Hairy Tongue: This is a relatively rare condition whose appearance is due to the elongation of filiform papillae. These papillae have a mechanical abrasive function. These papillae do not contain taste buds This condition can be caused by poor oral hygiene, chronic oral irritation or smoking. The far right picture shows a patient who was a heavy smoker and has been treated with radiation therapy for head and neck cancer. Radiation therapy causes a dry mouth with chronic oral inflammation. Treatment involves good oral hygiene, brushing of the tongue, mouth rinses and sometimes the trimming of the elongated papilla. The picture to the left is the same patient two months later after improvement in his oral hygiene.



Black Hairy Tongue: This patient has a black hairy tongue which was caused, at least in part, by significant gastroesophageal reflux . Control of her reflux along with the use of a topical anti-fungal medication (Nystatin), cessation of smoking and bushing of her tongue resulted in marked improvement. The pre-treatment picture is the picture on the far right. The patient's tongue two months post treatment is on the left.



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A third patient with a hairy tongue on the posterior midline portion of the tongue. The patient was a non-smoker and was treated with brushing his tongue three times a day and a two week course of a topical antifungal medication, Nystatin.





The pictures to the right shows the pretreatment appearance of the tongue with elongated filiform papillae. The picture on the left is two weeks after treatment with Nystatin and good oral hygiene.



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The fourth patient, shown on the right, has a combination of a geographic and hairy tongue. This condition does not produce any symptoms, and was not improved with the use of oral antibiotics, Nystatin, steroids and good oral hygiene. Click on Pictures to Enlarge

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*** Gastroesophageal Reflux (GERD) ***

*** Smoking and Cancer ***

*** Tobacco Facts (dot) Info ***



Leukoplakia is a white patch which can occur in the oral cavity. It is often caused by chronic irritation or infection but can also be a cancerous or precancerous lesion. In this patient the leukoplakia had areas of redness called erythroplakia. Erythroplakia often represents a cancer. On biopsy, the patient was found to have a fungal infection. Fungal infections of the oral cavity may often mimic a cancer both on gross appearance and sometimes even histologically. A condition called pseudoepitheliomatous hyperplasia can cause a similar appearance and pathologically can be mistaken for cancer.



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The picture on the right shows a large white lesion which mimics a T2 squamous cell carcinoma on the upper gingival buccal sulcus and hard palate. The leukoplakia extends anteriorly in the gingival buccal sulcus. The patient was a 75 year old male with a 90 pack year history of smoking. The patient quite smoking 15 years previously. The patient also used 1/3 of a pouch per day of tobacco for the last 65 years. The lesion was biopsied which revealed pseudoepithelial hyperplasia from candidiasis. Treatment with smoking cessation, improved oral hygiene and a fungal medication (Nystatin) resulted in marked improvement in the condition.











The picture on the right is from a 22 year old male who has used over one can of snuff for the past 15 years. He has high blood pressure from the vasoconstrictive (contraction of blood vessels) effect of nicotine and gastroesophageal reflux disease (stomach acid coming up from the stomach towards the mouth) which is also made worse from using tobacco products. The picture on the right shows extensive leukoplakia forming between his gums and lips. This is a pre-cancerous condition and if it does not resolve with his cessation of using tobacco products, it will need to be surgically removed. Click on Pictures to Enlarge

Learn More About The Dangers of Tobacco Use

*** Tobacco Facts (dot) Info ***

*** Larynx Cancer ***

*** Bronchoscopy Video ***

*** Larynx Cancer Biopsy Video ***

Apthosis Ulcers: Apthosis ulcers are shallow small painful ulcers which appear on mobile mucosa in the oral cavity. They are often found in individuals that are under stress. The cause of these ulcers is unknown. They can be treated by applying Amlexanox gel (a prescription medication).



