Psoriasis is associated with fissured tongue but not geographic tongue: a prospective, cross-sectional, case-control study.

BACKGROUND AND OBJECTIVES: It has been postulated that psoriasis is associated with tongue lesions and geographic tongue might be "oral psoriasis". However, reports are inconclusive, prevalence rates vary and data for Europe are sparse. In this prospective case-control study we investigated the point-prevalence of tongue conditions in an Austrian cohort. PATIENTS AND METHODS: Psoriasis patients and healthy volunteers were assessed regarding tongue and skin lesions, age, sex, smoking habits, allergies, onset of psoriasis, PASI scores and anti-psoriatic treatment. RESULTS: We included 173 psoriasis patients, 58 women, 115 men (median age: 50 [37-60] years), and 173 volunteers, 79 women, 94 men (median age: 54 [43-64] years). Overall, 95 subjects had allergies, 64 psoriasis patients and 50 volunteers were smokers. Median age at onset of psoriasis was 26 (12-40) years, the median PASI score was 2 (0-4.1), most patients received ustekinumab (n = 47). Fissured tongue was significantly associated with psoriasis (25 [14.4 %] psoriasis patients, 13 [7.5 %] volunteers; P = 0.04). Geographic tongue was present in four individuals of each group (2.3%) and associated with smoking (P = 0.01) but not with psoriasis. CONCLUSIONS: Overall, we found a low point-prevalence of tongue lesions in this Austrian cohort. Psoriasis was associated with fissured tongue but not with geographic tongue. Thus, we cannot corroborate the hypothesis that geographic tongue is an oral manifestation of psoriasis.

Melkersson-Rosenthal syndrome with coeliac and allergic diseases.

A 45-year-old man presented with a 10-year history of relapsing oedema of the lips. Moreover, he exhibited recurrent facial nerve palsy since the age of 10 years, coeliac disease since the age of 12 years, atopic eczema, allergic rhinitis and asthma. Physical examination revealed lip swelling and lingua plicata. Thus, he presented the classic triad of Melkersson-Rosenthal syndrome which includes recurrent orofacial oedema, facial nerve palsy and fissured tongue. A lip biopsy confirmed our clinical diagnosis.This case is particularly rare, as the classic triad is seen only in a minority of the cases. Moreover, allergic and coeliac diseases were observed concomitantly. This paper illustrates a potential pathophysiological interconnection between these pathologies in which interferon gamma could play a key role. To our knowledge, this is the first case report in which Melkersson-Rosenthal syndrome has been observed concurrently with coeliac disease.

Oral mucosal lesions in electronic cigarettes consumers versus former smokers.

OBJECTIVES: Electronic cigarettes (ECs) have become very popular in recent years. However, many uncertainties remain about their side effects. This study aims to evaluate the prevalence and characteristics of oral mucosal lesions (OMLs) in former smokers compared to ECs consumers. METHODS: A prospective case-control study was carried out. Outpatients for dental consultation were consecutively enrolled into two groups based on their habits, i.e. former smokers and ECs consumers. Each patient was examined to detect possible oral lesions and, if needed, a swab or biopsy of the lesion was taken for diagnosis. Data was entered into a spreadsheet and analyzed. RESULTS: A total of 90 patients were examined, 45 were former smokers (group A) and 45 were ECs consumers (group B). OMLs were detected in 55 cases, of which 19/55 (34.6%) belonged to group A and 36/55 (65.4%) to group B. Nicotine stomatitis, a hairy tongue and angular cheilitis resulted to be significantly more common among EC consumers. CONCLUSIONS: We found no statistically significant differences in terms of total prevalence of OMLs between former smokers and ECs consumers. An increased prevalence of three specific types of OMLs was detected among ECs consumers.

Frequency of fissured tongue (lingua plicata) as a function of age.

Fissured tongue (lingua plicata; LP) is a mostly asymptomatic condition characterized by grooves and fissures of varying depth on the dorsal surface of the tongue. Most reports in the literature indicate a prevalence of 10–20%, although there is marked variation. On the basis of 1,000 patients (n=465 males, n=535 females), this study examined the association between LP and age as well as further influencing factors. Participants completed a questionnaire comprising information regarding gender, age, alcohol and tobacco consumption, possibly existing removable dentures, and potential mouth burning. Subsequently, photographs of the protruded tongue were taken and examined by two investigators regarding the presence of LP. Four degrees of severity of the condition were distinguished. Degrees of severity of LP as well as numbers of affected individuals increased as a function of age (p<0.001). LP occurred more frequently in males than females (p=0.0029). In addition, smoking exerted a positive influence on the prevalence (p<0.05), and a positive correlation appeared between mouth burning and LP (p<0.01).

