Tongue lesion

Oral pathology

ORAL PATHOLOGY

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Classification
Developmental
Microglossia Macroglossia Ankyloglossia Lingual thyroid Fissured tongue

Acquired
Inflammatory foliate papillitis Infection - bacteria (TB, syphilis) & fungal (candidosis, median rhomboid glossitis) Autoimmune vesiculobullous disease Neoplastic squamous cell carcinoma Idiopathic - balck hairy tongue, geographic tongue, hairy leukoplakia, varicosities
ORAL PATHOLOGY 2

Developmental : Microglossia 
rare and unknown etiology  other associated anomalies are ; a. Cleft palate b. Mandibular hypoplasia c. Missing lower incisor d. Constriction of maxillary arch  Treatment : non/ surgery / orthodontic
ORAL PATHOLOGY 3

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

ORAL PATHOLOGY

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Developmental : Macroglossia
‡ Clinical features : a) Noisy breathing b) Drooling c) Difficult to eat d) Open bite e) Mandibular prognathism f) Choking g) Hypothyrodism h) Lympahngioma- multiple vesicle like blebs so called frog egg or tapioca pudding appearance i) Down syndrome- papillary and fissured tongue surface

ORAL PATHOLOGY

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Developmental : Macroglossia

‡ Histology : depends on etiology but some have no histological changes ‡ Treatment : depends on severity - Glossectomy - Speech therapy - No treatment needed

ORAL PATHOLOGY

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Developmental : Macroglossia
‡ Hemangioma (congenital macroglossia) - 2 types: 1. Capillary hemangioma multiple and small capillary channels 2. 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)
ORAL PATHOLOGY 7

Developmental : Macroglossia
‡ Lymphangioma (congenital macroglossia) Clinical features; a. Most common site tongue, cheek b. Raised, diffuse, bubbly nodules or vesicles c. No gender predilection d. Evident at birth or early childhood e. Range in colour from clear to pink, dark red, brown or black f. Asymptomatic g. Soft, fluctuant h. 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

ORAL PATHOLOGY

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Developmental : Hemifacial hypertrophy 
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
ORAL PATHOLOGY 9

Developmental : Hemifacial hypertrophy 
Oral manifestation: Dentition : - bigger crown and root size and shape, - premature shedding of deciduous and - early eruption of permanent Jaw bone : - Thicker and wider Tongue : - General unilateral enlargement - Enlargement of lingual papilla - Contralateral displacement Buccal mucosa : - Appears velvetly

ORAL PATHOLOGY

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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
ORAL PATHOLOGY 11

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
ORAL PATHOLOGY 12

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
ORAL PATHOLOGY 13

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.
ORAL PATHOLOGY 14

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
ORAL PATHOLOGY 15

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

ORAL PATHOLOGY

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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 condition
ORAL 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.

ORAL PATHOLOGY

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Acquired Varicosities (Varix)
‡ Treatment : - Not required - On the lips and mucosa: might need to excise for diagnosis

ORAL PATHOLOGY

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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
ORAL PATHOLOGY

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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
ORAL PATHOLOGY 21

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
ORAL PATHOLOGY 22

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

ORAL PATHOLOGY

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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
ORAL PATHOLOGY 24

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

ORAL PATHOLOGY

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THANK YOU

ORAL PATHOLOGY

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