A 78-Year-Old Man With a Lingual Ulcerative Lesion

Talib A. Najjar, DMD, MDS, PhD; Prabhjot Singh, DDS


July 21, 2016

Physical Examination and Workup

Upon physical examination, the patient appears well-nourished and in no apparent discomfort. His vital signs include an oral temperature of 99.5°F, heart rate of 78 beats/min, blood pressure of 134/88 mm Hg, respiratory rate of 14 breaths/min, and oxygen saturation of 98% while breathing room air. The cardiovascular, respiratory, and abdominal examination findings are normal. Head and neck examination is negative for any gross swelling or lymphadenopathy.

Figure 1.

Figure 2.

Figure 3.

Intraoral examination reveals an indurated nodular mass 1 × 1 cm in diameter on the left lateral margin of the tongue, with two separate areas of ulceration both superior and inferior to the mass (Figure 1). The mass is not tender to palpation and lacks bleeding or drainage. No sublingual elevation, induration, or asymmetry is noted, and the patient's maximal oral opening is measured at 45 mm. Well-healed incisional wounds from prior restorative work of the left mandible are noted.

The initial workup consists of a panoramic radiograph, a culture swab, and an incisional wedge biopsy of the lesion. The panoramic radiograph shows the blade implant in place in the left mandible (Figure 2). Minimal bone destruction is noted around the blade implant, and no other bony pathology can be seen. The biopsy specimen is sent for histopathologic diagnosis (Figure 3).


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