Oral lesions in patients with psoriasis: a controlled study

Stomatitis areata migrans was found in 5.4 percent of patients with psoriasis compared to 1 percent of control patients, while benign migratory glossitis was identified in 10.3 percent of patients with psoriasis and 2.5 percent of control patients. The association of these disorders with psoriasis indicates that they may be manifestations of psoriasis of the oral mucosa.

Oral Histoplasma capsulatum infection in association with HIV infection: a case report

The fungus Histoplasma capsulatum causes histoplasmosis, the most common endemic respiratory mycosis in the United States. Disseminated histoplasmosis in adults is often associated with immunosuppression, such as occurs in HIV infection. We report a case of oral histoplasmosis in an HIV-seropositive patient who presented with an ulceration on the left tip of the tongue, extending to the floor of the mouth, but was otherwise free of any active systemic disease. Histoplasma capsulatum was shown, by both histopathology and staining with a fluorescent antibody reagent specific for the organism, to be present in the lesion and was deduced to be the causative organism.

Oral hairy leukoplakia: a histopathologic study of 32 cases

Oral hairy leukoplakia (HL) was studied in 32 patients infected with the human immunodeficiency virus (HIV). Features most often found were parakeratosis of variable thickness, acanthosis, little or absent submucosal chronic inflammatory cell infiltrate, association with candidiasis in 71.8%, and intranuclear herpetic type inclusions in keratinocytes, associated with ballooned or ground-glass cytoplasm. The last feature was found in all biopsies and was most striking at the top of the stratum spinosum, just beneath the parakeratotic surface. We consider that intranuclear inclusions are the histologic hallmark of HL, which, together with other features described, make it possible to diagnose HL specifically by light microscopic examination. Ultrastructural studies were carried out in 20 cases. Viral particles of the human herpesvirus group were detected in 17 cases. Particles of papillomavirus (HPV) were not found in any of the specimens. Immunohistochemical studies were made in 26 cases using a rabbit antiserum to papillomavirus. Nuclear positivity was observed in 25 cases. Despite such apparently contradictory results, we think that a cross reaction may exist between the antiserum used against HPV and some antigens of the Epstein-Barr virus (EBV).

Life-threatening angioedema

Angioedema is a well-recognized edema involving the deeper layers of the skin, subcutaneous tissue, and mucosa. From July 1986 to July 1989 the authors have observed and treated 10 patients admitted to the Medical College of Virginia (MCV) Hospitals in Richmond, Virginia, with life-threatening angioedema as a complication of enalapril or captopril ingestion. Both drugs are angiotensin-converting enzyme (ACE) inhibitors prescribed for antihypertensive activity and the ability to improve symptoms in patients with congestive heart failure. We describe the clinical symptoms, diagnosis, and management of these patients, as well as reasons for each occurrence. Sporadic reports of angioedema secondary to ACE inhibitor therapy have appeared in the literature. This represents the first time a significant series of patients from the same institution have encountered this complication over a short period of time, suggesting that the complication may be much more common than has been thought.

Lingual cellulitis causing upper airway obstruction

A case is reported in which upper airway obstruction occurred in an immunosuppressed patient due to the presence of lingual cellulitis.

Oral squamous cell carcinoma arising in a patient with long-standing lichen planus. A case report

The risk of malignant transformation of oral lichen planus remains a controversial point. Many previous reports have been discounted on the basis of inadequate information or lack of histologic confirmation of lichen planus. We report a well-documented case of long-standing cutaneous and oral lichen planus in which squamous cell carcinoma of the dorsal portion of the tongue occurred. There is an apparent difference in the sites of oral carcinomas in patients with lichen planus compared with the general population. This suggests that lichen planus increases the risk of oral cancer in affected sites.

Disseminated histoplasmosis presenting as a non-healing tongue ulcer

A 51-year old man presented with a persistent tongue ulcer, fever, cervical lymphadenopathy and hepatomegaly. The diagnosis was initially thought to be tuberculosis. This led to the initiation of antituberculous chemotherapy to which the patient failed to respond. The correct diagnosis of histoplasmosis was made after the detection of Histoplasma capsulatum on further review of the tongue ulcer biopsy specimen. He responded to treatment with amphotericin B.

[Tongue disorders and jaw deformities. Nosological aspects and therapeutic concepts]

Tongue's disorders as abnormal volume, modified position and mobility can cause maxillary deformation. Nosological and therapeutic aspects are considered.

[Dynamic and postural changes in the tongue: influence on facial growth]

The Authors examine the effect of the tongue's postural and dynamic modifications on facial grow. Some clinical cases are presented.

A tongue resection in macroglossia due to primary amyloidosis

A lady of 62 years with longstanding macroglossia from primary amyloidosis had the anterior two-thirds of her tongue successfully resected. She had Factor X deficiency. The surgical, anaesthetic and haematological problems encountered are described.

Upper airway obstruction secondary to warfarin-induced sublingual hematoma

Sublingual hematoma is a rare but potentially fatal complication of oral warfarin sodium. Less than ten cases are reported in the English-language literature with only two of these appearing in the otolaryngologic literature. Spontaneous bleeding into the sublingual and submaxillary spaces creates a "pseudo-Ludwig's" phenomenon with elevation of the tongue and floor of mouth and subsequent airway compromise. Two new cases, along with a review of the literature are presented. Management is directed at prompt control of the airway and reversal of the coagulopathy. Sore throat is a uniform, early complaint that should be taken seriously in any patient receiving oral anticoagulation therapy.

The role of the dentist in diagnosing infection in the AIDS patient

A case report of an AIDS patient afflicted with disseminated histoplasmosis is presented. Characteristic granulomatous-appearing lesions on the tongue were observed during the patient's initial workup, but the patient became unavailable for a scheduled biopsy. Consequently, the diagnosis of a histoplasmosis infection was established only after the performance of several time-consuming, stressful, and, at times, invasive diagnostic procedures. It is proposed that early histologic evaluation of the suspicious oral lesions would have resulted in the diagnosis, thus making more extensive diagnostic testing unnecessary. This case illustrates the need for the dentist to pursue an aggressive approach in evaluating oral lesions in the AIDS patient.

Post-traumatic upper airway obstruction secondary to a lingual artery hematoma

An accident victim presented with maxillofacial trauma complicating a head injury. After the airway was secured by tracheostomy, surgical exploration revealed a lingual artery hematoma. This case illustrates the progressive airway occlusion seen with this disorder and the importance of repeated oral examinations.