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PERSENTED BY:
SACHIDANAND GIRI
JR-1
Contents:
 Introduction
 Classification
 Inherited or congenital diseases
 Diseases of lingual mucosa
 Diseases affec...
INTRODUCTION
 Tongue is a muscular organ situated in the floor of
mouth.
 It aids in chewing, swallowing, speech and tas...
CLASSIFICATION OF TONGUE
DISORDERS
 A)Inherited, congenital and developmental
anomalies:
 a) Minor variations:
 1 .Part...
 b) Major variations:
 1.Cleft, lobed, bifurcated and tetrafurcared tongue
 2.aglossia, hypoglossia and macroglossia
 ...
 B)Disorders of the lingual mucosa:
 a)changes in the tongue papillae:
 1.geographic tongue
 2.coated or hairy tongue
...
 c)keratotic white lesions:
 1.lichen planus
 2. leukoplakia
 d)depapillation and atrophic lesions:
1. Chronic trauma
...
 3. hematological abnormalities
 4.medication
 5.peripheral vascular disease
 5.diabetes and chronic candidiasis
 6.t...
 C) Disorders affecting body of tongue:
 1.Amyloidosis
 2.Infections
 3.Neuromuscular disorders
 4.Sleep apnea syndro...
 D) Tumers of tongue:
 Benign
 Malignant
Partial ankyloglossia:
 Partial ankyloglosia refers to congenital shortness of the
lingual frenum or a frenal attachment ...
 Syndromes associated are:
 Ankyloglossum superioris syndrome
 Trisomy of 13
 Pirrie robin syndrome
 Rainbow syndrome...
Variation in tongue movement
 Ability to curl up the lateral borders of tongue into a
tube is noted in 65% of caucasians ...
Tongue Thrusting
 Tongue thrust is a forward placement of the tongue
between the anterior teeth and against the lower lip...
1. Proclination of anteior teeth
2. Anterior open bite
3. Bimaxillary protrusion
4. Posterior open bite in case of lateral...
Fissured Tongue:
 Also called as scrotal tongue,plicated tongue,and
lingua dissecta.
 Characterised by furrows, one exte...
 Syndromes: trisomy 21 (mongolism) ,melkerson
rosenthal syndrome.
 Management: maintenance of oral hygiene.
Patent Thyroglossal Ducts and
Cysts
 Thyroid gland develops from an analogue of
endothelial cells in the midline of the f...
 In 70% of those with heterotopic thyroid ,the thyroid
gland is contained entirerly within the tongue.
 Enlagement of th...
Median Rhomboid Glossitis:
 ‘central papillary atrophy of tongue’
 Developmental defect resulting from an incomplete
des...
 c/f: m>f
 Generally asymptomatic
 The surface is dusky red and completely devoid of
filiform papillae and usually smoo...
Cleft,Lobed, Bifurcated and
Tetrafurcated Tongue:
 Seperation of the dorsal surface of tongue into 2 or 4
by deep grooves...
Aglossia,Hypoglossia
 Aglossia: complete absent of tongue at birth.
 Hypoglossia: small rudimentary tongue.
 c/f: diffi...
Macroglossia:
 Tongue enlargement-leads to functional and cosmetic
problems.
 Etiology:
 1.Congenital-hemangioma,lympha...
 C/F:noisy breathing,drooling of saliva, difficulty in
eating, speech and airways problums.
 Recurrent upper respiratory...
Hamartomas and Dermoids:
 The tongue may be enlarged or distorted by the
persence of variety of tumerlike growthsof
devel...
Bald or Depapillated tongues:
 An erythematous , edematous and painful tongue that
appears smooth because of loss of fili...
 Local causes:
 Eosinophilic granuloma
 Traumatic injuries-jagged teeth,rough margins of
restorations and inadvertent c...
 Systemic causes:
 Iron deficiancy anemia: first appears at tip,lateral
border of tongue with loss of filiform papila. I...
 Folic acid deficiency: tongue is fiery red and atrophy
of filiform & fungiform papilae. Tongue is swollen and
small crac...
 Diabetes: central papilary atrophy of the dorsum in
which low flat papillae are noticed just ant. to row of
circumvallat...
 Peripheral vascular disease: decreased nutritional
of the lingual papillae as a result of vascular changes
affecting the...
 Deficiency:
 Vitamin-A
 Vit-B1
 Vit-B2
 Pantothenic acid
 Vit-B6(niacin)
 Vit-B2,B6,B12,niacin
 Folic acid,vit-B6...
Papillomatous changes:
 In several congenital disorders the surface of tongue is
covered with multiple papilomas. When ex...
Geographic Tongue:
 Also called as benign migratory glositis,wandering rash,
glossitis areata exfoliativa, and erythema m...
 C/F- common in young & middle age.
 Female predilection
 Commonly on dorsal surface & lateral border
 Asymptomatic bu...
 The condition may persist for weeks to months and
then regress spontaneously only to occur at later date.
