Inherited or congenital diseases
Diseases of lingual mucosa
Diseases affecting body of tongue
Tumors of tongue
Tongue is a muscular organ situated in the floor of
It aids in chewing, swallowing, speech and taste.
It is organ of location of taste.
The tongue may be affected as part of oral disease
or as a signs of systemic diseases.
CLASSIFICATION OF TONGUE
A)Inherited, congenital and developmental
a) Minor variations:
1 .Partial ankyloglossia
2.Variations in tongue movement
5.patent thyroglossal duct and cyst
7.median rhomboidal glossitis
b) Major variations:
1.Cleft, lobed, bifurcated and tetrafurcared tongue
2.aglossia, hypoglossia and macroglossia
3.hamartoma and dermoid
4.bald and depapillated tongue
B)Disorders of the lingual mucosa:
a)changes in the tongue papillae:
2.coated or hairy tongue
2. white sponge nevus
3.vesiculobulous and other desquamative disorders
Partial ankyloglosia refers to congenital shortness of the
lingual frenum or a frenal attachment that extends nearly
tip of tongue,binding the tongue to floor of mouth and
restricting its extention.
Restricted tongue movements
Speech defects: lisping, inability to pronounce words such
as ta, te, time, water, cat etc.
Variation in tongue movement
Ability to curl up the lateral borders of tongue into a
tube is noted in 65% of caucasians and is inherited as a
n autosomal dominant trait.
Unusual extensibility of tongue, both farward to touch
tip of nose(gorlin sign)and backword into the pharynx
occurs in Ehlers-danlos syndrome.
The tongue in tuberous sclerosis-long and narrow
The mobility of tongue is also restricted in
epidermolysis bullosa as a result of fibrous scars
secondrry to blister farmation.
Tongue thrust is a forward placement of the tongue
between the anterior teeth and against the lower lip
during swallowing, speaking or at rest.
It is an infantile swallowing pattern.
It may be associated with macrogllosia.
1. Proclination of anteior teeth
2. Anterior open bite
3. Bimaxillary protrusion
4. Posterior open bite in case of lateral tongue thrust
5. Posterior cross bite
Also called as scrotal tongue,plicated tongue,and
Characterised by furrows, one extending
anteroposteriorly and others lateraly over the entire
Patterns: plication, central longitudinal fissuring,
double fissures, transverse fissuring, lateral
Bacteria and debris retained in the fissures causing
irritation or burning sensation.
Patent Thyroglossal Ducts and
Thyroid gland develops from an analogue of
endothelial cells in the midline of the floor of the
pharynx, between the first and second brachial arches,
just posterior to tubercular impar.
These cells sink into the base of developing tongue
,descent into the neck and proliferate below the larynx
to form thyroid gland.
Remnant of the epithelium along this path are reffered
as thyroglossal duct.
Cystic degeneration of it is called as duct cyst.
In 70% of those with heterotopic thyroid ,the thyroid
gland is contained entirerly within the tongue.
Enlagement of the lingual thyroid , cystic changes, or
malignancy may be first recognised due to symptoms
of an enlarging tongue, dysphagia or less
Dysphagia with firm cystic mass in midline of neck
will give clue to the diagnosis.
The cysr is lined by columner,respiratory or stratified
Management: surgically excised or enucleated.
Median Rhomboid Glossitis:
‘central papillary atrophy of tongue’
Developmental defect resulting from an incomplete
descent of tuberculum impar and entrapment of a
portion between fusing lateral halves of the tongue.
It is benign lesion.
Characterised by rhomboid or oval in shape, changes
occur in the tongue mucosa in the midline, just
anterior to the foramen caecum.
Some authers suggest fungal infection as etiology.
The surface is dusky red and completely devoid of
filiform papillae and usually smooth.
Kissing lesion-soft palate erythema may be seen where
the lesion of median rhomboid glossitis touch the
Management: antifungal agents,
Long standing cases:cryosurgery, excisional biopsy
Cleft,Lobed, Bifurcated and
Seperation of the dorsal surface of tongue into 2 or 4
by deep grooves.
Associated with orofacial-digital syndrome,fetal face
Management:regular cleaning of tongue.
Aglossia: complete absent of tongue at birth.
Hypoglossia: small rudimentary tongue.
c/f: difficulty in eating,speaking
High arched palate,narrow constricted mandible
Associated with hypoglossia-hypodactylia
syndrome,hypomelia, Pierre Robin syndrome.
