Lingual thyroid nodule

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2nd lab session

lingual thyroid nodule :
- has well-defined boarders
-how to confirm your differential diagnosis (how to confirm that this is a thyroid nodule) :
by using radioactive iodine; if it was uptaken by this dome shaped lesion we diagnosed as lingual thyroid nodule then this will confirm our diagnosis
-hot spot : the spot where iodine was uptaken

-other routs of treatment of this lingual thyroid nodule are :

1- surgical removal (even if there is no other thyroid tissue in the neck ) this surgical removal is accompanied with hormone replacement therapy .
2- the surgeon may remove it from the tongue and re-implant it in the neck .

fissure tongue:
-oriented laterally from midline or from the center to the periphery.
-clinical significance :
1. Some fissures maybe very deep so food impaction will occur followed by inflammation and sharp burning sensation.
2. The patient may show sensitivity upon consumption of acidic and spicy food leading to burning sensation .
-increases with age (the dr didn’t explain further )
-fissure tongue is associated with bad oral hygiene that may lead to bad mouth smell but not to carious lesions.
-etiology : unknown

geographic tongue:
-we don’t always find clear whitish boarders in geographic tongue especially when the lesion is near the lateral boarder of the tongue.
-etiology : unknown
-needs no active managements.
-student : when geographic tongue happens in other parts of the body we call it erythema migrans
Dr : does it affect other parts of the body or you mean the oral cavity ?
student: oral cavity
Dr : right it may occur on buccal mucosa for example
**** I will ask about this point I think the dr meant that the geographic tongue doesn’t hit other locations outside the oral cavity !!!!

- 20% of people with fissure tongue have geographic tongue

- fissure tongue is more widespread than the geographic tongue.
- Reiter syndrome: the Dr asked about this syndrome, someone answered, I couldn’t hear the answer so I googled it :
** Reactive arthritis (Reiter's syndrome or Reiter's arthritis), is classified as an autoimmune condition that develops in response to an infection in another part of the body (cross-reactivity). Coming into contact with bacteria and developing an infection can trigger the disease.[1] Reiter's syndrome has symptoms similar to various other conditions collectively known as "arthritis". By the time the patient presents with symptoms, oftentimes the "trigger" infection has been cured or is in remission in chronic cases, thus making determination of the initial cause difficult.

The manifestations of Reactive arthritis include the following triad of symptoms: an inflammatory arthritis of large joints including commonly the knee and the back (due to involvement of the sacroiliac joint), inflammation of the eyes in the form of conjunctivitis or uveitis, and urethritis in men or cervicitis in women. Patients can also present with mucocutaneous lesions, as well as psoriasis-like skin lesions such as circinate balanitis, and keratoderma blennorrhagica. Enthesitis can involve the Achilles tendon resulting in heel pain.[2] Not all affected persons have all the manifestations, and the formal definition of the disease is the occurrence of otherwise unexplained non-infectious inflammatory arthritis combined with urethritis in men, or cervicitis in women

- Geographic tongue IS NOT oral manifestation of psoriasis otherwise all people with psoriasis will have geographic tongue.

- The histology of boarders of the lesions in the geographic tongue look like those in psoriasis and due to similar histology some people linked these disturbances together.

- geographic tongue is also called Erythema migrans:

because the lesions have periods of remission; in some areas the lesions change their morphology by getting smaller in size and even undergo healing, in other areas new lesions will develop thereby the map will be rearranged and the patient will think that the new lesion is an old one and it moved from one location to another which is wrong
- In geographic tongue cases almost always the lesions appear on the dorsum of the tongue but in very rare cases it may develop on the floor of the mouth.
- In some stages the geographic tongue may appear as a single lesion so not always as multiple ones.

Median rhomboid glossitis :

-“ Median” because it appears in the midline of the tongue .

- Not always rhomboid but even if it has another shape we do call it median rhomboid glossitis
- Glossitis: inflammation of the tongue
- the papillae that undergo atrophy here is filiform papillae (not sure)
- Not all the cases of median rhomboid glossitis are candida infection

Median rhomboid glossitis

geographic tongue

Single lesion

Could be Multiple lesions

Specific location mentioned in the sheet

On dorsum of the tongue but no specific location

No whitish boarders

Whitish boarders

Etiology : we have 2 theories

Unknown etiology

One location ( dr said we can consider this point and the 3rd point as one point)


Could be associated with kissing lesions

Not associated with kissing lesions

Persistent chronic lesion

There is healing or remission periods so the lesions go away then might come back again .

- Histology: like histopathology of candidal infection ;

1-you will find bulbous rate ridges meaning we have acanthosis in the epithelium only in the places where we have rate ridges but between rate ridges we have very thin epithelium .
2- We see inflammation and increase in vascularity
this is why it appears red in color.
3- In the epithelium (under certain magnification and using specific stains ) you will find candida hyphae with neutrophil micro abscesses around them .


-In case of lateral incisor: it’s conical shaped or wedged shaped or pig shaped lateral incisor.

-aesthetic complications, drifting of teeth thereby affecting occlusion; midline shift.
-localized microdontia is not associated with diseases.
- Generalized true microdntia is associated with generalized spacing between teeth

- how can you differentiate this from fusion of teeth ?
fusion of teeth will have a mark of fusion like a notch for example plus teeth have separated (in the case of fusion ) crowns or roots .


- if the supernumerary tooth didn’t erupt the patient may have median diastema.
- Complications: malocclusion, periodontal disease and inflammation in gingiva or even caries in the areas between the extra tooth and the adjacent teeth if it’s difficult to be cleaned.
- a rare case but it was reported : they found a tooth that looks like a mesodense in the mandible.
**regarding permanent dentition:
-upper canines impaction: because upper 1st premolar and upper lateral incisor erupt before the canine this tooth will show impaction issues like if there is lack of space the premolar and the lateral incisor will erupt and occupy the space they need since both erupt before the canine and when time comes for the canine to erupt (11-12 yrs.) It will find no space and impaction will occur.
-lower canines erupt at (9-10 yrs.) and lower premolars erupt after that (10-11 or 11-12 yrs.) AS MENTIONED BY THE DR so in case we have lack of space in the lower arch the tooth that will be affected is the 2nd premolar.
-surgical intervention is not necessary in all the cases of impaction.

-a scalloped incisal edge indicates newly erupted permanent teeth.

Supernumerary teeth:
-are called supplementary when they look like permanent teeth, the supplementary teeth may have same morphology but different size when compared to permanent teeth.
- Complications: crowding, some areas are difficult to clean, calculus.

-In Gardner syndrome the patient have colon problems as mentioned in the sheet this problem is colon polyposis ; hundreds of polyps in his colon, this syndrome may also be associated with skin fibromas, lipomas, and osteomas.

-before you diagnose a case as hypodontia or anodontia make sure you take the history and check for extraction of teeth and take a radiograph to make sure the teeth are not impacted.
- Patients with cleidocranial dysplasia have dry shiny smooth skin , fine scattered hair .

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