 The lesion i...
 Diagnosis: clinically
 Biopsy shows loss of filiform papillae with
hyperparakeratosis and acanthosis.
 D/D-
 Psoriasi...
 Management:
 For control of burning-topical local anaesthetic agents
like lidocaine, dyclonine hydrochloride, or
diphen...
Hairy Tongue:
 Lingua villosa, lingua nigra, black hairy tongue
 An overgrowth of filiform papillae on the dorsum of
ton...
 Etiology:
 Fungal and bacterial overgrowth:
 Use of certain drugs: sodium perborate, sodium
peroxide, and antibiotics ...
 In Debilitated, dehydrated, terminally ill patients can
lead to very thick, leathery coatings on the tongue that
are ref...
 This gives it a coated or hairy appearance and retains
debris and pigments from substances from food,
tobaco, smoke, mad...
Thrush:
 Acute pseudomembranous candidiasis
 Often appears as pearly white , pinhead size flecks scattered over
the dors...
 d/d-
 Plaque form of licken planus
 Leukoplakia
 Gangrenous stomatitis
 Chemical burn
 Management:
 Topical application of clotrimazole cream-2-3 times
daily for 3-4 weeks.
 Ketoconazole 200-400 mg od for ...
White sponge nevus:
 Congenital anomaly in which the surface of tongue as
well as other parts of oral mucosa are involved...
Vasiculobullous and other
Desquamating disorders
 Desqumating disorders are often mistakenly identified
as white lesions ...
Licken planus:
 Oral licken planus is defined as a common chronic
immunological mucocutaneous disorder that varied in
app...
 Other facters: stress, habits, hypertention, diabetes
 c/f- oral lesions are characterized by radiating white
and gray ...
 d/d-
 Leukoplakia
 Candidiasis
 Drug induced reaction
 Geographic tongue
 Management:
 Removal of cause
 Steroids –topical and systemic
 Topical application of antifungal agents
 Retinoids
...
Leukoplakia:
 It is whitish patch or plaque that can not be
characterised, clinically or pathologically, as any other
dis...
 Etiological factors are classically known as 6 S
….smoking, syphilis, sharp tooth, sepsis, sprit, and
spices.
 Alcohal-...
 c/f- confied to ant. 2/3 rd of tongue,dorsum and lateral
border.
 The affected area show milky-white patches with
fissu...
 Management:
 Stop habits
 Conservative treatment-
 Use of beta carotenes, lycopene, L-ascarbic acid, vit.E,
retinoic ...
Pigmentation:
 Tongue may exhibit various patterns of racial melanin
pigmentation.
 Joundice may be apparent on ventral ...
 Extravasation of red cells around lingual varicocities
may give a patchy, bluish red discoloration, usually on
ant. Vent...
Ucers and infectious diseases:
 Quite severe ulcers, which are more in nature of
lacerations and contusions, are produced...
 Ulcers on lingual frenum in neonates with natal lower
incisors rae reffered as Riga’s ulcer or Riga-Fede
disease.
 Shal...
 Vesiculobulous disorders also may involve lingual
mucosa.
 Tuberculosis-post. ventral surface
 The ant. 1/3rd of the t...
 The most effective treatment to get rid of tongue ulcer
is to increase your body's immunity power by taking B-
complex t...
Superficial vascular changes:
 Lingual varicosities are evident as prominent purplish
blue spots, nodules, and redges, us...
Amyloidosis:
 Involvement of the tongue is described in both the
primary and secondary forms of amyloidosis.
 The charac...
Neuromuscular disorders:
 Neuromuscular disorders of central, peripheral, or
muscular origin may produce symptom of dysph...
 Damage to hypoglossal nerve, leads to hypoglossal
palsy.
 If bilateral, the tongue can not be extended
 If unilateral,...
Sleep Apnea Syndrome:
 Sleep apnea is a disorder characterized by a reduction
or pause of breathing (airflow) during slee...
 Sleep apnea is treated with lifestyle changes,
mouthpieces, breathing devices, and surgery.
Medicines typically aren't u...
Vascular disease of the body of
the tongue:
 The lingual artery is very susceptible to the
development of atherosclerotic...
Angioneurotic Edema:
 Angioneurotic edema is one form of acute
anaphylactic reaction representing an immediate
hypersensi...
Benign tumors of tongue:
 A benign mouth tumor is an abnormal growth located
in the mouth or tongue.
 The growths are no...
 c/f:
 bleeding lump –
 Mouth dentures don't fit
 difficulties swallowing
 lump in any part of the mouth
 poor pronu...
 Benign tumors of tongue are as:
 Fibroma
 Papilloma
 Hemangioma
 Lymphangioma
 Granular cell myiblastoma
 Lipoma
Fibroma:
 A fibroma is a benign, tumor-like growth made up
mostly of fibrous or connective tissue.
 Tumor-like growths s...
