Systemic lupus erythematosus, pregnancy and carcinoma of the tongue

We present a case which describes a 29-year-old woman with systemic lupus erythematosus who was treated aggressively with cytotoxic immunosuppression. Five years later and approximately 12 weeks pregnant, she is confirmed as having carcinoma of the tongue. Not wishing to consider termination of her pregnancy, she underwent surgical resection, which included partial glossectomy with microvascular reconstruction. Good oral function (speech and swallowing) was restored within 2 weeks. The pregnancy proceeded relatively uneventfully to 37 weeks gestation when proteinuric hypertension necessitated induction of labour. She remains well with no evidence of recurrence. This case highlights the options available in the treatment of carcinoma of the tongue during pregnancy together with the ethical considerations required, balanced against optimising maternal outcomes.

Oral changes stemming from hemangioma of the tongue

Hemangiomas are among the most common tumors found in children and are characterized by an excess of blood vessels. They most often affect the area of the head and neck, occur with greater frequency among women and Caucasians, and can be found in the oral cavity-especially on the lips, tongue, or mucosa. Clinically, hemangiomas present as asymptomatic red or blue-colored lesions that grow rapidly and are capable of spontaneous regression. When they are found on the tongue, they can result in clinical problems as well as recurrent trauma due to biting of the tongue and tooth-brushing, resulting in bleeding, obstruction of the upper airways, and difficulty with chewing, deglutition, and speaking. The purpose of this article was to present a case study of a 4-year-old child with a diagnosis of hemangioma of the tongue, emphasizing the oral changes found as a result of this lesion, as well as the dental treatment used to minimize these changes.

Long-term results of brachytherapy in early mobile tongue cancer with 10-year minimal follow-up

AIM

To retrospectively analyze the long-term toxicities of low-dose-rate interstitial brachytherapy (LDR-BT) with related prognostic factors for patients with early mobile tongue cancer (T1/2N0M0) at a minimum of 10 years' follow-up.

PATIENTS AND METHODS

The records of 187 patients treated with LDR-BT between 1980 and 2000, out of whom 25 were treated with additional prior external beam irradiation, were reviewed.

RESULTS

Overall survival at 15 and 20 years was 88.4% and 76.2%, respectively. Complications included tongue ulcer (26%), tongue erosion (3%), tongue atrophy (2%), bone exposure (15%), and osteoradionecrosis (4%). No patient presented xerostomia or taste disorders. Multivariate analysis revealed that tongue ulcer and the use of spacer were significantly associated with bone exposure and osteoradionecrosis. Local recurrence was demonstrated in 15 (8%) cases, 93% of which were salvaged by operation. Fifty patients (27%) experienced neck metastasis.

CONCLUSION

LDR-BT is an acceptable treatment option, with low rates of long-term toxicity.

Development of hemangioma in a tongue harboring long-standing angiokeratoma circumscriptum

Angiokeratoma is a very rare vascular lesion of the papillary dermis. It is characterized by vascular ectasia with overlying epidermal hyperkeratosis. The systemic form of angiokeratoma is associated with Fabry disease and fucosidosis. There are several localized forms. Tongue involvement is uncommon. Hemangiomas are tumors made up of capillaries; they grow by active endothelial proliferation as opposed to expansion of vascular spaces in vascular malformations. Lingual hemangiomas are usually indolent, but they can cause cosmetic deformities, recurrent hemorrhage, and functional problems with speaking, mastication, and deglutition. We report a case of angiokeratoma of the tongue with an underlying hemangioma in a 30-year-old woman. Angiokeratomas have been reported to develop over arteriovenous malformations and in the area of lymphangioma circumscriptum following repeated local trauma. To the best of our knowledge, the development of a lingual hemangioma in a patient with long-standing angiokeratomatous lesions has not been previously reported in the literature.