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Oral Ulcers : This patient is a 80 year old, with a smoking history and very poor dentition. The patient's lip ulcers mimic a cancer but are from erosion and infections secondary to her poor dentition. Click on Pictures to Enlarge

Cold Sores: Cold sores are caused by the Herpes Simplex Virus. Once infected, they plague the patient for life. Penciclovir cream is a prescription medication which is approved by the Federal Drug Authority (FDA) for treatment. Acyclovir ointment and oral anti-viral medications such as Valacyclovir and Famciclovir may also be prescribed by a physician to treat Herpes Simplex infections. An over-the-counter FDA approved medication for the treatment of cold sores is Abreva. This medication is believed to protect the skin cells from viral damage and promotes healing.

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Chelitis : Chelitis is crusting and cracking which occurs in the corners of the mouth. It is caused by a fungus and anti-fungal creams are usually curative.

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Shingles (Herpes Zoster): Shingles are caused by the Herpes Zoster Virus. They occur many years after an individual has had chicken pox. Once a patient has had chicken pox, they will carry the virus for the rest of their life. When the patient does not have symptoms, the virus is in a dormant state residing cell bodies of nerve tissue. Over the years, a patient's antibody levels fall and the dormant virus emerges. The virus causes lesions to erupt on the skin in the regions that are innervated by the infected nerve. In the right-hand picture, the lesions are seen on the patient's right jaw and right half of his tongue. This corresponds to the lower division of the trigeminal nerve (V cranial nerve) and the lingual nerve (XII cranial nerve). This patient was treated with a seven day course of Valacyclovir and had an uneventful recovery.

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Stomatitis: The pictures on the right show a 47 year old male with an intraoral viral eruption which occurred 24 hours after exposure to caustic chemicals. This patient was treated with Famvir (Famciclovir) and had rapid resolution of the lesions. The probable cause of these lesions was herpes simplex.



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The pictures on the right are from a 14 year old girl with punctuate viral lesions on the hard palate and tongue. She was treated with Famvir (famciclovir). The probable cause of these lesions is herpes simplex.



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Methicillin-resistant Staphylococcus aureus (MRSA): This patient had a two day history of a pimple on his right lower lip. Over the last 24 hrs he had rapid increase in pain, swelling and redness. The area was fluctuant and when lanced abundant puss was expressed. Culture revealed MRSA. The wound was drained and the patient was treated with Bactrum, a sulfa based antibiotic. MRSA is in the group of bacteria referred to as Multi-Resistant Drug Organisms (MDROs).

Learn More About MRSA

*** MRSA & MRDOs ****



Candidiasis (Yeast Infection): The pictures on the right show oral candidiasis caused by inhalation steroids. The patients had asthma and used inhaled steroids on a daily basis. These patients were treated with a topical anti-fungal medication, oral Nystatin.



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Acute Tonsillitis: This is a common condition which is usually caused by gram positive bacteria. If the organism is Streptococcal Pyrogenesis, there is a risk of developing Rheumatic Fever. Which is a condition where the values of the heart are damaged by the antibiotic response to bacteria. Tonsils normally have deep crypts or holes that extend into the body of the tonsil. Often multiple different bacteria exist in the tonsillar crypts. Treatment of tonsillitis with antibiotics to prevent Rheumatic Fever or tonsillar abscess formation is usually advisable. Click on Pictures to Enlarge



Learn More About Treatment Options

for Chronic Tonsillitis

*** Tonsillectomy ***

The picture to the right shows the appearance of acute tonsillitis due to Infectious Mononucleosis. The patient was a 24 year old male with bilateral 4 cm non-tender jugulo-digastric (upper neck) lymph nodes. Because the infection was caused by a virus it was resistant to antibiotics. Click on Pictures to Enlarge

The patients shown in the pictures to the right have a basal cell carcinoma of the upper (left picture) and lower (right picture) lips. Basal Cell Carcinoma is a less aggressive tumor than squamous cell carcinoma. It spreads and destroys tissues locally, but does not metastasize (spread by blood or lymphatics). Treatment is surgical excision or radiation therapy. Click on Pictures to Enlarge



Oral Cancer : This patient is a 57 year old, with a 75 pack year history of smoking and alcohol intake. He has an oral cancer involving the uvula (uvular cancer) which has also spread onto the nasopharynx surface of the soft palate . He was also found to have a carcinoma in the upper portion of his right lung.