Papiloma:
 Papilloma is a general medical term for a tumor of the
skin or mucous membrane with finger-like
projections.
...
Hemangioma:
 Hemangioma is a benign tumor of dilated blood vessels.
 It is also known as port-wine stain, strawberry
hem...
Lymphangioma:
 Lymphangiomas are benign hamartomatous tumors of
the lymphatic channels. They are thought to be
developmen...
Granular cell myoblastoma:
 Granular cell tumour, is a relatively uncommon benign
neoplasm, which is more commonly found ...
Lipoma:
 Lipoma is a rare benign tumour of mesenchymal
origin which infiltrates adjacent muscle and tend to
recur after e...
Malignant tumors of tongue:
 Cancer of the tongue is a malignant tumor that begins
as a small lump, a firm white patch, o...
Squamous cell carcinoma:
 It is most common oral carcinoma with 60% cases
arising from the ant. 2/3rd of the tongue and r...
 c/f: middle and later decades, m>f ,
 Painless mass or ulcer later becomes painful
 Excessive salivation
 Offensive s...
 Management:
 Early carcinoma of tongue(T1 and small T2) responds
equally well to surgical excision or by radiation.
 T...
 Treatment of carcinoma of the ant. 2/3rd of tongue
with evidance of node involvement may include
radical neck dissection...
Diseases of Tongue
Diseases of Tongue
Diseases of Tongue
Diseases of Tongue
Diseases of Tongue
Diseases of Tongue
Diseases of Tongue
Diseases of Tongue
Diseases of Tongue
Diseases of Tongue
Diseases of Tongue
Diseases of Tongue
Diseases of Tongue
Diseases of Tongue
Diseases of Tongue
Diseases of Tongue
Diseases of Tongue
Diseases of Tongue
Diseases of Tongue
Diseases of Tongue
Diseases of Tongue
Diseases of Tongue
Diseases of Tongue
Diseases of Tongue
Diseases of Tongue
Diseases of Tongue
Diseases of Tongue
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Diseases of Tongue

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classification
description of individual disease
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Diseases of Tongue

  1. 1. PERSENTED BY: SACHIDANAND GIRI JR-1
  2. 2. Contents:  Introduction  Classification  Inherited or congenital diseases  Diseases of lingual mucosa  Diseases affecting body of tongue  Tumors of tongue
  3. 3. INTRODUCTION  Tongue is a muscular organ situated in the floor of mouth.  It aids in chewing, swallowing, speech and taste.  It is organ of location of taste.  The tongue may be affected as part of oral disease or as a signs of systemic diseases.
  4. 4. CLASSIFICATION OF TONGUE DISORDERS  A)Inherited, congenital and developmental anomalies:  a) Minor variations:  1 .Partial ankyloglossia  2.Variations in tongue movement  3.tongue thrusting  4.fissured tongue  5.patent thyroglossal duct and cyst  6.lingual thyroid  7.median rhomboidal glossitis
  5. 5.  b) Major variations:  1.Cleft, lobed, bifurcated and tetrafurcared tongue  2.aglossia, hypoglossia and macroglossia  3.hamartoma and dermoid  4.bald and depapillated tongue  5.papilomatous changes
  6. 6.  B)Disorders of the lingual mucosa:  a)changes in the tongue papillae:  1.geographic tongue  2.coated or hairy tongue  b)Non-keratotic lesions:  1.thrush  2. white sponge nevus  3.vesiculobulous and other desquamative disorders
  7. 7.  c)keratotic white lesions:  1.lichen planus  2. leukoplakia  d)depapillation and atrophic lesions: 1. Chronic trauma 1. 2. Nutritional deficiency
  8. 8.  3. hematological abnormalities  4.medication  5.peripheral vascular disease  5.diabetes and chronic candidiasis  6.tertiary syphilis and interstitial glossitis  e)pigmentation:  f)ulcer and infectious disease  g)superficial vascular disease
  9. 9.  C) Disorders affecting body of tongue:  1.Amyloidosis  2.Infections  3.Neuromuscular disorders  4.Sleep apnea syndrome  5.TMJ Myofascial dysfunction  6.Vascular disease of body of tongue  7. Angioneurotic edema
  10. 10.  D) Tumers of tongue:  Benign  Malignant
  11. 11. Partial ankyloglossia:  Partial ankyloglosia refers to congenital shortness of the lingual frenum or a frenal attachment that extends nearly tip of tongue,binding the tongue to floor of mouth and restricting its extention.  Clinical features:  Restricted tongue movements  Feeding problums  Speech defects: lisping, inability to pronounce words such as ta, te, time, water, cat etc.  Tongue biting
  12. 12.  Syndromes associated are:  Ankyloglossum superioris syndrome  Trisomy of 13  Pirrie robin syndrome  Rainbow syndrome  Management:  1. counselling  2.surgery
  13. 13. Variation in tongue movement  Ability to curl up the lateral borders of tongue into a tube is noted in 65% of caucasians and is inherited as a n autosomal dominant trait.  Unusual extensibility of tongue, both farward to touch tip of nose(gorlin sign)and backword into the pharynx occurs in Ehlers-danlos syndrome.  The tongue in tuberous sclerosis-long and narrow  The mobility of tongue is also restricted in epidermolysis bullosa as a result of fibrous scars secondrry to blister farmation.
