Syphilis

Various syphilitic lesions are met with in the mouth, ranging from slight inflammation to deep ulceration.

It is not uncommon to meet with a Primary chancre on the lip. In that case there is a prominent tumour which has, in more than one instance, been taken for an epithelioma. On microscopic examination the tumour is found to consist of immense aggregations of round cells which may be altogether beneath the epithelium (see Fig. 123, p. 296, which is from a chancre of the lip excised under the belief that it was an epithelioma).

The Catarrh which accompanies the Secondary stage is often very slight, but it may be accompanied by superficial ulceration of considerable extent. Mncous patches, Flat condylomata, or Warts, are particularly frequent in the mouth, and they often break down and form superficial ulcers, especially on the lower lip and at the angle of the mouth.

The deeper ulcers arise in connection with Gummata. which form in the substance of the mucous membrane, and may lead to very serious loss of substance. If healing occurs a cicatrix forms, but cicatrices sometimes occur without ulceration having taken place, the gumma itself giving place to a cicatrix. The gummata not infrequently have their seat deep in the substance of the tongue, and the resulting cicatrices, with or without ulceration, may produce very marked deformity of this organ.

Tuberculosis is uncommon in the mouth. It may extend from the skin in Lupus, and in that case sometimes produces considerable ulceration. Tuberculosis of the tongue is the most common form of buccal tuberculosis. There maybe a somewhat deep-seated infiltration, so that tubercles are present even amongst the muscles, Interstitial inflammation may cause considerable induration of the tongue. Ulceration almost invariably occurs. There may also be considerable caseous masses in the substance of the tongue.

Leprosy also frequently affects the mucous membrane of the mouth, and Glanders occasionally manifests itself here.

Tumours Proper

These are of somewhat frequent occurrence and considerable variety. We meet rarely with fibromas, lipomas, and enchondromas. Eather more common are Glandular tumours of the lips. These take origin in the mucous glands of the lips, and frequently become converted into mucous or colloid Cysts. They form prominent rounded tumours, sometimes as large as a hazel nut, and are readily enucleated.

Warts occur on the lips, especially at the edges. In that situation they are mostly hard, while those on the proper mucous membrane are soft. Not infrequently the wart ulcerates, and, it is said, may give origin to a cancerous tumour. Warty outgrowths also occur on the tongue. The papillae of the tongue sometimes undergo great elongation, especially their epithelial layers, and we may have a condition as of hairs on the tongue, often associated with " Black Tongue".

The Angioma is met with chiefly on the lips, usually in the form of the nsevus. It occurs either as the cavernous or capillary angioma, and forms flat elevations or rounded prominent tumours. It occasionally occurs on the tongue.

The Lymphangioma is a cavernous lymphatic tumour, which occurs chiefly in the tongue, and in some cases contributes to the formation of macroglossia. The whole tongue may be permeated with dilated lymphatic vessels.

Macroglossia is a condition in which the tongue is greatly increased in bulk, the enlargement being nearly always congenital. It is frequent in cretins. Even at birth the tongue may be too large for the mouth and project beyond the lips. Afterwards it may increase still more, and, as the child grows, it may displace the alveolar processes considerably. For the most part there is no hypertrophy here except of the interstitial connective tissue, but evidences of new-formation of muscular tissue have been observed. As a rule, the lymph spaces of the hypertrophied connective tissue are greatly enlarged, and there is even a formation of cavernous tissue, the spaces of which are filled with lymph. In this way we may speak of lymphangioma cavernosum as taking part in the condition. It will be observed that the condition here somewhat resembles that in elephantiasis, there being in both cases a great new-formation of succulent connective tissue with wide lymph spaces. The resemblance is further indicated in the fact that the lips frequently hypertrophy as well (Macrochelia).

Sarcomas rarely develop in the mouth itself, although they have been met with in the tongue.