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*** HPV and Oral Cancer ***

*** Bronchoscopy Video ***



Another common oral cancer is tongue cancer. The picture on the right shows a cancer on the tongue in a 45 year old male who never smoked. The most common cause of oral tumors is Human Papilloma Virus which is found in 70% of oral tumors. This virus most commonly causes tumors on the tonsil and base of tongue. Learn more about HPV and oral cancer . Click on Pictures to Enlarge

Learn More About

*** HPV and Oral Cancer ***



The picture on the right shows a T1 squamous cell carcinoma of the oral cavity in the region of the retromolar trigone. The patient had a 30 pack year history of smoking an a two month history of feeling a lump in her throat.

Learn More About The Dangers of Tobacco Use

*** Tobacco Facts (dot) Info ***

*** Bronchoscopy Video ***



This patient is a 87 year old who used to smoke 1 pack per day many years ago she was not sure how long she smoked. This patient has a tumor on both her tongue and right floor of the mouth. The tumor is over her alveolus and extends onto the anterior tonsillar pillar. These types of tumors are often treated with a commando operation which consists of resection of the mandible , floor of mouth and tongue; along with a radical neck dissection which removes the muscles and lymph nodes in the neck.

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*** Dangers of Sun Exposure ***

*** Tobacco Facts (dot) Info ***

*** Bronchoscopy Video ***



The picture on the right shows a T1 squamous cell carcinoma on the floor of the mouth. The patient was a 60 yr old male and had a 50 pack year history of smoking. The cancer blocked the submaxillary salivary gland duct. The gland swelled and presented as a mass in his upper neck.



Learn More About The Dangers of Tobacco Use

*** Tobacco Facts (dot) Info ***

*** Bronchoscopy Video ***



This patient is a 70 year old who smoked 1 pack per day for 50 years he also drank alcohol heavily. He presented with severe dysphagia (trouble swallowing) and on examination was found to have a very small airway. He underwent an emergency tracheotomy (breathing hole placed in the neck) under local anesthesia no IV sedation or analgesia was given. The was then put to sleep with general anesthesia and had his oral tumor debulked. The pictures on the right show a large oral tumor in the hypopharynx with a very small airway under the epiglottis .



Torus palatinus is a hard bony growth in the center of the roof of the mouth (palate). It is not a tumor or neoplasm but a benign bony growth called an exostosis. This growth commonly occurs in females over the age of 30 and rarely needs treatment. Occasionally it is removed for the proper fitting of dentures. Click on Pictures to Enlarge





Torus Mandibularis: This is a hard bony growth on each side of the mandible (jaw bone) -- see arrows. They are benign slow growing and seldom need treatment. The prevalence in the United States is between 7% to 10%. Occasionally they are is removed for the proper fitting of dentures.



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The picture on the right shows a large HPV papilloma extending from then nasophayrnx into the oral pharynx. The patient was a 27 year old female She had no recurrence after surgerical removal.

Learn More About

*** HPV and Oral Cancer ***



Picture of an oral papilloma of the uvula. This is a common area for papilloma to grow. These lesions are caused by the Human Papillomavirus or HPV. Click on Pictures to Enlarge

Learn More About

*** HPV and Oral Cancer ***



Oral Fibroma: Oral fibromas are benign lesions which can be removed as an office procedure. The below left picture shows an oral fibroma in a young patient.



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Lingual Cavernous Hemangioma: This is a benign lesion but one which is very hard to treat. Surgery is difficult. Angiography is often needed to outline the feeding vessels and to embolize the hemangioma.



Lingual Hemangioma : The picture on the right is a small peduncular hemangioma on the tip of the tongue of a ten year old male. It was removed under local anesthesia in the surgeon's office.



Mass on Base of Tongue: This mushroom like mass presented on a 40 yr old female with a one month history of choking. It was treated with surgical excision. The pathology report showed that the mass was a benign vascular tumor.



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Sialocele: A sialocele arises from the blockage of a salivary gland duct. The duct enlarges and forms a sac of saliva. Treatment is with surgical excision.



