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  Hairy
Tongue: This is a relatively rare condition which is caused by the
elongation of the taste buds. This condition can be caused by poor
oral hygiene, chronic oral irritation or smoking. The far right
photograph shows a patient who has been treated with radiation therapy
for head and neck cancer and has chronic oral inflammation. Treatment
involves good oral hygiene, brushing of the tongue, mouth rinses and
sometimes the trimming of the elongated papilla. The left
picture is the same patient two months later after improvement in his oral
hygiene.
  Another
patient with a Black Hairy Tongue. This patient had significant
gastroesophageal reflux.
Control of her reflux along with the use of Nystatin and bushing of her
tongue resulted in a marked improvement in her condition. the
pre-treatment picture is the picture on the right. The patient's
tongue 2 months post treatment is shown on the left.
Click on Pictures to Enlarge
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 The
patient shown on the right has a combination of a geographic and hairy
tongue. This condition did not produce any symptoms and has been
refractory to oral antibiotics, Nystatin, steroids and good oral hygeine.
Click on Pictures to
Enlarge |
 Acute
Tonsillitis: This is a common condition which is usually caused by
gram positive bacteria. If the organism is Streptococcal
Pyrogenesis , there is a risk of developing Rheumatic
Fever. Often multiple different bacteria exists in the tonsillar
crypts, which can be difficult to culture. Treatment with antibiotics
to prevent Rheumatic Fever or tonsillar abscess formation is usually
advisable.
Click on Pictures to
Enlarge
 The
picture to the right shows the appearance of acute tonsillitis due to
Infectious Mononucleosis. The patient was a 24 year old male with
bilateral 4 cm non-tender jugulo-diagastric (upper neck) lymph nodes.
The infection was resistant to antibiotics (as all viral infections are).
Click on Pictures to
Enlarge |
 Ankyloglossia
or a persistent lingual frenulum is a congenital persistence of tissue
which binds the tongue to the floor of the mouth. When severe, the
frenulum should be cut to mobilize the tongue.
Click on Pictures to
Enlarge |
 Torus
palatinus is a hard bony growth in the center of the roof of the mouth
(palate). It is not a tumor or neoplasm by a benign bony growth called
an exostosis. This growth commonly occurs in females over the age of
30 and rarely needs treatment. Occasionally it is removed for the
proper fitting of dentures.
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Enlarge
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  The
torus to the right has a chronic non-healing ulceration exposing a focus of
dead bone. This is a
rare finding and may require surgical excision. This patient had been
on Fosamax for five years. Fosamax is a bisphosphonate, a medication used to treat osteoporosis. As
of 12/5/07, this complication had not been reported occurring in bones other
than the mandible (lower jaw) or maxilla (upper jaw). This patient
also had ear surgery (mastoidectomy) three years previously, while on
Foxamax for two years, without any problems. A year later and off of
Fosamax the bony sequestra fell off and the palate healed without surgery.
Fosamax inhibits bone resorption by
suppressing the activity of the cells which remodel bone, osteoclasts.
Some patients taking Fosamax have been found to form dead bone in their jaws
( mandibular necrosis ). This is especially true if the patient has
infected teeth or trauma to the overlying mucosa. Less frequently,
this complication has been found to occur in the upper jaw bone or palate
(maxilla). Treatment is difficult since any trauma or surgery to the
area may expand the bone loss.
For more information:
Marx RE 2005
Farrugia MC 2006
Merigo E 2006 |
 Torus
Mandibularis: This is a hard bony growth on each side of the
mandible (jaw
bone). It is a benign growing and seldom needs treatment -- see arrow.
Click on Pictures to
Enlarge |
 Lip
Cancer: Cancer of the lip is a relatively common condition. When
caught early, it is treatable with surgery or radiation therapy.
Cancers of the lower lip have a better prognosis than those of the upper
lip. Chronic sun exposure is the most common cause, but smoking can
also be an etiology. The picture on the right shows a T2 N0 (tumor
size between 2 to 4 cm, with no lymph node spread) squamous cell carcinoma
of the lower lip. The patient was treated with surgical resection and
reconstruction using an Abby-Estlander Lip Flap.
***More On Lip
Flaps***
Click on Pictures to Enlarge |
  These
patients have a basal cell carcinoma lip cancer. It is a less
aggressive tumor than squamous cell carcinoma, see above photo. Basal
Cell Carcinoma spread and destroy tissue locally, but do not metastasize
(spread by blood or lymphatics). Treatment is surgical excision or
radiation therapy.
Click on Pictures to Enlarge |
 Oral
Cancer: This patient is a 57
year old, with a 75 pack year history of smoking and alcohol intake.
He has an oral cancer involving the
uvula
(uvular cancer)
which has also spread onto the
nasopharynx
surface of the
soft palate.
He was also found to have a carcinoma in the upper portion of his right
lung. See
Bronchoscopy Video
Click on Pictures to Enlarge |
 Another
common oral cancer is tongue cancer. The picture on the right shows a cancer on the tongue in a 45 year old male who was a
non-smoker. The most common cause of oral tumors is Human Papilloma
Virus which is found in 70% of oral tumors. This virus most commonly
causes tumors on the tonsil and base of tongue.
