Traumatic ulcer or squamous cell carcinoma of the tongue? :... Dr. Syed Ishaquddin* , Dr.Dalaya Maya ,

International J. of Healthcare & Biomedical Research, Volume: 2, Issue: 1, October 2013, Pages 57-60
Traumatic ulcer or squamous cell carcinoma of the tongue? : Case report.
1Dr.
Syed Ishaquddin* , 2Dr.Dalaya Maya , 3Dr.Mahesh Ghadage
1 Associate
Professor, Dept.of Oral Pathology , Bharati Vidyapeeth Dental College , Navi Mumbai , India.
2Professor,
Dept.of Prosthodontics , Bharati Vidyapeeth Dental College , Navi Mumbai , India.
3PG
Student, Dept.of Prosthodontics, Bharati Vidyapeeth Dental College , Navi Mumbai , India.
*Corresponding author: Dr. Syed Ishaquddin
Abstract:
Ulcers commonly occur in the mouth. Their causes range from minor irritation to malignancies and systemic diseases. Innocent
solitary ulcerations, which result from trauma and infections, must be distinguished from squalors cell carcinomas, which also
typically present as solitary ulcers. Clinical criteria which are most useful in identifying the cause of oral ulcers are vesicles or
bullae, which may not be seen because they rupture rapidly in the oral environment; constitutional signs and symptoms; and
lesions on the skin and/or other mucosa. We reported a case of 75 years old female patient with a ulcerative lesion which was
quite confusing either it was traumatic ulcer or squamous cell carcinoma?
Key words : Oral ulcers, gingival ulcers, mucosal ulcerations.
Introduction:
filling, an ill-fitting partial denture, or a physical
Traumatic ulcer is usually a single lesion with
sharp bite (which may or not be due to a neurological
erythematous, non-everted margins and with a clean
disorder). Dorsal tongue TUGSE is usually due to
base covered with a pseudomembrane. They are
trauma from the maxillary incisors or sharp Cusps of
usually painful and occur due to bite or trauma from
the posterior teeth.
sharp teeth or ill-fitting dentures. They disappear in
Histologically,
7–10 days following elimination of the cause. If there
involving the underlying muscle, which may explain
is any clinical suspicion, a BIOPSY is indicated.
the process of slow healing and the tissue
Traumatic
stromal
eosinophilia. Healing may take up to eight weeks.
eosinophilia is known by a number of other names,
Eosinophils are found in areas of muscle damage.The
including traumatic granuloma, eosinophilic ulcer
treatment of choice is surgery but elimination of the
and eosinophilic granuloma of the tongue (7-9). (This
causative factor should come first, such as the filing
condition is not related to eosinophilic granuloma of
of sharp teeth, the replacement of broken fillings, the
the bone as in Langerhan cell histiocytosis.) This is a
use of a thin mouth-guard, or whatever else is
reactive, self limiting condition of the oral cavity. It
necessary.Conservative surgical removal with clean
occurs most commonly by far on the dorsal and
margins is the treatment of choice. Sometimes, an
lateral tongue, followed by the lips and buccal
incisional biopsy may lead to complete recovery,
mucosa (7-9).
other times; it may recur and require further surgery
Acute trauma in the form of a sharp puncture to the
with clean margins (7-9). Intra-lesional corticosteroid
muscle is the main cause, but occasionally a history
injections have been recommended for recurring
of trauma is absent and the etiology is unknown (7-
ulcers (7) but with a mixed outcome. The overall
9). The source of trauma can be a sharp tooth, a sharp
prognosis is good if diagnosed early & treated early.
ulcerative
granuloma
with
these
ulcers
are
deep
lesions
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International J. of Healthcare & Biomedical Research, Volume: 2, Issue: 1, October 2013, Pages 57-60
Case report:
membranes, ulcers which are localized to the oral
We presented a case of 75 year old patient reported
cavity may be more difficult to identify.