Tongue enlargement-leads to functional and cosmetic
thyroid, cretinism, down syndrome, neurofibromatosis
and multiple endocrineneoplsia type2B.
2.Inflammatory: syphilitic gumma,ranula,
3.Neoplastic:granular cell tumer,neurofibroma, lipoma
C/F:noisy breathing,drooling of saliva, difficulty in
eating, speech and airways problums.
Recurrent upper respiratory tract infection.
Displacement of teeth ,malocculusion
Crenation of lateral border of tongue
Associated with beckwith’s syndrome
Management: surgical, orthodontic, speech therapy
Hamartomas and Dermoids:
The tongue may be enlarged or distorted by the
persence of variety of tumerlike growthsof
or by epithelial inclusion cysts(dermoids,branchial
Bald or Depapillated tongues:
An erythematous , edematous and painful tongue that
appears smooth because of loss of filifirm papillae
and sometime fungiform papillae secondary to certain
nutrional deficiency .
Atrophy or loss of papillae may be caused by a
congenital anomaly ,or develop as a secondary features
Traumatic injuries-jagged teeth,rough margins of
restorations and inadvertent contact of tongue with
dental medicaments such as eugenol.
Allergic stomatitis: monomer of denture,
mouthwash, chewing gum, and lipstick.
Iron deficiancy anemia: first appears at tip,lateral
border of tongue with loss of filiform papila. In
extreme cases , the entire dorsum becomes smooth
and glazed. Very painful either pale or fiery red.
Plummer vinson syndrome: sideropenic anemia
shares atrophic glositis, angular cheilitis, generalised
atrophic oral mucosa, oral ulceration and secondary
Pernicious anemia: atrophy of filiform &fungiform
Folic acid deficiency: tongue is fiery red and atrophy
of filiform & fungiform papilae. Tongue is swollen and
small cracks may appear on dorsal surface.
Sceroderma: tongue shrinks, losing its mobility and
papillary pattern. Color of the tongue changes to a
vivid appearance due to circulatory disturbances. In
the end stages, the tongue lies as a stiff, reduced body
in the floor of mouth.
Dermatomyositis: in early stages, tongue is markedly
swollen and later becomes harder. In the late phase,
tongue is atrophic.
Diabetes: central papilary atrophy of the dorsum in
which low flat papillae are noticed just ant. to row of
Syphilis: depapilation of tongue usually occurs in
secondary and tertiary syphilis. Single or multiple
mucous patch on the tongue. A more difusse, chronic,
nonulcerating, iiregular induration, with an
asymmetrical pattern of grooves and atrophic field
covering the entire dorsum.
Zoster infection:numerous vesicles occur on ventral
surface of tongue.
Peripheral vascular disease: decreased nutritional
of the lingual papillae as a result of vascular changes
affecting the subpapillary dorsal capillry plexus.
Using fluorescence-enhanced capillary microscopy in
humans have documented variations in the fungiform
papillae associated with age, sex, and the number and
shape of terminal vessels in the papillae.
Infarcts of the tongue may be associated with
shrinkage of the affected side of tongue and atrphic
changes in the overlying mucosa.
Poor sense of taste
Purplish or magenta
Beefy enlaged tongue
Scarlet red tongue
Burning sore tongue
Ulcer on tongue
In several congenital disorders the surface of tongue is
covered with multiple papilomas. When extensive this
abnormalities is known as pebbly tongue.
Lesions of this type is associated with congenital
lingual lymphangiomas, neurufibromatosis and the
Anderson-Fabry syndrome and Meckel’s syndrome.
Also called as benign migratory glositis,wandering rash,
glossitis areata exfoliativa, and erythema migrans
It refers to irregularly shaped reddish areas of depapillation
and thinning of the dorsal epithelium which is surrounded
by a narrow zone of regenerating papillae that are whiter
than the surrounding tongue surface.
Hypersensitive patient: h/o-asthma, hay fever, eczema.
Other factors:immunological reaction, emotional strees ,
hereditary factors, nutrional deficiencies.
C/F- common in young & middle age.
Commonly on dorsal surface & lateral border
Asymptomatic but patient may complain of burning
sensation, stinging, pain
Initially appears as a smsll erythrmatous, non-
indurated, atrophic lesion, bordered by a slitaly
elevated distinct rim that varies from gray to white to
Loss of filiform papillae pink to red smooth shiny
surface , fungiform papillae persist in desqumated
areas as small elevated red dots.
The condition may persist for weeks to months and
then regress spontaneously only to occur at later date.
