628 Indian Journal of Forensic Medicine & Toxicology, July-September 2021, Vol. 15, No. 3 Tongue Lesions - A Review N.Anitha1, Dharini Jayachandran2 1Reader, Department of Oral Pathology and Microbiology,2Undergraduate Student, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research Abstract Tongue is a vital organ within the oral cavity that has varied function,and it may act as an index for the underlying systemic diseases.The investigation of the tongue diseases may begin with mere clinical examination .This review is to highlight the signs and symptoms of the various lesions that affects the tongue and especially to talk in brief about the benign and malignant tumours that affect the tongue along with other inherited and congenital abnormalities.Tongue lesions are categorized as tumours,infections, reactionary,congenital,developmental,acquired,autoimmune and potentially malignant disorders for easy understanding and to arrive at appropriate diagnosis.Tongue playing an important role in maintaining the harmony in the oral environment,it should be treated from diseases. Keywords: Tongue lesions,benign tumours,malignant tumours,diseases of tongue. CLASSIFICATION OF LESIONS ● Pyogenic granuloma AFFECTING THE TONGUE. ● Frictional keratosis BENIGN TUMOURS OF THE TONGUE INFECTIOUS LESIONS OF TONGUE ● Capillary hemangioma ● Oral squamous papilloma ● Fibroma ● Oral hairy leukoplakia ● Cavernous hemangioma ● Candidiasiis ● Giant cell granuloma ● Median rhomboid glossitis ● Lipoma ● Sublingual abcess ● Lymphangioma INHERITED,CONGENITAL,DEVELOPMENT ● Schwannoma AND ACQUIRED ABNORMALITIES OF TONGUE MALIGNANT TUMOURS OF TONGUE ● White sponge nevus ● Squamous cell carcinoma ● Foliate papillitis ● Veruccous carcinoma ● Angina bullosa hemorrhagica ● Non-Hodgkin’s lymphoma ● Geographic tongue TRAUMATIC/REACTIONARY LESIONS OF ● Fissured tongue THE TONGUE ● Median rhomboid glossitis ● Fibrous reactive hyperplasia ● Bifurcated/tetrafurcated tongue ● Traumatic ulcer Indian Journal of Forensic Medicine & Toxicology, July-September 2021, Vol. 15, No. 3 629 ● Bald;depapillated tongue vascular abnormalities is usually the preoperative endovascular embolization followed by the surgical ● Papillomatous change resection of the lesion or partial resection of the tongue, 4 AUTO IMMUNE DISORDERS depending on the size of the lesion. ● Lichen planus Giant cell granuloma ● Vesiculobullous lesion An exuberant reactive proliferation of multinucleated giant cells forming a mass on tongue.It is a reactive POTENTIALLY MALIGNANT DISORDERS process with no malignant potential5.Clinical features includes Reddish-blue rubbery nodules that range in size ● Leukoplakia from a few millimeters to 3 cm.Treatment includes local ● Oral submucous fibrosis surgical excision. BENIGN TUMOURS OF TONGUE Lipoma Capillary hemangioma Lipomas are the most common soft tissue mesenchymal neoplasms and usually exhibit slow and Capillary hemangioma,a benign tongue lesion. asymptomatic growth.The lipoma is characterized by Clinically,capillary hemangioma is a smooth or lobulated a significant fibrous component intermixed with the exophytic lesion manifesting as small, red erythematous lobules of fat cells.Clinically, they usually present as papules on a pedunculated or sometimes sessile base, well demarcated, slowly growing, painless, submucosal 1. which is usually hemorrhagic and compressible swellings which may appear yellowish in colour or Clinically the lesion is slow, asymptomatic and similar in colour to the surrounding mucosa depending on the thickness of the overlying epithelium.Surgical painless but it may also grow rapidly.Treatment excision is the treatment for these lesions. The recurrence includes observation for spontaneous remission and rate for lipomas in tongue has been reported to be 3 – using topical, intralesional and systemic corticosteroids, 62.5% .6 cryosurgery, radiation, embolization and laser therapy. Lymphangioma Fibroma Lymphangioma is a rare, benign, congenital disease Traumatic or Irritational fibroma is a common of unknown etiology that originates from lymph vessels benign exophytic and reactive oral lesion that develops 7.Tongue lymphangiomas typically demonstrate multiple secondary to injury2.Fibroma is a result of a chronic blister like nodules or a pebbly surface that resembles repair process that includes granulation tissue and scar a cluster of translucent vesicles on the enlarged dorsal formation resulting in a fibrous submucosal mass³. surface of tongue.Lymphangiomas of tongue have been Recurrences are rare and may be caused by repetitive divided into four categories.This lesion is common trauma at the same site. The lesion does not have a risk and mostly occurs on the dorsal surface and lateral for malignancy.They