Ulceración por trauma crónico: una lesión simuladora. Informe de un caso clínico / Oral traumatic ulceration: a mimic lesion. Report of a case

Objetivo: Describir la importancia del reconocimiento oportuno del trauma crónico de la mucosa bucal producido por un elemento dentario que generó una lesión erróneamente diagnosticada como neoplasia maligna. Caso clínico: Una paciente de sexo femenino, de 79 años de edad, realizó una consulta estomatológica por una lesión lingual con un diagnóstico presuntivo de cáncer. Tras la inspección de la cavidad bucal y el estudio anatomopatológico se diagnosticó úlcera asociada a trauma dentario. La intervención terapéutica odontológica (eliminación del trauma) resolvió el cuadro cínico. Conclusión: El trauma crónico en la mucosa bucal puede generar lesiones sobre mucosa sana o bien complicar una patología preexistente. En el presente caso, la inspección de la cavidad bucal con la identificación y la eliminación del trauma lograron la reparación de la lesión. El estudio anatomopatológico precisó el diagnóstico de ulceración asociada a trauma dentario (AU)

Aim: The aim of this case report is to show the importance of the early diagnosis of a traumatic lesion of the oral mucosa arising from a posterior broken tooth that was initially misdiagnosed as oral cancer. Case report: A 79-year-old female attends an appointment with the oral medicine specialist for a lesion on the lateral side of the tongue with a presumptive diagnosis of oral cancer. The examination of the oral cavity and the anatomopathological diagnosis confirmed the presence of an ulcer associated with dental trauma. The lesion healed completely with the elimination of the trauma. Conclusion: Chronic trauma in the oral cavity can produce lesions in the oral mucosa or exacerbate preexisting lesions. In this case report a thorough oral examination showed a broken tooth as the cause of trauma and after its removal the lesion healed completely. The result of the biopsy confirmed the diagnosis of an oral ulcer associated with dental trauma (AU)

Necrosis lingual como forma de presentación de arteritis temporal / Lingual necrosis as a form of presentation of temporary arteritis

La arteritis de células gigantes es una vasculitis sistémica que compromete arterias de mediano y gran calibre, principalmente la arteria aorta y sus ramas. Su prevalencia es mayor en mujeres a partir de los 50 años, típicamente se manifiesta con fiebre, claudicación mandibular, cefalea, hiperestesia del cuero cabelludo y pérdida de la visión con neuropatía óptica isquémica anterior, en una minoría de casos aparecen síntomas menos frecuentes que dificultan y retrasan el diagnóstico. Se presenta el caso de una mujer de 76 años que consultó por dolor en la cavidad bucal con edema lingual y en cuello de 48 horas de evolución asociado a cefalea el mes previo. En el examen físico presentaba signos clínicos de isquemia lingual, por lo que se consideró como diagnóstico presuntivo compromiso isquémico por arteritis de células gigantes, e inició tratamiento con corticoides sistémicos realizándose una biopsia de arteria temporal que evidenció infiltrado linfocitario panparietal con engrosamiento de la túnica íntima y hallazgos compatibles con panarteritis. La arteritis de células gigantes debe ser sospechada en pacientes con manifestaciones de isquemia lingual, iniciándose en forma precoz el tratamiento para evitar complicaciones irreversibles.

Giant cell arteritis is a systemic vasculitis that affects arteries of medium and large caliber, mainly the aorta artery and its main branches. It is more frequent in women older than 50 years. The most common symptoms are fever, jaw claudication, headache, hyperesthesia of the scalp and loss of vision with anterior ischemic optic nerve disease. But, in a minority of cases, less frequent symptoms are observed that delay and make more difficult the diagnosis. Here, we present the case of a 76-year-old woman who came to our consultation having pain in the oral cavity and presenting tongue and neck edema for 48 hours. She had also suffered from headaches during the previous month. Because the physical examination showed clinical signs of lingual ischemia, a presumptive diagnosis of ischemic involvement due to giant cell arteritis was considered. She started a treatment with systemic corticosteroids and a temporal artery biopsy was performed. We conclude, that giant cell arteritis should be suspected in patients presenting lingual ischemia symptoms in order to start the specific treatment early enough to avoid irreversible complications.

