What Is Caviar Tongue?
Caviar tongue is also known as lingual varicosity of the oral cavity or sublingual varicosity. This is mainly an elastolytic degenerative condition that occurs in the sublingual veins. This condition is considered a physiological change rather than a pathological condition that is associated with the advancing age of a person. This condition is more prevalent in the age group of 60 to 80 years, and according to various case reports and associated predisposing risk factors, it is found that the caviar tongue can also occur between the age of 40 to 60 years.
The common location of caviar tongue or sublingual varicosities is found on the ventral tongue surface, along the sublingual gland, and even on the lips. These look like tortuous or aberrantly dilated venous structures, which the dental surgeon can easily recognize.
What Is the Etiology of the Caviar Tongue?
Caviar tongue affects nearly 10 % of the global population, and the highest occurrence rate is amongst the older people. With advancing age, the soft tissue framework and smooth muscle fibers start degenerating and lead to the weakening of the venous walls. The changes happening due to aging cause interference with the remodeling capacity of the venous network, including blood vessels and connective tissues leading to declining blood flow. This process is indicated as the main etiological factor of caviar tongue, as the smooth muscle fibers encircling the blood capillaries and arterioles cause opening and subsequent closure of the blood vessels. This leads to a change in the distribution of blood, as the blood pools out from arterioles and then to the venules without passing through the capillary bed. This is the main theory or hypothesis explaining the dilated venous structures in the sublingual region.
What Are the Risk Factors Involved in Caviar Tongue?
The various risk factors which can worsen this condition are as follows -
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People with a risk of or who suffer from cardiovascular diseases (like hypertensive individuals are more prone to developing these diseases).
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Chronic denture irritation or wear out.
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Chronic liver diseases.
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Alcoholics.
It is also medically proven that patients diagnosed with sublingual varices or caviar tongue usually have other medical conditions like hypertension or cardiovascular disease.
What Are the Clinical Features of the Caviar Tongue?
The caviar tongue or sublingual varices is a common oral mucosal lesion in older individuals; the clinical features related to this are as follows -
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There are multiple dilated veins in the sublingual region, and they are irregularly shaped structures.
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The surface of these lesions appears to be tan, blue, purple, or black and can be raised, flat or oval.
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It can be clinically firm or compressible. The lesions may tend to be firmer when thrombosed.
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The lesions usually appear bluish purple, with elevated blebs commonly seen on the ventral or lateral or both the borders of the tongue.
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The ventral surface of the tongue is one of the most common sites for a definite diagnosis. However, it can also be found on the labial mucosa, lip skin, buccal mucosa, or other rare oral sites such as oral mucous membranes.
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These painless lesions rarely cause discomfort to the patient and will be diagnosed only upon a routine clinical examination.
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Under microscopic examination, these sublingual structures show a strong dilatation or collapse of the vascular space. Also, these spaces may demonstrate an erythrocyte or red blood cell accumulation at the site.
These clinical features are only associated with the color and appearance of the lesion, which is why it may still be confusing to some physicians or dentists, as it resembles various other lesions or structures of the oral cavity; such as the main veins that run from the tip of the tongue and backward. Also, these lesions are similar to primary malignant melanomas of the tongue that also bear a similar clinical appearance. Therefore, the dentist should establish differential diagnosis through biopsy and histopathologic examination for differentiation from similar tumors.
The characteristic feature of the caviar tongue on histopathologic and microscopic examination is the concentric arrangement of the erythrocyte and platelet layer called lines of zain. Along with that, there may also be multiple or huge aggregating granulation tissues that may be observed.
What Is the Management of the Caviar Tongue?
The caviar tongue or sublingual varices is an asymptomatic condition and can only be diagnosed by clinical examination because of the color change in the oral cavity. Only if the areas like lips or buccal mucosa are involved, then treatment is advised.
Physicians recommend sclerotherapy alongside photocoagulation and high-intensity diode lasers for esthetic rehabilitation.
Conclusion:
To conclude, caviar tongue or sublingual varicosity is a benign condition that occurs with advancing age. In cases where the patient's esthetic appearance is compromised because of this condition, it can be easily treated with the methods mentioned above, such as lasers and sclerotherapy. Dental healthcare providers must differentiate this condition from other malignant lesions by conducting a thorough histopathologic and microscopic examination.
