Caviar tongue refers to a condition identified by the presence on the ventral end of the tongue of purplish blood vessels.
The mucous membrane, which is so thin and translucent, makes it possible to see veins underneath the tongue.
Caviar tongue makes blood vessels appear blacker and more dilated, similar to caviar eggs ).
The caviar tongue can also be referred to as sublingual varices and looks like varicose blood vessels in the tongue.
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General Basics about Caviar Tongue before we learn high
Caviar tongue is found at several locations. It can be found under the tongue, opening to the sublingual glands, and along the ventral (underside), lateral sides of the tongue. It is not often seen on the buccal mucosa and lips.
It begins as tiny outpouchings in the veins.
As it grows, it slowly elevates the thin mucosa.
The wall is thick, cellular, and hypoplastic in the endothelium
Because of the dilation in blood vessels, blood flow will slow down, increasing the risk for thrombosis.
Varix that is regular will blanch under compression.
Varix that has thrombosis (a condition where the thrombus cannot be pressed into nearby vasculature) will not blanch on compression.
The mucosal surface of varix will make it feel more firm than BB pellets.
This sounds serious, but it is very unlikely to cause embolism.
What is Caviar Tongue?
sublingual varices are the common name for caviar tongue
This begins physiological change is usually caused by senile elastolytic sublingual vein degeneration.
Caviar lesions can occur at three places: beneath the tongue, near the sublingual nerve, on the floor of the mouth close to the Ostia of sublingual glands, and along lateral portions below the tongue.
Caviar tongue is most commonly seen under the tongue, near the sublingual cells. The mucosal surface of the sublingual glands is thin and translucent, which allows visualization of submucosal vessels.
The buccal mucosae and lips are also not very common. Caviar tongue is a small outpouching or enlargement of the veins.
As the veins become more prominent, the varicosities begin to raise the mucosa. Colors can vary from red and purple, resembling buckshot, caviar with an iridescent top, or even caviar.
Histologically speaking, a caviar lesion refers to a dilated or inflammatory vein. The wall of the caviar lesion is thick and cellular, but it is hypoplastic.
Sublingual varices can be benign vascular dilatations.
They are usually asymptomatic and typically affect 10% of the population above the age of 40. These varices are common and often observed by dentists. It is rare for these varices to result in bleeding.
If bleeding is a problem, it is important to investigate the underlying causes. The presence of the cava tongue is often associated with portal hypertension and superior vena cava syndrome.
This condition may be complicated by thrombophlebitis and phleboliths.
It has been reported that angiokeratomas of the scrotum may also be associated with this condition 8
William Bean found that caviar tongue was more frequent in the sixth to the seventh decade than in the fourth. This profile is identical to that of cherry angiomas, venous stars, and other caviar. It was not possible to find any evidence that there is a link between caviar tongue and systemic diseases, such as vascular or pulmonary disease. Recent Brazilian studies on oral hemangioma, varix, and vascular malformation revealed that 65.6% of Brazilians have multiple sublingual varices. Preponderance was found in Caucasians and women
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Sublingual varices are sometimes confused by the resemblance to cancers such as lymphangioma or hemangioma.
These conditions can usually be distinguished by thorough clinical evaluations and detailed histories. On histology, the Caviar tongue is simply a dilated vessel with no inflammatory changes.
Endothelial cells that are proliferating in vascular tumors, such as lymphangioma and hemangioma, respectively, and dilated Lymphatics, respectively, are seen.
Kaposi’s tumor cells consist of vascular space cells and spindle cells according to histology. Sublingual varices do not usually require treatment.
However, they can be reassured about their benign nature. One-off procedures such as surgery or sclerotherapy have been tried in rare locations, like the lips or buccal mucosae.
Caviar tongue dermoscopy revealed the absence of pigmentation, presence of multiple loosely scattered red lacunae over a yellowish background with a bluish-crimson veil.
These were interspersed and interspersed by fine arborizing vessels and scattered Telangiectasias as well as focal white structureless regions.
The red-bluish lacunae of hemangiomas are also visible, although they do not have the sharp demarcation that is seen in angiokeratomas from Fordyce.
There are yellow lacunae that are surrounded by pale septa and pink lacunae. These lacunae alternate between dark-red or blueish lacunae because of the inclusion of blood. One lacuna contained blood. This characteristic feature was referred to as the “hypopyon.”