The lesion is not always restricted to tongue and
similar irregular or circinate lesions occur elsewhere in
the oral cavity and are called as ectopic geographic
tongue or erythema circinate migrans or annulus
Biopsy shows loss of filiform papillae with
hyperparakeratosis and acanthosis.
Reiter’s syndrome:skin,occular,urethral lesion +
Licken planus:absense of raised whitish yellow rim.
Use of strong mouth wath-h/o
Anemic condition:hematological study and absense of
raised yellowish white border.
For control of burning-topical local anaesthetic agents
like lidocaine, dyclonine hydrochloride, or
diphenhydramine can be given.
Topical therapy: topical corticosteroids and topical
application of salicylic acid and tretinoin(retinoic
Lingua villosa, lingua nigra, black hairy tongue
An overgrowth of filiform papillae on the dorsum of
tongue , giving the tongue a superficial resemblance as
that of hairiness.
There is marked accumulation of keratin on the
Fungal and bacterial overgrowth:
Use of certain drugs: sodium perborate, sodium
peroxide, and antibiotics like penicillin and
Poor oral hygiene
Lowered ph-blocks the normal desqumation of
epithelial cells covering the filiform papillae
In Debilitated, dehydrated, terminally ill patients can
lead to very thick, leathery coatings on the tongue that
are reffered to as earthy or encrusted tongue.
C/F: papillae may reach a lenth of 2cm which
occasionally brush the palate and may produce
gagging or bad taste.
The hyperplastic papillae then become pigmented by
the colonisation of chromogenic bacteria,which can
impart a variety of colors ranging from green to brown
to black to yellow.
This gives it a coated or hairy appearance and retains
debris and pigments from substances from food,
tobaco, smoke, madicines.
Maintenance of oral hygiene
Elimination of predisposing factors
Topical keratolytic application- podophyllum in
acetone or alcohal suspention
Acute pseudomembranous candidiasis
Often appears as pearly white , pinhead size flecks scattered over
the dorsal surface.
Etiology:overgrowth of Candida albicans in patient taking
antibiotics, immunosuppressants drugs,or having a disease that
supresses the immunity.
C/F: f> m
Prodromal symptoms like rapid onset of bad taste, discomfort on
spicy food, burning sensation
White patches are easily wiped out
Plaque form of licken planus
Topical application of clotrimazole cream-2-3 times
daily for 3-4 weeks.
Ketoconazole 200-400 mg od for 2 weeks
Fluconazole 50-100mg od for 2-3 weeks
White sponge nevus:
Congenital anomaly in which the surface of tongue as
well as other parts of oral mucosa are involved by white
spongy plaques without significant hyperkeratosis.
c/f- children are most commonly affected
Friction may strip superficial keratotic area leaving
zone of normal looking epithelium or raw area.
Vasiculobullous and other
Desqumating disorders are often mistakenly identified
as white lesions because coalscence of whitish
desquamating epithelium with areas of papillary
atrophy and scarring.
Patches of regenerating papillae may also be
interspersed, giving red and white areas in a marble
Oral licken planus is defined as a common chronic
immunological mucocutaneous disorder that varied in
appearance from keratotic to erythematous and
Lacelike , erosive and bullous variety of this disorder
may affect the tongue in addition to the cheeks, lips,
Immune systum has primary role in development of
Other facters: stress, habits, hypertention, diabetes
c/f- oral lesions are characterized by radiating white
and gray valvety thread like papules in linear, angular
or retiform arrangement.
Tiny white elevated dots rae persent at the intersection
of white lines, called as Wickham’s striae.
In some cases superimposed candidial infection
Removal of cause
Steroids –topical and systemic
Topical application of antifungal agents
It is whitish patch or plaque that can not be
characterised, clinically or pathologically, as any other
disease and which is not associated with any other
physical or chemical causative agent except the use of
It can occur anywhere in the oral cavity but tongue is
one of the commonest site.
If it occurs on tongue ,it is called as ‘chronic superficial
Etiological factors are classically known as 6 S
….smoking, syphilis, sharp tooth, sepsis, sprit, and
Alcohal-facilitates the entry of carcinogen into
exposed cells and thus alters the oral epithelium and
c/f- confied to ant. 2/3 rd of tongue,dorsum and lateral
The affected area show milky-white patches with
fissure and cracks.
