Richard Taylor, Cristina Frezzini, Iain Varley
Median rhomboid glossitis is a benign lesion caused by papillary atrophy in response to candidal infection of the dorsal surface of the tongue. It is a common reason for referral to Oral and Maxillofacial Surgery units. In this unusual case, the patient’s tongue was in fact predominantly composed of a previous radial forearm flap yet resembled the same pathology found on oral mucosa.
A 62 year old patient presented to follow-up 4 years after a tongue reconstruction with radial forearm free flap with a lesion in the dorsum of the tongue resembling median rhomboid glossitis of the “neotongue”. The erythematous lesion contained at its centre a pedunculated and irregularly shaped mass. Histopathological analysis of the lesion determined that it was a manifestation of chronic hyperplastic candidiasis with fibro-epithelial hyperplasia. The lesion in this case resolved in its entirety after systemic and topical antifungal therapy.
Free tissue transfer has been used regularly for the reconstruction of maxillofacial defects since the development of the radial forearm flap by Yang in 1979, yet the histo-morphological changes of skin exposed to the oral environment are poorly understood. Oral candida species readily colonise the transposed skin, and have a varied presentation, leading to diagnostic uncertainty. Current literature suggests that there is a proportion of skin biopsies, especially those at the edges of skin flaps which show cellular atypia, dysplasia or worse. In such cases alternative management would be required.
There are several aetiologies for cellular changes in skin transferred to the mouth, including candidal infection. However, due to the possibility of dysplastic changes, biopsy is indicated in lesions of uncertain aetiology or diagnosis in order to appropriately identify and treat higher risk or malignant lesions, and correctly identify cases where antifungal therapy alone is suitable.