Let us learn the Etiology of the caviar tongue
The cause of the large, prominent blood vessels underneath the tongue isn’t fully understood.
Many studies have also looked at other conditions, including those related to smoking, diabetes mellitus, hypertension, chronic cough, venous and vitamin C deficiencies, denture wear, cardiovascular disease, and cardiopulmonary diseases.
Although all of these have been suggested as possible predisposing factors for certain diseases, researchers are not able to prove them.
Caviar tongue demo copy (10X polarized) showed absence of pigmentation, presence multiple loosely scattered red lacunes with bluish (rather than yellowish) veil, over a yellowish background.
It is interspersed with fine tree-forming vessels, scattered telangiectasias as well as focal white structureless regions 20.
Groups and Risk for Caviar Tongue
Caviar tongue is most common in people over 40 years of age.
Degeneration of elastic fibers causes a weakening and/or deterioration of the venous walls.
Lesions are often seen as a physiological reaction to age.
The changes in blood flow and blood vessels can alter the arterial pressure at the arteriovenous pumps.
The smooth muscle fibers are responsible for encircling the capillaries, arterioles, and at certain locations, causing them to open and close vessels.
This activity alters blood distribution in tissues and causes blood to pool between the arterioles and the venules without going through the capillary bed.
Although bleeding is not common, bleeding from a tortuous or enlarged vein could be a sign of a condition such as portal hypertension.
Portal hypertension refers to high blood pressure within the portal system. The portal vein is a blood vessel that is very helpful because it carries blood from the stomach to the liver.
Swollen veins in the body may result from increased pressure in portal veins.
Superior vena cava syndrome can be described as multiple symptoms that occur when blood flow is restricted through the superior vasa, which is the large blood vessel that carries blood from the upper body to the heart.
The symptoms include swelling of the face and neck as well as dilations of the veins at the skin’s surface.
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Treatment of caviar tongue
Caviar tongue is a physiological change due to advancing age.
It is not a treatment. A few lesion types have been treated with photocoagulation, surgery, or sclerosis using high-intensity diode lasers or NdYAG (neodymium-doped yttrium aluminum garnet) lasers, including the lips and buccal mucosa 25.
Are purple veins on the tongue normal?
These veins are almost always normal. You will find purple or blue veins underneath your tongue. This would only be considered abnormal if there was swelling and pain. If your tongue is red and/or painful, you should see a dentist. Your dentist might find the cause, but if not, he will recommend the best Oral Pathologists or Oral Surgeons.
Because veins carry low oxygen blood back from the heart, they are darker in color and more purple than oxygen-rich blood. It is easier to see the color of small vessels. Examining the tongue will reveal large, superficial veins (ranine veins), which are very obvious (see photo). Some cases of liver disease have seen varicose veins growing at the base and tip of the tongue. A simple exam and liver labs might be necessary if these symptoms are not yet apparent.
Are purple veins on the tongue normal?
These are normal veins. You will find purple or blue veins underneath your tongue. This will only be considered abnormal if there is swelling and pain. If your tongue is red and/or painful, you should see a dentist. Your dentist might find the cause, but if not, he will recommend the best Oral Pathologists or Oral Surgeons.
Because veins carry low oxygen blood back from the heart, they are darker in color and more purple than oxygen-rich blood. It is easier to see the color of small vessels. Examining the tongue will reveal large, superficial veins (ranine veins), which are very obvious (see photo).
Some cases of liver disease have seen varicose veins growing at the base and tip of the tongue. A simple exam and liver labs might be necessary if these symptoms are not yet apparent.
Common causes of caviar tongue
Lingual varicosities and sublingual varices also know caviar tongue. This is a physiological condition that can be attributed to aging. It’s usually caused by senile elastolytic degradation of sublingual veins .
The caviar tongue is most commonly seen below the surface of the tongue, near the sublingual cells.
This is where the mucosal skin is thin and translucent, which allows visualizations of submucosal vessels .
Caviar tongue symptoms
Caviar tongue refers to asymptomatic tortuous black or purplish-colored swellings under the tongue. You can see dilated tortuous veins along the lateral portion of the tongue’s undersurface on mucosal inspection. There are no reports of bleeding or any other systemic diseases.
Diagnosis of caviar tongue
The most common diagnosis of caviar-tongue is almost always clinical. However, it’s worth looking at differentials like lymphangioma or Kaposi sarcoma.