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

2ORAL PATHOLOGY

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

ORAL PATHOLOGY 6

• 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

7ORAL PATHOLOGY

• 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

8ORAL PATHOLOGY

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

9ORAL PATHOLOGY

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

10ORAL PATHOLOGY

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

12ORAL PATHOLOGY

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.

14ORAL PATHOLOGY

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

15ORAL PATHOLOGY

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.

18ORAL PATHOLOGY

Acquired – Varicosities (Varix)

• Treatment :- Not required- On the lips and mucosa: might need to excise

for diagnosis

19ORAL PATHOLOGY

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 20

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

21ORAL PATHOLOGY

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

ORAL PATHOLOGY 23

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

25ORAL PATHOLOGY

THANK YOU

26ORAL PATHOLOGY