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The picture case by Nasir et al in Minerva is in danger of giving a
false impression.1 Sublingual varices are not ‘unusual’. They are common,
and a frequent clinical finding (if in doubt, just ask your dentist).2
Their prevalence increases with age, with surveys indicating that they are
present in up to 60% of the elderly, in both sexes and in different
population groups.2-4
Haemoptysis has once been reported due to bleeding from base of
tongue varices associated with portal hypertension, however a textbook and
Medline search for spontaneous haemorrhage from sublingual varices does
not reveal any similar reported cases to that described.5 The advice
given that sublingual varices can cause ‘subtle and potentially dangerous
bleeding’ is based on negligible evidence. It would be unfortunate if the
case depicted induced a growth of unnecessary cauterisation of sublingual
varices, and mislead clinicians from searching for the true cause of a
patient’s haemoptysis.
References:
1. Nasir A, Gupta D, McBride G. Minerva picture case. BMJ 2006; 333:
104. (8 July)
2. Ettinger RL, Manderson RD. A clinical study of sublingual varices. Oral
Surg, Oral Med, Oral Path 1974; 38: 540-545.
3. Kleinman HZ. Lingual varicosities. Oral Surg, Oral Med, Oral Path 1967;
23: 546-548.
4. Kovac-Kavcic M, Skaleric U. The prevalence of oral mucosal lesions in a
population in Ljubljana, Slovenia. J Oral Pathol Med 2000: 29: 331-335.
5. Jassar P, Jaramillo M, Nunez DA. Base of tongue varices associated with
portal hypertension. Postgrad Med J 2000; 76: 576-577.
Sublingual varices are not unusual
The picture case by Nasir et al in Minerva is in danger of giving a
false impression.1 Sublingual varices are not ‘unusual’. They are common,
and a frequent clinical finding (if in doubt, just ask your dentist).2
Their prevalence increases with age, with surveys indicating that they are
present in up to 60% of the elderly, in both sexes and in different
population groups.2-4
Haemoptysis has once been reported due to bleeding from base of
tongue varices associated with portal hypertension, however a textbook and
Medline search for spontaneous haemorrhage from sublingual varices does
not reveal any similar reported cases to that described.5 The advice
given that sublingual varices can cause ‘subtle and potentially dangerous
bleeding’ is based on negligible evidence. It would be unfortunate if the
case depicted induced a growth of unnecessary cauterisation of sublingual
varices, and mislead clinicians from searching for the true cause of a
patient’s haemoptysis.
References:
1. Nasir A, Gupta D, McBride G. Minerva picture case. BMJ 2006; 333:
104. (8 July)
2. Ettinger RL, Manderson RD. A clinical study of sublingual varices. Oral
Surg, Oral Med, Oral Path 1974; 38: 540-545.
3. Kleinman HZ. Lingual varicosities. Oral Surg, Oral Med, Oral Path 1967;
23: 546-548.
4. Kovac-Kavcic M, Skaleric U. The prevalence of oral mucosal lesions in a
population in Ljubljana, Slovenia. J Oral Pathol Med 2000: 29: 331-335.
5. Jassar P, Jaramillo M, Nunez DA. Base of tongue varices associated with
portal hypertension. Postgrad Med J 2000; 76: 576-577.
Competing interests:
None declared
Competing interests: No competing interests