Phlebectasia linguae

A 55-year-old male was referred from dental outpatient department with asymptomatic and blue-colored lingual swellings for 2 years. There was no history of bleeding from the lesions. There is no history of trauma or dental procedure before onset of lesions. The patient was non-smoker and non-alcoholic. There was no evidence of any associated systemic illness. Examination revealed presence of multiple, round to oval shaped, purplish-blue-colored masses over the ventral and dorsal surface [Figure 1a] along with bluish dilated tortuous vessels on the undersurface of tongue [Figure 1b]. HPE could not be performed as the patient denied biopsy.

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Figure 1:

(a) Multiple, round to oval shaped, purplish-blue-colored masses over the ventral and dorsal surface and (b) bluish dilated tortuous vessels on the undersurface of tongue.

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It is also known as caviar tongue or sublingual varices characterized as benign vascular dilatations, usually asymptomatic and present over the ventral surface of the tongue. The incidence increases with increasing age due to senile elastotic degeneration and weakening of the vessel walls, affecting 10% of the population over the age of 40 years. It should be differentiated from venous malformation (congenital), hemangioma, lymphangioma, blue rubber bleb syndrome, and melanoma. Histology of Caviar tongue reveals a dilated vein with no inflammatory changes. Treatment is usually not required and the patient should be reassured about the benign nature. Surgery or sclerotherapy can be done for cosmetic purpose or for lesions at trauma prone sites.