International J. of Healthcare & Biomedical Research, Volume: 2, Issue: 1, October 2013, Pages 57-60 Traumatic ulcer or squamous cell carcinoma of the tongue? : Case report. 1Dr. Syed Ishaquddin* , 2Dr.Dalaya Maya , 3Dr.Mahesh Ghadage 1 Associate Professor, Dept.of Oral Pathology , Bharati Vidyapeeth Dental College , Navi Mumbai , India. 2Professor, Dept.of Prosthodontics , Bharati Vidyapeeth Dental College , Navi Mumbai , India. 3PG Student, Dept.of Prosthodontics, Bharati Vidyapeeth Dental College , Navi Mumbai , India. *Corresponding author: Dr. Syed Ishaquddin Abstract: Ulcers commonly occur in the mouth. Their causes range from minor irritation to malignancies and systemic diseases. Innocent solitary ulcerations, which result from trauma and infections, must be distinguished from squalors cell carcinomas, which also typically present as solitary ulcers. Clinical criteria which are most useful in identifying the cause of oral ulcers are vesicles or bullae, which may not be seen because they rupture rapidly in the oral environment; constitutional signs and symptoms; and lesions on the skin and/or other mucosa. We reported a case of 75 years old female patient with a ulcerative lesion which was quite confusing either it was traumatic ulcer or squamous cell carcinoma? Key words : Oral ulcers, gingival ulcers, mucosal ulcerations. Introduction: filling, an ill-fitting partial denture, or a physical Traumatic ulcer is usually a single lesion with sharp bite (which may or not be due to a neurological erythematous, non-everted margins and with a clean disorder). Dorsal tongue TUGSE is usually due to base covered with a pseudomembrane. They are trauma from the maxillary incisors or sharp Cusps of usually painful and occur due to bite or trauma from the posterior teeth. sharp teeth or ill-fitting dentures. They disappear in Histologically, 7–10 days following elimination of the cause. If there involving the underlying muscle, which may explain is any clinical suspicion, a BIOPSY is indicated. the process of slow healing and the tissue Traumatic stromal eosinophilia. Healing may take up to eight weeks. eosinophilia is known by a number of other names, Eosinophils are found in areas of muscle damage.The including traumatic granuloma, eosinophilic ulcer treatment of choice is surgery but elimination of the and eosinophilic granuloma of the tongue (7-9). (This causative factor should come first, such as the filing condition is not related to eosinophilic granuloma of of sharp teeth, the replacement of broken fillings, the the bone as in Langerhan cell histiocytosis.) This is a use of a thin mouth-guard, or whatever else is reactive, self limiting condition of the oral cavity. It necessary.Conservative surgical removal with clean occurs most commonly by far on the dorsal and margins is the treatment of choice. Sometimes, an lateral tongue, followed by the lips and buccal incisional biopsy may lead to complete recovery, mucosa (7-9). other times; it may recur and require further surgery Acute trauma in the form of a sharp puncture to the with clean margins (7-9). Intra-lesional corticosteroid muscle is the main cause, but occasionally a history injections have been recommended for recurring of trauma is absent and the etiology is unknown (7- ulcers (7) but with a mixed outcome. The overall 9). The source of trauma can be a sharp tooth, a sharp prognosis is good if diagnosed early & treated early. ulcerative granuloma with these ulcers are deep lesions 57 www.ijhbr.com International J. of Healthcare & Biomedical Research, Volume: 2, Issue: 1, October 2013, Pages 57-60 Case report: membranes, ulcers which are localized to the oral We presented a case of 75 year old patient reported cavity may be more difficult to identify. two weeks ago with a complaint of non healing ulcer Most traumatic oral ulcers can be identified by their and pain while eating on the left border of the association tongue,since last one month . The patient had history chemical, thermal or radio therapeutic cause. They of habits including Pan chewing with tobacco & betel may be single or multiple, symmetrical or irregular in nut approx. 