Oral leukoplakia; a proposal for simplification and consistency of the clinical classification and terminology

There is a distinct lack of uniformity in the definitions and clinical terminologies related to oral leukoplakia and leukoplakialike lesions and disorders. Proposals have been put forward to subclassify leukoplakia into a homo-geneous and a non-homogeneous type based on color only, being either predominantly white or mixed white-and-red, respectively, irrespective of the texture of the lesion. In this proposal there is no need anymore to regard the poorly defined proliferative verrucous leukoplakia as a separate entity. Since keratosis is primarily a histo-pathological term, its clinical use is discouraged. Alternative terminology for these so-called keratotic lesions and disorders has been put forward. Finally, a suggestion has been made to rename the term hairy leukoplakia, being a well defined, not potentially malignant disorder particularly related to HIV-infection, into 'EBV-positive white lesion of the tongue' (EBVposWLT)

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[The analysis of diagnostic errors by pathological conditions of the tongue].

To study the quality of medical diagnostics by pathological conditions of the tongue the retrospective analysis of 555 medical records of patients with various pathology of the tongue hospitalized in maxillofacial hospitals of Kazan was carried out. The analysis has shown that at a pre-hospital examination the wrong diagnosis was observed in approximately one third of cases. In the vast majority of cases the errors arose by tongue neoplasias.

Schwannoma lingual: presentación de un caso / Lingual schwannoma: a case report

El schwannoma o neurilemoma es un tumor benigno originado en las células de Schwann de la vaina nerviosa de nervios periféricos o intracraneales. Generalmente son solitarios. Las localizaciones más frecuentes son extremidades, cabeza y cuello y mediastino. De 25 a 40 por ciento de los casos se ubican en cabeza y cuello y aquí sólo el 1 por ciento son intraorales. En esta última localización, la lengua, es el sitio habitual de presentación, seguido en orden decreciente por paladar, mucosa bucal, labio y encías. Presentamos el caso de un paciente de sexo masculino de 38 años de edad que consulta por una tumoración lingual, la que se biopsia. El diagnóstico es schwannoma lingual. Se completa el tratamiento con resección quirúrgica de la neoformación.

Treatment, classification, and review of Tapia syndrome.

Tapia syndrome was first described by Antonio Garcia Tapia in 1904. Then, he believed that the existing lesion, resulting in some neurologic symptoms, was outside the central nervous system. Nowadays, this syndrome is characterized by the unilateral paralysis of the tongue and the vocal cord. Possible cause of this disorder is injury to the 10th and 12th cranial nerves without involvement of the pharyngeal branches of the 10th nerve. We present a patient with Tapia syndrome together with its treatment and new classification.

Importancia de la evaluación y clasificación del frenillo lingual / The importance of evaluation and classification of lingual frenum

El propósito de esta investigación surge a partir de la observación, cada vez más frecuente, de pacientes con maloclusiones, cuya causa principal es la anquiloglosia parcial o total. El objetivo fue determinar la cantidad de pacientes con maloclusión que presentaban anquiloglosia sobre una muestra de 282 pacientes de ambos sexos, correspondientes a las tres denticiones, quienes durante el período de un año (noviembre 2003-2004) concurrieron espontáneamente a la Facultad de Odontología de la UNC. En primer término, se evaluó la presencia de anquiloglosia, su frecuencia, y la maloclusión más frecuente en los pacientes con y sin anquiloglosia. Para categorizar los distintos tipos y grados de anquiloglosia, se aplicaron dos métodos de evaluación, considerándose 0 la norma en ambos grupos: (1) grado de movilidad lingual grados 0, 1, 2, 3, 4 (G), referido a la ubicación de la punta de la lengua y su relación con el paladar duro, por detrás de los incisivos superiores, estando el paciente en apertura bucal máxima (ABM); (2) longitud del frenillo lingual tipo 0, I, II, III, IV, medido con calibre de Boley, desde la inserción del frenillo hasta la punta de la lengua, considerándose clínicamente aceptable la lengua libre mayor de 16 mm. Los resultados obtenidos fueron: sobre 282 pacientes con maloclusión, 153 presentaron anquiloglosia, en los cuales la maloclusión más frecuente fue la Clase II, con 43,14 por ciento (n=66), siendo el grado de movilidad lingual G2 (n=92) con 60.13 por ciento y la longitud del frenillo lingual, Tipo II (n=65) con 42,50 por ciento, las más frecuentes.

Epiglottic and base-of-tongue prolapse in children: grading and management.

