Small purplish or blue-black round swellings may appear under the tongue with age. They are dilatations of the lingual veins and have no clinical significance. Reassure a worried patient. These varicosities are also called caviar lesions.
Aphthous Ulcer (Canker Sore)
A painful, small, round or oval ulcer that is white or yellowish gray and surrounded by a halo of reddened mucosa typifies the common aphthous ulcer. These ulcers may be single or multiple. They heal in 7 to 10 days, but may recur.
A persisting painless white patch in the oral mucosa is often called leukoplakia until biopsy reveals its nature. Here, the undersurface of the tongue looks as if it had been painted white. Smaller patches are more common. Leukoplakia of any size raises the possibility of malignant change.
Mucous Patch of Syphilis
This painless lesion occurs in the secondary stage of syphilis and is highly infectious. It is slightly raised, oval, and covered by a grayish membrane. Mucous patches may be multiple and occur elsewhere in the mouth.
Tori mandibulares are rounded bony protuberances that grow from the inner surfaces of the mandible. They are typically bilateral and asymptomatic. The overlying mucosa is normal in color. Like a torus palatinus (p. 201), these tori are harmless.
Carcinoma, Floor of the Mouth
This ulcerated lesion is in a common location for carcinoma, which also occurs on the side of the tongue. Medial to the carcinoma, note the reddened area of mucosa, called erythroplakia. Like leukoplakia, erythroplakia warns of possible malignancy.
(Sources of photos: Mucous Patch, Leukoplakia, Carcinoma—Robinson HBG, Miller AS: Colby, Kerr, and Robinson's Color Atlas of Oral Pathology. Philadelphia, JB Lippincott, 1990; Varicose Veins—From Neville B et al: Color Atlas of Clinical Oral Pathology. Philadelphia, Lea & Febiger, 1991. LJsed with permission.)
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