Some patient may complain of burning sensation
Use of beta carotenes, lycopene, L-ascarbic acid, vit.E,
Surgical treatment: cold knife surgical excision, laser
Tongue may exhibit various patterns of racial melanin
Joundice may be apparent on ventral mucosa
Exogenous pigmentation of the filiform papillae of the
normal and coated or hairy tongue is very common
and results from microbial growth and metabolic
products, food debris, and dyes from candy, beverages,
and mouth rinses.
Pigmentation by chemotherapeutic agent, doxorubicin
Extravasation of red cells around lingual varicocities
may give a patchy, bluish red discoloration, usually on
ant. Ventral surface of tongue.
Ucers and infectious diseases:
Quite severe ulcers, which are more in nature of
lacerations and contusions, are produced by sudden
biting trauma, either during epileptic seizure or as a
result of a sudden blow to the jaw while tongue lies
b/w upper and lower teeth.
Rough surface of restorations and jugged, brocken
cusps rapidly cause ulceration of the tongue.
Lateral margins and ventral surface of tongue are also
frequently damaged by contact with rapidly revolving
burs, discs, or other dental equipment.
Ulcers on lingual frenum in neonates with natal lower
incisors rae reffered as Riga’s ulcer or Riga-Fede
Shallow but persistant tontue ulcers , especially along
the posterior ventral surfaces, are common in patients
with licken planus, various nutritional deficiencies,
and hematological problums.
The lateral margins and tip of tongue are frequently
involved in sevsere episode of recurrent aphthous
Vesiculobulous disorders also may involve lingual
Tuberculosis-post. ventral surface
The ant. 1/3rd of the tongue may also be site of an
extragenital chancre in primary syphilis.
In primary herpes simplex gingivostomatitis, the
dorsum, ventral and lateral margin may be ulcerated.
In infections with erythrogenic, toxin producing
Streptococcus pyogens (scarlet fever), the sign of
The most effective treatment to get rid of tongue ulcer
is to increase your body's immunity power by taking B-
complex tablets and vitamin tablets.
Glycerin: Rinsing your mouth and tongue with glycerin
on the affected parts of tongue is the best way to
alleviate the pain caused by ulcers under tongue and
throat. Rinsing your mouth with glycerin also controls
the wounds or lesions further spreading and
expanding inside the mouth and throat.
Topical application of lignocaine
Superficial vascular changes:
Lingual varicosities are evident as prominent purplish
blue spots, nodules, and redges, usually on the anterior
ventral surface of the tongue and around the
submandibular-sublingual gland orifices.
But they are rarely symptomatic
They represent a normal age change
Petechial hemorrhages and telangiectases also can
demonstrated on vetral surface
Hemangiomas are relatively common on tongue.
Involvement of the tongue is described in both the
primary and secondary forms of amyloidosis.
The characteristic fibrous glycoprotein of this disease
is deposited in the submucosa as well as in deeper
muscular layers of tongue.
Generalised enlargement of the tongue(macroglsia)
and fungating swelling may result.
Neuromuscular disorders of central, peripheral, or
muscular origin may produce symptom of dysphagia
and choking as well as disordered mastication and
Repetitive , uncontrolled movement of the tongue,
head, and jaws, depapillation, burning sensations and
traumatic ulcers of tongue are common in
buccolingaul-facial dyskinesia, parkinsonism, and the
Weakness of tongue can occur in polymyositis,
multiple sclerosis and Duchenne’s muscular dystrophy.
Damage to hypoglossal nerve, leads to hypoglossal
If bilateral, the tongue can not be extended
If unilateral, the tongue deviates to the unaffected side
Sleep Apnea Syndrome:
Sleep apnea is a disorder characterized by a reduction
or pause of breathing (airflow) during sleep.
It is common among adults becoming more common
Obstructive sleep apnea is caused by the collapse of
the airwayduring sleep.
Obstructive sleep apnea is diagnosed and evaluated by
history, physical examination and polysomnography
One of the most common signs of obstructive sleep
apnea is loud and chronic (ongoing) snoring.
Sleep apnea is treated with lifestyle changes,
mouthpieces, breathing devices, and surgery.
Medicines typically aren't used to treat the condition.
The mouthpiece will adjust your lower jaw and your
tongue to help keep your airways open while you sleep.
Vascular disease of the body of
The lingual artery is very susceptible to the
development of atherosclerotic changes.
The extent of the lingual atherosclerosis increases with
age, but age does not bring ischemic comlications
secondary to atherosclerosis.