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The torus to the right has a chronic non-healing ulceration exposing a focus of dead bone. This patient had been on Fosamax for five years. Fosamax is a bisphosphonate, a medication used to treat osteoporosis. This patient also had ear surgery (mastoidectomy) three years previously, while on Fosamax for two years, without any problems. A year later and off of Fosamax the bony sequestra fell off and the palate healed without surgery. Fosamax inhibits bone resorption by suppressing the activity of the cells which remodel bone, osteoclasts. Some patients taking Fosamax have been found to form dead bone in their jaws ( mandibular necrosis ). This is especially true if the patient has infected teeth or trauma to the overlying mucosa. Less frequently, this complication has been found to occur in the upper jaw bone or palate (maxilla). Treatment is difficult since any trauma or surgery to the area may expand the bone loss.

For more information: Marx RE 2005 Farrugia MC 2006 Merigo E 2006



Severe necrosis of the mandible from use of bisphosphonates in a 68 year old who was undergoing treatment for cancer. The picture on the right shows an oral-cutaneous fistula with exposure of mandibular bone. Intra oral examination reveals necrosis and exposure of the entire left body of the mandible . The patient did not have any pain. Reconstruction had to be postponed for many months after the drug was discontinued. View Abstract



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Oral Pharynx Necrosis: The picture on the right shows necrosis of the posterior oral pharynx from intranasal narcotic usage. Click on Pictures to Enlarge



Learn More About Illicit Drug Abuse

*** ENT Signs of Drug Abuse ***







Stevens Johnson Syndrome: Shown in the photographs below is a severe mucositis with epidermal sloughing in a 17 year of female. Symptoms started 24 hours after taking tetracycline for a cough. Blisters first formed with sloughing of the mucosa. The lips, buccal mucosa and soft palate were the main areas of involvement. A working diagnosis of Stevens Johnson Syndrome was made and the patient was transferred to a major University Medical Center. Stevens Johnson Syndrome is a rare but serious disorder caused by a wide range of drugs and infections: Including antibiotics, non-steroidal anti-inflammatory agents, anticonvulsants and a variety of infections (flu, hepatitis, herpes, typhoid and HIV). Lesion may involve large portions of the skin. Prognosis is generally good with a 1-5% fatality rate with sloughing involves less than 10% of the skin. However, mortality rate can be greater than 25% when sloughing involves more than 30% of the skin surface.

Stevens Johnson Syndrome Support Page



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Lichen Planus: This condition presents as a white lace like pattern on the inside of the cheeks. It can be confused with many other conditions and evaluation by a physician is mandatory to make sure other serious problems are not present. Often the condition is caused by a reaction to medications. Beta Blockers and oral hypoglycemics are the most common offending medications. Lichen Planus can also be associated with other conditions such as Hepatitis C. Treatment is with oral steroid rinses, and if possible identifying and removing the causative agent.



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The pictures below are from a 37 year old patient with biopsy proven lichen planus which occurred during a stressful time in the patient's life. Her tongue had scarred plaques, her cheeks were inflamed. She also had multiple dental caries. The patient was treated with a liquid steroid taken by mouth and a topical steroid cream. Two years later she was asymptomatic without a recurrence. One might wonder if this patient is abusing methamphetamine, however, this abuse produces gingivitis and caries next to the gum line of the teeth.







Lichenoid Reaction: The patient shown in the pictures to the right is a 61 year old female who presented with a four month history of mildly painful white tongue lesions which slowly healed and became asymptomatic. After healing, her tongue had persistent smooth plaques surrounded by a whitish ring. No other lesions were identified.



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Phemphigoid: Bullous phemphigoid is an auto-immune disease which causes blistering of the skin. It can involve the mucous membranes in 10% to 25% of patients. Blisters form when antibodies attack proteins in the basement membrane of the skin (between the dermis and epidermis). Many cases are self limited and go into remission in five years or less. However, severe cases may require treatment with corticosteroids and immunosupressive agents. Phemphigoid should not be confused with Phemphigus Vulgaris which is a much more aggressive disease. In Phemphigus Vulgaris antibodies attack proteins called desmogleins. Desmogleins are the proteins which hold the skin together. Diagnosis of Phemphigoid and Phemphigus requires biopsy. For more information go to http://www.pemphigus.org . Click on Pictures to Enlarge





Ankyloglossia or a persistent lingual frenulum is a congenital persistence of tissue which binds the tongue to the floor of the mouth. When severe, the frenulum should be cut to mobilize the tongue.

