62 SECTION II  Disorders of the Upper Respiratory Tract and Oropharynx
Figure 11-1 Common Oral Lesions.
Recurrent aphthous ulcer
Median
rhomboid
glossitis
tory cascade specically acting against interleukin-3. These
are applied to the ulcer two to four times daily until healing
occurs. Topical corticosteroids are also used in treatment.
When applied directly to the dried ulcer or area of pro-
dromal pain and paresthesia, they reduce the duration of
the lesion, but they do not affect the frequency of recur-
rence. Intralesional steroid injections and systemic corti-
costeroids are reserved for more persistent cases of major
RAUs. Thalidomide has been shown to decrease lesion
duration and disease-free time in refractory RAUs. However,
this treatment has severe side effectsteratogenicity and
peripheral neuropathywhich have limited its use.
Infectious Lesions
Viral Stomatitis
Herpes Simplex
Herpes simplex is the most common organism causing viral
stomatitis. Initial exposure to herpes simplex virus (HSV)
usually occurs during childhood. After resolution of the
initial infection, the virus remains latent in the trigeminal
ganglion. Primary infection is often asymptomatic. When
Lichen planus
symptoms occur, they typically include the sudden onset
of 1- to 2-mm vesicles bordered by an inammatory, ery-
thematous base associated with fever. These lesions rupture
to form ulcers. Primary oral HSV lesions tend to involve
the buccal mucosa. Recurrent disease is usually conned
to keratinized areas, like the lips or perioral areas. The
ulcers undergo spontaneous healing in 10 to 14 days.
Recurrent oral herpes is not associated with fever and may
be incited by exposure to sunlight, trauma, and emotional
stress. Most patients develop pain, burning, and tingling
about 24 hours before the appearance of recurrent lesions.
The differential diagnosis of these lesions is similar to that
of aphthous ulcers. The diagnosis is generally clinical but
may be conrmed by identifying multinucleated giant cells
on a Tzanck smear. Viral culture from lesions is the gold
standard for diagnosis.
OPTIMUM TREATMENT. Most immunocompetent indi-
viduals with recurrent herpes labialis do not require treat-
ment other than the occasional use of local analgesics.
Steroid treatment is contraindicated. Systemic acyclovir
may shorten episodes and increase disease-free intervals
but works when the virus is most active, which is usually
 11  Common Oral Lesions 65

Figure 11-2 Common Oral Lesions.

Torus palatinus
Mucocele of lip
Papillomas of soft palate and anterior pillar

Figure 11-3 Common Oral Lesions.

Fibroma Geographic tongue

Hairy tongue

Fibromas the tongue. Hairy tongue has a characteristic appearance

and is treated by reassuring the patient of the benign nature
Fibromas are soft, tan or pink lesions found at sites of
of the condition. Some improvement of appearance can be
repetitive trauma, typically on the buccal mucosa or lateral
achieved by daily scraping of excess keratin and debris off
tongue. Recurrent trauma results in chronic inammation
the area (Fig. 11-3).
and brous hyperplasia. Excisional biopsy is diagnostic and
therapeutic (see Fig. 11-3).
Geographic Tongue
Hairy Tongue
Geographic tongue, or benign migratory glossitis, is a
Hairy tongue is a benign condition caused by accumulation benign condition characterized by areas of smooth atrophy
of keratin and commensal bacteria on liform papillae of on the tongue, with loss of papillae. This leads to ulcer-like