  14. 14. Tongue Thrusting  Tongue thrust is a forward placement of the tongue between the anterior teeth and against the lower lip during swallowing, speaking or at rest.  It is an infantile swallowing pattern.  It may be associated with macrogllosia.  And:
  15. 15. 1. Proclination of anteior teeth 2. Anterior open bite 3. Bimaxillary protrusion 4. Posterior open bite in case of lateral tongue thrust 5. Posterior cross bite
  16. 16. Fissured Tongue:  Also called as scrotal tongue,plicated tongue,and lingua dissecta.  Characterised by furrows, one extending anteroposteriorly and others lateraly over the entire anterior surface.  Patterns: plication, central longitudinal fissuring, double fissures, transverse fissuring, lateral longitudinal.  Bacteria and debris retained in the fissures causing irritation or burning sensation.
  17. 17.  Syndromes: trisomy 21 (mongolism) ,melkerson rosenthal syndrome.  Management: maintenance of oral hygiene.
  18. 18. Patent Thyroglossal Ducts and Cysts  Thyroid gland develops from an analogue of endothelial cells in the midline of the floor of the pharynx, between the first and second brachial arches, just posterior to tubercular impar.  These cells sink into the base of developing tongue ,descent into the neck and proliferate below the larynx to form thyroid gland.  Remnant of the epithelium along this path are reffered as thyroglossal duct.  Cystic degeneration of it is called as duct cyst.
  19. 19.  In 70% of those with heterotopic thyroid ,the thyroid gland is contained entirerly within the tongue.  Enlagement of the lingual thyroid , cystic changes, or malignancy may be first recognised due to symptoms of an enlarging tongue, dysphagia or less commonly,hypoglossal palsy.  Dysphagia with firm cystic mass in midline of neck will give clue to the diagnosis.  The cysr is lined by columner,respiratory or stratified squamous epithelium.  Management: surgically excised or enucleated.
  20. 20. Median Rhomboid Glossitis:  ‘central papillary atrophy of tongue’  Developmental defect resulting from an incomplete descent of tuberculum impar and entrapment of a portion between fusing lateral halves of the tongue.  It is benign lesion.  Characterised by rhomboid or oval in shape, changes occur in the tongue mucosa in the midline, just anterior to the foramen caecum.  Some authers suggest fungal infection as etiology.
  21. 21.  c/f: m>f  Generally asymptomatic  The surface is dusky red and completely devoid of filiform papillae and usually smooth.  Kissing lesion-soft palate erythema may be seen where the lesion of median rhomboid glossitis touch the palate.  Management: antifungal agents,  Long standing cases:cryosurgery, excisional biopsy
  22. 22. Cleft,Lobed, Bifurcated and Tetrafurcated Tongue:  Seperation of the dorsal surface of tongue into 2 or 4 by deep grooves.  Associated with orofacial-digital syndrome,fetal face syndrome,meckel’s syndromes.  Management:regular cleaning of tongue.
  23. 23. Aglossia,Hypoglossia  Aglossia: complete absent of tongue at birth.  Hypoglossia: small rudimentary tongue.  c/f: difficulty in eating,speaking  High arched palate,narrow constricted mandible  Airways problums  Associated with hypoglossia-hypodactylia syndrome,hypomelia, Pierre Robin syndrome.
  24. 24. Macroglossia:  Tongue enlargement-leads to functional and cosmetic problems.  Etiology:  1.Congenital-hemangioma,lymphangioma, lingual thyroid, cretinism, down syndrome, neurofibromatosis and multiple endocrineneoplsia type2B.  2.Inflammatory: syphilitic gumma,ranula, postoperative edema.  3.Neoplastic:granular cell tumer,neurofibroma, lipoma ,carcinoma.  4.Metabolic:myxedema,amyloidosis,acromegaly.
  25. 25.  C/F:noisy breathing,drooling of saliva, difficulty in eating, speech and airways problums.  Recurrent upper respiratory tract infection.  Displacement of teeth ,malocculusion  Crenation of lateral border of tongue  Associated with beckwith’s syndrome  Management: surgical, orthodontic, speech therapy
  26. 26. Hamartomas and Dermoids:  The tongue may be enlarged or distorted by the persence of variety of tumerlike growthsof developmental origin(hamartomas- neurufibroma,hemangiomas)  or by epithelial inclusion cysts(dermoids,branchial cleft cysts).
