Lip tongue lesions...quick summary

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