Lip tongue lesions...quick summary

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  • Non allergic angioedema is the most common and it s idiopathic. Usually it is intermittent and patient should be checked for C1 esterase inhibitor deficiency which lead to uncontrolled complement system activity. Deficincy in C1 esterase inhibitor can be heridetary of aquired
    Allergic angioedema is an acute state (type I hypersensitivity) could distribute to face, and airways. caused by allergens like food stuff (nuts), medication (ACE inhibitor, NSAID’s, penicillin) rubber latex
  • In some oral medicine book consider haemangioma and vascular malformation are the same thing, in fact histologically they are slightly different
    Haemangioma Vascular malformation varix haematoma
    DefinitionProliferation of endothelial cells Widening of blood vessels (venous, capillary, arterial) Pathological widening of blood Rupture of blood vessel and collection vessel due to loss of muscular support blood under mucosa
    aetiologyDevelopmental/congenital Developmental/congenital Usually trauma Acute trauma
    Onset Start at birth and increase
    rapidly in the first few months Start at birth Start at older age Immediately after trauma
    ResolutionDecrease with age and most
    of them resolve at 9 years Persist throughout life become darker in colour Once established size does not regress Reduce in size and heal
    Examples Port –wine stainSturg-weber synderom
    Clinical features Pulsatile if superfecial Blanch if not thrombosed
    Blanch if not thrombosed or calcified
    Could be intra-bony
  • Also known as self healing carcinoma, could be considered as well differentiated squamous cell carcinoma, it is a skin lesion (does not occur intra orally) suggested that it arises from hair follicle and sun exposure and virus are of suggested etiological factors. Can regress spontaneously in few weeks time, note the centre containing a keratin plug
  • More common in females
    Associated with stress and anxiety
    Only excessive production of keratin
  • )
  • Mainly children are affected
    Might not be aware of the habit
    Heals by stopping the licking
    Appliance can be used to interfere with tongue which might help the patient to stop the habit
  • Usually persist due to secondary infection (s.aurius or candida) treated by topical application of antibacterial/antifungal + steroid ointment
    Usually it recur
    common in OFG and Down patients
  • CHX mouth wash is useful in symptomatic fissured tongue
  • Usually an indication of bruxism
  • Some cases induced by antibiotic use and resolve after completing the course
    Mucous solvent mouth washes, chemical cauterization and tongue brushing all been tried and usually not effective
  • Lip tongue lesions...quick summary

    1. 1. Normal lip • Junction between skin & mucosa • Pink/brown in colour • Vermilion border • Fordyce’s granules • Pits • No swellings or indurations
    2. 2. What can you SEE on the lip? What you need to KNOW & to DO for reaching a diagnosis?
    3. 3. 1- Swellings What you need to DO: • History: o Time first noticed o Any changes in size, consistency, colour,… o Any associated symptoms o Any discharge • Examination o Determine whether it is diffuse or localized o Determine it’s consistency o Determine it’s colour • Further investigations
    4. 4. 1- Swellings What you need to KNOW • Differential diagnoses … • More you know a longer list of differential diagnosis and better diagnosis
    5. 5. Diffuse lip swelling Angioedema (allergic / non-allergic)
    6. 6. Diffuse lip swelling Oedema caused by infection / trauma
    7. 7. Diffuse lip swelling • Healthy young girl • Swelling notices 6 years ago, increasing gradually • Previous treatment with steroid inj. unsuccessful
    8. 8. Diffuse lip swelling • Orofacial granulomatosis • Oral Crohn’s disease • Monosymptomatic Melkerson-Rosenthal syndrome
    9. 9. Lip swelling Haemangioma Vs Haematoma
    10. 10. Localized lip swellings Adenoma
    11. 11. Localized lip swellings Mucocele
    12. 12. Localized lip swellings Keratoacanthoma
    13. 13. White lesions of the lip Actinic Cheilitis High risk High risk
    14. 14. White lesions of the lip Exfoliative chelitis • Excessive production of keratin • More common in females • Associated with stress & anxiety • Some improve by antidepressant/tranquilizers • Spontaneous remission
    15. 15. Lesions of the lip Allergic chelitis Perioral dermatitis
    16. 16. Allergic cheilitis Causes: • Allergic reaction to topical ointments/creams or lipstick • Tooth paste • Food • Medication Management: • Detailed history to identify allergen  confirmed by patch testing  eliminate • Topical steroid (short course)
    17. 17. Perioral dermatitis • Is a clinical entity with many etiological factors • Most common in females • Could be allergic / idiopathic • Some cases respond to long term tetracycline others to topical steroid (1% hydrocortisone) *DO NOT USE MORE POTENT STEROID ON FACE
    18. 18. Lesions of the lip Lick eczema • Mainly children are affected • Might not be aware of the habit • Heals by stopping the licking Management: • Appliance can be used to interfere with tongue
    19. 19. Lesions of the lip Lip fissures • Less common than angular cheilitis • Common in OFG and Down’s patients • Usually persist due to secondary infection (s.aurius or candida) • Management: o Remove pathogen by topical antibacterial / antifungal o Steroid ointment • Usually it recure
    20. 20. Lesions of the lip Cheilocandidosis Causes: 1.Candidal infection affecting unstable epithelium (Solar irritation) in healthy individual 1.Associated with IO candida Treatment: Early treatment by antifungal might lead to resolution
    21. 21. Lesions of the lip angles Angular chelitis Inflammation of the corners of the mouth
    22. 22. Angular chelitis is a multifactorial condition
    23. 23. How to determine causing factor? • History: o Generalized ill health o Xerogenic medication o Antibiotics / steroid therapy o Ill fitting denture / night wearing • Examination o Signs of anemia o Salivary gland swelling (xerostomia / diabetes) o Intraoral candidosis o Oral dryness o Signs of OFG o Lymphadinopathy o Ill fitting denture / reduced vertical dimension
    24. 24. How to determine causing factor? • Special investigations o Swab & smear o Blood test (CBC, B12, ferritin, folate) o Blood glucose • when blood testing should by performed? o If suspecting an underlying systemic factor o If local therapeutic measures fail
    25. 25. Management of angular chelitis 1.Eliminate predisposing factor 2.Correct deficiencies 3.Antifungal / anti bacterial
    26. 26. Tongue lesions
    27. 27. The Tongue • Only will consider lesions specific to the tongue NOT ones which are presentation of systemic conditions • Mobile organ • Specialized epithelial lining • Rich in sensory nerve endings
    28. 28. Developmental abnormalities of the tongue ankyloglossia
    29. 29. Lesions of the tongue Fissured tongue (scrotal tongue)
    30. 30. Lesions of the tongue Crenated tongue
    31. 31. Lesions of the tongue Median rhomboid glossitis
    32. 32. Lesions of the tongue Coated Tongue • Induced by: o General ill health o Reduced saliva o Painful lesion in tongue o Tobacco & alcohol consumption • Management o Tongue brushing o Mouthwashes containing ascorbic acid
    33. 33. Lesions of the tongue Hairy tongue Black hairy tongue
    34. 34. Lesions of the tongue Geographic tongue
    35. 35. Lesions of the tongue Atrophy of the lingual epithelium • Tongue usually sore • Always look for: o haematinic deficiency o Diabetes o Salivary hypofunction

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