[Oral hygiene and microcirculation of the mucous membrane of the tongue and gums dynamics in patients with burning mouth syndrome as a result of the use of a toothbrush with a gold-zinc electroplating]

THE AIM OF THE STUDY

Was to assess the level of oral hygiene and microcirculation of the mucous membrane of the tongue and gums in patients with burning mouth syndrome (BMS) as a result of using a toothbrush with a gold-zinc electroplating.

MATERIALS AND METHOS

The study included 50 patients of both sexes aged 45-64 years with the diagnosis of BMS divided into two groups. In the main group, the complex of hygienic measures included the use of a toothbrush with a gold-zinc electroplating and a paste with the fluorine content of 1350 ppm. In the comparison group, a regular manual toothbrush and a paste with a fluoride content of 1350 ppm were used for oral hygiene. A control group consisted of 25 healthy people with the mean age of 44±4.5 years without clinical signs of BMS in the oral cavity and concomitant acute somatic pathologies.

RESULTS

Tongue mucosa microcirculation level in patients using the toothbrush with a gold-zinc electroplating was significantly higher than in the comparison group using conventional manual toothbrush. Oral hygiene level assessment showed statistically significant better brushing efficacy in patients using the toothbrush with a gold-zinc electroplating.

CONCLUSION

The use of a toothbrush with a gold-zinc electroplating contributes to the normalization of microcirculation in the mucous membrane of the tongue and gums and is recommended for inclusion in the complex of therapeutic measures in patients with BMS.

Oral ulceration in Stüve-Wiedemann syndrome: a new presentation

Stüve-Wiedemann syndrome (SWS) is a rare, autosomal recessive disorder, causing dysautonomia and multisystem failure. Symptoms include skeletal malformations, restricted joint mobility and desensitisation to pain. Patients with SWS presenting with intraoral lesions are extremely rare and this is probably due to their shortened lifespan. We present a case of a 9-month-old patient who presented to our Oral and Maxillofacial Surgery (OMFS)Unit with a chronic inflamed ulcer affecting the tongue, secondary to trauma from erupting central incisors. We believe that depapillation in conjunction with an increased pain threshold contributed to its development. The patient was successfully treated by extraction of the lower central incisors and intralesional steroid injections under general anaesthetic. This case highlights that patients with SWS can present to the OMFS clinician with oral lesions and that they can be safely managed under general anaesthesia.

Botulinum Neurotoxin Therapy for Lingual Dystonia Using an Individualized Injection Method Based on Clinical Features

Lingual dystonia is a debilitating type of oromandibular dystonia characterized by involuntary, often task-specific, contractions of the tongue muscle activated by speaking or eating. Botulinum neurotoxin (BoNT) has been used to treat lingual dystonia; however, it is known to cause serious complications, such as dysphasia and aspiration. The purpose of this study was to evaluate the efficacy and adverse effects of individualized BoNT therapy for lingual dystonia. One-hundred-and-seventy-two patients (102 females and 70 males, mean age: 46.2 years) with lingual dystonia were classified into four subtypes based on symptoms of involuntary tongue movements: protrusion (68.6%), retraction (16.9%), curling (7.6%), and laterotrusion (7.0%). Patients were treated with BoNT injection into the genioglossus and/or intrinsic muscles via individualized submandibular and/or intraoral routes. Results were compared before and after BoNT therapy. Botulinum neurotoxin was injected in 136 patients (mean: 4.8 injections). Clinical sub-scores (mastication, speech, pain, and discomfort) in a disease-specific rating scale were reduced significantly (p < 0.001) after administration. Comprehensive improvement after BoNT injection, assessed using the rating scale, was 77.6%. The curling type (81.9%) showed the greatest improvement, while the retraction type showed the least improvement (67.9%). Mild and transient dysphasia occurred in 12.5% of patients (3.7% of total injections) but disappeared spontaneously within several days to two weeks. No serious side effects were observed. With careful diagnosis of subtypes and a detailed understanding of lingual muscle anatomy, individualized BoNT injection into dystonic lingual muscles can be effective and safe.

