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What Causes Pain And Irritation At The Base Of Tongue Along With A Lesion?

Posted on Tue, 7 Jun 2016

Question: Dear Dr.

- 35 years male

- Ex-Smokers & Drinker “From May 2009 to October 2015”

My story started in August 2015 when I felt “irritation and mild pain” in the base of the tongue. The pain and irritation was not continuous but I felt them from time to time. I have not looked in the base of my tongue until Mid-December 2015 where I found elevated lesion “Look-like papilla” and one of these papilla was cracked (I believe it was the source of irritation and mild pain” … Please check the attached picture.

I have tried several medication to treat these lesion, however, all of them have failed. The medications I have taken are as below:

1. Gengigel (Hyaluronic Acid)

2. Aloclair Plus Oral Rinse

3. Kenacort A Orabase

4. Miragel "Oral Gel"

5. 2 courses of anti-biotics “10 days each”

In the beginning of February 2016, I went to ENT consultant / Head and Neck Surgeon who suggested biopsy. The diagnosis was “Benign stratified squamous epithelium with viral cytopathic changes and lymphoid follicular hyperplasia” … what does this means?

As you can see in the attached report / microscopy, “stratified squamous epithelium exhibiting Koilocytosis” .. Does this means I am infected with HPV for sure? Does Koilocytosis indicate transformation to malignant lesion in anytime?

Now, 10 weeks post-biopsy, the biopsy wound have not been recovered totally. In fact, I am still feeling some irritation and mild pain in the biopsy site and under to tongue-right side. The wound looks like an ulcer “PLEASE SEE ATTACHED PICTURE”. I have tried several treatments to have it cured but with no improvement.

1. Betadine - Mouthwash / gargle

2. AVOHEX mouthwash

3. Miragel "Oral Gel"

4. Gengigel (Hyaluronic Acid)

5. ROTVEX Solution for Oral Ulceration

6. Sporanox "Oral Capsules"

DOES it look cancerous? DO I need another Biopsy? is there any other recommended treatement?

Answered by Dr. Honey Arora (51 minutes later)

Brief Answer:
Seems like Viral Infection, no need of another bio, consult Oral Surgeon..

Detailed Answer:
Hi..
Welcome to HEALTHCARE MAGIC..

I have gone through your query and can understand your concerns..

As per your complain the biopsy report is looking consistent of Viral infection like Human Papilloma Virus..

Now let me explain in brief about your Biopsy report..

Benign Stratified Squamous Epithelium with Viral cytopathic changes means firstly that you have a benign condition that means it's Non Cancerous..

Secondly Koilocytosis means formation of Koilocytes which are altered cells with changed structure that has a changed cellular body and nucleus and occurs commonly due to Papilloma Virus..

So as of now you do not seems to have cancer rather looks like Viral infection..
Papillomas if left untreated can in few causes transform into cancers but right now you do not have cancer..

I would therefore suggest you to consult an Oral Pathologist or an Oral Surgeon for a correlation between clinical and histopathology finding and get the treatment initiated..

Any further questions are welcome..

Hope this information helps..

Thanks and regards.
Dr.Honey Nandwani Arora.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Honey Arora (39 minutes later)

Thank you Dr. Honey Nandwani XXXXXXX for your prompt response. I still have some questions

1. How long does it usually take for tongue biopsy wound to be totally recovered?

2. Does Koilocytosis indicate only Human Papilloma Virus OR it could be herpes virus or other viruses.

3. Does my base tongue look abnormal? providing that I did a biopsy 10 weeks ago?

4. Is it normal that the viral infection persist for long time?

5. What do you think the available treatment approach for such viral infection? does it include Laser / Nitrogen / excision of the lesion?

One more think the lower white lump (PIC - 10 weeks after biopsy) feels very hard.

6. In your opinion, what is the white lump? is it WBC fighting the infection? why is it so hard?
Thank very much for your prompt response

Regards,

Answered by Dr. Honey Arora (13 hours later)

Brief Answer:
Answers are detailed below..

Detailed Answer:
Hi..
Welcome Again..

I have answered your questions point wise below..

1.Tongue Biopsy wound must have resolved in a week to ten days; but lasting since six weeks is not normal..

2. Koilocytes are commonly formed due to Human Papilloma Virus Infection..

3. Base of tongue does not look very much abnormal..

4.Yes, Viral infection especially Human Papilloma Virus Infection if not treated initially can last for months and even years, but care should be taken as they can keep progressing and can even become Cancerous..

5. There are multiple treatment modalities available like Freezing or Cryotherapy, lazer, Nitrogen, light therapy and surgical excision of warts but treatment will be decided to after a thorough clinical evaluation by an Oral Surgeon..

6.White lump seems to be like Mucous Cyst or Mucocele or can be inflamed minor salivary gland. It does not directly related to WBC cells.

Hope this information helps..

Any further questions are welcome..

Regards..

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Honey Arora (6 hours later)

Thank you Dr. Honey for your response.

I still have some questions. I uploaded 3 pictures as follow:

First Picture: Left tongue base
1. On left tongue base, I have some enlarged papilla as well ... Do you think I need to also biopsy?
2. Do they look Abnormal? Do they look like viral infection?

Second Picture: White batch -cheek
3. I have noticed this white color inside my cheek .. what is it?
4. Is it thing I need to worry about?
5. How can it be treated? If needed

Third Picture: Lip blister
6. What does cause these small white blisters / dots on my lips? It has been there for a year
7. Do I need to worry?
8. Can it be Herpes?

