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Section 33: Disorders of the Mouth

DISEASES OF THE LIPS ICD-10: K13.0

ANGULAR CHEILITIS (PERLÈCHE)

  • Associated with increased moisture (saliva) at commissures.

  • Predisposing factors: Thumb sucking in children; chin furrows (“marionette lines”); oral candidiasis; dentures; isotretinoin treatment.

  • Findings: Erythema and maceration at commissures (see Fig. 33-1).

  • Diagnosis: Clinical diagnosis, consider KOH for candidiasis and culture for S. aureus, Candida.

  • Management: Barrier cream, topical antifungal.

FIGURE 33-1

Angular cheilitis Mild erythema and scaling in bilateral commissures. (Used with permission from Dr. Nathaniel Treister.)

A patient with angular cheilitis exhibits inflammation, redness, and silver scaling at both the corners of the mouth.
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ACTINIC CHEILITIS

Actinic/solar keratoses, usually of the lower lip. Rule out squamous cell carcinoma in situ (SCCIS) or invasive if papule, nodule, or ulcer occurs (see Section 11).

CONDITIONS OF THE TONGUE, PALATE, AND MANDIBLE ICD-10: K14

FISSURED TONGUE

  • Normal variant in up to 11% of population. Asymptomatic.

  • Findings: Multiple folds with anterior-posterior orientation on the dorsal surface of the tongue (Fig. 33-2).

  • Associated disorders: Psoriasis, Down syndrome, acromegaly, and Sjögren syndrome.

  • Synonyms: Lingua fissurata, lingua plicata, scrotal tongue, grooved tongue, furrowed tongue.

FIGURE 33-2

Fissured tongue Deep furrows on the dorsum of the tongue are asymptomatic.

A patient with fissured tongue exhibits a deep longitudinal crack with smaller, branching cracks along the center of tongue.
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BLACK OR WHITE HAIRY TONGUE

  • Pathogenesis: Defective desquamation of filiform papillae resulting in hair-like projections on the dorsum of the tongue.

  • Associations: Heavy tobacco use, mouth breathing, systemic antibiotic therapy, poor oral hygiene, general debilitation, radiation therapy, chronic use of bismuth-containing antacids, or lack of dietary roughage.

  • Findings: Furry plaques on dorsal tongue (Fig. 33-3). Candidiasis may occur secondarily.

  • Management: Eliminate predisposing factors; good oral hygiene.

  • Synonym: Lingua villosa (nigra).

FIGURE 33-3

(A) Hairy tongue Defective desquamation of filiform papilla noted in posterior aspect of tongue. Tongue has a white surface caused by retained keratin. (Used with permission from Dr. Nathaniel Treister.) (B) Black hairy tongue In this example, chromogenic bacteria have stained the tongue black.

Two examples of the clinical appearance of hairy tongue.
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ORAL HAIRY LEUKOPLAKIA

  • Pathogenesis: Epstein–Barr virus infection; low CD4 cell counts (See Section 27).

  • Findings: White corrugated plaques on lateral aspects of tongue (see Fig. 27-65). Does not occur in successfully treated HIV/AIDS.

MIGRATORY GLOSSITIS ICD-10: K14.1

  • Irregular areas of dekeratinized and desquamated filiform papillae (red in color) are surrounded by elevated whitish or yellow margins (Fig. 33-4).

  • Etiology: Unknown; possible link with psoriasis. Incidence: Common; usually asymptomatic.

  • Synonym: Geographic tongue.

FIGURE 33-4

Migratory glossitis Areas of hyperkeratosis alternate with areas of normal pink epithelium, ...

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