[Lingual necrosis as a form of presentation of temporary arteritis]

Giant cell arteritis is a systemic vasculitis that affects arteries of medium and large caliber, mainly the aorta artery and its main branches. It is more frequent in women older than 50 years. The most common symptoms are fever, jaw claudication, headache, hyperesthesia of the scalp and loss of vision with anterior ischemic optic nerve disease. But, in a minority of cases, less frequent symptoms are observed that delay and make more difficult the diagnosis. Here, we present the case of a 76-year-old woman who came to our consultation having pain in the oral cavity and presenting tongue and neck edema for 48 hours. She had also suffered from headaches during the previous month. Because the physical examination showed clinical signs of lingual ischemia, a presumptive diagnosis of ischemic involvement due to giant cell arteritis was considered. She started a treatment with systemic corticosteroids and a temporal artery biopsy was performed. We conclude, that giant cell arteritis should be suspected in patients presenting lingual ischemia symptoms in order to start the specific treatment early enough to avoid irreversible complications.

Primary Tuberculosis of Tongue

Tuberculosis is a granulomatous disease caused by mycobacterium.1-3 The lung is the most common site of involvement, and it is very rare to involve the oral cavity.1,2 Most of the tuberculous lesions of oral cavity are secondary to lung disease, usually seen in elderly patients.1 Primary tuberculosis of the oral cavity is rare and is most commonly found in children and adolescents rather than in adults.1,2 Among them tuberculosis of tongue is very rare. Here we report a first case of our hospital with primary tuberculosis of tongue in a 55-year-old male from Madhya Pradesh.

Primary mucocutaneous histoplasmosis in an immunocompetent patient

We report a case of primary mucocutaneous histoplasmosis in an immunocompetent individual. The patient, a 61-year-old woman, presented with a non-healing ulcer on the lateral border of her tongue. Excisional biopsy of the lesion was consistent with histoplasmosis and no evidence of pulmonary or disseminated infection was found. Although mucocutaneous infection has been well-described as a manifestation of disseminated disease, especially in immunocompromised individuals, oral infections in immunocompetent patients are rare.

Orofacial tubercular lesions

AIM

The aim of this study was to evaluate the clinical characteristics of orofacial lesions like ulcer, swelling, discharge (with or without fistulae), nodules (tubercles), granulomatous growth, induration, diffuse inflammation, and extraction socket involvement in an Indian population through the case reports and review of literature.

MATERIAL AND METHODS

Four case reports are presented of patients who had orofacial lesions which turned out to be tuberculous. The diagnosis of tuberculosis was possible because it was kept high on the list of differential diagnosis of orofacial lesions. In our study, we used the following clinical criteria: 1) Suspicious lymph nodes should be biopsied. 2) Excision of non-healing, fistulous, or non-responsive lesions should be considered for biopsy. 3) Histopathological evidence of granulomatous inflammation with epithelioid cells and Langhan's giant cells or acid-fast bacilli should on Ziehl-Neelsen staining. 4) The patients' medical records were reviewed for details relating to presenting signs and symptoms, site and appearance of the lesions, chest x-ray findings, and sputum smear and tuberculosis culture results.

RESULTS

In all cases, the patients were prescribed antituberculosis therapy (ATT) by the physician. Strict follow-up was done to ensure completion of intensive phase therapy and both oral as well as pulmonary lesions were resolved.

CONCLUSION

Dentists and physicians treating orofacial lesions should be alert to the possibility of orofacial tuberculosis. Medical history should be taken very carefully and lymph node biopsy as well as other radiological and microbiological investigations should be carried out to rule out oral tuberculosis. Antituberculous therapy leads to successful resolution of the orofacial lesions.

Taste Disorders in Healthy “Carriers” and “Non-Carriers” ofCandida albicansand in Patients with Candidosis of the Tongue

Impairments in taste perception may be caused by a number of factors, including the presence of Candida albicans in the oral cavity. We attempted to establish whether the presence of Candida albicans on the tongue is a cause of taste disorders by studying taste disorders in patients with candidosis of the tongue and in healthy "carriers" and "non-carriers" of C. albicans. Taste disorders and their severity were objectively assessed by the filter-paper disk method in 18 patients with candidosis of the tongue and in 33 healthy "carriers" and 167 healthy "non-carriers" of C. albicans. The gustatory function was re-tested in 7 patients and 8 "carriers" after treatment with topical anti-mycotic medication to detect any improvement. Patients with candidosis of the tongue and "carriers" of C. albicans demonstrated significantly higher incidences (p<0.001) of taste disorders than did "non-carriers". The mean taste threshold of each of the four individual taste qualities was significantly higher in patients with candidosis than in "non-carriers". The average taste threshold was significantly higher in "carriers" than in "non-carriers". Post-treatment improvement or recovery from taste disorders was obtained in 5 out of 7 patients (71.4%) with candidosis and in 7 out of 8 "carriers" (87.5%) of C. albicans. This study clearly demonstrates that not only overt candidosis of the tongue but also commensal harboring of C. albicans is a cause of taste disorders.