OBJECTIVES: A distinct entity of airway obstruction from epiglottic and base-of-tongue (EBT) prolapse in the pediatric population is defined. Laryngopharyngeal findings, swallowing dysfunction, and gastroesophageal reflux disease are described in a group of children with EBT prolapse. A new grading system is also presented. STUDY DESIGN: A prospective study was conducted of laryngopharyngeal findings in children with EBT prolapse, a description of a new grading system, and review of the pediatric literature. METHODS: Fourteen children with EBT prolapse were prospectively studied with flexible fiberoptic nasopharyngolaryngoscopy. A new grading system for EBT prolapse was developed. Grade 0 is a normal airway. Grade 1 is prolapse of the epiglottis against the posterior pharyngeal wall but with normal position of the tongue. Grade 2 is prolapse of the epiglottis and base of tongue with only the epiglottic tip visible. Grade 3 is glossoptosis with no portion of the epiglottis visible. The diagnostic modalities and treatments for EBT prolapse are reviewed. RESULTS: Of the 14 children studied, seven (50%) had grade 1, four (29%) had grade 2, and three (21%) had grade 3 EBT prolapse. Swallowing dysfunction (five of 14, 38%) and gastroesophageal reflux disease (13 of 14, 93%) were also prevalent. CONCLUSION: The new grading system was applied successfully to describe the severity and sites of airway obstruction in 14 children with EBT prolapse. Swallowing dysfunction and gastroesophageal reflux disease occur in this population. Although surgical therapies are sometimes effective, lack of consistent success and the risk of aspiration with procedures other than tracheotomy may lead some to conclude that continuous positive airway pressure or tracheotomy are the safest options.

Oral lichen planus: a clinical and morphometric study of oral lesions in relation to clinical presentation.

Oral lichen planus (OLP) is a chronic inflammatory disease with different clinical presentations that can be classified as reticular or atrophic-erosive. Sixty-two OLP patients were studied to evaluate the clinical-pathologic characteristics of their OLP lesions and to investigate possible differences in their biological behavior. The most common clinical presentation was the reticular type (62.9% vs 37.1%). Atrophic-erosive presentations showed significantly longer evolution (chi square=4.454; p=0.049), more extensive lesions (chi square=16.211; p=0.000) and more sites affected than reticular ones (chi square=10.048; p=0.002). Atrophic-erosive OLP was more frequently found on the tongue, gingiva and floor of the mouth. No statistically significant differences could be identified between reticular and atrophic-erosive clinical presentations in terms of age, sex, tobacco habit, plasma cortisol level and depth of inflammatory infiltrate. We concluded that the classification of OLP lesions as reticular vs atrophic-erosive is a simple, easy to use classification that can identify clinical presentations with different biological behavior.

Nasopharyngoscopy in Robin sequence: clinical and predictive value.

OBJECTIVE: To correlate nasopharyngoscopic findings with clinical manifestations during the first month of life and study the course of respiratory obstruction during the first year in infants with Robin sequence (RS). DESIGN: A longitudinal prospective study of children with RS. SETTING: Hospital de Reabilitação de Anomalias Craniofaciais, University of São Paulo, Bauru-SP, Brazil, 1998 to 2000. PATIENTS: Fifty-six children were studied from the age of 1 month to 12 months. INTERVENTIONS: The type of respiratory obstruction was defined by nasopharyngoscopy. Patients for whom glossoptosis was the only mechanism of respiratory obstruction were classified as having mild, moderate, or severe glossoptosis by nasopharyngoscopy and as mild, moderate, or severe cases with respect to the clinical manifestations. RESULTS: Forty-two (75%) patients showed respiratory obstruction caused by glossoptosis; seven (43.7%) of these infants with mild clinical manifestations showed moderate glossoptosis during the first month of life and five (31.3%) presented severe glossoptosis; 10 (45.5%) of the infants with severe clinical manifestations showed moderate and 11 (50.0%) severe glossoptosis. At 12 months of age, glossoptosis was mild or absent in 83.3% of the patients, moderate in 14.3% and severe in 2.4%. CONCLUSIONS: A poor correlation between the severity of glossoptosis and the severity of clinical manifestations was observed for patients with respiratory obstruction caused by glossoptosis during the first month of life, but the correlation between glossoptosis and respiratory distress according to age was statistically significant. Nasopharyngoscopy is not a good method for predicting the severity of the clinical course of respiratory obstruction caused by glossoptosis.

A study of pathology associated with short lingual frenum.