Diseases of the tongue.

The tongue is a complex organ involved in speech and expression as well as in gustation, mastication, and deglutition. The oral cavity, along with the tongue, are sites of neoplasms, reactive processes, and infections, and may be a harbinger of systemic diseases. This review includes both common and rare diseases that occur on the tongue, including: vascular and lymphatic lesions (infantile hemangiomas and oral varices), reactive and inflammatory processes (hairy tongue, pigmented fungiform papillae of the tongue, benign migratory glossitis, and fissured tongue), infections (oral hairy leukoplakia, herpes simplex and varicella-zoster virus infections, human papillomavirus, and candidiasis), premalignant lesions (leukoplakia and erythroplakia), malignant lesions (squamous cell carcinoma, Kaposi sarcoma, and lymphoproliferative diseases), and signs of systemic disease (nutritional deficiency and systemic amyloidosis).

Granulomatous cheilitis of Miescher: the diagnostic proof for a Melkersson-Rosenthal syndrome.

BACKGROUND: The Melkersson-Rosenthal syndrome (MRS) is a very rare clinical entity and its classical form is being characterized by the following triad: facial nerve palsy, swelling of the lips and fissured tongue. However, the monosymptomatic form is more common and the typical manifestation is facial edema and/or enlargement of the lips. CASE REPORT: We report a case of monosymptomatic MRS with a positive biopsy of granulomatous cheilitis. CONCLUSIONS: In the daily practice as a pediatrician, it is not usual to diagnose a patient as having MRS. We consider that this is partly because of misdiagnosis. We therefore believe that this case report will supply additional information, in the scope of recurrent facial paralysis and orofacial edema in both children and adults.

Estudo da prevalência de alterações de língua / Prevalence study of the tongue alterations

Introdução - A língua desempenha importantes funções na mastigação, deglutição, gustação e fala. Alterações nesse órgão, como sinal de desordens no organismo, são muito valorizadas clinicamente, uma vez que várias doenças sistêmicas podem estar associadas. O objetivo deste estudo é realizar um perfil epidemiológico,retrospectivo, de seis alterações linguais presentes em pacientes assistidos no projeto de extensão de Estomatologia intitulado: “Diagnóstico, tratamento e epidemiologia das doenças da cavidade bucal (Lebu)”, na Clínica Odontológica da Universidade Estadual de Maringá (UEM), entre o período de 1995 a 2010 e averiguar a relação destas alterações linguais com portadores de prótese e/ou hábitos nocivos. Material e métodos – Realizou-se uma pesquisa retrospectiva na Clínica de Estomatologia doDepartamento de Odontologia da UEM, entre o período de 1995 a 2010, utilizando-se de 2176 prontuários de pacientes assistidos e biopsiados no projeto de extensão Lebu. Resultados - Dos prontuários analisados, 132 pacientes (6,06%) apresentavam algum tipo de alteração lingual. Do número total de pacientes com alterações de língua 72% apresentavam uma associação de lesões sobrepostas. Um total de 38,6% dos pacientes fazia uso de prótese, havendo correlação estatisticamente significante entreo uso de prótese e glossodinia. O uso do tabaco e/ou álcool foi visto em 35,60% dos pacientes, sendo sua relação estatisticamente significante com o desenvolvimento da língua saburrosa e língua pilosa negra. Conclusões – Dentre as alterações de língua estudadas a de maior prevalência foi a língua geográfica. A faixa etária de predileçãofoi a quarta década de vida. A prevalência da língua saburrosa e língua pilosa negra apresentou relação com os pacientes usuários de álcool e tabaco.

