early. His next chore, which he approached gladly, was removal of all metal from his mouth. He still had some Ascaris and other health problems but was highly motivated to clean them up, too. Glaucoma In glaucoma the pressure in the eyeball gets too high, putting pressure on fragile retina cells that do your seeing. It is your tip-off, though, that something is not right and you should correct it now, when it is easy, and before other damage is done. Read the section on high blood pressure (page 210) to learn how to reduce it by going off caffeine, checking for cadmium poisoning from your water pipes, and cleansing the kidneys (page 549). Simply getting your blood pressure to normal is sufficient help for beginning glaucoma. Antonia Guerrero, age 51, had glaucoma for five years and was dete- riorating rapidly. She cleansed her kidneys, killed parasites and changed her diet to the anti-arthritic one since she also suffered from arthritis in her hands for ten years with painful enlarged knuckles. She got rid of her asbestos toxins by bringing her own hair blower with her to the hairdresser. After seven months she had pain relief for her arthritis (without aspirin) and her glaucoma was pronounced stable by her ophthalmologist. We must look at the enamel, dentine and root of the tooth as well as the bone they rest in for some answers. Since commerce determines which re- search can be done (that is, paid for) sacred territory can be ig- nored. For example, the effects of sugar-eating, gum-chewing, tooth brushing, fluoridation, tooth filling materials and diet can be ignored if it interferes with product sales. Trivial studies such as comparing shapes of toothbrushes, studying the chemical composition of plaque, and studies of bacterial structure and genes are done instead. His scientific studies stand as a bea- con even today because truths, once found, do not change. He described what he saw in a book, titled Nutrition and Physical 13 Degeneration. Skulls of primitive peoples who lived along coastlines, such as Peruvians, Scandinavians and various islanders, and whose staple foods included fish daily, showed perfect teeth; not a single cavity in a lifetime. Skeletal structure was fully developed, meaning the jaw bone was not undershot or cheek bones squeezed together, forcing the teeth to grow into a smaller than ideal space. Consequently, there was room for the wisdom teeth, and no need to crowd the remainder.
Associate Professor in Oral Medicine and Pathology cheap kamagra effervescent master card erectile dysfunction medication costs, Dental School generic kamagra effervescent 100 mg without a prescription impotence icd 9, University of Athens cheap kamagra effervescent 100mg without prescription erectile dysfunction over the counter medications. Insofar as this book Color atlas of oral diseases / George Laskaris ; foreword mentions any dosage or application, readers may rest by Gerald Shklar. Published by Litsas Medical Publications, ist Italian edition 1991 Athens, Greece 1st French edition 1989 Some of the product names, patents and registered ©1988,1994 Georg Thieme Verlag, RudigerstraBe 14, designs referred to in this book are in fact registered 70469 Stuttgart, Germany trademarks or proprietary names even though specific Thieme Medical Publishers, Inc. Grammlich, GmbH This book, including all parts thereof, is legally protect- ed by copyright. The English text now offers a brief but ground, and wealth of experience in the disci- authoritative discussion of each condition. Brackett Professor of Oral Pathology guage journals, and it is fitting that his extensive and Head of the Department of Oral Medicine experience with oral diseases is now made avail- and Oral Pathology, able to the English-speaking world. Sixty-four illustrations of lesions and clinical entities affecting the oral cavity, not published in the first edition, are now included. Nineteen new illustrations of diseases pub- lished in the first edition have been added to broaden the spectrum of clinical presentation of these entities. This book is not a complete reference work of When 1 first started to work in this field 20 oral medicine and should be used in conjunction years ago, I could not imagine the variety of with current textbooks and articles regarding disorders that affect the oral cavity, including recommendations on treatment and new diagnos- genetic diseases, infections, cancers, blood dis- tic techniques that are beyond its scope. Fortunately, the oral plates and a description of the clinical features, cavity is accessible to visual examination, and I differential diagnosis, helpful laboratory tests, and have attempted to record oral lesions in color a brief statement on treatment. During my career as a stomatologist, I have Selective bibliography and index are included. The most representative and mouth and it will find its way in the places where educationally useful illustrations have been used the battle against oral diseases is waged daily, that in this Atlas. Almost all color slides have been is dental schools, hospitals, and private practice taken by me with a Nikon-Medical camera. Their sugges- dentists and physicians who have contributed by tions and criticisms have been gratefully received referring their patients to me through the years. My gratitude is extended to the