Learn more about HPV
and oral cancer.
Click on Pictures to
Enlarge |
The picture on the right is from a 22 year old male who has used over one
can of snuff for the past 15 years. He has high blood pressure from
the
vasoconstrictive
(contraction of blood vessels) effect of nicotine and
gastroesophageal reflux
disease (stomach acid coming up from the stomach towards the mouth) which
is also made worse from using tobacco products. The picture on the
right shows extensive
leukoplakia
forming between his gums and lips. This is a pre-cancerous
condition and if it does not resolve with his cessation of using tobacco
products, it will need to be surgically removed.
Click
on Pictures to Enlarge |
  This
patient is a 87 year old who used to smoke 1 pack per day many years ago she
was not sure how long she smoked. This patient has a tumor on both her
tongue and right floor of the mouth. The tumor is over her
alveolus
and extends onto the anterior tonsillar pillar. These types of tumors
are often treated with a commando operation which consists of resection of
the
mandible,
floor of mouth and tongue; along with a radical neck dissection which
removes the muscles and lymph nodes in the neck.
Click on Pictures to
Enlarge |
  This
patient is a 70 year old who smoked 1 pack per day for 50 years he also
drank alcohol heavily. He presented with severe
dysphagia
(trouble swallowing) and on examination was found to have a very small
airway. He underwent an emergency
tracheotomy
(breathing hole placed in the neck) under local anesthesia no IV sedation or
analgesia was given. The was then put to sleep with general anesthesia
and had his oral tumor debulked. The pictures on the right show a
large oral tumor in the
hypopharynx
with a very small airway under the
epiglottis.
|
 Carcinoma
of the Tongue: This patient has a T1 (2 cm or less) squamous cell
carcinoma of the tongue.
Click on Pictures to Enlarge |
 Chelitis:
This is crusting and cracking which occurs in the corners of the mouth.
It is caused by a fungus and anti-fungal creams are usually curative.
Click on Pictures to
Enlarge |
  Apthosis
Ulcers: Apthosis ulcers are shallow small painful ulcers which
appear on mobile mucosa in the oral cavity. They are often found in
individuals that are under stress. The cause of these ulcers is
unknown. They can be treated by applying Amlexanox gel to the ulcers
four times a day for 7 to 10 days.
Click on Pictures to
Enlarge |
 Cold
Sores: Cold sores are caused by the Herpes Simplex Virus.
Once infected, they plague the patient for life. Penciclovir cream is
a prescription medication which is approved by the FDA for treatment.
Other medications, Acyclovir ointment, Valacyclovir and Famciclovir are only
approved for genital herpes but many doctors also use them to treat oral
herpes (cold sores). A new over-the-counter medication approved by the
FDA is Abreva. It also effective in the treatment of cold sores.
It is believed to protect the skin cells from viral damage.
Click on Pictures to
Enlarge |
 Shingles
(Herpes Zoster): Shingles are caused by the Herpes Zoster Virus.
They occur many years after an individual has had chicken pox. Once an
individual has had chicken pox, he/she will carry, for life, the virus in a
dormant state in the cell bodies of nerve tissue. Over the years, a
patient's antibody levels fall and the dormant virus emerges. The
virus causes lesions to erupt on the skin in which the nerve innervates.
In the right-hand picture, the lesions are seen on the patient's right jaw
and right half of his tongue. This corresponds to the lower division
of the trigeminal nerve (V cranial nerve) and the lingual nerve (XII cranial
nerve). This patient was treated with a seven day course of
Valacyclovir given one gram three times a day.
Click on Pictures to Enlarge |
  Stomatitis:
The pictures on the right shows a 47 year old male with an intraoral viral
eruption 24 hours after exposure to caustic chemicals. This patient
was also treated with Famvir (famciclovir) 500 mg three times a day for 7 days.
The probable
cause of these lesions is herpes simplex.
Click on Pictures to Enlarge |
  The pictures on the right are from a 14 year old girl with punctuate viral
lesions on the hard palate and tongue. She was treated with Famvir (famciclovir) 500 mg three times a day for 7 days.
The probable
cause of these lesions is herpes simplex.
Click on Pictures to Enlarge
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Stevens Johnson Syndrome:
Shown in the photographs below is a severe mucositis with epidermal
sloughing in a 17 year of female. Symptoms started 24 hours after
taking tetracycline for a cough. Blisters first formed with sloughing
of the mucosa. The lips, buccal mucosa and soft palate were the main
areas of involvement. A working diagnosis of Steven-Johnson Syndrome
was made and the patient was transferred to a major University Medical
Center.
Stevens Johnson Syndrome (erythema
multiforme) is a rare but serious
disorder caused by a wide range of drugs and infections: Including
antibiotics, non-steroidal anti-inflammatory agents, anticonvulsants and a
variety of infections (flue, hepatitis, herpes, typhoid and HIV).
Lesion may involve large portions of the skin. Prognosis is generally
good with a 1-5% fatality rate with sloughing involves less than 10% of the
skin. However, mortality rate can be greater than 25% when sloughing
involves more than 30% of the skin surface.
