Differential diagnosis of tongue lesions This article reviews the clinical characteristics of the numerous local and systemic conditions that frequently involve the tongue and presents classifications based on their appearance and common locations that can aid dentists in their early recognition and clinical diagnosis. MeSH The hypoglossal nerve can be damaged at the hypoglossal nucleus, above the hypoglossal nucleus (supranuclear), or interrupted at the motor axons (infranuclear). Testing strength consists of the patient forcing the tongue to the side against the patients cheek, while the examiner tries to dislodge the tongue using his/her finger[2]. Video describes about the tongue deviation in upper motor neurone vs lower motor neurone hypoglossal palsy. 2009;29(1):4552. Questions about your medical history include: Last, your healthcare provider will perform a physical examination by checking your blood pressure, heart rate and listening to your lungs. It is necessary in many functions, including the synthesis of both DNA, RNA and myelin production, particularly in the spinal cord. Disclaimer. Fissured Tongue Differential Diagnoses Updated: May 14, 2018 Author: Robert D Kelsch, DMD; Chief Editor: Jeff Burgess, DDS, MSD more. This can . It presents among healthy individuals, as well as those with debilitating health conditions. Assessment of macroglossia should include palpation of the sublingual glands; these will be displaced in true macroglossia. Chemical burns and acute pseudomembranous candidiasis may have the . [QxMD MEDLINE Link]. Even though many reports claim no gender predilection, others suggest that the disorder is more common among women.4,6,7 In a study of 188 Thai subjects, Jainkittivong and Langlais found that women were slightly more likely to be affected than men.8. Assimakopoulos D, Patrikakos G, Fotika C, Elisaf M. Benign migratory glossitis or geographic tongue: an enigmatic oral lesion. A differential diagnosis of back pain includes: Symptoms of chest pain include aching, sharp pain, burning sensations, tightness or squeezing pressure localized in your chest area. Contact your healthcare provider if you experience symptoms to diagnose and treat your condition. Lingual haemangiosarcoma was diagnosed on histopathological examination of multiple biopsy samples, with confirmation of the vascular endothelial origin of tumour cells by positive immunolabelling for factor VIII-related antigen. The .gov means its official. 2009 Oct 15. "Wrong Side" Tongue Deviation in Hemiplegia From Stroke Key Diagnostic Features: Hemiatrophy of the tongue, with fatty replacement of the tongue muscles (high signal intensity on T1 and T2 and no enhancement), is one of the most important radiologic features of hypoglossal nerve palsy. Other conditions, such as oral lichen planus, lupus erythematous and drug reactions, can occasionally mimic this condition. official website and that any information you provide is encrypted document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); This site uses Akismet to reduce spam. Learn the technique of the inspection of the tongue, Review of important clinical findings of the tongue. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTA3ODUzNi1kaWZmZXJlbnRpYWw=. Centers for Disease Control and Prevention. Geographic tongue is sometimes referred to as migratory because its location and pattern of presentation tend to change. Tongue deviation in unilateral stroke most likely results from asymmetrical supranuclear control of the 12th cranial nerve in many individuals. The concept of trauma includes surgical trauma as with carotid endarterectomy (surgery to remove the plaques from the carotid artery). Tongue deviation in unilateral stroke most likely results from asymmetrical supranuclear control of the 12th cranial nerve in many individuals. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Macroglossia may be congenitally present in individuals with acromegaly. [1] Normal tongue [ edit] The vertebrobasilar arterial system perfuses the medulla, cerebellum, pons, midbrain, thalamus, and occipital cortex. Fitzpatrick SG, Hirsch SA, Gordon SC. Next is its size. Dermatologic Aspects of Addison Disease. Applicable To. Federal government websites often end in .gov or .mil. (3) Learn how doctors should perform a bedside swallow evaluation! -, Epilepsia. Another clinical variant is plaque-like oral lichen planus, which presents with white elevated patches (Figure 7). Dysphagia and dysarthria occurred in 43 and 90% of patients with tongue deviation. Tongue Shape Abstract. Lingual nerve involvement may manifest as an altered sensation in the tongue. Epub 2009 Feb 12. There are theories that suggest that geographic tongue may be associated with hormonal fluctuations or allergies, or that it could be psychosomatic.4 Geographic tongue may have a genetic cause as well.6 Dermatological conditions, such as pustular psoriasis, seborrheic dermatitis and pityriasis pilaris, have been linked to the condition. Microcopy Introduces the NeoDiamond X-Class, Zest