HAIRY POLYP on the dorsum of the tongue – detection and comprehension of its possible dinamics

ArticleinHead & Face Medicine 8(1):19 · June 2012with26 Reads
Impact Factor: 0.85 · DOI: 10.1186/1746-160X-8-19 · Source: PubMed
Abstract

The formation of a Hairy Polyp on the dorsum of the tongue is a rare condition that may hinder vital functions such as swallowing and breathing due to mechanical obstruction. The authors present the situation on a child with an approach of significant academic value. Imaging diagnostics with the application of a topical oral radiocontrastant was used to determine the extent of the tumor. Performed treatment was complete excision and diagnostics was confirmed with anatomopathological analysis. The patient was controlled for five months and, showing no signs of relapse, was considered free from the lesion. Accurate diagnostics of such a lesion must be performed in depth so that proper surgical treatment may be performed. The imaging method proposed has permitted the visualization of the tumoral insertion and volume, as well as the comprehension of its threatening dynamics.

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HAIRY POLYP on the dorsum of the tongue
detection and comprehension of its
possible dinamics
Edela Puricelli
1*
, Marinez Bizarro Barra
2
, Bruno Hochhegger
3
, Deise Ponzoni
1
, Henrique Voltolini de Azambuja
4
,
Mário Alexandre Morganti
4*
and Jorge Henrique Schmitt
5
Abstract
Background: The formation of a Hairy Polyp on the dorsum of the tongue is a rare condition that may hinder vital
functions such as swallowing and breathing due to mechanical obstruction. The authors present the situation on a
child with an approach of significant academic value.
Methods: Imaging diagnostics with the application of a topical oral radiocontrastant was used to determine the
extent of the tumor. Performed treatment was complete excision and diagnostics was confirmed with
anatomopathological analysis.
Results: The patient was controlled for five months and, showing no signs of relapse, was considered free from the
lesion.
Conclusion: Accurate diagnostics of such a lesion must be performed in depth so that proper surgical treatment
may be performed. The imaging method proposed has permitted the visualization of the tumoral inserti on and
volume, as well as the comprehension of its threatening dynam ics.
Keywords: Hairy Polyp, Computed Tomography, Benign Tumor
Introduction
Although the Hairy Polyp, also called Teratoid Polyp,
has its origins and classification hugely debated [1-3],
authors do agree that it is a benign and rare lesion. Its
essentially composed of normal tissue located at an
abnormal place, containing elements of the ectodermal
and mesodermal germ layers [1,2,4,5]; such as adipose,
glandular and muscular tissues, covered by epithelial
squamous stratified tissue.
Hairy Polyp is more frequently seen among women,
mainly newborns, scarcely happening to adults [2]. Its
presence in the tongue isnt common because, at such
location and in considerable volume, it could undermine
breathing and swallowing [2,3,5-9].
For diagnostic purposes, imaging exams such as com-
puted tomography (CT) or magnetic resonance (MRI)
might be performed. Particularly we indicated the
computed tomography with a topic radiocontrast as it
may not only detected the presence, but also the dynamics
of a tumor located on the dorsum of the tongue. This
paper, therefore, aims to describe and discuss the presence
of a Hairy Polyp in the tongue of a newborn girl, rapidly
developing into complications regarding the vital func-
tions of swallowing and breathing.
Case report
A 90 days old female patient, according to information
given by the mother, had shown progressive signs of
difficulty in swallowing and breathing, together with
repeated incidences of cough and vomiting. The
constant refusal to suck the pacifier and to be breastfed,
meant that it took a long time to feed the baby. The
medical report informed that there wa s a delay in weight
gain. At the first medical examination, a voluminous and
* Correspondence: epuricelli@uol.com.br; mpmorganti@mac.com
1
Department of Oral and Maxillofacial Surgery, Hospital de Clínicas de Porto
Alegre, (Ramiro Barcelos, 2350) Porto Alegre, RS (900350-903), Brazil
4
Department of Dentistry, School of Dentistry - UFRGS (Ramiro Barcelos St,
2492) Porto Alegre, RS (900035-003), Brazil
Full list of author information is available at the end of the article
HEAD & FACE MEDICINE
© 2012 Puricelli et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
Puricelli et al. Head & Face Medicine 2012, 8:19
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Page 1
mobile tumoral alteration was noticed on the dorsum of
the tongue, resting anteriorly, but it wasnt possible to
stipulate whether it extended to the oropharyngeal area.
