Diseases of the Lips, Swellings of the Face and Neck

1. Diseases of the Lips
Swellings of the face and neck
Dr. Hadi Munib
Oral and Maxillofacial Surgery Resident

2. Outline
 Diseases of the lips
 Diseases of the tongue
 Disturbance of taste and Halitosis
 Swellings of the Head and Neck
 References

3. Diseases of the lips
 Swelling of the lips:
 Individual and racial variation.
 Diffuse or Localized.
Diffuse Localized
Angioedema Mucocele
Edema Abscess
Orofacial Granulomatosis Hematoma
Crohn’s Disease Salivary Adenoma
Hemangioma Basal Cell Carcinoma
Lymphangioma Squamous Cell Carcinoma

4. Angular Cheilitis
 Angular stomatitis
 Cheilosis Perlèche
 Inflammation of one (or both) of the corners of the mouth,
 Trauma by either unsatisfactory dentures.
 Secondary infection by C. albicans, S. aureus (or both)
 Antimicrobial Therapy

5. Angular Cheilitis as a marker of systemic disease
Anemia
Iron, B12, or folate deficiency
OFG (including Crohn's disease)
HIV infection
Diabetes Mellitus
Sjögren's Syndrome (and other causes of salivary gland hypofunction)

6. Lip Fissures
 Vertical cracks in the lips.
 Midline of the lower lip.
 Infected by Staphylococcus aureus
 Conservative treatment vs. Surgical Excision
 Elimination of the secondary infection followed by the use of steroid creams.
 Marked tendency to reoccur and a permanent cure is unlikely.
 Down’s Syndrome patients – Mouth Breathing

7. Diseases of the Tongue
 Developmental abnormalities and morphological variations:
 Ankyloglossia (tongue tie) is usually congenital and may be associated with microglossia. No
evidence that it interferes with speech.
 Macroglossia can occur in a number of systemic conditions, such as congenital hypothyroidism,
Down's syndrome, acromegaly, and amyloidosis.

8. Tongue fissures
 The normal gross structure of the tongue includes fissures.
 May have a part in the modification, or initiation of pathological processes.
 Anaerobic stasis are present in the depths of these structures
 The use of a chlorhexidine mouthwash may be helpful for patients with a symptomatic fissured
tongue.
 Scrotal Tongue; is a normal morphological variant with multiple fissures on the dorsum of the tongue.
 Crenated Tongue; Irregular border of the tongue ( ‘pie-crust edge’) and can be one of the features of
bruxism in some patients.

11. Coated Tongue
 Coating consisting of mucus, desquamated epithelial cells, organisms, and debris.
 Rapid flow of saliva, and this coating is kept to a minimum.
 A lack of mobility of the tongue, disturbance in saliva flow, excess tobacco or alcohol, a gastric or
respiratory upset
 White or coloured plaque.
 Its removal may be quite difficult since very often it is firmly adherent to the tongue.
 Vigorous brushing of the tongue and effervescent mouthwashes, such as those containing ascorbic
acid.

13. Hairy Tongue
 An elongation of the filiform papillae.
 Dark colour, black or brown.
 The mechanism is quite unknown.
 Some appear after a course of antibiotic therapy.
 Other hairy tongues apparently appear completely spontaneously.
 Treatment of hairy tongue is remarkably difficult.
 The use of effervescent and mucus-solvent mouthwashes may be helpful.
 Trichloracetic acid; only small areas can be managed at a time, discomfortable
 ‘Sucking a dry peach stone’; potentially hazardous!

15. Geographic Tongue
 Erythema Migrans
 Benign Migratory Glossitis
 Depapillation of the tongue.
 Red patches surrounded by white borders, distributed in a ‘map-like’ fashion and tend to vary
position.
 The appearance of the lesions may be the patient's only complaint but a complaint of tenderness of
the tongue when eating highly flavored food.
 Age of 3 years upwards.
 Biopsy is rarely necessary to confirm diagnosis.
 No successful treatment is known for a painful geographic tongue, but avoidance of disturbing
foods and an analgesic mouthwash may provide symptomatic relief.

17. Median Rhomboid Glossitis
 Chronic mucocutaneous Candidosis or in debilitating chronic diseases.
 Candidal Pseudo membrane and may become deeply fissured and apparently fibrosed.
 Lesions of superficial midline glossitis are usually seen in apparently healthy patients in the midline of
the tongue from immediately in front of the vallate papillae towards the anterior dorsal surface of the
tongue.
 Appears as an area of depapillation on the dorsum of the tongue and may have a red, white, or yellow
appearance.
 Long-term therapy with topical antifungal agents with systemic Antifungal Therapy.

19. Disturbance of taste and Halitosis
 Dysguesia; Unpleasant or altered taste sensation
 Ageusia; Complete loss of taste
 Hypogeusia; Reduced taste sensation
 Most Difficult to manage.
 True Neurological Disturbance is extremely rare.

20. Conditions associated with alterations in taste
 Drugs:
 ACE inhibitors
 Lithium salts
 Gold
 Carbimazole
 Metronidazole
 Penicillin
 Xerogenic drugs
 Gastro- Esophageal Reflux Disorder
 Systemic disease:
 Uremia
 Neurological disorders
 Anemia
 Deficiencies e.g. zinc

21. Halitosis
 Bad breath.
 Transient or needs investigations.
Local causes of halitosis
Poor oral hygiene
Food packing
Chronic periodontal disease
Acute necrotizing ulcerative gingivitis
Dry socket
Pericoronitis
Infections
Malignant tumors
Pharyngitis, Tonsillitis, Sinusitis
Foreign Bodies

22. Systemic diseases causing halitosis
Lower respiratory tract infections
Diabetic ketoacidosis
Kidney failure
Liver failure
Febrile illness
Drugs that may produce halitosis
Paraldehyde
Isosorbide dinitrate
Disulfiram
Alcohol
Cytotoxic drugs (indirectly)
Xerogenic drugs (indirectly)

23. Swellings of the Head and Neck
Differential Diagnosis of Facial Swelling
Congenital (e.g. lymphangioma, haemangioma)
Infectious; Orodental infections, Salivary gland infections, Cutaneous infections
Neoplastic; Sarcomas, Carcinoma
Traumatic; Post-injury, Postoperative,Surgical emphysema
Immunological; Allergic, Hereditary
Endocrine and metabolic; Cushing's syndrome, Acromegaly, Myxoedema, Nephrotic syndrome
Others, e.g.; Orofacial granulomatosis, angioedema, Corticosteroid therapy, Masseteric hypertrophy

24. Differential Diagnosis of swellings in the neck
 Side of neck
 Cervical lymphadenopathy
 Salivary gland enlargement
 Actinomycosis
 Carotid body tumors
 Branchial cyst
 Pharyngeal pouch
 Cystic hygroma

25.  Middle of the neck
 Thyroid enlargement (multinodular goiter—neoplasia,
ectopic)
 Thyroglossal cyst
 Dermoid cyst
 Plunging Ranula
 Ludwig's angina
Differential Diagnosis of swellings in the neck

27. Cervical Lymphadenopathy – Infective and
Neoplastic Causes
 Lymphadenitis; Orodental, Antral, Tonsillar, Aural, Nasopharyngeal, Scalp
 Facial Tuberculosis
 Brucellosis
 Infectious mononucleosis (glandular fever)
 HIV infection
 Toxoplasmosis (cat scratch fever)
 Syphilis
 Lymphoma
 Leukemia
 Secondary neoplasia

28. References
 Chapter 6: Diseases of the lips and tongue and disturbances of taste and
halitosis
 Chapter 7: Swellings of the head and neck

29. THANK YOU