Dental Solutions Launches Fully Guided Surgical Kit for Full-Arch Solutions, Ultradent Introduces J-Temp A Light-Cured, Premixed Temporary Resin. With gloved hands, hold the tongue with gauze in one hand while palpating the tongue between the thumb and index finger of the other, noting masses and areas of tenderness. The lateral borders and tip of the tongue remain uninvolved.5, The etiology for hairy tongue is not well understood. Bronchitis. https://www.physio-pedia.com/index.php?title=Hypoglossal_Nerve&oldid=267232, Infranuclear and nuclear lesions cause weakness of the tongue but additionally cause ipsilateral atrophy. Several conditions should be included in the differential diagnosis of frictional keratosis in both children and adults. Sometimes the sore will bleed if you touch or bite it.. 12 Furthermore, it forms 1 of the 3 triads of Melkersson-Rosenthal syndrome, namely, a fissured tongue, relapsing orofacial edema, and facial nerve palsy. In this article we summarise an approach to the assessment and diagnosis of functional symptoms in neurology, paying attention to those symptoms that are particularly "neurological", such as paralysis and epileptic-like attacks. These tests will lead to your diagnosis. Epub 2022 Dec 8. Unilateral Tongue Atrophy Due to Hypoglossal Nerve Mechanical Food is positioned on the body of the tongue and raised upward to the palate to break up the food prior to swallowing. Commonly referred to as benign migratory glossitis, geographic tongue was first identified by French physician Pierre Franois Olive Rayer in 1831. Int J Environ Res Public Health. Embryologically, it was thought that the tuberculum impar was not covered by the lateral borders of the tongue, resulting in a smooth surface red spot on the midline of the posterior aspect of the dorsal tongue. Have the patient touch the tip of the tongue to the roof of their mouth and inspect the ventral surface. Tongue deviation in hypoglossal palsy - YouTube Occlusion of large vessels in this system usually leads to major disability. Pallavi Parashar, BDS, DDS, FRCD(C), is a board certified oral pathologist. Mild stimulation of the hypoglossal nerve causes the nerve to pull the tongue forward enabling better airflow[2]. Others theorize that oral lichen planus may be a reaction to medications or dental materials, or another allergic response but these theories are not supported by clinical evidence. However, bilateral lesions can cause profound difficulty with speech and swallowing as the patient cannot protrude the tongue for these necessary functions. Before your provider makes a diagnosis, they will evaluate your symptoms by asking questions that go over your overall health and your medical history. You should contact your healthcare provider if: Several conditions share similar symptoms. 10,11 Fissured tongue is a common oral lesion in patients with psoriasis. It is generally believed that the supranuclear innervation of the hypoglossal nucleus is bilateral and symmetrical. Diagnostic evaluation may include measuring the degree of head tilt and face turn. The surface of the tongue is covered with small bumps called papillae. The clinical appearance of geographic tongue can range from minimally evident to very prominent. One possible treatment if the patient is refractory to continuous positive airway pressure (CPAP), oral devices, or surgery. Get useful, helpful and relevant health + wellness information. A differential diagnosis of asthma includes: Allergic rhinitis. 1996 Apr. xw`E?<3{no/\KBr$$AjHRTD, `,(E,E%B; Tongue cancer must be differentiated from other diseases that cause malignant lesions of the oral cavity and from non- neoplastic lesions of the oral cavity, such as lymphoma, sarcoma,, metastatic tumor, malignant salivary gland tumors, tuberculosis, scarlet fever, syphilis, papilloma, lipoma, l eiomyoma, neurofibroma, s chwannoma, granular . Asthma Symptoms of asthma include shortness of breath, wheezing, pain or a tight feeling in your chest and coughing. It's important to bring a list of any medications, vitamins or supplements that you take with you when you visit your providers office so they can keep a record to make sure your medications are not influencing your symptoms. and transmitted securely. Last reviewed by a Cleveland Clinic medical professional on 01/27/2022. At this stage in the diagnostic process, your healthcare provider will offer tests as a process of elimination to narrow down your specific diagnosis. What medications, vitamins and/or supplements are you taking? These may present with dysarthria or dysphagia. Bookshelf Neville BW, Damm DD, Allen CM and Bouquot JE. On occasion, candidiasis also may coexist with geographic tongue.10, The diagnosis of geographic tongue and its treatment are based on the patients medical history and clinical examination. During a differential diagnosis, it might be daunting to see a list of possible conditions that could cause your symptoms. Gonsalves WC, Chi AC, Neville BW. This website also contains material copyrighted by 3rd parties. Background: Vitamin B12 (cobalamin) is a water-soluble vitamin found in nutrition. -, Neurocrit Care. Please enable it to take advantage of the complete set of features! Disorders of Oral Pigmentation Differential Diagnoses Madani FM, Kuperstein AS. 2005 Jul. Will the Healing Touch Go Out the Door With the Stethoscope? The tongue may be involved by many organic disorders and particularly weakness; in this respect, "wrong-way" tongue deviation is helpful to diagnose functional tongue deviations ( Keane, 1986). 