  27. 27. Bald or Depapillated tongues:  An erythematous , edematous and painful tongue that appears smooth because of loss of filifirm papillae and sometime fungiform papillae secondary to certain nutrional deficiency .  Atrophy or loss of papillae may be caused by a congenital anomaly ,or develop as a secondary features
  28. 28.  Local causes:  Eosinophilic granuloma  Traumatic injuries-jagged teeth,rough margins of restorations and inadvertent contact of tongue with dental medicaments such as eugenol.  Allergic stomatitis: monomer of denture, mouthwash, chewing gum, and lipstick.  Facial hemiatrophy
  29. 29.  Systemic causes:  Iron deficiancy anemia: first appears at tip,lateral border of tongue with loss of filiform papila. In extreme cases , the entire dorsum becomes smooth and glazed. Very painful either pale or fiery red.  Plummer vinson syndrome: sideropenic anemia shares atrophic glositis, angular cheilitis, generalised atrophic oral mucosa, oral ulceration and secondary candidiasis  Pernicious anemia: atrophy of filiform &fungiform papilae.  Niacin deficiency:
  30. 30.  Folic acid deficiency: tongue is fiery red and atrophy of filiform & fungiform papilae. Tongue is swollen and small cracks may appear on dorsal surface.  Sceroderma: tongue shrinks, losing its mobility and papillary pattern. Color of the tongue changes to a vivid appearance due to circulatory disturbances. In the end stages, the tongue lies as a stiff, reduced body in the floor of mouth.  Dermatomyositis: in early stages, tongue is markedly swollen and later becomes harder. In the late phase, tongue is atrophic.
  31. 31.  Diabetes: central papilary atrophy of the dorsum in which low flat papillae are noticed just ant. to row of circumvallate papillae.  Syphilis: depapilation of tongue usually occurs in secondary and tertiary syphilis. Single or multiple mucous patch on the tongue. A more difusse, chronic, nonulcerating, iiregular induration, with an asymmetrical pattern of grooves and atrophic field covering the entire dorsum.  Zoster infection:numerous vesicles occur on ventral surface of tongue.  Atrophic gastritis:
  32. 32.  Peripheral vascular disease: decreased nutritional of the lingual papillae as a result of vascular changes affecting the subpapillary dorsal capillry plexus.  Using fluorescence-enhanced capillary microscopy in humans have documented variations in the fungiform papillae associated with age, sex, and the number and shape of terminal vessels in the papillae.  Infarcts of the tongue may be associated with shrinkage of the affected side of tongue and atrphic changes in the overlying mucosa.
  33. 33.  Deficiency:  Vitamin-A  Vit-B1  Vit-B2  Pantothenic acid  Vit-B6(niacin)  Vit-B2,B6,B12,niacin  Folic acid,vit-B6,zinc  Symptoms:  Poor sense of taste  Furrowed tongue  Purplish or magenta tongue  Beefy enlaged tongue  Scarlet red tongue  Burning sore tongue  Ulcer on tongue
  34. 34. Papillomatous changes:  In several congenital disorders the surface of tongue is covered with multiple papilomas. When extensive this abnormalities is known as pebbly tongue.  Lesions of this type is associated with congenital lingual lymphangiomas, neurufibromatosis and the Anderson-Fabry syndrome and Meckel’s syndrome.  Management:
  35. 35. Geographic Tongue:  Also called as benign migratory glositis,wandering rash, glossitis areata exfoliativa, and erythema migrans  It refers to irregularly shaped reddish areas of depapillation and thinning of the dorsal epithelium which is surrounded by a narrow zone of regenerating papillae that are whiter than the surrounding tongue surface.  Etiology:  Hypersensitive patient: h/o-asthma, hay fever, eczema.  Other factors:immunological reaction, emotional strees , hereditary factors, nutrional deficiencies.
  36. 36.  C/F- common in young & middle age.  Female predilection  Commonly on dorsal surface & lateral border  Asymptomatic but patient may complain of burning sensation, stinging, pain  Initially appears as a smsll erythrmatous, non- indurated, atrophic lesion, bordered by a slitaly elevated distinct rim that varies from gray to white to light yellow.  Loss of filiform papillae pink to red smooth shiny surface , fungiform papillae persist in desqumated areas as small elevated red dots.
  37. 37.  The condition may persist for weeks to months and then regress spontaneously only to occur at later date.  The lesion is not always restricted to tongue and similar irregular or circinate lesions occur elsewhere in the oral cavity and are called as ectopic geographic tongue or erythema circinate migrans or annulus migrans.
  38. 38.  Diagnosis: clinically  Biopsy shows loss of filiform papillae with hyperparakeratosis and acanthosis.  D/D-  Psoriasis  Reiter’s syndrome:skin,occular,urethral lesion +  Licken planus:absense of raised whitish yellow rim.  Use of strong mouth wath-h/o  Anemic condition:hematological study and absense of raised yellowish white border.
