Oral pathology - tongue lesion
Transcript of Oral pathology - tongue lesion
Tongue lesion
Oral pathology
1ORAL PATHOLOGY
Classification
Developmental Acquired
Microglossia
Ankyloglossia
Macroglossia
Lingual thyroid
Fissured tongueNeoplastic – squamous cell carcinoma
Idiopathic - balck hairy tongue, geographic tongue, hairy leukoplakia, varicosities
Autoimmune – vesiculobullous disease
Infection - bacteria (TB, syphilis) & fungal (candidosis, median rhomboid glossitis)
Inflammatory – foliate papillitis
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Developmental : Microglossia
rare and unknown etiology other associated anomalies are ;a. Cleft palateb.Mandibular hypoplasiac. Missing lower incisord.Constriction of maxillary arch
Treatment : non/ surgery / orthodontic
3ORAL PATHOLOGY
Developmental : Macroglossia• Congenital- Lymphangioma (benign
proliferation of lymphatic vessels)
- Hemangioma- Facial hemi hypertrophy- Cretinism - Down syndrome- Neurofibromatosis- MEN (multiple endocrine
neoplasia) type III
• Acquired- Edentulous- Amyloidosis- Myxoedema- Acromegaly- Angioma- Carcinoma
4ORAL PATHOLOGY
• Clinical features : a) Noisy breathingb) Droolingc) Difficult to eatd) Open bitee) Mandibular prognathismf) Choking g) Hypothyrodism h) Lympahngioma- multiple vesicle like blebs so called ‘frog –
egg’ or ‘tapioca pudding’ appearancei) Down syndrome- papillary and fissured tongue surface
Developmental : Macroglossia
5ORAL PATHOLOGY
Developmental : Macroglossia
• Histology : depends on etiology but some have no histological changes
• Treatment : depends on severity
- Glossectomy- Speech therapy- No treatment needed
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• Hemangioma (congenital macroglossia)- 2 types: 1. Capillary hemangioma – multiple and small capillary
channels2. Cavernous hemangioma – large tortuous dilated
vascular spaces densely packed with erythrocytes.
- Investigation : blanch on pressure with slide- Treatment : leave until puberty or excise for function
or cosmetic (sclerosing agent, cryosurgery or strangulation of the feeder vessel)
Developmental : Macroglossia
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• Lymphangioma (congenital macroglossia)Clinical features;a. Most common site – tongue, cheekb. Raised, diffuse, bubbly nodules or vesiclesc. No gender predilectiond. Evident at birth or early childhoode. Range in colour from clear to pink, dark red, brown or blackf. Asymptomaticg. Soft, fluctuanth. Varies in size
Histological features:- Multiple and intertwining lymph vessels in a loose fibrovascular stroma- Lymphatic vessels are lined by a single layer of endothelial cells- O encapsulation
Developmental : Macroglossia
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Congenital Female > male Left = right Involves :- The entire half of the body- 1 or 2 limbs- The face, head and associated structures
Differential diagnosis- Fibrous dysplasia- neurofibromatosis
Developmental : Hemifacial hypertrophy
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Developmental : Hemifacial hypertrophy
Oral manifestation:
Dentition :- bigger crown and root size and shape,- premature shedding of deciduous and - early eruption of permanentJaw bone :- Thicker and widerTongue :- General unilateral enlargement- Enlargement of lingual papilla- Contralateral displacementBuccal mucosa :- Appears velvetly
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Developmental : Ankyloglossia
• Lingual frenum is thick and short.• Restricted tongue movement• High mucogingival attachment cause
periodontal problems• Treatment :- Not required if not disturb function- Frenectomy
11ORAL PATHOLOGY
Developmental : Lingual thyroid• Thyroid bud did not descend normally to its location at
the anterior trachea and larynx• Ectopic thyroid tissue can be seen between foramen
caecum and epiglottis• 4 times higher in female due to hormone and can
appear during puberty, pregnant or menopause• Small and asymptomatic nodule and can be large and
obstruct respiration• Dysphasia, dysphonia and dyspnea• It may be the only thyroid tissue so no surgery before
further investigation
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Developmental : Lingual thyroid
• Diagnosis :- Thyroid scan- Avoid biopsy (can cause
bleeding and maybe the only thyroid tissue)
• Treatment :- Asymptomatic – non and
follow-up- Symptomatic – hormone
thyroid to decrease the size
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Developmental : Fissured tongue• Or scrotal tongue• On the dorsum surface of tongue• Clinical features:- 2-5 % population- Prevalence increase with increasing age- Asymptomatic but may feel burning and pain.
