Lip tongue lesions...quick summary
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Transcript of Lip tongue lesions...quick summary
![Page 1: Lip tongue lesions...quick summary](https://reader033.fdocuments.us/reader033/viewer/2022052908/5594d0701a28ab321d8b476f/html5/thumbnails/1.jpg)
Normal lip
• Junction between skin & mucosa• Pink/brown in colour• Vermilion border• Fordyce’s granules• Pits• No swellings or indurations
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What can you SEE on the lip?
What you need to KNOW & to DO for
reaching a diagnosis?
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1- Swellings
What you need to DO:• History:
o Time first noticedo Any changes in size, consistency, colour,…o Any associated symptomso Any discharge
• Examinationo Determine whether it is diffuse or localizedo Determine it’s consistencyo Determine it’s colour
• Further investigations
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1- Swellings
What you need to KNOW
• Differential diagnoses …
• More you know a longer list of differential diagnosis and better diagnosis
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Diffuse lip swelling
Angioedema (allergic / non-allergic)
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Diffuse lip swelling
Oedema caused by infection / trauma
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Diffuse lip swelling
• Healthy young girl• Swelling notices 6 years ago, increasing gradually• Previous treatment with steroid inj. unsuccessful
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Diffuse lip swelling
• Orofacial granulomatosis• Oral Crohn’s disease• Monosymptomatic Melkerson-Rosenthal syndrome
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Lip swelling
HaemangiomaVs
Haematoma
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Localized lip swellings
Adenoma
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Localized lip swellings
Mucocele
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Localized lip swellings
Keratoacanthoma
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White lesions of the lipActinic Cheilitis
High risk
High risk
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White lesions of the lipExfoliative chelitis
• Excessive production of keratin• More common in females• Associated with stress &anxiety• Some improve by antidepressant/tranquilizers• Spontaneous remission
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Lesions of the lip
Allergic chelitisPerioral dermatitis
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Allergic cheilitis
Causes:• Allergic reaction to topical ointments/creams or
lipstick• Tooth paste• Food• MedicationManagement:• Detailed history to identify allergen confirmed by
patch testing eliminate • Topical steroid (short course)
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Perioral dermatitis• Is a clinical entity with many
etiological factors
• Most common in females
• Could be allergic / idiopathic
• Some cases respond to long term tetracycline others to topical steroid (1% hydrocortisone)
*DO NOT USE MORE POTENT STEROID ON FACE
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Lesions of the lipLick eczema
• Mainly children are affected
• Might not be aware of the habit
• Heals by stopping thelicking
Management:• Appliance can be used to interfere with tongue
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Lesions of the lipLip fissures
• Less common than angular cheilitis
• Common in OFG and Down’s patients
• Usually persist due to secondary infection (s.aurius or candida)
• Management:o Remove pathogen by topical antibacterial /
antifungalo Steroid ointment
• Usually it recure
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Lesions of the lipCheilocandidosis
Causes:1.Candidal infection affecting
unstable epithelium (Solar irritation) in healthy individual
1.Associated with IO candida
Treatment:Early treatment by antifungal might lead to resolution
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Lesions of the lip angles
Angular chelitisInflammation of the corners of the mouth
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Angular chelitis is a multifactorial condition
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How to determine causing factor?• History:
o Generalized ill healtho Xerogenic medicationo Antibiotics / steroid therapyo Ill fitting denture / night wearing
• Examinationo Signs of anemiao Salivary gland swelling (xerostomia / diabetes)o Intraoral candidosiso Oral drynesso Signs of OFGo Lymphadinopathyo Ill fitting denture / reduced vertical dimension
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How to determine causing factor?
• Special investigationso Swab & smearo Blood test (CBC, B12, ferritin, folate)o Blood glucose
• when blood testing should by performed?o If suspecting an underlying systemic factoro If local therapeutic measures fail
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Management of angular chelitis
1.Eliminate predisposing factor2.Correct deficiencies3.Antifungal / anti bacterial
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Tongue lesions
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The Tongue
• Only will consider lesions specific to the tongue NOT ones which are presentation of systemic conditions
• Mobile organ
• Specialized epithelial lining
• Rich in sensory nerve endings
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Developmental abnormalities of the tongue
ankyloglossia
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Lesions of the tongue
Fissured tongue (scrotal tongue)
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Lesions of the tongue
Crenated tongue
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Lesions of the tongue
Median rhomboid glossitis
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Lesions of the tongueCoated Tongue
• Induced by:o General ill healtho Reduced salivao Painful lesion in tongueo Tobacco & alcohol consumption
• Managemento Tongue brushingo Mouthwashes containing ascorbic acid
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Lesions of the tongue
Hairy tongue Black hairy tongue
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Lesions of the tongue
Geographic tongue
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Lesions of the tongueAtrophy of the lingual epithelium
• Tongue usually sore• Always look for:
ohaematinic deficiencyoDiabetesoSalivary hypofunction