Lesions of Tongue : A Five Year Experience.

Context: Tongue lesions are quite common and affect both genders and all age groups. However, very few studies concentrate on the histopathological spectrum of tongue lesions, usually including them as a part of oral cavity lesions. No such study has been published from the newly formed state of Uttarakhand. Aim: A retrospective review of histopathology of various types of tongue lesions in different age groups of both genders, amongst cases reported in the department of pathology. Methods and Materials: Study included a total of 121 cases of tongue lesions reported in the histopathology section over a duration of five years, from July 2004 to June 2009. Result: In this study, the most common lesions were malignant (58.7%), followed by benign lesions (33%) and pre-malignant lesions (8.3%). The most common site for tongue lesions was base of tongue (52.8%). Common age groups affected were 41- 50 years (27.2%) and 51-60 years (28.0%). The most common clinical presentation was growth and induration. Overall males were affected more than females; with Male:Female ratio of 3.3:1. Conclusions: The commonest tongue lesion in this study was moderately differentiated squamous cell carcinoma among the malignant lesions whereas chronic inflammation was the commonest out of non-malignant lesions. Tongue may show some less common tumours like schwannoma and hemangioma etc.

Abscesso de língua: relato de caso / Tongue abscess: case Report

INTRODUÇÃO: Os abscessos na língua são raros mesmo estando frequentemente em contato com traumas, mordeduras, e corpos estranhos. Isto decorre devido às características imunológicas da saliva e algumas características histológicas e anatômicas da língua. Este trabalho tem como objetivo relatar um caso de abscesso de língua ocorrido em nosso serviço, e fazer uma revisão da literatura. RELATO DO CASO: Paciente 76 anos, sexo masculino, atendido com queixa de dor a deglutição de evolução progressiva há uma semana, com piora importante há 3 dias. Relata história de cirurgia para implante dentário no início do período. Na admissão durante o exame da cavidade oral foi evidenciado abaulamento de aproximadamente 2X2 cm no terço médio posterior de língua à direita, doloroso a palpação. Optou-se pela internação do paciente. Solicitou-se uma ressonância nuclear magnética que evidenciou lesão sugestiva de abscesso na base da língua à direita. Foi submetido a tratamento clínico com antibioticoterapia drenagem cirúrgica. O paciente evoluiu satisfatoriamente. DISCUSSÃO: A manifestação clínica do abscesso de língua pode ser variada. O diagnóstico deve ser feito pela história clínica, correlacionando os fatores de risco associados, exame físico e aos exames de imagem confirmatórios. A etiologia e os diagnósticos diferenciais devem ser considerados dependendo do local da manifestação clínica. A abordagem deve incluir a permeabilidade da via aérea, suporte clínico, antibioticoterapia sistêmica e drenagem do abscesso. CONSIDERAÇÕES FINAIS: O abscesso de língua deve entrar no diagnóstico diferencial dos abaulamentos de língua devendo ser conduzido com antibioticoterapia e drenagem cirúrgica de maneira rotineira.

INTRODUCTION: The tongue abscesses are rare even being frequently in touch with trauma, bites, and foreign bodies. It occurs because of the immunological features of the saliva and some histological and anatomical characteristics of the tongue. This work has as objective report a case of tongue abscess occurred in our job, and do a literature review. CASE REPORT: Patient of 76 years, male, assisted with complaint of pain when swallowing with progressive evolution for a week, with a significant deterioration over three days. Report history of the surgery, for dental implant in the beginning of the period. In the admission during the oral cavity examination was evident bulging of nearly 2x2 cm in the middle third posterior of the right tongue, painful to palpation. Was opted the hospitalization of the patient. Was required a MRI that showed suggestive lesions of abscess in the base of the tongue in the right side. Was submitted to a clinical treatment with antibiotic therapy and surgical drainage. The patient recovered uneventfully. DISCUSSION: The clinical manifestation from the tongue abscess can be varied. The diagnosis must be done by clinic history, correlating risk factors associated, physical exam and the confirmatory imaging exams. The etiology and the differential diagnosis must be considered depending of the place of the clinical manifestation. The approach must include the permeability of airway, clinical support, and systemic antibiotic therapy and abscess drainage. FINAL CONSIDERATIONS: The abscess of the tongue must go in the differential diagnosis of bulging of the tongue being conducted with the antibiotic therapy and surgical drainage in a daily basis.

