Disaeses of the tongue Manifestation of systemic diseases on the surface of the tongue MUDr. Hana Poskerová Department of Stomatology, Faculty of Medicine, Masaryk University Brno, St. Anne's University Hospital Brno Tongue examination • •Inspection, palpation • •Radix (root), body, tip • •Dorsal surface •Lateral sides •Inferior (ventral) surface • 8686 Papillae of the surface of the tongue - Papillae filiformes • chuťuvé pohárky Chlup FiliformPapillae2 Papillae of the surface of the tongue -Papillae fungiformes • VR - jazyk maly nik59902 Papillae of the surface of the tongue -Papillae foliatae tonsila ling Papillae of the surface of the tongue -Papillae circumvalatae • Prominující cirkumvalátní papily TongueTaste chuť pohárek Taste buds - specialised receptores, are found over the entire dorsum of the tongue, along the sides of the tongue, the epiglosttis, soft palate Tongue examination •Size, asymetry •Coating - color, amount •Humidity •Perfusion of blood •Surface - grooves, furrows, impressions, lesions • - solitary, multiple •Sensitivity •Localization and extent of changes •Relationships to surrounding tissues •Frenum of the tongue - ankyloglossia jazyk asymetrie ankyloglossia •Large tongues -acromegaly -hypothyroidism -Down´s syndrome -hemangioma -muscular hypertrophy -amyloidosis -tumors -angio-neurotic oedema -Crohn‘s disease Hemangiom nik35922 Nik_00001 Tongue examination •Small tongues -congenital small mandible syndromes -lingual hypoplasia -other developmental disorders -pseudo-bulbar palsy (spastic tongue) - - Tongue examination •Pale - anaemia •Yellow, orange - jaundice •Strawberry red - scarlat fever, ATB, diarrhoea, pernicious anemia (beefy red) •Blue - cyanosis, polycythemia •Pigmented - racial, Addison‘s disease •Black (hairy) - smoking, mouth rinses Colour changes Jazyk map jazyk asymetrie Examination of tongue coating •Fyziological Examination of tongue coating •daytime •Fysiological •Patological acute multiplication - acute upper respiratory tract infection (fresh coating) • - serious illness with dehydration and shock (fuligo) •Patological chronical multiplication • - chronic gastrointestinal disease (dyspeptic) •Patological atrophy • - anemia, hypovitaminoses, Sjögren's syndrome, mitral stenosis, cirrhosis, intoxication Coatings of the Tongue •elongated filiform papillae •dead epithelial cells •food residues, debris •microorganisms Coatings of the Tongue -heavy smokers -mouth rinses - -mouth breathers -only soft foods, -due to fasting - -ill fitting dentures Chlup •White (yeast, acute viral inf, milk) • •Gray (renal failure, TBC) •Brown (smoking, antibiotics and antiseptics, chromogenic bacteria) •Black (smoking) • GSH jazyk Candida jazyk Coatings of the Tongue • Acute - Chronic? • Localization? • Coating? Color? • Size of language? oSolitary lesion? Extensive diffuse lesions? oPainful - not painful? oConsistency? oOverall symptoms oTime data? Differential Diagnosis - questions Erosions/ulcers of the tongue -trauma - aphtous ulcers - drugs -nutritional disorders -AI diseases (P-P) OLP, EEM -specific gut diseases -leukemia, agranulocytosis, neutropenia -mucositis after oncology treatment -malignant ulcers -syphilis, TBC nik28399 Vesiculo - bullous diseases of the tongue -acute viral infections (HSV, VZV, Coxackie) -EEM, P-P GSHjazyk2 Pemfigus jazyk White lesions •- frictional keratoses -tobacco keratoses -leukoplakia -OLP -candida infection -psoriasis Leukolpakie Acute (chronic) glossitis -drug induced glossitis -infections (bacterial, fungal, viral) -allergic and toxic reactions -nutritional (Fe, B12, folic acid, other B vit) - Alerg Jazyk amox Examination of tongue coating Chlup Jaz Pernic anemie2 Gingivostom • • 1/ Local changes of the tongue 2/ Manifestation of generalized disease 1/ Local changes of the tongue •Congenital or developmental disorders •Environmental factors (trauma, bites into the tongue, foreign bodies, burns) •Local infection •RAS •Tumor Traum 1/ Local changes of the tongue Map Glossitis rhomb •Lingua plicata •Lingua geografica •Glossitis rhombica mediana •Lingua villosa nigra Chlup ScrotalTongue Lingua plicata 250px-Tongue Fissur Lingua plicata (Down sy, Melkersson's syndrome) L scrotal_tongue_ nik29882 nik59908 nik59909 geographictongue lingua geog Jaz Lingua geografica nik50375 nik59465 nik59466 nik59467 Jaz Lingua Geografica Map Map CANDIDOSIS4MED ROMB Gloss Glossitis rhombica mediana – Rhomboid glossitis GRM 5 Ling romb GRM 3 Glossitis rhomb P.