Tuberculosis of the tongue in a patient with rheumatoid arthritis treated with methotrexate and adalimumab

In recent years Tumor Necrosis Factor alpha (TNF alfa) inhibitors have been highly effective in treating rheumatoid arthritis (RA). However, patients receiving these inhibitors have an increased risk of developing tuberculosis (TB). We describe a rare case of tuberculosis of the tongue in an RA patient treated with methotrexate (MTX) and the TNF alfa inhibitor adalimumab (ADA) for the previous six years. Pretreatment tuberculin skin test (TST) was negative. The patient was admitted to our division complaining of a sore throat for months. Clinical examination revealed a swollen non-healing ulcer at the base of the tongue, which was suspected to be a squamous cell carcinoma. Histopathological assessment unexpectedly revealed a chronic granulomatous inflammation compatible with tuberculosis. TST was strongly positive and the T Spot TB test was also reactive. MTX and ADA were discontinued and the patient received antituberculous treatment with complete healing of the lesion. After three months our patient had a worsening RA that was treated with MTX and rituximab with no TB related adverse events. This case highlights the importance of considering tuberculosis in the differential diagnosis of ulcerative lesions of the oral cavity, especially in immunocompromised patients treated with TNF alfa inhibitors. Rituximab can be a valid alternative therapy in such patients.

Disseminated verruciform xanthoma: a case report

Verruciform xanthomas (VXs) are rare mucocutaneous lesions that can appear in isolation or in association with chronic inflammation, systemic diseases, or metabolic abnormalities. We report the case of a patient who presented with disseminated VX with oral, cutaneous, and genital involvement without an obvious underlying cause. Treatments including salicylic acid 40%, high-potency topical corticosteroids, antibiotics, and chlorhexidine failed to improve the lesions; however, the patient was satisfied with the cosmetic results of serial shave excisions. This case highlights a rare entity of unknown etiology. Further studies are needed to determine the cause of this mucocutaneous entity so that more effective treatment modalities can be elucidated.

[An abscess in the tongue]

Abscesses of the tongue are rare and potentially life-threatening because of risk of airway obstruction. It is most often preceded by trauma. In this paper we present an otherwise healthy patient with an abscess in the tongue eleven days after a trauma involving the presence of an insect believed to be a spider in the mouth. The symptoms were oedema, redness and pain of the tongue. A computed tomography was used as a diagnostic tool. The abscess was successfully treated with incision and antibiotics. Abscess should be considered as a differential diagnosis in patients presenting with a swollen tongue.

Chemotherapy-associated tongue hyperpigmentation and blue lunula

Combination chemotherapy is associated with cutaneous and mucosal side effects. Antineoplastic agents have been associated with mucosal and nail pigmentation. We describe a 16-year-old Saudi Arabian girl with combination chemotherapy-associated black tongue hyperpigmentation and blue lunula. The diagnosis of drug-associated pigmentary changes is based on correlating the onset of the clinical observations with the temporal initiation of the patient's chemotherapy agents. Spontaneous fading of antineoplastic therapy-induced tongue or nail dyschromia may subsequently occur following discontinuation of the causative drug.

Lingual tuberculosis

Oral tuberculosis is very rare and when present they are usually secondary to pulmonary tuberculosis. Tuberculous lesions of the tongue have become so infrequent that they are virtually a forgotten disease entity and may pose a diagnostic problem. The case reported in this paper emphasizes the importance of including tuberculosis in the differential diagnosis of any chronic oral ulcer. The low number of oral infections by M. tuberculosis could be due to underreporting.

Tongue histoplasmosis mimicking malignancy

A 42 year old male presented with progressive difficulty in swallowing for the past 6 months. Oral examination revealed ulcer on right dorsum of tongue, which was mistaken for malignancy. Histopathology of incision biopsy specimen diagnosed it as histoplasmosis. The patient was put on oral itraconazole therapy and responded well to the treatment.