Introduction - The tongue plays an important role in chewing, swallowing, taste and speech. Alterations in this organ as a sign of disorders in the body, are highly valued clinically, since many systemic diseases may be associated. The aim of this study is an epidemiological, retrospective six tongue alterations present in patients from the Extension Project of Stomatology titled “Diagnosis, treatment and epidemiology of diseases of the oral cavity (LEBU)” in the Dental Clinic, State University of Maringá, between the period from 1995 to 2010 and the investigate the relationship of these tongue alterations with prostheses and/or harmful habits.Material and methods – A retrospective study at the Clinic of Stomatology, Department of this University was held between the period 1995 to 2010, using the 2176 records of patients assisted and biopsied in the extension project LEBU. Results – 132 patients (6.06%) had some type of the tongue alterations. The total number of patients with tongue alterations (N = 132), 72% had a combination of overlapping lesions. Total of 38.6% of patients used a prosthesis, there was a statistically significant correlation between the use of prosthesis and glossodynia. In relation to tobacco addiction and / or alcohol abuse, 35.60% of patients had some type of addiction, and tobacco useand / or alcohol use was statistically significant for coated tongue and black hairy tongue. Conclusions - Among the tongue alterations studied the most prevalent was the geographic tongue. The age of predilection was the fourth decade of life. The prevalence of coated tongue and black hairy tongue patients were related to the usersof alcohol and tabacco.

Oral manifestations of human T-cell lymphotropic virus infection in adult patients from Brazil.

OBJECTIVE: Human T-cell lymphotropic virus type 1 (HTLV-1) was the first human retrovirus discovered and its pathogenesis is related to T cells infection. This study aimed to verify the presence of oral manifestations in a Brazilian population of patients who was seropositive for HTLV, and identify risk factors for oral manifestations. SUBJECTS AND METHODS: An assessment was made of 139 patients at the Emilio Ribas Institute of Infectious Diseases. RESULTS: A total of 112 (80.5%) patients were HTLV-1, 26 (18.7%) were HTLV-2+. About 35.2% of patients had myelopathy/tropical spastic paraparesis (HAM/TSP), with 48 of them being HTLV-1+ and one patient was seropositive for HTLV-1 and -2. The most common oral manifestations were: xerostomia (26.8%), candidiasis (20.8%), fissured tongue (17.9%), and loss of tongue papillae (10.0%). A multivariate logistic regression analysis showed that HAM/TSP is an independent risk factor for xerostomia (P = 0.02). The patients who were HAM/TSP+ were three times more likely to develop xerostomia when compared with patients without HAM/TSP (odds ratio = 2.69, 95% confidence interval = 1.17-6.17). CONCLUSION: Despite the fact that the findings of this study suggest a relationship between xerostomia and HAM/TSP, more studies should be developed to show what the association would be between xerostomia presented by HTLV patients and pathogenesis of the virus.

Melkersson-Rosenthal syndrome revisited as a misdiagnosed disease.

PURPOSE: We aimed to attract our college's attention to the Melkersson-Rosenthal syndrome (MRS), which has been an infrequently encountered subject in otolaryngology journals during the last 10 years. MATERIALS AND METHODS: A retrospective review of the last 10 years' patient database was performed to find patients with MRS. The medical files, treatment charts, and radiological and histopathological records of these patients were reviewed. RESULTS: The study group consisted of 3 MRS patients who had been misdiagnosed for 9, 10, and 16 years. Two of them have had the symptoms since adolescence. All of them presented orofacial edema and fissured tongue, whereas first two also had recurrent facial paralysis. Characteristic histopathological features were noted in 1 patient. Electromyography (EMG) was done in 1 patient who underwent facial decompressiom. All patients responded to either systemic or intralesional corticosteroid treatment. CONCLUSIONS: In the daily practice of an otolaryngologist, it is not usual to diagnose a patient as having MRS. We consider that this is partly because of misdiagnosis. We therefore believe that this study will supply an additional aspect to otolaryngologists, in the scope of recurrent facial paralysis and orofacial edema in both children and adults.

Plastic surgical solutions for melkersson-rosenthal syndrome: facial liposuction and cheiloplasty procedures.

