OtoRhinoLaryngology Portal

The Leading Online Gallery of Otolaryngology and Head & Neck Surgery Specialty

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Tongue Tie (Ankyloglossia)- (Untreated)

Geographical Tongue

                            In a child.                                             In an adult.

Hairy/Thickened/Stained Tongue  

This can occur secondary to poor oral hygiene, chronic heavy smoking,

and in betel quid consumption.  Fungal infection need to be considered.

Staining of filiform papillae after prolonged betel leaf chewing.  This leaf is usually taken together with areca nut and mixed with mineral slaked lime (calcium hydroxide).  It also predisposes to submucous fibrosis

and dysplastic changes in the oral cavity.

 

Betel quid and areca nut are carcinogenic without tobacco.

Hairy Leukoplakia

White lesion (leukoplakia) involving left lateral border of tongue (ellipse) which proved on histology as hairy leukoplakia.  Biopsy site marked as (+).  Retroviral disease needs to be ruled out.

Buccal Ulcers

Chronic progressive ulceration of 4 months durations affecting the buccal mucosa of lower lip.  Biopsy showed no evidence of malignancy.  It responded well to topical hyaluronic acid gel application and tapering dose of oral prednisolone.  Images were taken 10 days apart.

Aphthous Stomatitis

This figure shows a small shallow ulcer with overlying

fibrinous exudate involving right palatoglossal fold.

 Multiple small size ulcers involving ventral surface of tongue (arrows).

Multiple larger size ulcers involving ventral surface of tongue.

Traumatic Tongue Ulcer

This elderly lady presented with left lateral border ulcer and granuloma formation.  Biopsy was negative for malignacy or dysplastic changes.  The culprit was the second molar tooth whic had caused recurrent traumatic abrasion most likely as a consequent of alveolar resorption which occurs with ageing process.

Lingual Cyst

Lingual cyst presenting as a uniform swelling with smooth surface involving right lateral border of tongue. 

Fibroma of Tongue Tip

A small histologically-confirmed fibroma involving dorsal surface of tongue tip.

Granuloma of Tongue Tip

Figure shows a post-traumatic tongue granuloma complicating accidental self-bite.  Pyogenic granuloma of pregnancy has a similar appearance.

Haemangioma of Tongue (Dorsal Surface)

An exophytic haemangioma located close to circumvallate papillae.

Patechial Haemorrhage in Dengue Haemorrhagic Fever

Close-up view of soft palate patechiae. 

Palatal patechiae when the platelet count was 34 x 109 /L.

The palatal lesion of the same patient 2 days later when the platelet count has improved.

Generalized maculopapular rash - "islands of whites in the seas of red"

Close-up view of the rash involving the leg 2 days later.

Mucositis

    

Inflammation of mucous membranes of oral cavity in a patient undegoing oncologic treatment of head and neck cancer is a common phenomena.  Oral disinfective rinse/gargle, pain relief, and attention to hydration and nutrition are essential during this acute phase which will slowly recover with time.

Herpes Simplex

Herpes labialis (rounded rectangle - initial blisters contain clear fluid) with severe anterior tongue mucositis causing extreme pain and poor oral intake.  Lesions responded well to antiviral therapy (Valacyclovir).

Fordyce Granules

Ectopic sebaceous glands known as Fordyce granules or spots involving right buccal mucosa (rounded square].

Prominent Stenson's Duct Opening Surrounded by Fordyce Granules

Buccal Haematoma

Figure shows a small left buccal haematoma occuring along the occlusal line of buccal mucosa complicating accidental bite during meal.  It can be left alone, or aspirated/marsupialized under local anaesthesia spray if symptomatic and bothering the patient.  [SP - soft palate, T - tongue, arrow - haematoma]

A big haematoma (arrow) complicating food injury while chewing.  No other history to suggest blood dyscrasia and patient is not on anticoagulant.

 The same patient reviewed 2 weeks later showing focal fibrin exudate and the haematoma has cleared.

Buccal Mass

Pedunculated right buccal polyp which felt soft in consistency.

Torus Palatinus

 

Typical site: along midline of hard palate.

Mucosal ulceration over torus.

Torus which has becomes bigger and encroaching denture edge.

'Giant' asymptomatic torus (T).  [SP - soft palate] 

Torus Palatinus Surgery

 

Surgical removal of large and symptomatic torus palatinus.  Mucoperiosteal flap (arrows) was raised and preserved, later to be sewn back to cover the raw drilled area.  [+ - torus, sp - soft palate, a - alveolar ridge]

 

Surgery by Dr. Jeevanan Jahendran.

