Dentaltown September 2019 - 78
Question
Five
A 76-year-old patient presents for an evaluation of the right
side of his tongue. The right side of the tongue shows a large
erythematous, keratotic, firm, verrucoid mass. He has severe
pain over the tongue mucosa and has restricted range of motion
of the tongue musculature. When he protrudes his tongue, it
deviates to the right side. He smokes a pack of cigarettes a day,
and has done so for the last 45 years.
Answer: Squamous cell carcinoma.
Squamous cell carcinoma is the most common type of oral malignancy. While a single causative agent has not
been identified, there are certain risk factors, including tobacco and alcohol use. Squamous cell carcinoma may
also be preceded by a potentially malignant lesion such as leukoplakia. High-risk sites are the tongue and floor of
mouth. Early detection is paramount. Nerve involvement indicates progression of the disease and poorer prognosis.
In this case, the patient has pain (which suggests trigeminal nerve involvement) as well as deviation of the tongue
on protrusion (which suggests hypoglossal nerve involvement). Prompt referral to a head and neck surgeon is
necessary for a comprehensive diagnostic work-up and treatment.
Question
Left buccal mucosa.
Left lateral border of the tongue.
Right lateral border of the tongue.
Answer: Oral lichen planus, erosive type.
Lichen planus is an immune-mediated mucocutaneous disease that often involves the oral mucosa.
It occurs through a T-cell mediated process. It is more common in women (3:2 female/male ratio)
and may affect the skin, presenting as purple, pruritic, polygonal papules. There are different forms:
reticular, erosive, plaque-type and bullous.
The erosive type causes symptomatic lesions, while the reticular form is more common and
does not cause symptoms. Clinically, the patient will exhibit ulceration surrounded by atrophic,
erythematous areas. These lesions can present similarly to mucous membrane pemphigoid and
pemphigus vulgaris, so biopsies should be done under light microscopy and immunofluorescence.
Management involves topical and/or systemic corticosteroids or other immunomodulating
medications.
78
SEPTEMBER 2019 // dentaltown.com
Six
Right buccal mucosa.
A 65-year-old patient presents with ulcers all
over his mouth. He reports these lesions began two
years ago. He's already seen another dentist, an oral
surgeon, and an ear, nose and throat physician, and
reports having had two biopsies done with a nonspecific
histopathologic diagnosis. He states he was diagnosed
with burning mouth syndrome-he experiences pain
and cannot eat spicy foods. His medical history is
noncontributory. He denies oral blisters preceding the
ulcerations. The lesions are constant, but they can wax
and wane in severity.
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Dentaltown September 2019
Table of Contents for the Digital Edition of Dentaltown September 2019
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