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: Case Report:

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.
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

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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.
| 32 | Journal of Himachal IDA
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 K-
H . 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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