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Video of Surgical Technique To Repair Ankyloglossia

*** Lingual Frenulectomy Video ***



Salivary Gland Stone: This patient had a stone which formed in the Submandibular (Submaxillary) Gland Duct. The picture on the far right shows the duct's papilla in the floor of the mouth, underneath the patient's tongue. This duct drains uphill, is wide and has a mucoid or viscous secretion. Thus, when salivary gland stones occur, they usually occur in this duct. Treatment consists of excising the stone. Prevention is with hydration, gland massage and using a few drop of sour lemon juice several times a day to increase salivary flow.

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The picture on the right is from a patient who has a small salivary gland stone in its duct. Note the dilatation of the salivary gland duct. Click on Pictures to Enlarge

Learn More About Salivary Gland Stones

*** Surgery For Removal of the Submandibular Gland Video ***

*** View CT Scan of Parotid Stone ***



The X-Ray on the right shows a giant salivary gland stone (Larger than 1.5 cm) just under the mandible . For more information on the management of giant salivary gland stones, go to the World Articles in Ear Nose and Throat. Note the size of the stone next to the penny. Click on Pictures to Enlarge







The picture below shows a stone in the left submandibular (submaxillary) salivary gland duct. The submandibular salivary gland is the most common salivary gland to form stones. This is because it has a wide duct and mucoid saliva which flows uphill. Prevention of stone formation includes plenty of fluids and sialogues, such as a few drops of lemon juice or a dill pickle. Notice the normal orifice of the right submandibular gland (Warthin's) duct. Click on Pictures to Enlarge

Learn More About Salivary Gland Stones

*** Surgery For Removal of the Submandibular Gland Video ***

*** View CT Scan of Parotid Stone ***



The picture to the right shows a stone in the left Parotid salivary gland duct (Stensen's Duct). The submandibular salivary gland is the most common salivary gland to form stones. This is because it has a wide duct and a mucoid saliva which flows up hill. Stones are rare in the parotid gland since the saliva is serous and the duct flows down hill. Prevention of stone formation includes plenty of fluids and sialogues, such as a few drops of lemon juice or a dill pickle. Click on Pictures to Enlarge

Learn More About Salivary Gland Stones

*** Salivary Gland Surgery For Removal of the Parotid Gland ***

*** View CT Scan of Parotid Stone ***



The pictures on the right show a patient with severe sialothiasis (salivary gland stones). One of the stones has eroded through the floor of the mouth. Two stones were recovered with a third still in the duct. This patient had a long history of recurrent salivary gland swelling and infection. Treatment will probably require excision of the submandibular salivary gland.

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Geographic Tongue: This is a benign non-painful condition caused by the absence of lingual papilla. The glassy patches move around the tongue and change shape. The cause of this condition is unknown and treatments are not reliable. The left hand picture is from a 20 year old male who is at the beginning stages of a bout of acute tonsillitis. He stated the condition worsens during the acute episodes. Click on Pictures to Enlarge



The picture to the right is an 18 year old with a combination of a hairy and geographic tongue.



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Oral-Maxillary Fistula: In this condition, a hole (fistula) develops between the mouth and the large sinus cavity above the palate (roof of the mouth). This condition can be caused by dental infections or a complication of surgery. Treatment is with a two layer surgical closure. An incision is made around the periphery of the fistula. The mucosa of the fistula is elevated and inverted. It is then sewn together, forming an inner layer. The cheek mucosa is then advanced over the inner closure and sewn over the defect. Click on Pictures to Enlarge







The patient shown on the right has a small hole in the middle of a tooth socket. A tooth had been pulled and a hole was made into the maxillary sinus. The hole did not fully heal and a small fistula was left in the middle of the upper alveolar ridge.



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