Treating Geographic Tongue
NME is the hallmark finding in glucagonoma syndrome. It is characterized by a polymorphous eruption that most commonly presents as scaly, erythematous papules and plaques with superficial erosions. The lesions typically are in a perioral distribution on the face (Fig. 9), but also involve the perineum, lower abdomen, thighs, buttocks, and less commonly the distal extremities. NME has been reported to be the presenting complaint in approximately two-thirds of patients with this tumor, but there are only rare cases of glucagonoma without NME ever occurring. Stomatitis, glossitis, dystrophic nails, and alopecia can also be seen. The eruption is frequently misdiagnosed as seborrheic dermatitis or intertrigo and can also resemble pemphigus foliaceus, acrodermatitis enteropathica, chronic mucocutaneous candidiasis, or psoriasis.
Gastrostomy (gas-tros'to-me) The creation of an opening in the stomach wall through which food and liquids may be administered when swallowing is not possible. glossitis (glo-si'tis) Inflammation of the tongue. ileitis (il e-i'tis) Inflammation of the ileum. ileus (il'e-us) Obstruction of the intestine due to an inhibition
White red patches the oral mucosa may become white due to accumulation of keratin or epithelial hyperplasia and may become red because of epithelial atrophy, increased vascularity or inflammation. Physical stimuli such as friction from teeth or dentures or through the use of tobacco can produce an irritational keratosis on any part of the oral mucosa, most often lining mucosa. Chevron parakeratosis and melanin incontinence point to tobacco-related lesions. Lichen planus lichenoid reaction occurs commonly on the lining mucosa and dorsum of tongue as white striae or papules against a red background. Erosive forms are characterised by ulceration. Some lesions are a consequence of systemic drug therapy or as a response to amalgam restorations in adjacent teeth. Geographic tongue is characterised by irregular areas of mucosal erosion affecting the dorsal surface. Central areas of atrophy are outlined by a narrow peripheral zone of white mucosa and may be accompanied by deep fissuring of...
Apart from the ruddy complexion, specific head and neck manifestations are unusual. Epistaxis in addition to bleeding from other sites may occur in up to 40 of patients. Pyoderma gangrenosum is reported to occur with the MPD. This is a necrotizing skin ulceration that occurs most commonly on the limbs of patients with inflammatory bowel disease. It can also occur on the face. Manifestations of iron deficiency may include glossitis and cheilosis.
Lichen planus, hyperplastic candidiasis, geographic tongue, and certain genodermatoses. Of note, OHL is not associated with progression to malignancy, despite the well-known oncogenic association of EBV with other malignancies (Burkitt's lymphoma, nasopharyngeal carcinoma, and others).
Topically, sage is used as a gargle for laryngitis, pharyngitis, stomatitis, gingivitis, glossitis, minor oral injuries and inflammation of the nasal mucosa (Blumenthal et al 2000). These uses can be based on the pharmacological activity of its chemical components. In an open-label, single-blind, RCT of 420 patients, the non-steroidal anti-inflammatory drug, benzydamine hydrochloride, was found to be more effective than sage in relieving postoperative pain when used as a mouthwash after tonsillectomy in children and adults (Lalicevic & Djordjevic 2004).
Frequently all three forms coexist and the term multifocal candidiasis is used to describe the lesions. Candida is also frequently responsible for inflammatory lesions found between the lips (angular cheilitis), under dentures (denture stomatitis), and on the dorsal surface of the tongue (median rhomboid glossitis). Symptoms associated with this infection are pain, burning mouth, and dysphagia, which can lead to poor nutrition and significant patient morbidity (Fotos and Hellstein, 1992).
Megaloblastic anemia is usually a disease of middle-aged to older age with a high predilection for women. Severe anemia, in which the hemoglobin drops to 7 to 8 g dL, is accompanied by symptoms of anemias such as shortness of breath, light-headedness, extreme weakness, and pallor. Patients may experience glossitis (sore or enlarged tongue), dyspepsia, or diarrhea. Evidence of neurological involvement may be seen with patients experiencing numbness, vibratory loss (paresthesias), difficulties in balance and walking, and personality changes. Vitamin B12 deficiency causes a demyeliniza-tion of the peripheral nerves, the spinal column, and the brain, which can cause many of the more severe neurological symptoms such as spasticity or paranoia. Jaundice may be seen, because the average red cell life span in megaloblastic anemia is 75 days, a little more than one half of the average red cell life span of 120 days. The bilirubin level is elevated, and the lactate dehydrogenase (LDH) level is...
Melkersson-Rosenthal syndrome is characterized by a triad of recurrent episodes of facial paralysis and facial edema along with a fissured tongue. Other neurologic sequelae have been documented, including headache, trigeminal neuralgia, cranial nerve dysfunction, and autonomic dysfunction. Although the etiology is unknown, recent investigation points toward a granulomatous disease leading to recurrent attacks of edema and inflammation of the face and oral cavity with a predilection for facial nerve involvement. Facial nerve involvement may be unilateral or bilateral, with varying frequencies of attacks and progression. No confirmatory blood test, histopathology, or radiographic evaluation is available, as the diagnosis is entirely clinical.
Macrocytic anemia is the most common presentation of vitamin B12 or folate deficiency. Bone marrow findings show erythroid hyperplasia with an abnormal morphology, as well as megaloblastoid granulopoiesis and megakaryocytopoiesis. These features may mimic either AML or MDS (Green and Kinsella 1995). MDS may present with macrocytosis, reduced reticulocytosis and pancytopenia, making it indistinguishable from these nutritional deficiencies. In addition to other clinical features (e.g., cognitive changes, decreased proprioception, glossitis), evaluation of the peripheral blood smear is often helpful to distinguish MDS from megalo-blastic anemia. While reduced neutrophil lobulation (i.e., pseudo-Pelger-Huet abnormality) and hypogranu-lar neutrophils are more characteristic of the peripheral blood smear of MDS, all of the typical changes in megaloblastoid anemias may be seen in MDS. Hyper-segmentation, increased neutrophil lobulation, and megaloblastoid changes have all been reported in...
This 67-year-old female with a fissured tongue complained of a two-month history of a painful, sensitive, red tongue. There is mild atrophy of the lingual papillae. Fungal culture was positive for candidal organisms. Her symptoms cleared and appearance of her tongue returned to her normal fissured appearance with the use of clo-trimazole troches. Source Photo courtesy of Bruce Barker, DDS. FIGURE 45 Atrophic candidiasis. This 67-year-old female with a fissured tongue complained of a two-month history of a painful, sensitive, red tongue. There is mild atrophy of the lingual papillae. Fungal culture was positive for candidal organisms. Her symptoms cleared and appearance of her tongue returned to her normal fissured appearance with the use of clo-trimazole troches. Source Photo courtesy of Bruce Barker, DDS. FIGURE 46 Central papillary atrophy. Also referred to as median rhomboid glossitis, this was long believed to be a developmental condition. It is now...
A broad root and bulbous tip, thin lips, cleft lip or palate, fissured tongue, micrognathia, and small chin. Additional manifestations include cardiac and renal anomalies, hypoplastic or cystic lungs, and skeletal anomalies such as camptodactyly, scoliosis, and flexion deformities. Ophthalmic features include hyper-telorism, upward slanting of the palpebral fissures, long, curled
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