  39. 39.  Management:  For control of burning-topical local anaesthetic agents like lidocaine, dyclonine hydrochloride, or diphenhydramine can be given.  Topical therapy: topical corticosteroids and topical application of salicylic acid and tretinoin(retinoic acid)  Psychological assurance
  40. 40. Hairy Tongue:  Lingua villosa, lingua nigra, black hairy tongue  An overgrowth of filiform papillae on the dorsum of tongue , giving the tongue a superficial resemblance as that of hairiness.  There is marked accumulation of keratin on the filiform papillae.
  41. 41.  Etiology:  Fungal and bacterial overgrowth:  Use of certain drugs: sodium perborate, sodium peroxide, and antibiotics like penicillin and Aureomycin  Poor oral hygiene  After surgery  Lowered ph-blocks the normal desqumation of epithelial cells covering the filiform papillae
  42. 42.  In Debilitated, dehydrated, terminally ill patients can lead to very thick, leathery coatings on the tongue that are reffered to as earthy or encrusted tongue.  C/F: papillae may reach a lenth of 2cm which occasionally brush the palate and may produce gagging or bad taste.  The hyperplastic papillae then become pigmented by the colonisation of chromogenic bacteria,which can impart a variety of colors ranging from green to brown to black to yellow.
  43. 43.  This gives it a coated or hairy appearance and retains debris and pigments from substances from food, tobaco, smoke, madicines.  Management:  Maintenance of oral hygiene  Elimination of predisposing factors  Topical keratolytic application- podophyllum in acetone or alcohal suspention
  44. 44. Thrush:  Acute pseudomembranous candidiasis  Often appears as pearly white , pinhead size flecks scattered over the dorsal surface.  Etiology:overgrowth of Candida albicans in patient taking antibiotics, immunosuppressants drugs,or having a disease that supresses the immunity.  C/F: f> m  Prodromal symptoms like rapid onset of bad taste, discomfort on spicy food, burning sensation  White patches are easily wiped out
  45. 45.  d/d-  Plaque form of licken planus  Leukoplakia  Gangrenous stomatitis  Chemical burn
  46. 46.  Management:  Topical application of clotrimazole cream-2-3 times daily for 3-4 weeks.  Ketoconazole 200-400 mg od for 2 weeks  Fluconazole 50-100mg od for 2-3 weeks
  47. 47. White sponge nevus:  Congenital anomaly in which the surface of tongue as well as other parts of oral mucosa are involved by white spongy plaques without significant hyperkeratosis.  c/f- children are most commonly affected  Friction may strip superficial keratotic area leaving zone of normal looking epithelium or raw area.  No treatment
  48. 48. Vasiculobullous and other Desquamating disorders  Desqumating disorders are often mistakenly identified as white lesions because coalscence of whitish desquamating epithelium with areas of papillary atrophy and scarring.  Patches of regenerating papillae may also be interspersed, giving red and white areas in a marble like pattern.
  49. 49. Licken planus:  Oral licken planus is defined as a common chronic immunological mucocutaneous disorder that varied in appearance from keratotic to erythematous and ulcerative.  Lacelike , erosive and bullous variety of this disorder may affect the tongue in addition to the cheeks, lips, and gingiva.  Etiology: unknown  Immune systum has primary role in development of this disease.
  50. 50.  Other facters: stress, habits, hypertention, diabetes  c/f- oral lesions are characterized by radiating white and gray valvety thread like papules in linear, angular or retiform arrangement.  Tiny white elevated dots rae persent at the intersection of white lines, called as Wickham’s striae.  In some cases superimposed candidial infection
  51. 51.  d/d-  Leukoplakia  Candidiasis  Drug induced reaction  Geographic tongue
  52. 52.  Management:  Removal of cause  Steroids –topical and systemic  Topical application of antifungal agents  Retinoids  Psychotherapy
  53. 53. Leukoplakia:  It is whitish patch or plaque that can not be characterised, clinically or pathologically, as any other disease and which is not associated with any other physical or chemical causative agent except the use of tobaco.  It can occur anywhere in the oral cavity but tongue is one of the commonest site.  If it occurs on tongue ,it is called as ‘chronic superficial glossitis’
  54. 54.  Etiological factors are classically known as 6 S ….smoking, syphilis, sharp tooth, sepsis, sprit, and spices.  Alcohal-facilitates the entry of carcinogen into exposed cells and thus alters the oral epithelium and its metabolism.  Vitamin deficiency
  55. 55.  c/f- confied to ant. 2/3 rd of tongue,dorsum and lateral border.  The affected area show milky-white patches with fissure and cracks.  Some patient may complain of burning sensation
  56. 56.  Management:  Stop habits  Conservative treatment-  Use of beta carotenes, lycopene, L-ascarbic acid, vit.E, retinoic acid,  Surgical treatment: cold knife surgical excision, laser surgery
  57. 57. Pigmentation:  Tongue may exhibit various patterns of racial melanin pigmentation.  Joundice may be apparent on ventral mucosa  Exogenous pigmentation of the filiform papillae of the normal and coated or hairy tongue is very common and results from microbial growth and metabolic products, food debris, and dyes from candy, beverages, and mouth rinses.  Pigmentation by chemotherapeutic agent, doxorubicin hydrochloride
  58. 58.  Extravasation of red cells around lingual varicocities may give a patchy, bluish red discoloration, usually on ant. Ventral surface of tongue.