Estudo da prevalência de alterações de língua / Prevalence study of the tongue alterations

Introdução - A língua desempenha importantes funções na mastigação, deglutição, gustação e fala. Alterações nesse órgão, como sinal de desordens no organismo, são muito valorizadas clinicamente, uma vez que várias doenças sistêmicas podem estar associadas. O objetivo deste estudo é realizar um perfil epidemiológico,retrospectivo, de seis alterações linguais presentes em pacientes assistidos no projeto de extensão de Estomatologia intitulado: “Diagnóstico, tratamento e epidemiologia das doenças da cavidade bucal (Lebu)”, na Clínica Odontológica da Universidade Estadual de Maringá (UEM), entre o período de 1995 a 2010 e averiguar a relação destas alterações linguais com portadores de prótese e/ou hábitos nocivos. Material e métodos – Realizou-se uma pesquisa retrospectiva na Clínica de Estomatologia doDepartamento de Odontologia da UEM, entre o período de 1995 a 2010, utilizando-se de 2176 prontuários de pacientes assistidos e biopsiados no projeto de extensão Lebu. Resultados - Dos prontuários analisados, 132 pacientes (6,06%) apresentavam algum tipo de alteração lingual. Do número total de pacientes com alterações de língua 72% apresentavam uma associação de lesões sobrepostas. Um total de 38,6% dos pacientes fazia uso de prótese, havendo correlação estatisticamente significante entreo uso de prótese e glossodinia. O uso do tabaco e/ou álcool foi visto em 35,60% dos pacientes, sendo sua relação estatisticamente significante com o desenvolvimento da língua saburrosa e língua pilosa negra. Conclusões – Dentre as alterações de língua estudadas a de maior prevalência foi a língua geográfica. A faixa etária de predileçãofoi a quarta década de vida. A prevalência da língua saburrosa e língua pilosa negra apresentou relação com os pacientes usuários de álcool e tabaco.

Introduction - The tongue plays an important role in chewing, swallowing, taste and speech. Alterations in this organ as a sign of disorders in the body, are highly valued clinically, since many systemic diseases may be associated. The aim of this study is an epidemiological, retrospective six tongue alterations present in patients from the Extension Project of Stomatology titled “Diagnosis, treatment and epidemiology of diseases of the oral cavity (LEBU)” in the Dental Clinic, State University of Maringá, between the period from 1995 to 2010 and the investigate the relationship of these tongue alterations with prostheses and/or harmful habits.Material and methods – A retrospective study at the Clinic of Stomatology, Department of this University was held between the period 1995 to 2010, using the 2176 records of patients assisted and biopsied in the extension project LEBU. Results – 132 patients (6.06%) had some type of the tongue alterations. The total number of patients with tongue alterations (N = 132), 72% had a combination of overlapping lesions. Total of 38.6% of patients used a prosthesis, there was a statistically significant correlation between the use of prosthesis and glossodynia. In relation to tobacco addiction and / or alcohol abuse, 35.60% of patients had some type of addiction, and tobacco useand / or alcohol use was statistically significant for coated tongue and black hairy tongue. Conclusions - Among the tongue alterations studied the most prevalent was the geographic tongue. The age of predilection was the fourth decade of life. The prevalence of coated tongue and black hairy tongue patients were related to the usersof alcohol and tabacco.

