Year : 2006 | Volume
: 10 | Issue : 1 | Page : 15--16
Unusual presentation of palatal varicosities
S Susmita, K Mandeep, S Anushree
Department of Oral Pathology, Subharati Dental College, Meerut, Uttar Pradesh, India
Department of Oral Pathology, Subharati Dental College, Subhartipuram, Meerut, Uttar Pradesh
Varix is a dilated, tortuous vein, most commonly a vein which is subjected to increased hydrostatic pressure but poorly supported by surrounding tissue. Most commonly it involves lingual ranine veins on the tongue. In this article, an exceptionally rare and unique case of varicosities of the palate including uvula has been reported.
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Susmita S, Mandeep K, Anushree S. Unusual presentation of palatal varicosities.J Oral Maxillofac Pathol 2006;10:15-16
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Susmita S, Mandeep K, Anushree S. Unusual presentation of palatal varicosities. J Oral Maxillofac Pathol [serial online] 2006 [cited 2020 Jul 11 ];10:15-16
Available from: http://www.jomfp.in/text.asp?2006/10/1/15/37754
Varicosities are abnormally dilated and tortuous veins. They are relatively trivial but common vascular malformations when seen in the oral mucosa. Age appears to be an important etiologic factor as they are common in older adults. Varices involving the ventral aspect of the tongue are common developmental abnormalities. Less frequently varices occur in other areas of the mouth .
We herewith present a bluish-red lesion of the palate, that blanched on pressure. This lesion was due to varicosities of the greater palatine vasculature. To our knowledge, there is no reference to palatal varicosities in the literature.
A 59-year-old male edentulous patient reported with asymptomatic discoloration of one half of the hard and soft palate including uvula [Figure 1]. Presence of prominent bluish blood vessels with tortuosity was seen. The lesion blanchee on pressure [Figure 2] and [Figure 3]. Patient had no discomfort and there was no history of increase in size. Medical history did not reveal any systemic disorder or blood dyscrasia. Patient was absolutely unaware of it. Thus we would describe this case as palatal varices arising from varicosities of greater palatine vasculature.
A varicosity is a condition indicating an enlarged and tortuous vein, artery or lymph vessel. Intraorally, varicosities are seen as purple to red shot like clusters. Varicosities observed by the dentist and physicians have been related to age, tissue relaxation, and increased venous pressure. These entities have been noted on the lateral border of the tongue and the floor of mouth mostly in persons of 40 years and above. It is occasionally seen in cheeks and lips .
Ettinger and Mandersen confirmed that the incidence of varicosities increases with age . Koscard and coworkers concluded that diminished elastic support to capillaries, associated with age, allowed the capillaries to dilate and varicosities to form. Elastic fibres are less numerous in gingiva than in more mobile mucosa such as cheek, floor of mouth, and ventral surface of tongue. They are more numerous in the skin of adult than in skin of infants .
Elastic fibres tend to be less numerous in palate also and it is possible that they may decrease with age.
Da costa and Cramer suggested that in a venous system without valves, as found in the tongue, coughing may cause an intermittent increase in venous pressure and this may be a contributing factor in the etiology of varicosities. Schaffer suggested that respiratory or cardiovascular disease with associated pulmonary hypertension was also an etiologic factor, but Burket could not substantiate this relationship. Bhasker in a study was unable to find a correlation between varices and hypertension and liver cirrhosis .
A relationship between chronic vitamin C deficiency and lingual varicosities has been suggested. Taylor considered vitamin C deficiency to be a cause of senile purpura which in the tongue he called sublingual petechial haemorrhage. The palatal petechie could be due to tonsillitis, infectious mononucleosis, etc. But in our case all these disorders were ruled out. There might be a decrease in vitamin C concentration as measured in white cells in the elderly which was stated by Tattersall and Servile and Andrews and Brook. They also stated that senile purpura was not related to sublingual petechia .
The literature provides a variety of names for the condition observed such as sublingual varices, phlebectasia linguae, caviar lesions, and linguae varicosities. They are benign and acquired. No direct association was established between varicosities and other specific organic disease, as seen in our case. Varicosities in the younger age groups might indicate premature physiologic change.
In discussing the genesis of varicose veins of the leg, King commented that vessels of capillary size may develop the characters of large vessels when they become dilated for a period, so that the varied structure of the walls of the dilated sublingual vessels is likely to have followed and not preceded formation .
So, it is possible that palatal varices could develop by a hemodynamic mechanism from an increased AV blood flow transmitting arterial pressures to the venous part of the circulation with dilation of greater palatine vasculature and secondary morphologic changes in their walls. Estimation in the oxygen and carbon dioxide tension in the blood in the varices could be important in the confirmation of such mechanism.
Varicosities are a type of acquired vascular malformation that represents focal dilation of single vein. They are commonly seen in the ventral aspect of tongue and occasionally cheeks and lips. An exceptionally rare case of palatal varicosities including uvula was reported here. It is an age-related condition. They are typically blue and blanch with compression. Thrombosis, which is insignificant in these lesions occasionally, occurs, giving them a firm texture. No treatment is required for a venous varix unless it is frequently traumatized or is cosmetically objectionable.
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