may exhibit inflammation on the border of the tongue.The anterior two-thirds on the epithelial surface when traumatized .Surgical removal of dorsal surface of the tongue is the most common site the growth is needed, and the dental professional should for intraoral lymphangiomas leading to macroglossia. evaluate any chronic habits that may be the causative Treatment is aimed at complete surgical excision. Partial factor. surgical excision, injection of sclerosing solutions Cavernous hemangioma electrocoagulation, cryotherapy, embolization, steroid administration, radiation and laser surgery may be the Cavernous hemangioma is formed by large, thin other modalities of treatment of diffuse lymphangioma walled vessels, or sinusoids lined by epithelial cells of the tongue separated by thin layer of connective tissue septa.It is almost never encapsulated. Treatment of the tongue 630 Indian Journal of Forensic Medicine & Toxicology, July-September 2021, Vol. 15, No. 3 Schwannoma includes surgery or radiation. Schwannoma is a benign, encapsulated, slow- Non hodgkin’s lymphoma growing and generally solitary tumour that arise Lymphomas are malignant neoplasms of the from schwann cells of the peripheral nerve sheath8. lymphocyte cell lines.Non-hodgkin’s lymphoma (NHL) Schwannomas originate from schwann cells and are of the oral region is rare. It is usually identified by commonly encapsulated.Schwannomas of the tongue asymmetry of the tongue,on digital palpation a large most commonly occur between the second and fourth sub-mucosal mass usually involves the lateral border of decades of life and has no gender predilection, and often the tongue. The most common symptoms are swelling, present as a painless mass.Transoral resection is the pain and discomfort ,involvement of the intrinsic standard approach for the treatment of the vast majority tongue musculature causing restriction of movement, of these tumours. The recurrence rate is very low and dysarthria and dysphagia11.Occasionally, the tumor malignant transformation is very rare. may cause upper airway obstruction.The most common MALIGNANT TUMOURS OF TONGUE treatments for non-Hodgkin’s lymphoma include chemotherapy,radiation,immunotherapy including Squamous cell carcinoma monoclonal anti bodies tyrosine kinase inhibitors,stem Squamous cell carcinoma of the tongue (SCCOT) cell transplant and surgery. is one of the most common tumors of the head and neck TRAUMATIC TUMOURS OF TONGUE region.About 95% of oral cavity cancers are squamous cell carcinoma.Usually occurs between 50 - 70 years of Reactive fibrous hyperplasia age9. Usually occurs at the dorsal surface of tongue,base Reactive hyperplastic lesions are tumor-like non of the tongue and metastasize to submandibular and neoplastic proliferations due to chronic irritation or jugular nodes.The most commom sign of squamous cell trauma.The clinical appearance of reactive lesions is carcinoma on tongue is a painless mass or ulcer that very similar to that of neoplastic proliferations.Clinically becomes more painful if secondarily infected.The tumour it is sessile or pedunculated mass.It is few millimeters is usually superficially indurated with slightly raised in diameter, soft and painless, that gradually gets hard borders and proceeds to develop a fungating exophytic and sometimes pedunculated12.Color may be similar to mass,or to infiltrate the deep layers of the tongue mucosa or vary depending on extent of inflammation. producing fixation and induration without much change It is generally isolated.The lesions are asymptomatic. in the surface of the tongue.The posterior portion of the Recurrence rate is low and treatment is surgical excision. tongue is usually at a high risk of malignancy,metastasize earlier and offer a poorer prognosis due to inaccessibility Traumatic ulceration of tongue to treatment. Metastasis occurs at a greater frequency in case of tongue cancer.Treatment procedure is usually If an ulcerative lesion lasts for two weeks or longer, surgical excision and radiation therapy. it is considered chronic; otherwise, it is regarded as an acute ulcer.They are caused by mechanical damage, Verrucous carcinoma thermal, electrical, or chemical burns.Traumatic ulcers are most common on the tongue.These lesions may Verrucous carcinoma is a rare variant of well persist for a few days or even several weeks.The borders differentiated squamous cell carcinoma that has of traumatic ulcers are usually slightly raised and reddish, some unique characteristics.The neoplasm is usually with a yellowish-white necrotic pseudomembrane. exophytic and appears to be papillary in nature which Traumatic ulcers normally become painless within three has a pebbly surface which sometimes covered by white days and after the injury