Stevens Johnson Syndrome Support Page
Click on Pictures to
Enlarge
  
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 Leukoplakia
is a white patch in the oral cavity. It
is often caused by chronic irritation or infection but may also be a cancer.
In this patient the leukoplakia has areas of redness called erythroplakia.
Erythroplakia more often represents a cancer. On biopsy, the patient
was found to have a fungal infection. Fungal infections of the oral
cavity may often mimic a cancer both on gross appearance and sometimes even
histologically.
Click on Pictures to
Enlarge |
  Salivary
Gland Stone: This patient had a stone which formed in the Submandibular
(Submaxillary) Gland Duct. The picture on the far right shows the
duct's papilla in the floor of the mouth, underneath the patient's tongue.
This duct drains uphill, is wide and has a mucoid or viscous secretion.
Thus, when salivary gland stones occur, they usually occur in this duct.
Treatment consists of excising the stone. Prevention is with
hydration, gland massage and using a few drop of sour lemon juice several
times a day to increase salivary flow.
 The
picture on the right is from a patient who has a small salivary gland stone
in its duct. Note the dilatation of the salivary gland duct.
For more information on
Salivary Gland Stones Click Here !!!
Rarely, the parotid salivary gland will for a stone
View a
Parotid Salivary Gland Stone
Click on Pictures
to Enlarge
  The
pictures on the right show a patient with severe sialothiasis (salivary
gland stones). One of the stones has eroded through the floor of the
mouth. Two stones were recovered with a third still in the duct.
This patient had a long history of recurrent salivary gland swelling and
infection. Treatment will probably require excision of the
submandibular salivary gland. |
 Oral Fibroma. This is a benign lesion in a young patient which
can easily be removed as an office procedure.
Click on Pictures to
Enlarge |
 Lingual Cavernous Hemangioma. This is a benign lesion but one
which is very hard to treat. Surgery is difficult. Angiography
is often needed to outline the feeding vessels and to embolize the
hemangioma. |
 Lingual Hemangioma.
The picture on the right is a small peduncular hemangioma on the tip of the
tongue of a six year old male. It was removed under local anesthesia
in the surgeon's office. |
 Geographic
Tongue. This is a benign non-painful condition caused
by the absence of taste bud papilla. The glassy patches move around
the tongue and change shape. The cause of this condition is unknown
and treatments are not reliable.
Click on Pictures to
Enlarge
 To
the left is a picture of a hairy and geographic tongue in an 18 yr old
male.
Click on Pictures to
Enlarge |
 Mass
on Base of Tongue: This mushroom like mass presented on a 40 yr
old female with a one month history of chocking. It was treated with
surgical excision. The pathology report showed that the mass was a
benign vascular tumor.
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Enlarge
  
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 Sialocele.
A sialocele arises from the blockage of a salivary gland duct. The
duct enlarges and forms a sac of saliva. Treatment is with surgical
excision.
Click on Pictures to
Enlarge |
 Oral-Maxillary
Fistula. In this condition, a hole (fistula) develops between the
mouth and the large sinus cavity above the palate (roof of the mouth).
This condition can be caused by dental infections or a complication of
surgery. Treatment is with a two layer surgical closure.
An incision is made around the periphery of the fistula. The mucosa of
the fistula is elevated and inverted. It is then sewn together,
forming an inner layer. The cheek mucosa is then advanced over
the inner closure and sewn over the defect.
Click on Pictures to
Enlarge
 The
patient shown on the right has a small hole in the middle of a tooth socket.
A tooth had been pulled and a hole was made into the maxillary sinus.
The hole did not fully heal and a small fistula was left in the middle of
the upper alveolar ridge.
Click on Pictures to
Enlarge |
 Lichen Planus: This
condition presents as a white lace like pattern on the inside of the
cheeks. It can be confused with may other conditions and evaluation
by a physician is mandatory to make sure other serious problems are not
present. Often the condition is caused by a reaction to
medications. Beta Blockers and oral hypoglycemics are the most
common offending medications. Lichen Planus can also be
associated with other conditions such as Hepatitis C. Treatment is with oral
prednisone (5mg/ 5cc) rinses, mixed (1:1) with kopectate to allow the
medication to stick to the oral mucosa.
Click on Pictures to
Enlarge |
  Phemphigoid:
Bullous phemphigoid is an auto-immune disease which causes blistering of
the skin. It can involve the mucous membranes in 10% to 25% of
patients. Blisters form when antibodies attack proteins in the basement
membrane of the skin (between the dermis and epidermis). Many cases
are self limited and go into remission in five years or less. However,
severe cases may require treatment with corticosteroids and immunosupressive
agents. Phemphigoid should not be confused with Phemphigus Vulgaris
which is a much more aggressive disease. In Phemphigus Vulgaris
antibodies attack proteins called
desmogleins. Desmogleins are the
proteins which hold the skin together. Diagnosis of Phemphigoid and
Phemphigus requires biopsy. For more information go to
http://www.pemphigus.org .
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