Oral problems

Dr Philip Marazzi outlines some commonly presented oral problems

Pyogenic granuloma

This elderly man complained of a swelling in his mouth. He wore dentures and thought this was causing the problem. In fact, he had a swelling arising from his hard palate. He was referred to a maxillofacial surgeon who diagnosed a pyogenic granuloma and he was subsequently admitted for excision. The surgery was made more complicated as he has AF and is on anticoagulants. However, it was uneventful and the diagnosis was confirmed on histology.

Ankyloglossia


This girl had ankyloglossia (tongue tie). It can be seen pulling down the front of her tongue and may have been partly responsible for her speech problems. She was referred to speech therapy but it was also deemed sensible to deal with the tongue tie. Various different procedures are possible to deal with tongue tie. The choice is made on the basis of age and severity. The easiest option divides the frenulum and ranges from 'snipping' to full scale reconstruction with frenuloplasty. Laser techniques are increasingly used, being quick and simple.

Sublingual gland obstruction


This man presented with a swelling in the floor of his mouth. This was due to an obstruction of his sublingual gland producing this large fluctuant swelling. It was thought to be a ranula and the options offered to the patient were either to excise the lesion completely or to drain it and then inject it with his own blood under a local anaesthetic. He chose the latter, which was undertaken successfully.

Herpes simplex


This man presented with very painful oral ulceration. The problem was caused by herpes simplex type-1. It was his first infection and the source was unclear. In view of the severity, he underwent investigations to ensure there were no underlying problems, but nothing was found. He was given oral antivirals and analgesics and the ulceration gradually healed.

Recurrent tonsillitis


This young girl has a history of recurrent tonsillitis. Although not always severe, her attacks have been quite frequent and interfered with school. She has enlarged tonsils and her parents are concerned that she cannot swallow food due to the obstruction. She is nutritionally fine and will have her tonsils removed soon. She also snores and has enlarged adenoids, which can be removed at the same time as her tonsils.

Dental decay


This man had sustained a serious injury to his jaw in childhood and he has not looked after his teeth since. He presented with a severely arthritic knee and was referred for total knee replacement. However, the orthopaedic surgeons were not happy to operate until a dental clearance was carried out to remove any risk of infection.

Mouth ulcer


This woman fell and sustained a serious head injury. She then developed hydrocephalus requiring insertion of a ventriculoperitoneal shunt. She presented with this large ulcer following her discharge. It was very painful and was treated effectively with thalidomide. The drug is still available under very strict controls and is used by ENT specialists for this purpose.It is also used by oncologists in the treatment of multiple myeloma.

Papilloma


This woman noticed an annoying swelling on the tip of her tongue. She said she kept biting it, although admitted she was more bothered about its cosmetic appearance. It was removed by surgeons and histology came back as a benign squamous papilloma consistent with HPV infection.

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