A new exam was set and when the computer images
were obtained for which the patient was sedated under
spontaneous breathing a pediculated mass with a
cylindrical body could be seen (phallic). It was located
longitudinally on the dorsum of the tongue, with its base
placed in the median furrow, at an almost equal distance
between the apex of the tongue and the foramen cecum.
The lesion was mobile to any direction, composed of a
soft consistency, yielding to traction and with color and
texture similar to those of the oral mucous membranes
(Figure 1).
Computed topography images were obtained. Through
the use of a non ionic oral radiocontrastant a polipoid
lesion was clearly distinguishable on the dorsum of the
tongue, measuring 2,1cm x 0,8cm. The use of an oral
radiocontrast allowed not only for the delimitation of the
lesion's contours, but also, its dynamics, demonstrating its
movement from the dorsum of the tongue to the
oropharyngeal area, suspending the soft palate (Figure 2).
Surgery was performed under general anesthetic, using
nasotracheal intubation. A complete resection of the
pedicle was performed, involving, in depth, the fibers of
the superior longitudinal muscle of the tongue. After the
hemostasis, the procedure was concluded with layer
sutures to isolated points. The surgical specimen was
stored in a 10% buffered formaldehyde solution and sent
for anatomopathological analysis (Figure 3).
On the macroscopic examination a polypoid fragment
of light brown tissue covered by a grayish and wrinkled
mucous membrane was observed, measuring 0,8 x 0,9 x
0,8 cm. At the sections, in turn, it shows a bright light
brown color.
The microscopic examination revealed a polipoid lesion
lined with keratinizing squamous epithelium, containing
stroma, besides connective and adipose tissue, smooth
and striated muscle and salivary glands (Figure 4- a,b,c,d).
The postoperative period evolved without complica-
tions. In the five-month follow up there wasntany
recurrence and the patient, therefore, was considered free
from the lesion.
Discussion
In spite of its uncommonness, the Hairy Polyp is
recognized as a significant pathology that affects both naso
and oropharynx. Its a congenital tumor quite usual for
those areas [6]. However, there are no cases of malignancy
reported so far [10].
Figure 1 Image of the voluminous cylindrical lesion (phalic) on
the dorsum of the tongue, erect and dislocated to the anterior
portion of the oral cavity.
a
b
Figure 2 a. Computed Tomographies viewed in sagital
reconstruction and with topical oral contrast. A hyperdense
image is visible with its base on the dorsum of the tongue. b. The
tridimensional reconstruction of the lesion, visible in blue color,
demonstrates its relation to the skeletal structures.
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Displaying an approximate incidence of 1 per 40.000
births, most of the cases are considered isolated.
According to Burns , Axon and Pahade [1], the Hairy
Polyp is an abnormality of the development, and a com-
mon association with such malformation is related to
the first and second branchial arches or to the nasopha-
ryngeal membrane. For tha t reason, it could be linked to
systemic alterations, for instance, the Oral-Facial-Digital
Syndrome or Dysostosis [11], being essen tial a diagnostic
investigation.
Carranza [2] regards the term Hairy Polyp as accurate
and explanatory, for the process is considered as a devel-
opmental malformation. Its histology, though variable, is
typical, and likely to be distinguished from other lesions
that may affect the patient, dissociating itself from
malign precesses. On the contrary to the epignathus,
teratomas and trigeminal teratoids, the Hairy Polyp
doesnt have the endodermal layer in its origin [1].
The emergence of this lesion on the tongue frequently
happens with children, up to 2 years old. In spite of
appearing in different places, the Hairy Polyp is more
often seen in the anterior area of the dorsum [11]. For
Carranza [2], the obstruction of the upper airways can
be reckoned as a sign of big lesions. Thus, it must be
considered that, the large volume of the lesion reported
in this case, besides compromising the vital functions ,
also hindered the conduction of more conclusive
intraoral examinations.
Among possible imaging examination methods, there
are ultrasonographies, radiographies and magn etic res-
onance. The advantage of compu ted tomography is its
fast acquisition time, which facilitates the sedation. In
spite of that, the use of ionizing radiation is a factor that
must always be kept to a minimum necessary in these
patients. The use of iodated oral radiocont rastant, in a
reduced amount, dripped on the tongues surface, aggre-
gated the advantages of lessening the time of sedation
and exposing the area to viewing with a much higher
resolution. In addit ion, it permitted the pro mpt compre-
hension of the extension and mobility of the lesion,
which used to vary between distal and medial positions,
constantly adapting itself to the oral functions.