Thank you very much

Answered by Dr. Honey Arora (7 hours later)

Brief Answer:
Answers detailed below..

Detailed Answer:
Hi..
Welcome back..

As per your images and queries it seems that the papillae are too much enlarged but you have sent images that are too close and understanding the exact nature and location of the growth/ lesion is not getting easy and precise..
So I would like you to please send me the images clicked from a bit far so that I can atleast observe the location and size of the lesions appropriately..

As per this picture the papillae are appearing too much enlarged and a biopsy must be done for confirmation of the exact cause of the enlargement..

Secondly the white patches on cheeks seems to be due to hyper keratosis or excess keratin deposition leading to Leukoplakia..
This too needs a biopsy for confirmation..
It can be treated with multivitamins, antioxidants and cessation of the mal-habits like tobacco, smoking etc, in case if you have any..

Thirdly the bumps over the lips seems like clusters of blisters and can be herpes virus infection causing cold sores but they generally recover in a 2 week time and can although recur..
It also needs proper evaluation and investigations like microscopic examination of scrapings from the lesions and blood tests for diagnosis..

I would still request you to send me the images clicked from a bit far and clearer so that evaluation becomes a bit more precise..

Regards.

Above answer was peer-reviewed by : Dr. Naveen Kumar

Follow up: Dr. Honey Arora (11 hours later)

Thank you Dr. Honey XXXXXXX for your response.

I have taken other pictures form from and I hape they are clear enough.

With regards to the blisters, they have been there for long time and they do not hurt at all.
One more thing, I have this hairy tongue with thick white coating on it. I have been using:
- differnt mothwash
- Gel for anti-funual
- Tongue scrper

Howerver, it is peristent. whenever I clean the tonuge, it just comes in the same day. what are the causes of the hairy tongue with thick white coating.

Thank you very much

I am waiting your your valuable responses.

Answered by Dr. Honey Arora (4 hours later)

Brief Answer:
Blisters might be fordyce's spots,white coating might be Thrush..

Detailed Answer:
Hi..
Welcome Back..

As per the images attached and the description the blisters on your lips that are painless seems to be fordyce's spots that are raised sebaceous glands and are not pathological but are normal anatomical structures..

So need not to worry about it..

Secondly the lumps on the side of tongue seems to be enlarged papillae along with swollen lingual tonsil and all this can be due to infection..
As the infection will subside they will resolve..

In case if they do not show any signs of improvement even with a period of 15 days, you might need a biopsy..

Lastly the thick white coating on tongue can be most probably yeast infection known as Oral thrush but for a better evaluation please send an image of the top or dorsal surface of the tongue..

In case if it is due to thrush and is not resolving with antifungal mouthwash and gel then you might need an oral dosage of antifungal medications along with taking antifungal lozenges like Clotrimazole and plenty of probiotics like Yoghurt and garlic..

Any further queries are welcome..

Wishing you a good health..

Regards..

Above answer was peer-reviewed by : Dr. Deepak

Follow up: Dr. Honey Arora (17 hours later)

Dear Dr. Honey XXXXXXX

Thank you for your response.

The lumps on the side of tongue are persistent for few months and biltarally. This one (left side) is painless and a little hard when I touch.

I have attached pictures of my tongue, internal cheek and floor of mouth.

I am concered about my cheek. Do you see abnormality on them?

Thank your for your response in advance.

Answered by Dr. Honey Arora (2 hours later)

Brief Answer:
Oral Thrush, Needs antifungal medicines..

Detailed Answer:
Hi..
Welcome Back..

As per your latest picture of your tongue it seems that you have a thick white coating over it and is probably yeast infection known as Thrush..
You should consult an Oral Physician and get evaluated and and he can do a proper clinical evaluation and also observe the scrapings from tongue under microscope..
If thrush is confirmed the treatment has to be proceeded as I advised in previous discussion..

Secondly if the lumps are persistent since months a biopsy has to be done for confirmation of the exact cause and nature of lesion..

Thirdly as you are concerned about your inner cheek, I have already explained you about the white patch as it looks like leukoplakia..
Please send me another clear image of your inner cheek for better evaluation..
Also please answer the following:
-Do you have any tobacco chewing or smoking habit?
-Do you have cheek biting habit?
-Since how long the white patches are present?

Any further queries are welcome..

Wishing you a good health..

Regards.

Above answer was peer-reviewed by : Dr. Sonia Raina

Follow up: Dr. Honey Arora (2 hours later)

Dear Dr. Honey XXXXXXX

Thank you for your reply.

I have smoked for about 5 years. I have not had any tobacco chewing habit. I do not smoke any more.

I do not feel I am biting my cheek but I am not sure if I do bite while i am sleeping.

It has been there for long time i guess. I first noticed that about a year ago.

More question: How does the floor of mouth look?

Thank you again for your time and valuable responses.

Answered by Dr. Honey Arora (2 hours later)

Brief Answer:
Seems like Leukoplakia..

Detailed Answer:
Hi..
Welcome again..

As far as the white patch on the cheek is concerned, it seems to me most probably like Leukoplakia and for a confirmation a clinical evaluation and investigations like Biopsy can be diagnostic..

If Leukoplakia is confirmed as the diagnosis then treatment will be followed as I advised in previous discussions..

For evaluation of floor of mouth, I would need an image with the tongue raised upwards so that the floor of mouth is clearly visible..

Any further queries are welcome..

Thanks and regards.

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Above answer was peer-reviewed by : Dr. Deepak