Isolated lingual dystonia : responding to anticholinergic treatment

We report a 42 year-old woman with 6 month history of isolated lingual dystonia induced during speaking and was treated with anticholinergic drug. She experienced a marked improvement in her abnormal tongue movements. Primary lingual dystonia is a rare presentation.

Cryptococcocis: a rare fungal infection of the tongue

Fungal infection in the oral cavity is not uncommon. The site involved is usually species related. Cryptococcus rarely infects the oral cavity. We report an elderly patient who presented with a central lesion on the dorsum of the tongue. Biopsy revealed a fungal infection. Special stains confirmed cryptococcus. Being a rare location for cryptococcal infection, clinical suspicion should be correlated with histopathological examination. Once confirmed, the patient should be treated with an antifungal medication.

Oral lichen planus in childhood: A rare case report

Oral lichen planus is a cell-mediated immune condition and is infrequently encountered in children, with a prevalence of about 0.03 percent in childhood. Reports of oral lichen planus affecting children are scarce in the literature. The purpose of this article is to present a rare case of oral lichen planus affecting a seven-year-old child without concomitant cutaneous lesions. Intraoral lesions and associated mild discomfort treated with topical corticosteroid therapy and a plaque control regime resulted in a favorable result.

Nodules on the tongue in an HIV-positive patient

Syphilis is a sexually transmitted disease caused by Treponema pallidum. Epidemiological studies show that rates have increased dramatically in recent y, especially in human immunodeficiency virus (HIV)-seropositive patients. Although lesions most frequently develop on the genital area, they are presently frequently detected in the oral cavity. We present an HIV-positive patient without antiretroviral treatment and immunologically stable, with firm nodules on the tongue. Following serological tests, clinical symptoms and histopathological findings, lesions were diagnosed as secondary syphilis. A spectacular improvement was achieved with specific treatment. To our knowledge this is the first case described in the literature of secondary syphilis presenting as nodular, painless lesions on the lingual mucosa.

Actinomycosis of the tongue

Actinomycotic infections are known to be associated with difficulties in making the diagnosis and treatment. Actinomycosis of the tongue is rare and of great importance, not only because it can mimic many other diseases, but also because the tongue itself has some histophysiologic features that make it resistant to infections. In this report, we present a case of lingual actinomycosis and discuss the predisposing factors as well as the diagnostic methods and therapeutic modalities.

Acute bilateral tongue necrosis--a case report

We report the case of an 88-year-old lady who presented with acute necrosis of the whole tongue. Giant cell arteritis was suspected, and early treatment with corticosteroids led to complete resolution and no need for further intervention. We emphasise the importance of early diagnosis of giant cell arteritis and treatment with corticosteroids to stabilise the condition and to avoid serious ocular complications.

Bartonella-related pseudomembranous angiomatous papillomatosis of the oral cavity associated with allogeneic bone marrow transplantation and oral graft-versus-host disease

Patients undergoing allogeneic stem cell transplantation are at high risk for infection with a variety of pathogens during different phases of the procedure. Human infections due to Bartonella spp. are viewed as emerging diseases typical in, although not exclusive to, immunosuppressed patients, in particular those with AIDS, organ transplants and haematological malignancies. We describe four patients, three children and one adult, who developed vegetating papillomatous lesions exclusively on the oral mucosae. They shared a history of haematological malignancy and allogeneic bone marrow/stem cell transplantation, and later developed chronic graft-versus-host disease, also involving the oral mucosae. Histopathologically, the vegetating lesions were characterized by a diffuse neoangiogenesis, granulation-like tissue, and a mixed cell infiltrate predominantly composed of neutrophils. Gram-negative bacteria were found in the endothelial cells of the vessels in the deeper portion of the corium by electron microscopy. In three cases, DNA of B. henselae was detected by polymerase chain reaction (PCR), and confirmed by sequencing of the PCR products. All the lesions healed after systemic antibiotic therapy, although some recurred after months, and regressed again after systemic antibiotic treatment associated with conservative surgical excision.