OBJECTIVE: : Melkersson-Rosenthal Syndrome (MRS) is a rare granulomatous disease characterized by a triad, including orofacial swelling, facial palsy and lingua plicata with usually recurrent or progressive course. Orofacial swelling, the most often sign of MRS, leads to the both esthetic and functional deformities. Because of its unknown etiology, a rational treatment is difficult and management of MRS still remains symptomatic, aiming at to remove orofacial swelling mainly. Although the many nonsurgical therapies have been mentioned in the literature, none has been proved uniformly and predictably successful to date. In this paper, we present different surgical procedures and their outcomes in a series of 4 cases with MRS. The procedures including mucosa, submucosa and tangential muscle resection, crescent shaped commissuroplasty, and facial liposuction may be considered in surgical armamentarium when orofacial swelling becomes persistent. We think that the plastic surgeons may act more effectively in the management of the syndrome in the future.

Orofacial granulomatosis presenting as persistent lip swelling: review of 6 new cases.

PURPOSE: Orofacial granulomatosis (OFG) is an uncommon disease, which presents usually as a persistent swelling of the soft tissues in the orofacial region and is characterized histologically by a granulomatous inflammation. The term orofacial granulomatosis is used in the literature to describe a nonspecific granulomatous inflammation. A subset, cheilitis granulomatosa (CG), which presents clinically as persistent lip swelling, is a granulomatous inflammation of unknown origin of the lips. CG may also be part of the triad of the Melkersson-Rosenthal syndrome (MRS) and some consider it as an oligosymptomatic form of MRS. PATIENTS AND METHODS: In a retrospective study, we reviewed the clinical records of all patients between the years 1990 and 2002 with the histologic diagnosis of granulomatous inflammation of the lip from the Department of Pathology at the Montreal General Hospital. The age at biopsy, sex, site of lesion, other signs of MRS, signs and symptoms of systemic granulomatous disease, and the treatment were compiled. RESULTS: Six subjects were included in the study, 5 females and 1 male. Four had swelling of the lower lip and 2 of the upper lip. In one patient a history of facial nerve palsy was reported and in another one a mild fissured tongue was present. No signs or symptoms of systemic granulomatous disease were noted. The treatment consisted of intralesional steroids with good results in 5 out of 6 patients. CONCLUSION: A thorough work-up to eliminate other etiologies of granulomatous disease is essential when a patient presents with granulomatous inflammation of the lip. CG seems to respond well to steroid treatment and the need for surgery is minimal and should be reserved for recalcitrant cases.

Oral lesions in patients with psoriasis: clinical presentation and management.

Psoriasis is a chronic inflammatory skin disease that rarely involves the oral cavity. In this report we describe 2 cases, initially diagnosed with cutaneous psoriasis, that present with oral lesions on the attached gingiva. The clinical appearance and differential diagnosis are presented and discussed. Case 1 describes the non-surgical management of intraoral psoriasiform lesions and the use of a free gingival graft to restore an area of gingival recession resulting from an oral lesion. The second case outlines the use of topical corticosteroid therapy as an adjunct to non-surgical periodontal therapy. Although patients with cutaneous psoriasis rarely present with oral involvement, the clinician should be aware that oral lesions may occur. Accurate diagnosis is dependent on a thorough clinical examination, a biopsy of the oral lesions, and a history of cutaneous psoriasis.

An 8-year-old girl with unilateral facial and ear pain and isolated frontal headaches.

An 8 1/2-year-old with chronic but fluctuating unilateral facial pain, earache, frontal headache and facial swelling is presented. Her journey through the health care system provides an instructional lesson for all who deal with patients with unusual or difficult to recognize conditions.

[Glossitis granulomatosa--an unusual subtype of Melkersson-Rosenthal syndrome]. / Glossitis granulomatosa--ein ungewöhnlicher Subtyp des Melkersson-Rosenthal-Syndroms.

So-called "glossitis granulomatosa", described in 1952 by H. Schuermann as a peculiar manifestation of Melkersson-Rosenthal syndrome (MRS), is little known in oral medicine due to the paucity of cases published so far. During the past 25 years the author has observed eight definite cases of glossitis granulomatosa and confirmed its close connections with MRS. The recurrent inflammation tends to change into persisting macroglossia with considerable functional and sensory oral disturbances. The clinical diagnosis, histologically supported by biopsy, can definitely be established, yet the outcome of the mostly chronic macroglossitis (with danger of later tongue carcinoma) may be very doubtful. Knowledge of Schuermann's glossitis, a member of the group of etiologically unclarified lingual inflammations, is important for physicians involved in oral medicine because of its therapeutic and prognostic implications.