Š. 1966 Chlupatý Chlup Ling Jaz Lingua villosa nigra Jaz po TTC Jaz dyspept Chlup Chlup nik58908 Local changes of the tongue •Tonsila lingualis •Lingual thyroid gland •Cyst ductus thyreoglossus •Dermoid and epidermoid cyst (floor of mouth and body of the tongue, macroglossy) • • • lingual_tonsil tonsila ling Local changes of the tongue •Mechanical factors • •Traumatic ulcer •Impressions • •Granuloma pyogenicum • Granuloma_Pyogenicum_2_040620 traumatic-ulcer Traum nik15149 Koag Zungenimpression Jaz Burn of the tongue with hot food Oral piercing nik15150 nik15148 nik15149 nik15151 Oral piercing nik16598 bodypiercing_jazyk piersing piercing_jaz Mukozela jazyk Retention cyst (mucocele) of minor salivary gland Local changes of the tongue Afta jazyk Local changes of the tongue Aphtous ulcers - lateral, ventral side - dorsum (major form) MR jazyk Melkerson Rosenthal Melkersson -Rosenthal syndrome - recurrent lip (facial) edema - fissured tongue - facial paralysis Quincke2 Quincke3 Melkersson's syndrome - recurrent lip (facial) edema - fissured tongue - facial paralysis Local changes of the tongue • Benign tumors • - fibroma (lateral side) - papiloma - myoma (dorsum) - lipoma (yellowish) - neurofibroma • Jazyk lipom Lipoma nik16332 Fibrolipoma Fibrom jazyk Fibroma Local changes of the tongue •Hemangioma •Lymfangioma Lymphangio-Zyste lymfangiom lymfangioma Congenital lymfangioma Macroglossia%20due%20to%20a%20hemangioma Hemangiom Hemangiom 1 Hemangiom Hemangioma HEMATOMA1 Local changes of the tongue •Vascular changes •Teleangiectasias •Sublingual venectasias (varices linguae) • RenduOsler sublingual-varicosities Ling Local changes of the tongue •Metalic pigmentations • • • •Melanin pigmentations Pigm rot artistic tattoo Local changes of the tongue •Precancerous lesions, leukoplakias and erytroplakias • 10% -15% of leukoplakias occurs on the tongue • •Leukoplakias on the tongue - malignant transformation at 24 – 38 % •Erytroplakie on the tongue - malignant transformation at 96 % • nik59897 Leukolpakie nik50498 nik50499 Leuko nehomo Trauma jazyk Malignant tumors • 30 % of oral malignant lesions are located at the radix of the tongue • • spinocellular Ca (lateral side) • malignant lymfomas (NHL) • tumors of the salivary glands (ventral) • sarkoma (rare, Kaposi sarkoma) • metastatic tumors (radix) Ca jazyk2 Jaz Ca Ca Ca jaz nik59479 Man, 1960, felt defect under tongue (about a month), 15 cig / day, increased submandibular lymph nodes 2/ Manifestation of generalized diseases • •Systemic infection •Blood diseases •Immunity disorders (autoimmune, allergic reaction) •Metabolic disorders • nik34575 2/ Manifestation of generalized disease •Infection (local or systemic problem) - Viral infection HSV (GSH, HS), VZV, Coxsackie, HPV - Oral candidiasis - Scarlet fever - syphilis - TBC - HIV Hand-, foot-, mouth disease GSHjazyk2 Gingivostom GSH jazyk Viral infection HSV Obrázek 18 Kondylom na špičce jazyka Obrázek 20 Stopkatý útvar na laterální straně hřbetu jazyka HPviróza HPV infection nik43085 nik43084 Oral candidiasis Candida jazyk 280px-Oralcandi candida02 kandida 3 Oral candidiasis spála3 Spála jazyk Scarlet fever Lues-II Syfilis prim Lues jazyk I. III. II. Syfilis - all 3 stages III. • gumma • glossitis luetica interstitialis superficialis et profunda • lingua lobata III. TBC Tuberculous ulcer with bulging edges Leukopl jaz HairyLeukoplakiaSmall hairy%20leukoplakia%201A • HIV - HSV, VZV - hairy leukoplakia (HSV8) - oral candidiasis - aphtoid lesions - Kaposi sarkoma Manifestation of generalized disease •Pemfigus •Pemfigoid DLE •Sclerodermia •Sjőgren's syndrome •EEM •OLP •Psoriasis OLP jazyk5 Pemfigus jazyk Pemfigus jazyk nik34575 Pemfigus OLP OPLjazyk4 Lichen jazyk OLP jazyk5 nik50757 OLP Sjogren2 Sjogren výřez SjÖgren's syndrome Manifestation of generalized disease •Allergic a toxo – allergic reactions • •Angioedema • • polékový jazyk Alerg Jazyk amox Amoxicilin Eugenol nik15142 Toxo – allergic reaction Amoxicilin Manifestation of generalized disease •Blood disorders • •- Hemorhagic diateses • •- Anemias • •- Leukemias • Pernic anemie2 Pernic Atrofická glossitis Pernic anemi 3 Jaz Plummer Vinson def Fe B12 deficiency nik49352 nik49349 Folic acid deficiency Plummer - Vinson syndrome •iron deficiency anemia •atrofic glossitis •dysphagia •koilonychia • •- precancerous condition • Manifestation of generalized disease endocrinopathy •Hypothyreosis • myxoedema → macroglossy; xerostomia • nik35919 nik35922 •Diabetes mellitus GRM, candidasis, glossodynia •Acromegaly (overproduction of STH) at 50 % macroglossy • •M. Addison (adrenal cortex insufficiency, MSH - failure of the feedback) • Manifestation of generalized disease Addison jazyk Manifestation of generalized disease •Metabolic disorders of proteins, fat, carbohydrates • •Amyloidosis • •Mucopoly - saccharidosis • Nik_00001 Mucopolysacharidosis Manifestation of generalized disease •Neurologic diseases • •Neuralgia - III. branch n. V, n. IX •Palsies, paralysis •Glossodynia jazyk asymetrie Pigmentations •Manifestation of generalized disease •- Addison‘s disease •- Peutz - Jeghers sy Addison jazyk zipper-tongue jezyk tvar