Oral lichen planus treated with 13-cis-retinoic acid (isotretinoin): effects on the apoptotic process

The aim of the present study is to verify the efficacy of isotretinoin in oral lichen planus (OLP). In a double-blind study, ten patients with biopsy-proven OLP were treated for 4 months with 0.1% isotretinoin gel and another ten patients with placebo. At the end of the first period of observation, the patients who had been given the placebo were given isotretinoin for a further 4 months. A complete response was defined as the disappearance of the lesions as assessed by inspection, whereas a partial response was defined as a 50% or more reduction in the size of the lesions. All patients treated with isotretinoin showed a significant improvement of the oral lesions, whereas in the patients who were given the placebo, the size of the lesions remained the same. The patients who were given isotretinoin after the placebo showed a reduction in lesions. In total, there were ten complete and ten partial responses. Lesions were analysed histologically and immunohistochemically with antibodies against bcl-2 and Ki-67. Ki-67 and bcl-2 have statistical significant increased values from before to after treatment, whereas apoptotic bodies decreased one. All these facts could have contributed to the partial or complete regression of OLP lesions. The increase in Ki-67 positive cells show that the epithelium requires for enhanced proliferation and healing. The present results revealed a disturbed cell death programme in OLP that could underline an abnormal epithelial differentiation. The results of this pilot study show that the topical use of isotretinoin is effective in treating OLP.

[Oral involvement in lymphomatoid papulosis]

Lymphomatoid papulosis is a cutaneous lymphoma with an indolent clinical behaviour characterized by chronic development of recurrent, self-limited lesions appearing as necrotic papules and with a pathology compatible with T cell lymphoma. Mucosal involvement by lymphomatoid papulosis is very rare but has been reported in the literature. It usually appears as ulcers in patients previously diagnosed of lymphomatoid papulosis. From a histological perspective it is characterized by an infiltrate of CD 30 positive atypical lymphocytes together with a mixed inflammatory infiltrate of eosinophils, neutrophils, histiocytes and plasma cells. We report the case of a man previously diagnosed of lymphomatoid papulosis that developed two ulcerated lesions in the tongue whose biopsy confirmed the diagnosis of oral involvement by lymphomatoid papulosis.

[Late secondary syphilis with ulceration of the tongue during HIV coinfection: case report]

With the continuing rise of syphilis incidence, late stages and atypical courses with HIV-coinfection can be expected. A 45 year old HIV infected male presented with an unusual manifestation of late secondary syphilis on the tongue, which was first diagnosed as a squamous cell carcinoma but cleared after therapy with penicillin. He also exhibited psoriasiform and annular lesions on the trunk and hyperkeratotic papules on the palms of the hand and soles of the feet. A TPHA test was negative due to a prozone phenomenon. With this case, we would like to emphasize the formerly well known relationship between the lesions of tertiary syphilis on the tongue and development of secondary carcinoma.

Too much of a good thing, is it bad? Adrenaline on trial

Adrenaline is vital in the treatment of severe allergic reactions (anaphylaxis), however it is often underutilised or inappropriately administered. Adrenaline treatment is not without risk and most adverse reactions to adrenaline occur when it is given in overdose or as an intravenous bolus. We report a case of myocardial injury and hypotension following inappropriate administration of adrenaline.

Tuberculose disséminée révélée par une localisation linguale

INTRODUCTION

Tuberculous lesions of the oral cavity are uncommon. Most of cases are secondary to pulmonary disease and the primary form is rare.

EXEGESIS

We report the case of a 64 year-old man, smoker, presenting a chronic ulcer of the tongue, with anorexia and important weight loss. The biopsy of this ulcer showed granulomatous inflammation and Langhans type giant cells, without necrosis. Ziehl-Nielsen stain was negative. Pulmonary lesions were subsequently detected (chest X-ray, CT-scan) and the disseminated tuberculosis was confirmed by a positive culture with acid-fast bacilli in urine, blood, and pulmonary sample. Antituberculosis treatment resulted in the complete resolution of the oral lesion.

CONCLUSION

Biopsy for histopathological diagnosis, acid-fast stains and culture, is essential to determine the exact nature of chronic oral ulceration to distinguish between oral malignancy, infectious (syphilis), traumatic, or aphthous ulcers. Tuberculosis of the tongue is a difficult diagnosis. However it should be searched for because treatment usually results in a rapid recovery.

[Simultaneous pulmonar, laryngeal and lingual affectation by Mycobacterium tuberculosis]

The incidence of tuberculosis has lately increased in developed countries. The most frequent affectation is the pulmonar one and in the ORL area the laryngeal. The lingual affectation is exceptional. We present a case of a man 39 years old, with bilateral pulmonar, left vocal cord and mobile tongue affectation, negative Mantoux, positive spit culture and presence of acido-alcohol resistent bacillus in lingual and laryngeal biopsies. After antituberculosis treatment during 6 months the laryngeal and lingual lesions disappeared. We have only found two cases published of simultaneous tuberculosis in these three localisations in the last 30 years.