3. A very serious symptom of tongue inflammation is when you experience severe swelling. National Library of Medicine Accessibility The formal continuing education programs of this program provider are accepted by the AGD for Fellowship/Mastership and membership maintenance credit. Your provider will compile a list of potential conditions that relate to your symptoms. In refractory cases, the use of other topical or systemic immunomodulators and retinoids has been tried. Robert D Kelsch, DMD is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology, American Dental AssociationDisclosure: Nothing to disclose. A biopsy may be needed to confirm the clinical diagnosis when the clinical presentation is not readily apparent. 2023 ICD-10-CM Diagnosis Code K14.8: Other diseases of tongue The condition is most frequently referred to as black hairy tongue (lingua villosa nigra); however, hairy tongue may also appear brown, white, green, pink, or any of a variety . They'll then make a final diagnosis and recommended treatment. The patient presents with painless, white plaques on the tongue or oropharynx which are easily scraped off. [QxMD MEDLINE Link]. A differential diagnosis is part of the diagnostic process that eliminates error. Due to the close association of geographic tongue in psoriatic patients, dentists are advised to inquire about skin problems in patients with geographic tongue, and refer these individuals for a skin evaluation if needed.11, Hairy tongue, also referred to as black hairy tongue or coated tongue, affects just 0.5% of the adult population.5 Amato Lusitano, a Portuguese physician, first described this condition in 1557.12 In a study conducted on 5150 Turkish dental patients, 11.3% presented with hairy tongue that included filiform papillae elongated more than 3 mm, and 23.2% exhibited hairy tongue in which the filiform papillae were less than 3 mm.3 In a study of 3611 Minnesota schoolchildren, however, prevalence of this condition was very low (0.05%).7 There is no gender predilection. In patients with a history of stroke, it occurred more frequently in those with previous stroke on the contralateral side. [QxMD MEDLINE Link]. On rare occasions, a biopsy is required to confirm a histologic diagnosis.6 Because the majority of patients are asymptomatic and because geographic tongue is chronic or intermittent no treatment is generally indicated. It may be pinkish-red in color. Shulman JD, Carpenter WM. Darwazeh AM, Almelaih AA. Semin Neurol. This is the American ICD-10-CM version of K14.8 - other international versions of ICD-10 K14.8 may differ. Alioglu Z, Caylan R, Adanir M, Ozmenoglu M. Melkersson-Rosenthal syndrome: report of three cases. Differential diagnosis of facial pain and guidelines for management Available at http://library.med.utah.edu/neurologicexam/html/gait_abnormal.html#13. Aphthous ulcers, or aphthous stomatitis, are a painful form of ulcer that is frequently encountered. A differential diagnosis of hypertension includes: Symptoms of knee pain include swelling around the knee, instability when standing, stiffness and popping noises when you move your knee. 2023 - Decisions in Dentistry All Rights Reserved. 2. Tongue cancer differential diagnosis - wikidoc M.J. has experienced some of the above symptoms, including fatigue, weakness, shortness of breath and pallor. Lower. Your patient gets this rash, whats the diagnosis? Tongue diagnosis is one of those ways. It supplies into the tongue, There are two hypoglossal nerves in the body: one on the left, and one on the right.[1]. In newborns there may be an apparent microglossia resulting from a congenitally short lingual frenulum (ankyloglossia) commonly called a tongue tie. He described the condition as a wandering rash of the tongue. The most commonly affected site is the anterior two-thirds of the dorsal tongue, although these benign red and white lesions can also present on other oral mucosal sites.4,5 Geographic tongue has a number of monikers, including lingua geographica, erythema migrans, exfoliation areata lingua, superficial migratory glossitis, lingual dystrophy, pityriases linguae, transitory benign plaques of the tongue, marginal exfoliative glossitis, ectopic geographic tongue and glossitis areata migrans. The prevalence of tongue lesions in 5150 Turkish dental outpatients. She served as an assistant professor at the University of Colorado School of Dental Medicine in Aurora, Colorado, for more than seven years.
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