  59. 59. Ucers and infectious diseases:  Quite severe ulcers, which are more in nature of lacerations and contusions, are produced by sudden biting trauma, either during epileptic seizure or as a result of a sudden blow to the jaw while tongue lies b/w upper and lower teeth.  Rough surface of restorations and jugged, brocken cusps rapidly cause ulceration of the tongue.  Lateral margins and ventral surface of tongue are also frequently damaged by contact with rapidly revolving burs, discs, or other dental equipment.
  60. 60.  Ulcers on lingual frenum in neonates with natal lower incisors rae reffered as Riga’s ulcer or Riga-Fede disease.  Shallow but persistant tontue ulcers , especially along the posterior ventral surfaces, are common in patients with licken planus, various nutritional deficiencies, and hematological problums.  The lateral margins and tip of tongue are frequently involved in sevsere episode of recurrent aphthous ulcers.
  61. 61.  Vesiculobulous disorders also may involve lingual mucosa.  Tuberculosis-post. ventral surface  The ant. 1/3rd of the tongue may also be site of an extragenital chancre in primary syphilis.  In primary herpes simplex gingivostomatitis, the dorsum, ventral and lateral margin may be ulcerated.  In infections with erythrogenic, toxin producing Streptococcus pyogens (scarlet fever), the sign of strawberry tongue.
  62. 62.  The most effective treatment to get rid of tongue ulcer is to increase your body's immunity power by taking B- complex tablets and vitamin tablets.  Glycerin: Rinsing your mouth and tongue with glycerin on the affected parts of tongue is the best way to alleviate the pain caused by ulcers under tongue and throat. Rinsing your mouth with glycerin also controls the wounds or lesions further spreading and expanding inside the mouth and throat.  Topical application of lignocaine
  63. 63. Superficial vascular changes:  Lingual varicosities are evident as prominent purplish blue spots, nodules, and redges, usually on the anterior ventral surface of the tongue and around the submandibular-sublingual gland orifices.  But they are rarely symptomatic  They represent a normal age change  Petechial hemorrhages and telangiectases also can demonstrated on vetral surface  Hemangiomas are relatively common on tongue.
  64. 64. Amyloidosis:  Involvement of the tongue is described in both the primary and secondary forms of amyloidosis.  The characteristic fibrous glycoprotein of this disease is deposited in the submucosa as well as in deeper muscular layers of tongue.  Generalised enlargement of the tongue(macroglsia) and fungating swelling may result.
  65. 65. Neuromuscular disorders:  Neuromuscular disorders of central, peripheral, or muscular origin may produce symptom of dysphagia and choking as well as disordered mastication and speech problems.  Repetitive , uncontrolled movement of the tongue, head, and jaws, depapillation, burning sensations and traumatic ulcers of tongue are common in buccolingaul-facial dyskinesia, parkinsonism, and the tardive dyskinesia.  Weakness of tongue can occur in polymyositis, multiple sclerosis and Duchenne’s muscular dystrophy.
  66. 66.  Damage to hypoglossal nerve, leads to hypoglossal palsy.  If bilateral, the tongue can not be extended  If unilateral, the tongue deviates to the unaffected side when extended.
  67. 67. Sleep Apnea Syndrome:  Sleep apnea is a disorder characterized by a reduction or pause of breathing (airflow) during sleep.  It is common among adults becoming more common in children  Obstructive sleep apnea is caused by the collapse of the airwayduring sleep.  Obstructive sleep apnea is diagnosed and evaluated by history, physical examination and polysomnography (sleep study).  One of the most common signs of obstructive sleep apnea is loud and chronic (ongoing) snoring.
  68. 68.  Sleep apnea is treated with lifestyle changes, mouthpieces, breathing devices, and surgery. Medicines typically aren't used to treat the condition.  The mouthpiece will adjust your lower jaw and your tongue to help keep your airways open while you sleep.
  69. 69. Vascular disease of the body of the tongue:  The lingual artery is very susceptible to the development of atherosclerotic changes.  The extent of the lingual atherosclerosis increases with age, but age does not bring ischemic comlications secondary to atherosclerosis.  Infarcts of tongue are fairly rare
  70. 70. Angioneurotic Edema:  Angioneurotic edema is one form of acute anaphylactic reaction representing an immediate hypersensitivity response allied to urticaria, allergic rhinitis, and asthma.  Antigenic stimuli are-respiratory allergens, food such as shellfish, chocolate, nuts, various drugs and occasionally cold and physical trauma to tongue.  Medications used to treat angioedema include:  Antihistamines  Anti-inflammatory medicines (corticosteroids)  Epinephrine shots (people with a history of severe symptoms can carry these with them)  Inhaler medicines that help open up the airways
  71. 71. Benign tumors of tongue:  A benign mouth tumor is an abnormal growth located in the mouth or tongue.  The growths are not cancerous and very rarely spread to other body parts.  The condition is most common in adults over the age of 60.  The risk of developing an abnormal growth within the mouth is greater increased in smokers.