two weeks ago with a complaint of non healing ulcer
Most traumatic oral ulcers can be identified by their
and pain while eating on the left border of the
association
tongue,since last one month . The patient had history
chemical, thermal or radio therapeutic cause. They
of habits including Pan chewing with tobacco & betel
may be single or multiple, symmetrical or irregular in
nut approx. 5 to 10 times a day from last 20 to 30
shape, and are usually painful. Most are of recent
years. Now she reported complaints ulcer with pain
onset, but some are chronic. Acute traumatic ulcers
during eating along with throat pain, otalgia,
have a removable, yellow-white base and erythe-
dysphagia, odynophagia since one month.
matous borders. Chronic traumatic ulcers may be
On careful examination a definite ulcerative lesion 2
non-painful with an indurated base and raised
X1 cm in size, on the Left Lateral border of the
borders; consequently, they may be indistinguishable
tongue coming in contact with the sharp posterior
from squamous cell carcinomas on the basis of their
teeth, which also shows attrition due to betel nut
clinical features.
chewing . The margins of the ulcer were elevated
Treatment:
showing rough base and cauliflower like appearance.
Following treatment outline was planned.
No cervical lymph-node Enlargement. Base of the
1)…Oral prophylaxis
tongue and throat were normal.No other intra oral
2)…Correction of sharp cusps of lower left molar and
lesion detected.
premolar teeth
Investigations:
3)…Anti oxidant and multivitamins
Complete Blood Count –Normal
4)…Topical application of astringent gel
Liver function test-Normal
5)…Anti bacterial mouth wash
Blood sugar level-Normal
6)…Reassurance and follow up
with
an
identifiable
mechanical,
X ray chest -Normal
Sonography of head and neck region-Normal
CT scan of the neck and lungs -Normal.
Diagnosis:
Ulcers occur in the mouth with considerable
frequency. Traumatic lesions usually resolve rapidly
International Journal of
Healthcare & Biomedical Research
Is now officially listed in
and are not seen by clinicians. For relatively common
conditions such as recurrent herpetic vesiculo ulcers
Medhunt , Switzerland
and aphthous ulcers, presumptive diagnoses are often
made without recourse to laboratory tests. While the
& GetCited , UK
diagnosis of some types of oral ulcers is facilitated by
their association with constitutional signs and
symptoms or lesions on the skin and/or other mucous
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International J. of Healthcare & Biomedical Research, Volume: 2, Issue: 1, October 2013, Pages 57-60
3.Continuous trauma from sharp cusps of the teeth or
faulty design of complete or the partial denture,can
lead to the ulcers of the tongue.
Precautions :
1.Hence during denture insertion the extension of the
denture should be carefully examined and relived
properly.
2.If any sharp cusps of the teeth existing,should be
rounded off and smooth.
3.Discontinuation of the prosthodontic appliance till
the lesion is heal.
Conclusion:
The various types of oral ulcers may appear clinically
to be very similar. Features which are
helpful in identifying the cause of ulcers are the
1.BEFORE TREATMENT
associated
2. AFTER TREATMENT
presence of lesions on the skin and/or other mucosa,
Prosthodontic consideration:
and the presence of bullae and vesicles.
1.Any tongue ulcerative lesions caused either due to
In some cases, however, laboratory procedures are
trauma from an overextended denture(complete or
required to make the diagnosis. Biopsy is necessary
partial dentures)is of utmost importance to be
in the management of several of these conditions,
considered in the diagnosis of the tongue lesion.
especially in multiple ulcers due to autoimmune
2.Any faulty clasp design can lead to ulcerative
diseases,
constitutional
signs
and
symptoms,
lesions on the lateral border of the tongue can be
misleading to precancerous lesion.
References:
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6. Syrjanen SM, KJ Syrjanen et al. Human papillomavirus (HPV) DNA sequences in oral precancerous lesions and
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Date of submission: 28 Aug 2013
Date of provisional acceptance: 05 September 2013
Date of Final acceptance: 18 September 2013
Date of Publication: 03 October 2013
Source of support: Nil; Conflict of Interest: Nil
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