Lip Cancer Photos

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Lip Cancer Photos Biography

 Hairy Tongue:  This is a relatively rare condition which is caused by the elongation of the taste buds.  This condition can be caused by poor oral hygiene, chronic oral irritation or smoking.  The far right picture shows a patient who has been treated with radiation therapy for head and neck cancer and has 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:   

Another patient with a Black Hairy Tongue.   This patient had significant gastroesophageal reflux.  Control of her reflux along with the use of Nystatin and bushing of her tongue resulted in a marked improvement in her condition.  the pre-treatment picture is the picture on the right.  The patient's tongue 2 months post treatment is shown on the left.  

   

 The patient shows 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 nystatin.

  

The picture to the right shows a close-up view where the elongated taste buds can be clearly seen.  

 The patient was treated with two weeks of nystatin and brushing the tongue using a tooth brush.   

 The patient shown on the right has a combination of a geographic and hairy tongue.  This condition does not produce any symptoms and can be refractory to oral antibiotics, Nystatin, steroids and good oral hygiene. 

 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.  Often multiple different bacteria exists in the tonsillar crypts, which can be difficult to culture.  Treatment with antibiotics to prevent Rheumatic Fever or tonsillar abscess formation is usually advisable.  

 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-diagastric (upper neck) lymph nodes.  The infection was resistant to antibiotics (as all viral infections are). 

 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.

 Torus palatinus is a hard bony growth in the center of the roof of the mouth (palate).  It is not a tumor or neoplasm by 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.

 The torus to the right has a chronic non-healing ulceration exposing a focus of dead bone.  This is a rare finding and may require surgical excision.  This patient had been on Fosamax for five years.  Fosamax is a bisphosphonate, a medication used to treat osteoporosis.  As of 12/5/07, this complication had not been reported occurring in bones other than the mandible (lower jaw) or maxilla (upper jaw).  This patient also had ear surgery (mastoidectomy) three years previously, while on Foxamax 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

  Torus Mandibularis: 

 This is a hard bony growth on each side of the mandible (jaw bone).  It is a benign growing and seldom needs treatment -- see arrows.

 Lip Cancer:

 Cancer of the lip is a relatively common condition.  When caught early, it is treatable with surgery or radiation therapy.  Cancers of the lower lip have a better prognosis than those of the upper lip.  Chronic sun exposure is the most common cause, but smoking can also be an etiology.  The picture on the right shows a T2 N0 (tumor size between 2 to 4 cm, with no lymph node spread) squamous cell carcinoma of the lower lip.  The patient was treated with surgical resection and reconstruction using an Abby-Estlander Lip Flap.  

***More On Lip Flaps***     

 These patients have a basal cell carcinoma lip cancer.  It is a less aggressive tumor than squamous cell carcinoma, see above photo.  Basal Cell Carcinoma spread and destroy tissue locally, but do not metastasize (spread by blood or lymphatics).  Treatment is surgical excision or radiation therapy.

 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.

 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.  See 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 was a non-smoker.  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. 

 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. 

Learn more about HPV and oral cancer. 

   

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.

 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.  

 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. 

 Carcinoma of the Tongue:  This patient has a T1 (2 cm or less) squamous cell carcinoma of the tongue.

 Chelitis: 

 This 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.

 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 to the ulcers four times a day for 7 to 10 days.

 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 FDA for treatment.  Other medications, Acyclovir ointment, Valacyclovir and Famciclovir are only approved for genital herpes but many doctors also use them to treat oral herpes (cold sores).  A new over-the-counter medication approved by the FDA is Abreva.  It also effective in the treatment of cold sores.  It is believed to protect the skin cells from viral damage.

 Shingles (Herpes Zoster):  

Shingles are caused by the Herpes Zoster Virus.  They occur many years after an individual has had chicken pox. Once an individual has had chicken pox, he/she will carry, for life, the virus in a dormant state in the 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 which the nerve innervates.  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 given one gram three times a day. 

 Stomatitis: 

 The pictures on the right shows a 47 year old male with an intraoral viral eruption 24 hours after exposure to caustic chemicals.  This patient was also treated with Famvir (famciclovir) 500 mg three times a day for 7 days.  The probable cause of these lesions is herpes simplex.   

 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) 500 mg three times a day for 7 days.  The probable cause of these lesions is herpes simplex.   

 

 The pictures on the right shows oral candidiasis caused by inhalation steroids.  These patients were treated with oral nystatin.     

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 Steven-Johnson Syndrome was made and the patient was transferred to a major University Medical Center. 

Stevens Johnson Syndrome (erythema multiforme) 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 (flue, 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

 

 Oral Pharynx Necrosis: 

 The picture on the right shows necrosis of the posterior oral pharynx from intranasal narcotic usage.  

For more information regarding the presentation of illicit drug abuse in otolaryngology go to  http://healthtopicsblogs.blogspot.com/ent_illegal_drugs.htm  

 

 Leukoplakia is a white patch in the oral cavity.  It is often caused by chronic irritation or infection but may also be a cancer.  In this patient the leukoplakia has areas of redness called erythroplakia.   Erythroplakia more 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.  

 

 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.  

 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.  

For more information on the surgical treatment of submandibular salivary gland stones click the link below.  

 

Rarely, the parotid salivary gland will for a stone  

View a Parotid Salivary Gland 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.

  

 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. 

 

 Oral Fibroma: 

 This is a benign lesion in a young patient which can easily be removed as an office procedure.

 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 six year old male.  It was removed under local anesthesia in the surgeon's office. 

  

 Geographic Tongue:   

 This is a benign non-painful condition caused by the absence of taste bud 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.  

  

 To the left is a picture of a hairy and geographic tongue in an 18 yr old male. 

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

  

 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.

 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.    

 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.

   

 Lichen Planus:  This condition presents as a white lace like pattern on the inside of the cheeks.  It can be confused with may 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 prednisone (5mg/ 5cc) rinses, mixed (1:1) with kopectate to allow the medication to stick to the oral mucosa.

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 scared 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.  Although one may think of methamphetamine usage, however, this produces gingivitis and caries next to the dental line of the teeth.