Tongue abscess: a rare clinical entity

Swelling of the tongue is a rare clinical entity. It is a potentially life-threatening condition, as it could result in airway compromise. The differential diagnosis of acute tongue swelling includes hemorrhage, infarction, abscess, tumor, and edema. A tongue abscess should be considered in all cases of acute tongue swelling, especially when host defenses are severely impaired. Although the diagnosis of lingual abscess can be reached clinically because of the rarity of the condition, in neglected cases, the diagnosis can be difficult. Despite of the rarity and complexity of this condition, its management strategy is relatively simple. In the present study, we describe a case of a tongue abscess on the anterior two-thirds of the tongue in a 60-year-old woman, and discuss the pathophysiology, diagnosis, and treatment of this complex entity.

Angiosarcoma arising from the tongue of an 11-year-old girl with xeroderma pigmentosum

Xeroderma pigmentosum (XP) is a rare autosomal recessive defect in DNA endonuclease activity that is associated with the development of cutaneous malignancies, at sun exposed sites, including basal cell carcinoma, squamous cell carcinoma, and melanoma. Squamous cell carcinomas are also known to target the anterior tongue. Patients sometimes develop angiosarcomas, and these invariably arise from sun-exposed skin. A biopsy was taken from a large mass arising in the anterior tongue of an 11-year-old girl with XP and a history of cutaneous basal cell carcinomas. The histopathologic findings demonstrated a high grade epithelioid neoplasm resembling a poorly differentiated squamous cell carcinoma, but the immunohistochemical profile (AE1/AE3 negative, p63 negative, CD31 positive, CD34 positive) established the diagnosis of angiosarcoma. Angiosarcoma is an XP-related tumor that usually arises in sun-exposed skin but can also arise in the oral cavity. For patients with XP who develop epithelioid neoplasms of the oral cavity, epithelioid angiosarcoma should be considered in the differential diagnosis.

Paraneoplastic vesiculobullous dermatomyositis with synchronic prostate and tongue tumors: case report

Dermatomyositis is an inflammatory myopathy with skin manifestations. In the adult over the age of 50 years, it can be associated with malignant neoplasias, being, thus, a signal of malignancy.

OBJECTIVE

To show the association of dermatomyositis of atypical presentation with two synchronous tumors, usually not related to that.

CASE REPORT

We report the case of a 72-year-old male, who developed dermatomyositis, initially with only classic skin findings, which progressed to vesiculobullous lesions, and, months later, to myopathy. After extensive investigation, prostate adenocarcinoma was diagnosed. After treatment of the cancer and administration of glucocorticoid, the disease went into remission. During gradual glucocorticoid withdrawal, dermatomyositis recurred, and the new investigation revealed the presence of squamous cell carcinoma of the tongue. After treating this neoplasia, complete remission occurred, even after total corticoid withdrawal.

CONCLUSION

This is a rare case involving less usual dermatomyositis presentation forms, relating to the cutaneous-muscle findings and the association with prostate and tongue tumors (tumors never reported together). This case demonstrates the importance of a careful investigation, searching for neoplasias, when approaching such patients.

Harmonic scalpel for a bloodless partial glossectomy: a case report

Tongue surgery is almost always complicated by intraoperative bleeding. Its rich blood supply especially from the lingual vessels makes the operative field bloody. Electrocautery has been widely used to replace cold scissors in order to achieve better hemostasis. The use of ultrasonic harmonic scalpel for glossectomy is still new in this country. We report a case of partial glossectomy using the harmonic scalpel in a patient who had a squamous cell carcinoma of the lateral border of the tongue.

Lymphangioma of the tongue with macroglossia: a case report

Lymphangioma are rare benign lesions of the lymphatic vessels, found mainly in the head and neck. Almost all cases of macroglossia in young children are caused by lymphangioma of the tongue. Aesthetic, occlusal, functional and psychosocial problems may arise as a result of this condition. The preferred treatment is surgery but in some cases sclerosant therapy may be used as an adjunct treatment. We report a case of lymphangioma of the tongue with macroglossia that was treated successfully with a Vshaped anterior glossectomy and discuss the surgical considerations.