Mucocele de las glándulas Blandin-Nuhn, aspectos patológicos y terapéuticos, a propósito de dos casos clínicos / Mucocele of the glands of Blandin-Nuhn

Las glándulas de Blandin-Nuhn son un grupo de pequeñas glándulas salivales mucoserosas, ubicadas en el espesor de los haces musculares de la zona anterior de la cara ventral de la lengua. Los mucoceles de las glándulas de Blandin-Nuhn son poco frecuentes. Se revisa la literatura y se presentan dos casos de mucocele de las glándulas de Blandin-Nuhn, ambos casos eran lesiones exofíticas, indoloras, una de ellas asociada a trauma. Los mucoceles de las glándulas salivales linguales anteriores deben ser resecados hasta el plano muscular para evitar la recidiva. Como esta lesión puede ser confundida con otras patologías, se recomienda su estudio histopatológico para evitar diagnósticos errados.

The Blandin-Nuhn glands are a small group of mucous serous salivary glands, located in the thickness of the muscle bundles of the anterior ventral side of the tongue. Mucocele of the glands of Blandin-Nuhn has been reported as unusual. We review the literature and present two cases of mucocele of the glands of Blandin-Nuhn, both cases were exophytic lesions, painless, one associated with trauma. Mucoceles of the salivary glands should be resected up to the muscular plane to avoid recurrence. Because this lesion may be confused with other diseases, it is recommended an histopathological exam to avoid misdiagnosis.

Darier disease with oral and esophageal involvement: A case report.

A 58-year-old man presented with itchy papular eruptions all over the body since 15 years. Intraoral examination revealed raised papular lesions on the labial mucosa, hard palate, and tongue. The histopathology of the oral and skin lesions was confirmative of Darier disease (DD). This patient also showed esophageal involvement, which was confirmed histopathologically. Such a presentation of DD, with oral and esophageal involvement, is rare.

Tuberculosis of the tongue clinically masquerading as a neoplasm: a case report and literature review

Tuberculosis of the tongue is a very rare event even in areas and countries in which tuberculosis is endemic. The disease can present itself in a variety of clinical appearances, most of which may mimic malignant lingual neoplasms clinically. In this case, we present a patient who initially complained of an ulcerated lingual swelling, which was suspected to be a squamous cell carcinoma on clinical examination. In addition, the diagnosis was missed on the first and initial biopsy as it was not representative of the lesion. The diagnosis of lingual tuberculosis was made by histopathology on a second biopsy. In this article, we described the clinicopathological features of tuberculous glossitis with a comparison between our case and other similar reported cases in addition to a literature review

Schwannoma of the tongue: An unusual presentation in a child.

Schwannomas are benign tumors of nerve sheath and quite uncommon in the oral cavity. In contrast to the earlier reports in the literature, a confounding case of a lingual schwannoma presenting as a symptomatic and exophytic growth on the ventral surface of the tongue in a 12-year-old boy is discussed here.

Método de medición y promedio de la apertura bucal máxima en individuos con maloclusión, en las tres denticiones / Measurement method and average of maximum mouth opening in malocclusion individuals, in the three dentitions

Este trabajo de investigación se realizó con el fin de evaluar el grado de movilidad lingual en pacientes con maloclusión y anquiloglosia, para lo cual previamente y mediante una prueba piloto, se obtuvo el promedio de apertura bucal máxima (ABM) en individuos de las tres denticiones. Se trabajó con una población de 369 pacientes con maloclusión entre 5 a 45 años de edad, de ambos sexos, en denticiones primaria, mixta y permanente, que concurrieron espontáneamente durante el período de un año (noviembre 2003-2004), a la Cátedra de Integral Niños área Ortodoncia A, a la Clínica Odontológica y a la Escuela de Graduados de la Facultad de Odontología de la UNC, República Argentina. La medición se realizó con un calibre de Boley sobre la línea media, valorando la distancia en mm que separa los bordes incisales de los incisivos centrales superiores e inferiores, estando el paciente en apertura bucal máxima (ABM), sin esfuerzo. Los resultados obtenidos fueron: de los 369 pacientes con maloclusión, la ABM en pacientes con dentición primaria (n=105) fue de 42,2 mm, en aquello individuos con dentición mixta (n=152) fue de 46,36mm y en los pacientes con dentición permanente (n=112) fue de 47,38mm.

Riga-Fede disease: A histological study and case report.