late Professor Finally, I wish to thank my colleagues at the of Dermatology, John Capetanakis, and the cur- Department of Oral Medicine and Pathology of rent Professor of Dermatology and Head of the the Dental School, University of Athens, with Department of Dermatology, University of whom I have worked closely for more than 25 Athens, "A. Eleana Stufi for their assistance in the prepa- I am also indebted to Associate Professor of ration of the first edition of the Atlas. My sincere thanks are extended to the scientific I thank the following colleagues for permission staff of "A. Karpathios (Greece) for ling and prompt help during the 23 years of our Figure 358, Dr. Crispian Scully (England) for on the translation of the Greek edition of this Figure 278, Dr. My deepest gratitude is due to Professor Cris- Last, but by no means least, I can never fully pian Scully, Department of Oral Medicine and repay all that I owe my wife and three children for Surgery, University of Bristol, England, and Pro- their constant patience, support, and encourage- fessor Gerald Shklar, Department of Oral ment. Normal Anatomic Variants Linea Alba Leukoedema Linea alba is a normal linear elevation of the Leukoedema is a normal anatomic variant of the buccal mucosa extending from the corner of the oral mucosa due to increased thickness of the mouth to the third molars at the occlusal line. As a rule, it occurs bilaterally and with normal or slightly whitish color and normal involves most of the buccal mucosa and rarely the consistency on palpation (Fig. The oral opalescent or grayish-white color with slight mucosa is slightly compressed and adjusts to the wrinkling, which disappears if the mucosa is dis- shape of the occlusal line of the teeth. Leukoedema has normal consistency on palpation, and it should not be confused with leukoplakia or lichen planus. Normal Oral Pigmentation Melanin is a normal skin and oral mucosa pigment produced by melanocytes. However, areas of dark discoloration may often be a normal finding in black or dark- skinned persons. However, the degree of pigmen- tation of skin and oral mucosa is not necessarily significant. In healthy persons there may be clini- cally asymptomatic black or brown areas of vary- ing 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 (Fig. The pigmentation is more prominent in areas of pressure or friction and becomes more intense with aging. Clinically, there are many small, slightly raised whitish-yellow spots that are well circumscribed and rarely Congenital Lip Pits coalesce, forming plaques (Fig. They occur Congenital lip pits represent a rare developmental most often in the mucosal surface of the upper lip, malformation that may occur alone or in combina- commissures, and the buccal mucosa adjacent to tion with commissural pits, cleft lip, or cleft the molar teeth in a symmetrical bilateral pattern. Clinically, they present as bilateral or They are a frequent finding in about 80% of unilateral depressions at the vermilion border of persons of both sexes. There is no satisfactory explana- tion for the occurrence of oral hair although a developmental anomaly is the most likely possibil- ity. The presence of oral hair and hair follicles may offer an explana- tion for the rare occurrence of keratoacanthoma intraorally. The differential diagnosis should be made from traumatically implanted hair and the presence of hair in skin grafts after surgical procedures in the oral cavity. Ankyloglossia Cleft Palate Ankyloglossia, or tongue-tie, is a rare develop- Cleft palate is a developmental malformation due mental disturbance in which the lingual frenum is to failure of the two embryonic palatal processes short or is attached close to the tip of the tongue to fuse. Rarely, the condition may occur as a exhibit a defect at the midline of the palate that result of fusion between the tongue and the floor may vary in severity (Fig. The malfor- sents a minor expression of cleft palate and may mation may cause speech difficulties. Surgical clipping of the frenum cor- Cleft palate may occur alone or in combination rects the problem. Early surgical correction is recom- usually involves the upper lip and very rarely the mended. The incidence of cleft lip alone or in combination with cleft palate varies from 0. Plastic surgery as early as possible corrects the esthetic and functional problems. Developmental Anomalies Bifid Tongue Torus Palatinus Bifid tongue is a rare developmental malforma- Torus palatinus is a developmental malformation tion that may appear in complete or incomplete of unknown cause. The inci- deep furrow along the midline of the dorsum of dence of torus palatinus is about 20% and appears the tongue or as a double ending of the tip of the in the third decade of life, but it also may occur at tongue (Fig. It may coexist with shape may be spindlelike, lobular, nodular, or the oro-facial digital syndrome. The exostosis is benign and consists of bony tissue covered with normal mucosa, although it may become ulcerated if traumatized. Because of its slow growth, the Double Lip lesion causes no symptoms, and it is usually an Double lip is a malformation characterized by a incidental finding during physical examination. It may be congenital, but it may be anticipated if a total or partial denture is can also occur as a result of trauma.