Inspect the Tongue

Inspect the mucosa, and note any masses or ulceration. Is the tongue moist? Ask the patient to stick out the tongue. A neuromuscular weakness may be present if the tongue cannot protrude in the midline or move rapidly in all directions. Are there any mass lesions on the sides or undersurface of the tongue? Ask the patient to lift the tongue to the roof of the mouth so that the inferior aspect of the tongue can be inspected. In older individuals, the large veins on the ventral aspect of the tongue may be tortuous. These varicosities never bleed spontaneously and have no clinical significance. Figure 12-23 shows a patient with sublingual varices. Figure 12-24 shows a patient with a benign lipoma of the tongue.

A geographic tongue is a benign condition in which the dorsum of the tongue has smooth, localized red areas, denuded of filiform papillae, surrounded by well-defined, raised yellowish-white margins and normal filiform papillae. These areas together give the tongue a maplike appearance. The appearance of the tongue gradually changes as the depapillated areas heal and new areas of depapillation occur. A black hairy tongue is another benign condition in which the filiform papillae on the dorsum of the tongue are greatly elongated;these enlarged, ''hairy'' papillae become pigmented with a brownish black color caused by staining from food or tobacco or proliferating chromogenic microorganisms. This condition, more commonly seen in men, may be a sequela to antibiotic therapy. A scrotal, or fissured, tongue is another normal variant;approximately 5% of the population has fissures in the tongue. The fissures first develop in late childhood and become deeper with age. The fissure pattern is quite variable. Food debris may collect in the fissures, causing inflammation, but the condition is otherwise benign. Halitosis may be a problem. Figure 12-25 shows these three normal tongue variants.

Figure 12-23 Sublingual varices of the tongue.

Figure 12-23 Sublingual varices of the tongue.

Mycotic Infection GenitalsWhite Tongue Normal Variant
Figure 12-24 Benign lipoma of the tongue.

Is candidiasis present? Candidiasis, also known as moniliasis or thrush, is an opportunistic mycotic infection. It frequently involves the oral cavity, gastrointestinal tract, perineum, or vagina. The lesions appear as white, loosely adherent membranes, beneath which the mucosa is fiery red. Oral candidiasis is the most common cause of white lesions in the mouth. It is uncommon in healthy individuals who have not been receiving broad-spectrum antibiotic or steroid-based therapies. The presence of thrush in such a patient may be an initial manifestation of acquired immunodeficiency syndrome (AIDS). Candidiasis is the most common oral infection in patients with AIDS. The tongue of a patient with AIDS and oral candidiasis is pictured in Figure 12-26.

Is leukoplakia present? One form of leukoplakia, termed oral hairy leukoplakia, is associated with the subsequent development of AIDS. These raised white lesions appear corrugated, or "hairy," and range in size from a few millimeters to 2 to 3 cm. They are most commonly found on the lateral margins of the tongue but may also be seen on the buccal mucosa. In the absence of other causes of immunosuppression, oral hairy leukoplakia is diagnostic of HIV infection. It is seen in more than 40% of patients with HIV infection. The tongue of a patient with AIDS with oral hairy leukoplakia is pictured in Figure 12-27.

Look for indurated ulcers or masses in the middle, lateral aspect of the tongue. This is the most common site for intraoral squamous cell carcinoma. Figure 12-28 depicts squamous cell carcinoma of the tongue in the classic location.

Inspect Tongue
Figure 12-25 Three normal tongue variants. A, Geographic tongue. B, Black hairy tongue. C, Scrotal, or fissured, tongue.

Figure 12-26 Oral candidiasis.

Geographic VaginitisMedical Gnital PalpationMedical Gnital Palpation
Figure 12-29 Palpation of the tongue.
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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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Responses

  • ilse
    What causes geographic tongue?
    1 year ago

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