Persistent painful ulcer of the posterior lingual mandibular mucosa

An ulcer involving the left posterior mandibular lingual mucosa was the chief complaint of this 55-year old white man. (Figure 1) The ulcer was first noted about one month previously and no local eliciting factors could be identified. The ulcer had become progressively more painful in spite of antibiotic treatment (cephalexin, 500 mg, q.i.d, 8 days) and concomitant use of benzydamine hydrochloride rinse. The patient was healthy with no medical problems other than occasional nasal "stuffiness," which was treated, as required, with budesonide nasal spray.