Tongue diseases Tongue diseases and disordersand disorders

ExaminationExaminationInspectionInspection

B- Palpation B- Palpation BidigitalBidigital Consistency Consistency

C- Function evaluationC- Function evaluation

Tongue Tie

Tongue deviation

Disorders of Tongue

• Glossodynia (burning mouth syndrome)- spontaneous burning, discomfort, pain, irritation, or rawness of the tongue, has no identifiable etiology most of the time

Etiology of Glossodynia

• Neurologic– Peripheral nerve

damage– Diabetic neuropathy – Trigeminal neuralgia

• psychiatric– Depression– Anxiety– Cancerophobia

• Systemic disorders– Anemia (iron deficiency,

pernicious)– Nutritional deficiency – Gastroesophageal reflux

disease– Sjogren syndrome– Hypothyroidism– Acquired immunodeficiency

syndrome

Treatment

• Tricyclic antidepressant

Disorders of Tongue…• Glossitis- presents as pain, irritation or burning, hypogeusia,

or dysgeusia

• Atrophic glossitis– Due to filiform de-papillation– Mild patchy erythema to a completely smooth, atrophic,

beefy-red surface

– Etiology - pernicious anemia, protein and other nutritional deficiencies, chemical irritants, drug reactions,, vesiculobullous diseases, oral candidiasis and systemic infections

Disorders of taste dysgeusia

• Viral infections• Candidiasis• Malnutrition• Neoplasms• Xerostomia• Metabolic disturbance• Drugs• Radiation• Zinc deficiency

COMMON LESIONS

Normal variations

Varicosities

Foliate papillae

They are occasionally mistaken fortumors or inflammatory disease

Developmental lesions

Fissured tongue

• normal variant seen in 5-11% individuals

• Numerous small irregular fissures oriented laterally on the dorsal tongue

• Also seen in - Melkersson-Rosenthal syndrome, psoriasis, Down syndrome, acromegaly, Sjogren syndrome

Macroglossia• Congenital or acquired process, tongue is disproportionately

large relative to the patient’s jaw size• Difficulty with mastication and speech and accidental tongue

biting are common• Differential- Down syndrome, hypothyroidism,

haemangioma, neurofibromatosis, infection by mycobacteria, or deep fungus, amyloidosis………

MicroglossiaMacroglossia\Fissured tongue

Hairy tongue• Hypertrophy of filiform papillae

resembling hair-like projections• Associated with - heavy tobacco

use, mouth breathing, antibiotic therapy, poor oral hygiene, general debilitation, radiation therapy, chronic use of antacids.

• White, yellow green, brown, or black color is due to chromogenic bacteria or staining from exogenous sources

Black hairy tongue

Brown hairy tongue

TREATMENT: Treatment consists of brushing the tongue with a soft bristle toothbrush . Surgical scraping.

1. What is the clinical diagnosis

2. What are the predisposing factors?

3. What is the treatment?

Geographic tongue

• Geographic tongue- benign inflammatory condition, due to loss of filiform papillae

• Erythematous plaques with well demarcated white border

• Etiology- idiopathic, psoriasis, Reiter syndrome, atopic dermatitis, idiopathic

Hemangioma of the lateral aspect of the tongue

Lingual thyroid

Other lesions

OraI hairy leukoplakia• Caused by Epstein-Barr

virus.• Presents as asymptomatic,

corrugated, white plaques with accentuation of vertical folds along the lateral borders of tongue

• Predominantly seen in HIV infection, organ transplant recipients and patients on chemotherapy

OraI hairy leukoplakia, Diagnosis

•DNA in situ hybridization•Biopsy

CandidiasisPseudomembranous

• Etiology• Predisposing factors• Classification• Treatment

Median rhomboid glossitis• Median rhomboid glossitis

- atrophic disorder of the tongue secondary to chronic candidiasis

Atrophic (erythematous) candidiasis

Squamous cell carcinoma• Early carcinoma may

clinically appear as leukoplakia or erythroplasia.

• The tongue and floor of the mouth are the most common areas

• PROGNOSIS: The overall five year survival rate is about 50%. Early diagnosis increases the chance of survival.

Leukoplakia

unilateral indurated white patch related to the lateral surface of the tongue.

EARLY SQUAMOUS-CELL CARCINOMA OF THE LATERAL BORDER OF THE

TONGUEEARLY SQUAMOUS-CELL CARCINOMA

OF THE FLOOR OF THE MOUTH

SQUAMOUS-CELL CARCINOMA PRESENTING AS EXOPHYTIC ULCERATED TUMOR OF THE

LATERAL BORDER OF THE TONGUE..

LATE SQUAMOUS-CELL CARCINOMA ON THE DORSUM OF THE TONGUE.

• DIFFERENTIAL DIAGNOSIS: All ulcerations present for more than 2-3 weeks in which there is no apparent cause should be biopsied to rule out carcinoma, especially in adults whose lesions are in high risk areas.

Traumatic ulcerSource of trauma should be identified