Management of chronic traumatic ulcer mimicking oral squamous cell carcinoma on the tongue

Revi Nelonda, Riani Setiadhi

Abstract views = 457 times | views = 264 times


Background: Traumatic ulcers represent the most common oral mucosal lesions that can be differentiated from oral squamous cell carcinoma (OSCC) by their clinical appearance. From a clinical perspective, OSCC may resemble a chronic traumatic ulcer (CTU) because the base of the CTU that is healing is filled with reddish-pink granulated tissue, similar to that in OSCC. Purpose: The aim of this case report is to provide information about the oral management of a CTU case that imitates OSCC. Case: A 30-year old female presented with a major, painful, non-healing ulcer located on the right lateral of the tongue for the previous two months. Approximately two years before, she had experienced a similar lesion on the tongue. Intra oral examination showed a 10mm x 5mm yellowish ulcer with a fibrous center, erythematous irregular-induration margin and concave yellow base. The 15th, 44th and 47th teeth were sharp and on occlusion caused trauma to the right lateral border of the tongue. Case management: Based on the clinical features, the lesion was imitating OSCC. After a case history review, clinical examination and appropriate investigation, the patient was diagnosed as suffering from a chronic traumatic ulcer. The primary treatment of traumatic ulcers involves eliminating etiological factors. As pharmacological therapy, a mixture of triamcinolone acetonide and 1mg dexamethasone tablet was administered in addition to folic acid and vitamin B12. Conclusion: Clinical presentation of traumatic lesions varies significantly and may, at times, be ambigous. It is important to immediately establish a correct diagnosis and implement prompt treatment of CTU lesions because they play a role at the oral carcinogenesis promotion stage.


management; chronic traumatic ulcer; oral squamous cell carcinoma

Full Text:



Lazos JP, Piemonte ED, Lanfranchi HE, Brunotto MN. Characterization of chronic mechanical irritation in oral cancer. Int J Dent. 2017; 2017: 1–7.

Ishaquddin S, Maya D, Ghadage M. Traumatic ulcer or squamous cell carcinoma of the t ongue? : case report. Int J Healthc Biomed Res. 2013; 2: 57–60.

Nalin AS, Mary J, Leukose T, Sreedhar S, Padiath S. Traumatic ulcer – mimicking squamous cell carcinoma. IOSR J Dent Med Sci. 2016; 15(3): 83–6.

Pérez MA, Raimondi AR, Itoiz ME. An experimental model to demonstrate the carcinogenic action of oral chronic traumatic ulcer. J Oral Pathol Med. 2005; 34: 17–22.

Bombeccari GP, Guzzi G, Pallotti F, Porrini M, Giannì AB, Spadari F. Large oral ulcer of tongue related to dental trauma. Stomatol Balt Dent Maxillofac J. 2017; 19: 51–4.

Nidarsh H, Mithra H, Aastha P, Raksha B. Differential diagnosis of long term tongue ulcers. Int Res J Pharm. 2012; 3(8): 145–8.

Hirota SK, Migliari DA, Sugaya NN. Oral squamous cell carcinoma in a young patient - case report and literature review. An Bras Dermatol. 2006; 81(3): 251–4.

Rao RS, Patil S, Ganavi BS. Current updates on early detection and prevention of oral cancer. J Med Radiol Pathol Surg. 2015; 1: 1–2.

Anura A. Traumatic oral mucosal lesions: a mini review and clinical update. Oral Health Dent Manag. 2014; 13(2): 254–9.

Parisay I, Ghafournia M, Shafagh M, Mousavi SA. Lingual traumatic ulceration (riga-fede disease): report of a case and review. J Dent Mater Tech. 2013; 2(4): 142–7.

Sunil A, Kurien J, Mukunda A, Basheer A Bin, Deepthi D. Common superficial tongue lesions. Indian J Clin Pract. 2013; 23(9): 534–42.

Pereira T, Shetty S, Pereira S. Sheep in wolf’s clothing – enigma unravelled. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015; 3: 6–8.

Bhavthankar JD, Patil AA, Singh P, Mandale M, Humbe J. Malignant vs traumatic tongue ulcer : a clinical approach. J Evol Med Dent Sci. 2014; 3(14): 3758–63.

Siu A, Landon K, Ramos DM. Differential diagnosis and management of oral ulcers. Semin Cutan Med Surg. 2015; 34(4): 171–7.

Apriasari ML. The management of chronic traumatic ulcer in oral cavity. Dent J (Maj Ked Gigi). 2012; 45(2): 68–72.

Walsh T, Liu LYJ, Brocklehurst P, Glenny A, Lingen M, Kerr AR, Ogden G, Warnakulasuriya S, Scully C. Clinical assessment to screen for the detection of oral cavity cancer and potentially malignant disorders in apparently healthy adults. Cochrane Database Syst Rev. 2013; (11): 1–70.

Ford PJ, Farah CS. Early detection and diagnosis of oral cancer: strategies for improvement. J Cancer Policy. 2013; 1(1–2): e2–7.

Tyagi N, Tyagi R. Squamous cell carcinoma (well differentiated): a case report. J Dent Oral Hyg. 2013; 5(4): 31–4.

González-Moles MÁ. The use of topical corticoids in oral pathology. Med Oral Patol Oral Cir Bucal. 2010; 15(6): 827–31.

Savage NW, McCullough MJ. Topical corticosteroids in dental practice. Aust Dent J. 2005; 50(4 Suppl 2): S40–4.

Meddipour M, Zenouz AT. Role of corticosteroids in oral lesion. Intech. 2016; 6: 111–33.

González-Moles MÁ, Scully C. Vesiculo-erosive oral mucosal disease — management with topical corticosteroids : (1) fundamental principles and specific agents available. J Dent Res. 2005; 84(4): 294–301.


  • There are currently no refbacks.

View My Stats