Acute traumatic ulcerations and granulomas of the oral mucosa may result from physical damage via sharp foodstuffs, accidental biting, or talking. Most ulcerations heal within days. Others become chronic, reactive, and exophytic. A histopathologically unique type of chronic traumatic ulceration is the traumatic ulcerative granuloma with stromal eosinophilia (TUGSE). TUGSE exhibits a deep "pseudoinvasive" inflammatory reaction. This lesion may occur under the tongue in infants as a result of chronic mucosal trauma caused by mandibular anterior primary teeth during nursing and is termed Riga-Fede disease (RFD). The clinical presentation many resemble squamous cell carcinoma causing concern. RFD, although not uncommon, is not frequently reported. Thus, dental practitioners are unfamiliar with such lesions. We present a large Riga-Fede lesion in an infant along with the clinical management.

Vallecular cyst-revisited.

We report a 3 months-old-male infant presented with recurrent cough, noisy breathing and regurgitation of feeds since 15 days of life. Examination revealed inspiratory stridor. CECT showed cystic lesion in base of tongue. After excision it was proved a case of vallecular cyst on histopathology. Although rare, vallecular cyst should be included in the differential diagnosis of congenital laryngeal stridor in neonates. The literature of vallecular cyst is being reviewed in the current article.

White spongy nevus: a nonhereditary presentation.

White spongy nevus (WSN) is a rare hereditary dyskeratotic hyperplasia of the mucous membranes. It is an autosomal dominant disorder with variable penetrance. A few cases of WSN occur due to de novo mutations. We report a case of WSN in a 12-year-old female child, with none of her family members having similar lesions.

Importancia de la evaluación y clasificación del frenillo lingual / The importance of evaluation and classification of lingual frenum

El propósito de esta investigación surge a partir de la observación, cada vez más frecuente, de pacientes con maloclusiones, cuya causa principal es la anquiloglosia parcial o total. El objetivo fue determinar la cantidad de pacientes con maloclusión que presentaban anquiloglosia sobre una muestra de 282 pacientes de ambos sexos, correspondientes a las tres denticiones, quienes durante el período de un año (noviembre 2003-2004) concurrieron espontáneamente a la Facultad de Odontología de la UNC. En primer término, se evaluó la presencia de anquiloglosia, su frecuencia, y la maloclusión más frecuente en los pacientes con y sin anquiloglosia. Para categorizar los distintos tipos y grados de anquiloglosia, se aplicaron dos métodos de evaluación, considerándose 0 la norma en ambos grupos: (1) grado de movilidad lingual grados 0, 1, 2, 3, 4 (G), referido a la ubicación de la punta de la lengua y su relación con el paladar duro, por detrás de los incisivos superiores, estando el paciente en apertura bucal máxima (ABM); (2) longitud del frenillo lingual tipo 0, I, II, III, IV, medido con calibre de Boley, desde la inserción del frenillo hasta la punta de la lengua, considerándose clínicamente aceptable la lengua libre mayor de 16 mm. Los resultados obtenidos fueron: sobre 282 pacientes con maloclusión, 153 presentaron anquiloglosia, en los cuales la maloclusión más frecuente fue la Clase II, con 43,14 por ciento (n=66), siendo el grado de movilidad lingual G2 (n=92) con 60.13 por ciento y la longitud del frenillo lingual, Tipo II (n=65) con 42,50 por ciento, las más frecuentes.

Lingual thyroid gland: clinical evaluation and management.

The authors present three illustrative cases of lingual thyroid gland in paediatric age group with a protocol for diagnosis and management of the condition. Elements in the diagnostic and therapeutic evaluation are outlined with attention to the clinical findings, laboratory tests and radiographic imaging studies employed in confirming the diagnosis and planning appropriate treatment. Presentations varied from swelling noticed on routine evaluation for upper respiratory tract infection in one, to dysphagia in the next and sore throat in the third patient. On examination they had swelling on the tongue just behind the circumvallate line. 99mTc thyroid scan confirmed the swelling as lingual thyroid with no thyroid tissue in the normal location. All three children had raised TSH levels and were put on suppressive L-thyroxine. At follow up patients are asymptomatic.