Sarcoidosis of the tongue: a case report

A case of sarcoidosis involving the tongue is described in a 48-year-old Japanese man. A definite diagnosis of sarcoidosis was made for the clinical lesion and pathological examinations. Sarcoidosis is a multisystem granulomatous disease that may affect any organ. Sarcoidosis of the tongue is particularly rare.

Injection tongueplasty: effects of sclerosant OK-432 on rat tongue

Our aim was to investigate the effect of sclerosant agent OK-432 on tongue fibrosis and to determine whether the fibrosis formed by this substance increases with dose. Fifty Wistar albino rats were divided into three groups for the study. In the first group 0.2 ml OK-432, in the second group 0.5 ml OK-432, and in the third group physiological saline as the control substance was injected into the tongue of these rats. Subjects were sacrificed on the first day, first week, first month, third month and sixth month following the injection. Cross-sections of the tongues were stained with hematoxylin-eosin (HE) and Masson Tri-chrome. The degree of fibrosis was measured using ocular micrometry. A significant amount of fibrosis was observed in both the 0.2 ml (P = 0.020) and 0.5 ml (P = 0.003) OK-432 injection groups. OK-432 is a material that causes significant fibrosis in the muscle when compared to physiological saline. The degree of fibrosis in the tongue increases with dose.

[Diagnostic image (283). A man with a swollen tongue]

A 70-year-old man presented with a swollen tongue caused by an angiotensin-converting enzyme inhibitor.

Peno-gingival lichen planus

BACKGROUND

Lichen planus with simultaneous oral and genital involvement in males is a quite rare condition and often difficult to diagnose. The prevalence, treatment options, and management for this condition are far from being established, and research in this area primarily relies on anecdotes. We present the clinical features of eight cases of peno-gingival lichen planus and propose a management algorithm for this condition based on the best available published evidence.

METHODS

Personal medical history was collected for all cases. Following careful examination of the oral and genital mucosae, pathology was obtained, previous treatments and duration of mucosal lesions ascertained, treatment initiated, and response evaluated at 8 weeks on both oral and genital lesions. The first-line drug was topical clobetasol propionate 0.05% cream in all cases; in case of failure, topical cyclosporin was used. A review of the literature on treatment options for this rare condition was performed based upon standard literature review practices.

RESULTS

Five cases presented gingival lesions that clinically resembled lichen planus. Glans penis was involved in all patients. All patients responded to treatment except for one. Oral candidiasis was the only observed side effect.

CONCLUSIONS

Genital lichen planus may be suspected in males when atrophic-erosive gingival lichen planus is found. A thorough multidisciplinary medical management and active early treatment are necessary to improve symptoms and prevent genital sequelae and, given the risk of squamous cell carcinoma, as a preventative strategy, although this area still needs investigation. Therapeutic trials relating to the treatment of peno-gingival lichen planus may be undertaken considering that current management relies exclusively on observations of case reports.

[Hemilingual abscess]

Lingual abscess is an extremely rare entity since the discovery of antibiotics, which, despite of its seriousness, it is usually a cause of death. We describe the case of a right hemilingual abscess, diagnosed by MRI scan because of its poor symptoms. This case is unique because of it affects the hemilingual central part and free edge. We discuss the most relevant aspects of this pathology.

Tuberculous ulcer of tongue with oral complications of oral antituberculosis therapy

Tuberculosis (TB) is an infectious disease affecting humans of all ages in all parts of the world. The dentist plays an important role in the identification and control of this condition by early recognition of oral lesions that may precede the detection of the pulmonary form. Occurrence of increased incidence of mycobacterial infections as a part of the spectrum of AIDS only emphasizes the importance of early diagnosis. A case of a tuberculous ulcer on the tongue along with oral ulcerations, which occurred as a consequence of oral antituberculosis therapy (ATT), is presented. Such complications have rarely been reported in the literature and the management of these is described herein. The tuberculous ulcer healed uneventfully in five weeks after institution of ATT and the other ATT-induced ulcers healed after a week of topical anesthetic application. The clinical presentations, differential diagnoses to be considered, and management of such oral manifestations is discussed. The occupational risk posed by TB to the dentist and appropriate precautions to be observed have been highlighted.

