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Lingual Varicosities: A case report Kalpna Thakur,1 Nitish Bhat,2 Sucheta Bansal,3 Nandini Bharadwaj4 1 Lecturer H.P. Government Dental College and Hospital, Shimla-Himachal Pradesh,2 Sr. Lecturer,3 Associate Professor,4 Post graduate student, Department of Oral Pathology and Microbiology, Himachal Institute of Dental Sciences, Paonta Sahib, Himachal Pradesh



Abstract: Several changes in oral cavity can be observed in individuals due to the normal aging process. One of these changes commonly seen in the oral cavity in older individuals includes lingual varicosities. They may also be related with some medical diseases; however, this association is not clear. Here, we present a case of lingual varicosities in a 52yr old female patient. Key words: Caviar tongue, Lingual varix, Lingual varicosities, Sublingual varicosities.



Introduction: Varicosity is a condition that indicates an enlarged and tortuous vein, artery, or lymph vessel. Orally, varicosities are seen as purple to red shot like clusters. Lingual varicosities observed by the dentist and physician have been ascribed to age, tissue relaxation, and increased venous pressure. The varicosities are rare in infants, however common in adults. [1] Lips and buccal mucosa are less common sites.[2] These entities have been noted on the lateral borders of the tongue and the floor of the mouth. Burket associated the occurrence of lingual varicosities with cardiorespiratory disease, however this assumption was shown to be unsubstantiated in a double blind study by Kleinman. [3] The history and a careful physical examination are sufficient to establish a clinical diagnose in most of cases of oral varicosities. Here we report a case of lingual varicosities.



Figure 1: Tortuous purplish Lingual varicosities on the under surface of the tongue.



Journal of Himachal IDA



Case Report: A 52-year-old woman presented with complaints of an asymptomatic tortuous purplish swellings on the under surface of the tongue [Figure: 1] for 10 months. She first noticed a few red to purple small outpouching of the veins on the under surface of tongue. The lesion has increased progressively in due course of time. On mucosal examination, dilated tortuous vessels were seen along the undersurface of the tongue. Examination of the skin, hair and other mucosal surfaces were normal. There was no history of bleeding from the site and there was no evidence of any associated systemic disease. Discussion: The increase elderly population is real challenge and requires that the dental practitioner is fully aware of prevailing oral changes in this particular age group [4] in order handle them properly. Oral lesions are strongly age related, as there is an increase in severity and prevalence with increased [5] age. Varicosities of the ventral surface of the tongue represents a common oral ? nding in old [6] age. Caviar tongue is a widely used name that has been given to them, given its typical feature of multiple, round little masses of purplish blue [7] colour. However, it has been given several denominations, including phlebectasia linguae, caviar tongue, spots or lesions,[8] lingual and sublingual varicosities.[9]Colby et al. in 1961 found that people with varicosities of the legs were more [10] likely to develop varicosities on the tongue. Due to trauma, varicosities located on the lips or buccal mucosa sometimes requires treatment. Few modalities of treatment of oral varicosities are described in the literature. Tal and Gorsky[11] reported a management of mucosal varicosities with cryosurgery. Sclerotherapy is another choice in such cases. Sclerotherapy is an effective and conservative technique for the treatment of benign 2018/Vol.3/Issue 1 | 31 |



vascular lesions. Sclerotherapy is a safe and efficient treatment for vascular benign lesions [12] located in various regions of the body. In our case the patient was counseled about the benign nature of the disease and that is common in the elderly; no treatment was given. References: 1. Kleinman HZ. Lingual varicosities. Oral Surg Oral Med Oral Pathol 1967; 23:546-8. 2. Cavalieri-Gomes C, Santiago-Gomez R, Vieira-do Carmo MA, Henriques Castro W, Gala-García A, Alves-Mesquita R. Mucosal varicosities: case report treated with mono ethanolamine oleate. Med Oral Patol Oral Cir Bucal 2006; 11: 44-6. 3. Manley HJ, Bailie GR, Eisele G. Bilateral renal cortical necrosis associated with cefuroxime axetil. Clin Nephrol 1998; 49:268–70. 4. Ettinger RL. The unique oral health needs of an aging population. Dent Clin North Am 1997; 41: 633–49. 5. Ettinger RL, Manderson RD. A clinical study of sublingual varices. Oral Surg Oral Med Oral Pathol 1974; 38: 540–5.



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6. Pemberton MN. Sublingual varices are not unusual. BMJ 2006; 333: 202. 7. Kocsard E, Ofner F, D'Abrera VS. The histopathology of caviar tongue. Ageing changes of the undersurface of the tongue. Dermatologica 1970; 140: 318–22. 8. Bean WB. Vascular Spiders and Related Lesions of the Skin. Spring? eld, IL: Thomas, 1958. 9. Lazos JP, Piemonte ED and Panico RL. Oral varix: a review. Gerodontology 2013:1-8. 10. Colby RA, Kerr DA, Robson HBG. Color Atlas of Oral Pathology, 2ed, Philadelphia: J.B. Lippincott Company; 1961. p.125. 11. Tal H, Gorsky M. Cryosurgical treatment of a buccal varix. J Oral Med 1987;42:63-5. 12. Choi YH, Han MH, O-Ki K, Cha SH, Chang KH . C r a n i o f a c i a l C a v e r n o u s Ve n o u s Malformations: percutaneous scleroterapy with use of ethanolamine oleate. J Vasc Interv Radiol 2002;13:475-82.



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