Torus Mandibularis

 Bony hard swellings arising from inner surface of the mandible (arrows).

An ulcerated torus mandibularis (arrow). 

Multiple bony-hard swellings due to torus mandibularis (arrows).

 Torus mandibularis (arrows). 

Ranula

Midline Floor of Mouth Cystic Lesion

Differential diagnosis includes ranula, plunging ranula, dermoid cyst, epidermoid cyst, haemangioma, and lymphangioma.  Examine the submental and submandibular regions for evidence of swelling if any (can be symmerical, asymmetric, or unilateral).  Imaging delineate the anatomical boundaries and extent of lesion and helps in the planning the surgical approach.

 Figure shows diffuse submental swelling (+) which extends to the anterior border of submandibular fossa and encroaching hyoid bone posteriorly.

Haemangioma of Floor of Mouth

Radiology and histologically-confirmed cavernous haemangioma of floor of mouth.

Oral Thrush or Candidiasis

 

 Early palatal candidiasis manifested as mucosal induration (X) with focal areas of white curds at its periphery.  The patient also has severe candida oesophagitis and perianal herpes simplex which give clue to underlying immune-suppression state.

Diffuse oral thrush involving the palate and oropharynx.

Oropharyngeal thrush.

Another example of oral thrush in a patient using high dose corticosteroid inhaler.

 

Watch video of mouth and throat candidiasis @ YouTube

Infected Dental Cyst

Fluctuant abscess (rounded rectangle) originating from an infected dental cyst.  The dead tooth (+) is the root-cause of this lesion.  Pain and swelling above the upper lip are its usual presentation.  (LL - lower lip, UL - upper lip)

Raised anterior floor of nose related to the formed abscess (+).  (S - nasal septum Little's area, IT - inferior turbinate)

 

Intraoral view showing swollen central alveolus-hard palate area (X).  (+) - dead left 1st upper incisor.

Bucco-Alveolar Sinus

Figure shows right paramedian sinus (arrow) with mucopus discharge (+) in a patient presented with recurrent swelling involving the skin between the nostril and the upper lip with intra-oral pus taste.  The right anterior floor of nasal cavity was elevated, fluctuant and tender. 

Oral Abscess- (Buccoalveolar Sulcus)

 

Figure shows anabcsess involving left upper buccoalveolar sulcus.

Bucco-labial abscess (+) complicating lower central incisors apical abscess.

 CT-scan in coronal cut showing the dimension and extent of the above patient's abscess. 

Another example of an abscess involving the upper right bucco-alveolar region (X). Arrow - draining pus.

Leukoplakia and Chronic Non-Healing Ulcer

Non-healing ulcer of palate over 4 months duration (arrow) with surrounding area or leukoplakia.  Malignancy need to be ruled out by taking biopsy.

Erythroplakia: A Premalignant Mucosal Lesion

ML- upper molar tooth, T- tongue, star- erythroplakia lesion,

arrows- intervening leukoplakia border.

Gingival-Alveolar Candidiasis

 
Candidiasis lesion involving cental upper ginvival-alveolar region in a patient wearing dentures.  Pain and fever were his presenting symptoms. 

Candidiasis lesion involving cental upper ginvival-alveolar region in a patient wearing dentures.  Pain and fever were his presenting symptoms. 
Candidiasis lesion involving cental upper ginvival-alveolar region in a patient wearing dentures.  Pain and fever were his presenting symptoms. 
Candidiasis lesion involving cental upper ginvival-alveolar region in a patient wearing dentures.  Pain and fever were his presenting symptoms. 
Candidiasis lesion involving cental upper ginvival-alveolar region in a patient wearing dentures.  Pain and fever were his presenting symptoms. 

Buccal Mucosa Candidiasis

Right buccal mucosa candidiasis.

Left buccal mucosa candidiasis.

 

The patient was treated with oral and topical antifungal therapy

Soft Palate Dysplasia

Figure shows mucosal appearance of soft palate in a histologically-confirmed dysplasia.  Intervening borders beween nornal (anteriorly) and affected area (posteriorly) are clearly seen.

Close-up view of the most dysplastic area.

Palatal Haemangioma

Long-standing large haemangioma involving left side of hard and soft palate, uvula, and tonsil.

Soft Palate Mass and Tumour

Lymphoma presenting as right-sided soft palate tumour.

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