Successful treatment of tongue aspergillosis caused byAspergillus flavuswith liposomal amphotericin B in a child with acute lymphoblastic leukemia

A 5-year-old boy with acute lymphoblastic leukemia and probable pulmonary aspergillosis developed a hard, protuberant, white-yellow and aggressive elongated lesion on the left side of his tongue during a febrile agranulocytopenic episode. Despite the use of broad-spectrum antibiotics and other supportive therapies, the lesion increased to about 2x4 cm in size within two days and became grey-black with an erythemateous, irregular line. Partial excision of the tongue was performed and isolates recovered from the tongue biopsy specimen were identified as Aspergillus flavus. An increase in the systemic dose (7 mg/kg/day) and local intraoral delivery of liposomal amphotericin B was successful in treating the patient and resulted in improved clinical and laboratory findings. Herein, we document the observation of tongue aspergillosis in a leukemic child with probable pulmonary aspergillosis receiving liposomal amphotericin B therapy and the successful treatment of tongue aspergillosis with an increased dose (7mg/kg) of liposomal amphotericin B. To the best of our knowledge, this is the youngest patient with documented intraoral aspergillosis and only the second case of tongue aspergillosis caused by Aspergillus flavus.

The role of female and male sex hormones in the healing process of preexisting lingual and gastric ulcerations

Studies in different animal species and in humans have suggested that sex hormones influence gastric acid secretion and contribute to the integrity of the oral and gastroduodenal mucosa but the effect of male and female sex hormones on the healing of the preexisting ulcers in the oral cavity and stomach have not been studied. We compared the effects of major male hormone, testosterone, and female hormone, progesterone, on the healing of lingual and gastric ulcers induced by acetic acid technique in male rats with intact or removed testicles (testectomy) and female rats with intact or removed ovaries (ovariectomy). The gastric acid secretion was determined in rats with gastric ulcers equipped with chronic gastric fistula (GF). Rats were sacrificed at day 7 upon ulcer induction; the ulcer area was measured by planimetry and the lingual and gastric blood flow (GBF) was determined by H(2)-gas clearance method and venous blood was collected for determination of plasma gastrin and plasma proinflammatory cytokine interleukin (IL)-1 beta levels. Gastric acid output from GF rats was significantly reduced while plasma gastrin was significantly enhanced in testectomized animals as compared to those in intact control rats and these effects were reversed by supplementation of testectomized animals with testosterone. The area of lingual and gastric ulcers in placebo-control rats decreased significantly at day 7 and this effect was significantly accelerated by testectomy or ovariectomy. In contrast, testosterone significantly delayed ulcer healing while producing a significant fall in the gastric blood flow and lingual blood flow determined at the margin of these ulcers. Treatment with progesterone significantly accelerated ulcer healing and increased the gastric and lingual blood flow at margin of these ulcers. Testosterone applied alone or supplemented in testectomized animals produced the significant increment in plasma IL-1 beta levels as compared to the respective levels of this cytokine in placebo-control animals. We conclude that: 1) major male (testosterone) and female (progesterone) sex hormones exhibit opposite effect on healing of preexisting ulcers in the oral cavity and stomach because testosterone markedly delayed while progesterone significantly accelerated this healing; 2) testosterone-induced delay in ulcer healing involves the fall in the gastric microcirculation at the margin of lingual and gastric ulcers and the excessive production and release of proinflammatory cytokine IL-1 beta; and 3) testectomy improves the gastric ulcer healing due to inhibition of gastric acid secretion and the rise in plasma gastrin, which exerts gastroprotective, trophic and ulcer healing action on the gastric mucosa.

Tapia's syndrome following septorhinoplasty

No surgery is free of complications varying from common minor problems to very unexpected and severe ones. In the case presented here, unilateral paralysis of the muscles of the tongue and ipsilateral vocal cord paralysis due to a lesion of the 10th and 12th cranial nerves occurred following a septorhinoplasty that was performed under endotracheal general anesthesia. This rare entity known as Tapia's Syndrome is believed to be caused by pressure neuropathy of both nerves due to inflation of the cuff within the larynx. We remind surgeons of this unusual complication that can occur in any surgery under general anesthesia and discuss its diagnosis, treatment method, and the followup results in light of the literature.