Tongue lesion

Oral pathology

ORAL PATHOLOGY 1
 Classification

Developmental Acquired
Inflammatory – foliate papillitis
Microglossia Infection - bacteria (TB, syphilis) &
Macroglossia fungal (candidosis, median
rhomboid glossitis)
Ankyloglossia Autoimmune – vesiculobullous
Lingual thyroid disease
Neoplastic – squamous cell
Fissured tongue 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 • Acquired
- Lymphangioma (benign - Edentulous
proliferation of lymphatic - Amyloidosis
vessels) - Myxoedema
- Hemangioma
- Acromegaly
- Facial hemi hypertrophy - Angioma
- Cretinism - Carcinoma
- Down syndrome
- Neurofibromatosis
- MEN (multiple endocrine
neoplasia) type III

ORAL PATHOLOGY 4
 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 5
 • Histology : depends on
Developmental :
Macroglossia etiology but some have no
histological changes
• Treatment : depends on
severity
- Glossectomy
- Speech therapy
- No treatment needed

ORAL PATHOLOGY 6
 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 8
 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 10
 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
 • Diagnosis :
Developmental : Lingual - Thyroid scan
thyroid
- 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 16
 • Idiopathic
Acquired – Hairy
leukoplakia • 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 18
 Acquired – Varicosities (Varix)
• Treatment :
- Not required
- On the lips and mucosa: might need to excise
for diagnosis

ORAL PATHOLOGY 19
 • Or benign migratory glossitis
Acquired – Geographic
tongue • 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

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
 • Inflammatory
Acquired – Foliate
papillitis • 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
 • Fungal infection
Acquired – Median • Or central papillary atrophy
rhomboid glossitis
• 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 25
THANK YOU

ORAL PATHOLOGY 26