lip tongue lesions...quick summary
TRANSCRIPT
Normal lip
• Junction between skin & mucosa• Pink/brown in colour• Vermilion border• Fordyce’s granules• Pits• No swellings or indurations
What can you SEE on the lip?
What you need to KNOW & to DO for
reaching a diagnosis?
1- Swellings
What you need to DO:• History:
o Time first noticedo Any changes in size, consistency, colour,…o Any associated symptomso Any discharge
• Examinationo Determine whether it is diffuse or localizedo Determine it’s consistencyo Determine it’s colour
• Further investigations
1- Swellings
What you need to KNOW
• Differential diagnoses …
• More you know a longer list of differential diagnosis and better diagnosis
Diffuse lip swelling
Angioedema (allergic / non-allergic)
Diffuse lip swelling
Oedema caused by infection / trauma
Diffuse lip swelling
• Healthy young girl• Swelling notices 6 years ago, increasing gradually• Previous treatment with steroid inj. unsuccessful
Diffuse lip swelling
• Orofacial granulomatosis• Oral Crohn’s disease• Monosymptomatic Melkerson-Rosenthal syndrome
Lip swelling
HaemangiomaVs
Haematoma
Localized lip swellings
Adenoma
Localized lip swellings
Mucocele
Localized lip swellings
Keratoacanthoma
White lesions of the lipActinic Cheilitis
High risk
High risk
White lesions of the lipExfoliative chelitis
• Excessive production of keratin• More common in females• Associated with stress &anxiety• Some improve by antidepressant/tranquilizers• Spontaneous remission
Lesions of the lip
Allergic chelitisPerioral dermatitis
Allergic cheilitis
Causes:• Allergic reaction to topical ointments/creams or
lipstick• Tooth paste• Food• MedicationManagement:• Detailed history to identify allergen confirmed by
patch testing eliminate • Topical steroid (short course)
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
Lesions of the lipLick eczema
• Mainly children are affected
• Might not be aware of the habit
• Heals by stopping thelicking
Management:• Appliance can be used to interfere with tongue
Lesions of the lipLip 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 /
antifungalo Steroid ointment
• Usually it recure
Lesions of the lipCheilocandidosis
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
Lesions of the lip angles
Angular chelitisInflammation of the corners of the mouth
Angular chelitis is a multifactorial condition
How to determine causing factor?• History:
o Generalized ill healtho Xerogenic medicationo Antibiotics / steroid therapyo Ill fitting denture / night wearing
• Examinationo Signs of anemiao Salivary gland swelling (xerostomia / diabetes)o Intraoral candidosiso Oral drynesso Signs of OFGo Lymphadinopathyo Ill fitting denture / reduced vertical dimension
How to determine causing factor?
• Special investigationso Swab & smearo Blood test (CBC, B12, ferritin, folate)o Blood glucose
• when blood testing should by performed?o If suspecting an underlying systemic factoro If local therapeutic measures fail
Management of angular chelitis
1.Eliminate predisposing factor2.Correct deficiencies3.Antifungal / anti bacterial
Tongue lesions
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
Developmental abnormalities of the tongue
ankyloglossia
Lesions of the tongue
Fissured tongue (scrotal tongue)
Lesions of the tongue
Crenated tongue
Lesions of the tongue
Median rhomboid glossitis
Lesions of the tongueCoated Tongue
• Induced by:o General ill healtho Reduced salivao Painful lesion in tongueo Tobacco & alcohol consumption
• Managemento Tongue brushingo Mouthwashes containing ascorbic acid
Lesions of the tongue
Hairy tongue Black hairy tongue
Lesions of the tongue
Geographic tongue
Lesions of the tongueAtrophy of the lingual epithelium
• Tongue usually sore• Always look for:
ohaematinic deficiencyoDiabetesoSalivary hypofunction