Ankyloglossia is a developmental anomaly of the tongue characterized by a short, thick, lingual frenum resulting in limitation of tongue movement. The frenum is attached to the tip of the tongue in varying degrees. This study evaluates short lingual frenum and other associated pathologies (dentofacial anomalies and lingual dysglossia) and investigates whether ankyloglossia is related to speech problems. A thorough intraoral examination was carried out using the WHO regulations for dentofacial anomalies and occlusion problems and a new scale of lingual mobility. This article also discusses the difficulty in diagnosing this condition and finally following to the results of our study, describes the indications for nonsurgical and surgical treatment of this anomaly.

Inter-rater reliability of an oral assessment guide for elderly patients residing in a rehabilitation ward.

The aim of this study was to test the inter-rater reliability of a revised oral assessment guide (ROAG) for patients residing in a geriatric rehabilitation ward. A consecutive sample of 140 patients was recruited for the study. Oral assessments were performed for 133 newly admitted patients by one registered nurse (RN) during a period of six months. A dental hygienist (DH) carried out 103 oral assessments during the same half-year. For 66 patients, the RN and the DH performed independent assessments. There was an agreement between the RN and the DH in the majority of the independent assessments, except for tongue and teeth/dentures. The percentage agreement exceeded 80 percent. Inter-rater agreement measured by Cohen's Kappa coefficient ranged from moderate to very good and percentage agreement had a range of 58 to 91 percent. The agreement was highest in assessment of voice and swallowing (91%). Assessments of teeth and dentures seemed to be most difficult for the RN to evaluate. ROAG was found to be a clinically useful assessment tool. Additional education and training is needed to improve the reliability of the oral assessments and should include continuous support from a dental hygienist as well as a pictorial manual on how to use the ROAG.

[Nosologic descriptions of lesions of the oral mucosa]. / Description nosologique des lésions de la muqueuse orale.

This article describes extensively and systematically oral mucosa diseases. Macroscopical aspects are particularly described in order to give the dentist all important elements of differential diagnosis. This nosological description is based on a clinical approach: white and pigmented lesions are distinguished from ulcerated and benign so as malignant tumoral lesions. Specifically on the oral mucosa located lesions and oral mucosa lesions of systemic diseases are described.

[Epidemiologic survey of tongue lesions and analysis of the etiologic factors involved]. / A nyelvelváltozások epidemiológiai felmérése és aetiológiai tényezöinek vizsgálata.

The prevalence of tongue lesions, and relationships with different systemic diseases, according to the international literature of epidemiologic studies were reviewed. The data were compared with a Hungarian investigation of 5034 individuals, between 1992 and 1995 in Budapest. Tongue lesions were found in 22.76% of the examined individuals. The ratio was similar in women (51%) and men (49%). Fissured tongue was found in 21.49%, geographic tongue in 2.21%, atrophic tongue in 0.12% and central papillar atrophy in 0.70%. These data agree in general with the epidemiological data found in the international literature. Some rare tongue alterations were also investigated. Lingua indentata was found in 1.49% and hypertrophy of papillae foliatae was found in 0.20%. The relationship with different systemic diseases was the following: In diabetes mellitus tongue lesions were found in 29.03%, in hypertension in 28.63%, connected to heart- and vascular diseases in 25.15%, to haematologic diseases in 17.54%. Tongue lesions were found in 23.86% in the case of liver disease, in 22.38% in gastrointestinal diseases and in 20.69% associated to tumors. In the case of Candida's infection tongue alterations were found in 41.6%, in smokers in 23.72%. Tongue lesions caused complaints rarely, only in 2.27%. The recognition of tongue lesions may be helpful in the early diagnosis of systemic diseases.

Acute enlargement of the tongue.

Acute enlargement of the tongue can present as an emergency. The problems of management in the acute situation and the diagnosis of the underlying condition are discussed and illustrated with reference to four unusual cases. There is a case for a simple classification and such a classification is presented.

[Incidence of tongue diseases based on epidemiologic studies (review of the literature)]. / Nyelvbetegségek elöfordulásának gyakorisága epidemiológiai vizsgálatok alapján (irodalmi áttekintés).

According to the literary data the prevalence of fissured tongue varies between 0.8-60.0%, that of geographic tongue between 0.1-14.3%, that of atrophy tongue between 1.3-9.0% and that of the central papillary atrophy of the tongue between 0.0-3.35%. The wide-ranging diversity concerning the epidemiological data of tongue diseases can be explained by the multiple character of sampling, diagnosis and other methods used in different types of examinations. Disregarding the extremities and considering the average prevalence data, these agree in general with the epidemiological data found in Hungary in 1990: fissured tongue 8.8% geographic tongue 3.0%, atrophic tongue 6.37% and central atrophy of the tongue 0.35% prevalence.