5 to 10 times a day from last 20 to 30 shape, and are usually painful. Most are of recent years. Now she reported complaints ulcer with pain onset, but some are chronic. Acute traumatic ulcers during eating along with throat pain, otalgia, have a removable, yellow-white base and erythe- dysphagia, odynophagia since one month. matous borders. Chronic traumatic ulcers may be On careful examination a definite ulcerative lesion 2 non-painful with an indurated base and raised X1 cm in size, on the Left Lateral border of the borders; consequently, they may be indistinguishable tongue coming in contact with the sharp posterior from squamous cell carcinomas on the basis of their teeth, which also shows attrition due to betel nut clinical features. chewing . The margins of the ulcer were elevated Treatment: showing rough base and cauliflower like appearance. Following treatment outline was planned. No cervical lymph-node Enlargement. Base of the 1)…Oral prophylaxis tongue and throat were normal.No other intra oral 2)…Correction of sharp cusps of lower left molar and lesion detected. premolar teeth Investigations: 3)…Anti oxidant and multivitamins Complete Blood Count –Normal 4)…Topical application of astringent gel Liver function test-Normal 5)…Anti bacterial mouth wash Blood sugar level-Normal 6)…Reassurance and follow up with an identifiable mechanical, X ray chest -Normal Sonography of head and neck region-Normal CT scan of the neck and lungs -Normal. Diagnosis: Ulcers occur in the mouth with considerable frequency. Traumatic lesions usually resolve rapidly International Journal of Healthcare & Biomedical Research Is now officially listed in and are not seen by clinicians. For relatively common conditions such as recurrent herpetic vesiculo ulcers Medhunt , Switzerland and aphthous ulcers, presumptive diagnoses are often made without recourse to laboratory tests. While the & GetCited , UK diagnosis of some types of oral ulcers is facilitated by their association with constitutional signs and symptoms or lesions on the skin and/or other mucous 58 www.ijhbr.com International J. of Healthcare & Biomedical Research, Volume: 2, Issue: 1, October 2013, Pages 57-60 3.Continuous trauma from sharp cusps of the teeth or faulty design of complete or the partial denture,can lead to the ulcers of the tongue. Precautions : 1.Hence during denture insertion the extension of the denture should be carefully examined and relived properly. 2.If any sharp cusps of the teeth existing,should be rounded off and smooth. 3.Discontinuation of the prosthodontic appliance till the lesion is heal. Conclusion: The various types of oral ulcers may appear clinically to be very similar. Features which are helpful in identifying the cause of ulcers are the 1.BEFORE TREATMENT associated 2. AFTER TREATMENT presence of lesions on the skin and/or other mucosa, Prosthodontic consideration: and the presence of bullae and vesicles. 1.Any tongue ulcerative lesions caused either due to In some cases, however, laboratory procedures are trauma from an overextended denture(complete or required to make the diagnosis. Biopsy is necessary partial dentures)is of utmost importance to be in the management of several of these conditions, considered in the diagnosis of the tongue lesion. especially in multiple ulcers due to autoimmune 2.Any faulty clasp design can lead to ulcerative diseases, constitutional signs and symptoms, lesions on the lateral border of the tongue can be misleading to precancerous lesion. References: 1. Fantasia JE, Damm DD. Red nodular lesion of tongue. Pyogenic granuloma. Gen Dent. 2003 Mar-Apr;51(2):190194. 2. Ichimiya M, Yoshikawa Y, Hamamoto Y, Muto M. Successful treatment of pyogenic granuloma with injection of absolute ethanol. J Dermatol. 2004 Apr;31(4):342-4. 3. Pham J, Yin S, Morgan M, Stucker F, Nathan CA. Botulinum toxin: helpful adjunct to early resolution of laryngeal granulomas. J Laryngol Otol. 2004 Oct;118(10):781-5. 4. Bundgaard T, S Bentzen, et al. Histopathologic, stereologic, Epidemiologic, and clinical parameters in the prognostic evaluation of squamous cell carcinoma of the oral cavity. Head & Neck. 18:142-152 (1996). 5. Barasch A, DE Morse, et al. Smoking, gender, and age as risk factors for site-specific intraoral squamous cell carcinoma. Cancer 73:509-513 (1994). 59 www.ijhbr.com International J. of Healthcare & Biomedical Research, Volume: 2, Issue: 1, October 2013, Pages 57-60 6. Syrjanen SM, KJ Syrjanen et al. Human papillomavirus (HPV) DNA sequences in oral precancerous lesions and squamous cell carcinoma demonstrated by in situ hybridization. J Oral Pathol. 17:273 (1988). 7. Neville BW, Damm DD, Allen CM, Bouquot JE. Traumatic ulcerations. In: Oral and Maxillofacial Pathology, 3rd edition. Philadelphia: W.B. Saunders, 2009. p. 287-289. 8. Richard PE. Richmond VA: Traumatic ulcerative granuloma with stromal eosinophilia (Riga-Fede's disease and traumatic eosinophilic granuloma), Oral Surg, Oral Med. Oral Pathol, Endod, 1983, vol 55: 497-506. 9. Sklavounou A, Laskaris G: Eosinophilic ulcer of oral mucosa, J Oral Surg, 1998, vol 58: 431 – 436. Date of submission: 28 Aug 2013 Date of provisional acceptance: 05 September 2013 Date of Final acceptance: 18 September 2013 Date of Publication: 03 October 2013 Source of support: Nil; Conflict of Interest: Nil 60 www.ijhbr.com