On the other hand, it is not uncommon to find a Myeloid sarcoma of the jaws, growing from the periosteum and projecting into the mouth. This is the commonest form of Epulis, a name given generally to tumours which arise from the alveolar processes of the jaws. They are mostly composed of spindle-cells, but nearly always contain Giant-cells, and sometimes these are in large numbers. Osseous trabecular frequently pass into them from the bone. As these tumours grow they push the mucous membrane of the gums before them and so form red prominences of a rounded form, behind, in front of, or between the teeth. They are generally of dense consistence. The teeth are often considerably displaced by them as they grow, especially when they assume large dimensions, as sometimes happens.

Cancers of the mouth are nearly all Flat-celled epitheliomas. They are of very frequent occurrence on the lower lip and are also common in the tongue.

Epithelioma of the lip is almost confined to the male sex. This is frequently ascribed to the fact that in men the lips are more frequently exposed to irritation by smoking short pipes and in shaving. The tumour which has almost always its seat on the lower lip, is in the form of a superficial infiltration which soon goes on to ulceration. There may thus be great destruction of the lip struotures. The structure is that of the typical epithelioma, of which this is the most frequent seat.

In the tongue the epithelioma usually forms at the edge, and it is often attributed to the irritation of the sharp edge of a carious tooth. There is here also usually a superficial ulcer, but the tumour generally penetrates deeply into the substance of the tongue. There may also be considerable irritation of the tongue and new-formation of connective tissue so that the structure may resemble that of a scirrhus. As the epithelium of the tongue does not become horny, we scarcely have the typical laminated capsules of the ordinary flat-celled epithelioma. Epithelioma, we have already seen, occurs frequently in leucomatous tongues (see Fig. 385).

Secondary epitheliomatous formations are liable to occur in the submaxillary lymphatic glands, and may extend to the glands of the neck.

Ranula is a name applied to cysts which form beneath the tongue. These mostly arise as retention-cysts from closure of Wharton's duct (duct of the submaxillary gland), or one of the ducts of the sublingual gland, but they may take origin in the mucous glands. Before the occurrence of the cyst there is usually some inflammation of the floor of the mouth very often connected with affections of the teeth.

According to the observations of Recklinghausen referred to at p. 236, the cyst arises by dilatation of the duct, while the gland structure persists and furnishes the material by whose accumulation the cyst forms (see Fig. 94, p. 236).

Literature

Bohn, Mundkr. der Kinder, 1886, and in Gerhardt's Handb. d. Kinderkr., iv.; Hirsch, (Noma) Hist, and geogr. path. (Syd. Soc. transl.), iii., 272; West, Dis. of infancy and childhood, 7th ed., 1884; Bruns, Handb. d. oper. Chirurg., 1859; Kraus, Die Erkrank. d. Mundhohle, etc., Nothnagel's Spec. Path. u. Ther., xvi., 1897; Kehrer, Soorpilz, 1883; Plaut, Soorpilz, 1885; Grawitz, Virch. Arch., lxx., lxxiii.; Nedopil, (Leucoplakia, with literature) Arch. f. klin. Chir., 1877, Band xx., p. 324; Schwimmer, Vierteljahrschrift f. Derm. u. Syph., 1877, p. 511; Hulke, (Ichthyosis) Trans. Clin. Soc. Lond., vol. ii., p. 1; Butlin, Diseases of the Tongue, 1885; Lang, Path. u. Therap. d. Syph., 1885; Hutchinson, Syphilis, 1887; Hansemann, (Tuberculosis) Virch. Arch., ciii.; Schliferowitsch, (with literature) Deut. Zeitschrift f. Chirurgie, 1888, B. 26, s. 527; Virchow, (Macroglossia) Gesch-wiilste, ii.; Arnstein, Virch. Arch., liv., 1872; Billroth, Path. Hist., 1858; Recklinghausen, Virch. Arch., lxxxiv., v., 1881; Scheier, (Sarcoma) Ber. klin. Woch., 1892.