Watermelon stomach, hemorrhagic pericarditis, small cell carcinoma of the lung and synchronous squamous cell carcinoma of the tongue base

Based on a case of gastric antral vascular ectasia (watermelon stomach) that was associated with hemorrhagic pericarditis, small cell lung carcinoma with mediastinal lymph node metastases and a synchronous squamous cell carcinoma of the base of the tongue, the authors made a review of the clinical, endoscopic and histopathological aspects of this type of gastropathy, and its association with other diseases, and of the results of its endoscopic therapy. The causes of hemorrhagic pericarditis are considered, emphasizing the necessity to know if the effusion has a malignant etiology. To the best of our knowledge the association of watermelon stomach to small cell lung carcinoma and squamous cell carcinoma of the base of the tongue has not yet been described. Extensive metastases to mediastal lymph nodes are common to small cell lung carcinoma.

Regional odontodysplasia involving three quadrants of the jaws: a case report

Regional odontodysplasia is a rare developmental anomaly of the teeth that affects enamel and dentin. Its etiology is unknown, but the most accepted theory refers to circulatory disorders associated with vascular nevi. An uncommon case of regional odontodysplasia involving three quadrants of the jaws is reported. An 8-year-old boy was referred to the authors' institution with lack of teeth as a major symptom. There was no hereditary anomaly in the family. Extraoral examination revealed a brown discoloration on the skin on the right side of the face, neck, and chest. Detailed intraoral examination showed hypoplastic and carious teeth. Fistulae and gingival overgrowth were also observed. Radiographically, the affected teeth presented the pathognomonic image of "ghost teeth." Conservative treatment was instituted.

One case of Candidemia developed after surgery for tongue cancer in a young adult

Candidemia is an opportunistic infection caused primarily by Candida albicans. We experienced a case of severe Candidemia that developed after surgical treatment for tongue cancer and required considerable labor to diagnose and to treat, though no particular immunodeficiency was seen before. The case was resistant to an antifungal agent, fluconazole, but was successfully treated with amphotericin B. Positive blood cultures, local wound culture, and increased β;-D-glucan were useful to diagnose the infection. In particular, gallium-67 scintigraphy was remarkably useful for the diagnosis and the evaluation of therapeutic effects in this case. Development of Candidemia following an oral and maxillofacial surgery is extremely rare among young adults, thus this case report serves to draw attention to the risk in oral and maxillofacial surgery.

[Diagnostic image. A woman with a swollen tongue]

A 46-year-old woman had a swollen tongue due to amyloid light chain (AL) amyloidosis caused by multiple myeloma.

The treatment of tongue haemangioma by plasma knife surgery

A seven-year-old girl presented with a 4 cm x 2 cm lesion of the tongue which was located at the posterior one-third in the midline. The lesion was excised by plasma knife surgery. No complication, such as bleeding, shortness of breath or infection, occurred after the treatment. Plasma knife surgery is an acceptable choice for selected benign lingual vascular malformations.

Macroglossia caused by adenoid cystic carcinoma. Case report

A 33-year-old woman sought medical care at our institution for macroglossia. She had been treated before with tracheostomy and gastrostomy due to an adenoid cystic carcinoma (ACC) of the mobile tongue, in clinical stage IVC. She was subjected to total glossectomy with larynx preservation, modified radical dissection of the right neck and of the left supraomohyoid muscle, as well as reconstruction using a free flap from the rectus abdominus. The histological report described a 15x11 cm solid type ACC of the mobile tongue (grade III), with infiltration to adjacent soft tissues, vascular and lymphatic vessels, as well as two metastatic lymph nodes in the right neck dissection. One month after surgery, bone and bilateral pulmonary tumor activity became evident. In advanced-stage tumors, treatment must be individualized, and when accompanied by severe deterioration of the quality of life, surgery is recommended independently from the extension, provided that a good reconstruction is accomplished.