  72. 72.  c/f:  bleeding lump –  Mouth dentures don't fit  difficulties swallowing  lump in any part of the mouth  poor pronunciation  sore lump - mouth
  73. 73.  Benign tumors of tongue are as:  Fibroma  Papilloma  Hemangioma  Lymphangioma  Granular cell myiblastoma  Lipoma
  74. 74. Fibroma:  A fibroma is a benign, tumor-like growth made up mostly of fibrous or connective tissue.  Tumor-like growths such as fibroma develop when uncontrolled cell growth occurs for an unknown reason, or as a result of injury or local irritation.  Fibromas can form anywhere in the body and usually do not require treatment or removal.  Usually painless  Surgical exicision
  75. 75. Papiloma:  Papilloma is a general medical term for a tumor of the skin or mucous membrane with finger-like projections.  Papillomas are either pedunculated or sessile growth on any surface of oral mucous membrane.  Multiple papillomae are occur in cowden’s syndrome, down’s syndrome.  Surgical excision.
  76. 76. Hemangioma:  Hemangioma is a benign tumor of dilated blood vessels.  It is also known as port-wine stain, strawberry hemangioma, and Salmon patch.  They are characterized by hyperplasia of blood vessels, usually veins and capillaries, in a focal area of submucosal connective tissue.  Surgical or invasive treatment of oral hemangiomas has evolved. Complete surgical excision of these lesions offers the best chance of cure, but, often, because of the extent of these benign lesions, significant sacrifice of tissue is necessary. For example, lesions of the tongue may require near-total glossectomy
  77. 77. Lymphangioma:  Lymphangiomas are benign hamartomatous tumors of the lymphatic channels. They are thought to be developmental malformations arising from sequestration of lymphatic tissue that do not communicate with the rest of the lymphatic channels  Oral lesions are most frequently found on the tongue.  Treatment:injection of sclerosing solutions, cryosurgery, intravascular emovilization with silicon spheres.
  78. 78. Granular cell myoblastoma:  Granular cell tumour, is a relatively uncommon benign neoplasm, which is more commonly found in females in the 4th to 6th decades of life even though it can occur in all ages.  Most of the intraoral lesions occur on the tongue, usually on the lateral aspect.  Granular cell tumours are slow-growing, painless tumours with no known cause.  They may start in nerve cells.  They occur mostly on the top of the tongue.
  79. 79. Lipoma:  Lipoma is a rare benign tumour of mesenchymal origin which infiltrates adjacent muscle and tend to recur after excision  It is prevalently found in the cheek and tongue, but also in the lip, gingival and floor of the mouth.  Particularly, lipoma accounts for 0.3% of all lingual tumours
  80. 80. Malignant tumors of tongue:  Cancer of the tongue is a malignant tumor that begins as a small lump, a firm white patch, or a sore (ulcer) on the tongue.  If untreated, the tumor may spread throughout the tongue to the floor of the mouth and to the gum (jaws).  As a tumor grows, it becomes more life threatening by spreading (metastasizing) to lymph nodes in the neck and later to the rest of the body  Eg: squamous cell carcinoma,
  81. 81. Squamous cell carcinoma:  It is most common oral carcinoma with 60% cases arising from the ant. 2/3rd of the tongue and reminder from base of tongue.  Etiology: physical trauma, alcohal, tobacco, smoking, candidiasis, syphilis, sepsis, chronic dental trauma and chronic superficial glossitis.  About 80% of all people who develop tongue cancer are smokers.
  82. 82.  c/f: middle and later decades, m>f ,  Painless mass or ulcer later becomes painful  Excessive salivation  Offensive smell in mouth occurs due to bacterial stomatitis.  Sore thraot  Immobility of tongue-causes difficulty in speech.  Hoarseness of voice and dysphagia  It spread by infiltration and invasion.
  83. 83.  Management:  Early carcinoma of tongue(T1 and small T2) responds equally well to surgical excision or by radiation.  T1 and T2 with no evidance of lymph node metastasis, surgical treatment is usually restricted to partial glossectomy.  If it is T2 or T3 without node involvement , prophylactic neck dissection is advised.
  84. 84.  Treatment of carcinoma of the ant. 2/3rd of tongue with evidance of node involvement may include radical neck dissection, partial mandibulectomy, and intraoral dissection(commando operation) in adition to glossectomy  Better cure rates obtained with combined chemotherapy(cis-platinum and bleomycin)-surgery- radiation aproaches, use of neutron irradiation, immunotherapy, and transoral laser resection for accessible early stage carcinoma. 

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