OtoRhinoLaryngology Portal

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Tongue Tie (Ankyloglossia)- (Untreated)

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.


Yellow appearance of mucous membrane of oral cavity (above) and the throat (below) in a patient with cholestatic jaundice.

Geographical Tongue

                            In a child.                                             In an adult.

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.

Iatrogenic Soft Tissue Injury of Tongue


Haematoma (H) involving dorsal aspect of tongue on left side complicating an excessive and uneven pressure of a retractor device during surgery to drain right peritonsillar abscess.


Bruise and teeth marks involving ventral surface of the tongue on the left side made noticeable 48 hours after the procedure (same patient as above). 

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 papilla.

Squamous Cell Carcinoma


Histologically confirmed squamous cell carcinoma of tongue presenting as painful fungating tumour (T) at its left lateral border.  The patient gave history of betel nut chewing.




Another example of ulcero-fungating squamous cell carcinoma lesion involving left lateral border of tongue.  The patient presented with a paintul non-healing ulcer and level III left cevical lymphadenopathy.  There were no history of smoking or betel nut chewing.

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.

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).



Worsening of tongue lesion with extreme pain (same patient as above) before treatment given.



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.