Dental treatment planning and management in the patient who has cancer

The oral cavity has the potential to be a major source of short-term and long-term complications from cancer therapy. Appropriate evaluation and elimination of potential sources of oral infection before cancer therapy is vital because oral bacteria are a known source of bacteremia and septicemia during cancer therapy. Cancer diagnosis with previous and planned treatment, past medical history, past dental history, current medications, drug allergies, social history, family history, laboratory values, extraoral findings, intraoral findings, and radiographic findings must all be evaluated in planning dental treatment for these complex cases.

An alternative for postorthodontic labial retention in an unusual case

An integral part of sustaining long-term orthodontic results is a lingually bonded retainer. These retainers have been established as a standard retention protocol, as they combine efficiency and esthetics. Increasing patient demands for improved esthetics and maintenance of good health of dental and periodontal tissues have led to the development of new techniques and materials involving reinforced polyethylene fibers. In this case report, retention featuring the use of a reinforced polyethylene fiber retainer, placed labially to avoid irritating the tongue, is presented. Three-year posttreatment records indicated no relapse and that the integrity of soft and hard tissues had remained intact.

Analysis of Determinants on Speech Function After Glossectomy

PURPOSE

To determine which of the following factors-type of reconstruction, size of tumor, and site of excision-may influence speech intelligibility after glossectomy.

MATERIALS AND METHODS

The speech intelligibilities of 27 tongue cancer patients who underwent glossectomy within the range of the hemitongue were investigated within 6 months after operation with a speech intelligibility test formed by 100 sensitive Chinese sounds. They were compared according to the following factors: type of reconstruction (forearm flap or adjacent flap); size of tumor (T1, T2, T3); and site of excision (anterior, middle, posterior, or hemi part).

RESULTS

There was no significant difference in speech intelligibility between the forearm flap reconstructed group and adjacent flap reconstructed group (P > .05). There was a significant difference in the result between the T1 and T3 groups (P < .05). The speech intelligibilities of the patients with tumors in anterior tongue or hemitongue were significantly lower than those with tumor in the middle or posterior tongue (P < .05). Patients with preservation of the tip of the tongue or floor of the mouth had higher intelligibilities (P < .05).

CONCLUSION

For the patients after glossectomy within the range of hemitongue, except for the type of reconstruction, the tumor site or excision extent of the tongue followed by the tumor size may be key factors in determining the postoperative articulation intelligibility.

Carcinoma of the tongue and bulbar-onset amyotrophic lateral sclerosis: unusual differential diagnosis

We present a 72-year-old woman with progressive dysphagia, dysarthria and tongue palsy who was initially diagnosed with bulbar-onset amyotrophic lateral sclerosis (ALS). However, the absence of atrophy or fasciculations in the tongue, as in other voluntary muscles, and the lack of reproducible neurophysiological evidence of denervation, prompted a revision of the diagnostic work-up, which eventually led to the discovery of a carcinoma of the tongue. This case report describes a relatively rare type of oropharyngeal carcinoma that, in its early stage, resembled a bulbar-onset ALS. This differential diagnosis is unusual, and it was fostered by the persistent lack of atrophy of the tongue and the absence of spreading of signs and symptoms of motor neuron degeneration.

Implant-retained feeding aid prosthesis for a patient following total glossectomy and laryngectomy: a clinical report

This clinical report describes the prosthetic management of a patient following total glossectomy and total laryngectomy that severely compromised his oral function, caused facial disfigurement, and limited the patient's quality of life. A feeding aid prosthesis was designed to address the patient's chief complaint of difficulty in feeding and mastication. The prosthesis was designed as an implant-retained overdenture with a lingual metal plate to facilitate food introduction into the oropharynx. This treatment improved mastication, appearance, and the quality of the patient's social life.