Pathologic dilatations of veins or venules are varices or varicosities, and the chief site of such involvement in the oral tissues is the ventral tongue.Varicosities become progressively prominent with age; thus, lingual varicosities are encountered in elderly individuals. Lingual varicosities appear as tortuous serpentine blue, red, and purple elevations that course over the ventrolateral surface of the tongue, with extension anteriorly. Even though they may be quite striking in some patients, they represent a degenerative change in the adventitia of the venous wall and are of no clinical consequence. They are painless and are not subject to rupture and hemorrhage.
A focal dilatation of a vein or group of venules is known as a varix (Figure 6-1). These lesions also tend to occur in elderly persons and are primarily located on the lower lip, appearing as a focal raised pigmentation. They may be blue, red, or purple, and the surface mucosa is often lobulated or nodular. Whereas some can be blanched, others are not, due to the formation of intravascular thrombi. The varix resembles the hemangioma both clinically and histologically, yet it is distinguished by two features: (1) the patient’s age at its onset and (2) its etiology. As previously mentioned, a hemangioma is usually congenital and has a tendency to spontaneously regress whereas a varix arises in older individuals and, once formed, does not regress. Alternatively, a varix has a finite growth potential; once a varix has formed, further enlargement is uncommon.Whereas hemangiomas are vascular hamartomas of unknown etiology, the varix represents a venous dilatation that may evolve from trauma such as lip or cheek biting. The traumatic event probably damages and weakens the vascular wall and culminates in dilation.
Microscopically, varices resemble cavernous hemangiomas. They may be represented by a single dilated vascular channel lined by endothelial cells lacking a muscular coat, or they may comprise numerous tortuous channels. Most show intraluminal thrombosis, and the thrombi show evidence of organization and canalization.
Varices of the lips and buccal mucosa may be unsightly and may interfere with mastication. The lesion can be excised or removed by other surgical methods, including electrosurgery and cryosurgery. Intralesional 1% sodium tetradecyl sulfate injection is effective as well, yet it is usually more painful than simple excision. This sclerosing agent should be injected directly into the lumina with a tuberculin syringe (depositing .05 to 0.15 mL/cm3).
Varices of the lips and buccal mucosa may be unsightly and may interfere with mastication. The lesion can be excised or removed by other surgical methods, including electrosurgery and cryosurgery. Intralesional 1% sodium tetradecyl sulfate injection is effective as well, yet it is usually more painful than simple excision. This sclerosing agent should be injected directly into the lumina with a tuberculin syringe (depositing .05 to 0.15 mL/cm3).