• Melkerson-Rosenthal syndrome- fissured tongue +facial palsy +lip swelling- Treatment: non and brush the tongue.
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Acquired – Hairy tongue (black hairy tongue)
• Idiopathic• Benign condition• Result from collection of keratin in filiform papilla • 0.5 % of adult population• etiology- uncertain
• Predisposing factors:-smoking-antibiotic therapy-radiotherapy-poor oral hygiene-oxidizing mouthwash-overproliferation of fungal/bacteria
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Acquired – Hairy tongue (black hairy tongue)
• Clinical features:- midline, anterior to circumvallate papilla- Papilla is long, brown, yellow/black colour as a result
pigmentation from bacteria/ staining from tobacco/food- Usually asymptomatic, sometimes gagging/bad taste
• Treatment:- Oral hygiene instruction- Remove predisposing factors (tobacco, antibiotic,
mouthwash)- Brush the tongue
16ORAL PATHOLOGY
Acquired – Hairy leukoplakia
• Idiopathic• No risk to change to
malignant• Typical on lateral border of
the tongue• Associated with virus
Epstein-Barr• Usually associated with
HIV/other immunosuppressant conditionORAL PATHOLOGY 17
Acquired – Varicosities (Varix)• Abnormally dilated and tortuous vein• Etiology-unknown and > elderly adult• Not associated with systemic disease
• Clinical features:-sublingual varix – commonest-multiple bluish-purple, elevated/papular blebs on the ventral
surface of tongue-asymptomatic except thrombosis-other location: lips, buccal mucosa-thrombosed varix: firm, non-tender, bluish purple nodule.
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Acquired – Varicosities (Varix)
• Treatment :- Not required- On the lips and mucosa: might need to excise
for diagnosis
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Acquired – Geographic tongue
• Or benign migratory glossitis• Idiopathic • Especially on the tongue, can
also be seen at the other mucosa (buccal, labial mucosa and soft palate)
• Incidence : 1-3% population• Female> male• Children and adult
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Acquired – Geographic tongue
• Clinical features:
- On the anterior 2/3 of tongue- Multiple, well demarcated zones of erythema
surrounded by white margin- On lateral border of the tongue and tip of the tongue- Erythematous area- result of papillary atrophy, healed
in few days and appeared in other place- Usually asymptomatic: sometimes burning
sensation/irritation with spicy/ acidic food
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Acquired – Geographic tongue
• Histology:- hyperparakeratosis, acantosis, spongiosis and
elongation of rete ridges- Collection of neutrophil in the epithelium
• Treatment:- Reassurance- Symptomatic case: topical steriod/zinc
supplement
22ORAL PATHOLOGY
Acquired – Foliate papillitis
• Inflammatory • Foliate papilla = lingual
tonsil at the posterior aspect of lateral border of the tongue
• Might increase in size as a result of trauma from denture/tooth or reactive hyperplasia
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Acquired – Median rhomboid glossitis
• Fungal infection• Or central papillary atrophy• On the midline of the dorsum
surface of tongue, anterior to foramen caecum
• Rhomboid, surface may be smooth/nodular, reddish without papilla
• Palpation – slight induration• Incidents – 2/1000• Etiology – trauma/localized
anatomical abnormalities allowing candida to proliferate
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Acquired – Median rhomboid glossitis
• Histology: as candidosis and lined by parakeratotic and acantotic epithelium and inflammatory cells lamina dura
• Treatment: not required except symptomatic - antifungal
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THANK YOU
26ORAL PATHOLOGY