The subsequently possibility of multiplanar and tridi-
mensional reconstruction adds great academic value to
the acknowledgment and comprehension of this path-
ology and its anatomical associations. In this case, its
concluded that the whole outline of the process allowed
the cylindrical mass, when positioned on the anterior
part of the tongue, took on the functions of a pacifier.
At a slight swallowing provoked by the contrast used,
the lesion made a motion towards the opposite direc-
tion. Such a dislodgment, activated upon swallowing,
creates favorable conditions for breathing and ingestion
difficulties.
Its possible that suction, when the lesion is moved
anteriorly, might have sped up the growth of the lesion,
justifying the complaints and the urgency in the interven-
tion. With its body getting more and more voluminous, it
Figure 3 Image of the surgical specimen immediately after the
resection.
abcd
Figure 4 Set of histological sections, demonstrating the existence of connective and adipose tissues, striated muscle, squamous
mucous membrane, besides the salivary glands. The lesion is diagnosed as Hairy Polyp, containing mesodermal and ectodermal layers.
a. Connective and adipose tissues; b. Striated muscle; c. Squamous mucous membrane and connective tissue; d. Salivary gland.
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was clear that there was a constant mechanical obstruc-
tion of the oropharynx.
The stimuli reflexes of coughing and liquid regurgita-
tion, added to difficulties of the reflex between swallowing
and breathing, hardened the patients feeding and led her
into an increased irritability, expressed through crying.
The presence of vomiting couldnt be confirmed. The
apprehension of this aspect at the location of the lesion
equally guided the choices of orotracheal intubation and
general anesthetic.
Conclusion
This pathology deserves special attention since its
existence, by obstructing the upper airways, compromises
vital functions such as swallowing and breathing. Due to
clinical similarities to other kinds of lesions, its recognition
at the oral routine examinations of the child may sign to
systemic diseases. The referred case brings out the Hairy
Polyp as a process susceptible to fast development, making
vital functions vulnerable, mainly with newborns. There-
fore, its essential that the clinical diagnosis be accurate, so
that the surgical ablative local treatment can be done, and
the final anatomopathologic can be substantiated. The use
of computed tomography with an oral radiocontrastant
may not only aid in diagnostics, but also clarify the
dynamics of the tumor.
The postoperative follow-u p is key, not only to check
that the healing happens without recurrence, but also to
watch the functional response of the tongue in a devel-
oping and growing patient.
Consent
Written informed consent was obtained from the patient
for publication of this report and any accompanying
images.
Competing interests
The authors declare that they have no competing interests.
Author details
1
Department of Oral and Maxillofacial Surgery, Hospital de Clínicas de Porto
Alegre, (Ramiro Barcelos, 2350) Porto Alegre, RS (900350-903), Brazil.
2
Department of Pathology, UCSPA, (Sarmento Leite St 245) Porto Alegre, RS
(90050-170), Brazil.
3
Department of Radiology, UCSPA, (Sarmento Leite St
245) Porto Alegre, RS (90050-170), Brazil.
4
Department of Dentistry, School of
Dentistry - UFRGS, (Ramiro Barcelos St, 2492) Porto Alegre, RS (900035-003),
Brazil.
5
Department of Anesthetist at Irmandade Santa Casa de Misericordia
de Porto Alegre (Professor Annes DiasSt, 295) Porto Alegre, RS (90010-170),
Brazil.
Authors contributions
EP: surgery performed and documented the case. Drafted the manuscript.
MBB: performed the histopathological analysis. BH: exams performed the
analysis of the image. DP: performed surgery. HVA: performed the surgery
and review of literature. Drafted the manuscript. MAM: conducted a review
of literature. Drafted the manuscript. JHS: anesthesia carried out in obtaining
the CT scan and at surgery. All authors read and approved the final
manuscript.
Received: 11 February 2012 Accepted: 15 June 2012
Published: 15 June 2012
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doi:10.1186/1746-160X-8-19
Cite this article as: Puricelli et al.: HAIRY POLYP on the dorsum of the
tongue detection and comprehension of its possible dinamics. Head &
Face Medicine 2012 8:19.
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