Infarcts of tongue are fairly rare
Angioneurotic edema is one form of acute
anaphylactic reaction representing an immediate
hypersensitivity response allied to urticaria, allergic
rhinitis, and asthma.
Antigenic stimuli are-respiratory allergens, food such
as shellfish, chocolate, nuts, various drugs and
occasionally cold and physical trauma to tongue.
Medications used to treat angioedema include:
Anti-inflammatory medicines (corticosteroids)
Epinephrine shots (people with a history of severe
symptoms can carry these with them)
Inhaler medicines that help open up the airways
Benign tumors of tongue:
A benign mouth tumor is an abnormal growth located
in the mouth or tongue.
The growths are not cancerous and very rarely spread
to other body parts.
The condition is most common in adults over the age
The risk of developing an abnormal growth within the
mouth is greater increased in smokers.
bleeding lump –
Mouth dentures don't fit
lump in any part of the mouth
sore lump - mouth
A fibroma is a benign, tumor-like growth made up
mostly of fibrous or connective tissue.
Tumor-like growths such as fibroma develop when
uncontrolled cell growth occurs for an unknown
reason, or as a result of injury or local irritation.
Fibromas can form anywhere in the body and usually
do not require treatment or removal.
Papilloma is a general medical term for a tumor of the
skin or mucous membrane with finger-like
Papillomas are either pedunculated or sessile growth
on any surface of oral mucous membrane.
Multiple papillomae are occur in cowden’s syndrome,
Hemangioma is a benign tumor of dilated blood vessels.
It is also known as port-wine stain, strawberry
hemangioma, and Salmon patch.
They are characterized by hyperplasia of blood vessels,
usually veins and capillaries, in a focal area of submucosal
Surgical or invasive treatment of oral hemangiomas has
evolved. Complete surgical excision of these lesions offers
the best chance of cure, but, often, because of the extent of
these benign lesions, significant sacrifice of tissue is
necessary. For example, lesions of the tongue may require
Lymphangiomas are benign hamartomatous tumors of
the lymphatic channels. They are thought to be
developmental malformations arising from
sequestration of lymphatic tissue that do not
communicate with the rest of the lymphatic channels
Oral lesions are most frequently found on the tongue.
Treatment:injection of sclerosing solutions,
cryosurgery, intravascular emovilization with silicon
Granular cell myoblastoma:
Granular cell tumour, is a relatively uncommon benign
neoplasm, which is more commonly found in females in
the 4th to 6th decades of life even though it can occur in all
Most of the intraoral lesions occur on the tongue, usually
on the lateral aspect.
Granular cell tumours are slow-growing, painless tumours
with no known cause.
They may start in nerve cells.
They occur mostly on the top of the tongue.
Lipoma is a rare benign tumour of mesenchymal
origin which infiltrates adjacent muscle and tend to
recur after excision
It is prevalently found in the cheek and tongue, but
also in the lip, gingival and floor of the mouth.
Particularly, lipoma accounts for 0.3% of all lingual
Malignant tumors of tongue:
Cancer of the tongue is a malignant tumor that begins
as a small lump, a firm white patch, or a sore (ulcer) on
If untreated, the tumor may spread throughout the
tongue to the floor of the mouth and to the gum
As a tumor grows, it becomes more life threatening by
spreading (metastasizing) to lymph nodes in the neck
and later to the rest of the body
Eg: squamous cell carcinoma,
Squamous cell carcinoma:
It is most common oral carcinoma with 60% cases
arising from the ant. 2/3rd of the tongue and reminder
from base of tongue.
Etiology: physical trauma, alcohal, tobacco, smoking,
candidiasis, syphilis, sepsis, chronic dental trauma and
chronic superficial glossitis.
About 80% of all people who develop tongue cancer
c/f: middle and later decades, m>f ,
Painless mass or ulcer later becomes painful
Offensive smell in mouth occurs due to bacterial
Immobility of tongue-causes difficulty in speech.
Hoarseness of voice and dysphagia
It spread by infiltration and invasion.
Early carcinoma of tongue(T1 and small T2) responds
equally well to surgical excision or by radiation.
T1 and T2 with no evidance of lymph node metastasis,
surgical treatment is usually restricted to partial
If it is T2 or T3 without node involvement ,
prophylactic neck dissection is advised.
Treatment of carcinoma of the ant. 2/3rd of tongue
with evidance of node involvement may include
radical neck dissection, partial mandibulectomy, and
intraoral dissection(commando operation) in adition
Better cure rates obtained with combined
chemotherapy(cis-platinum and bleomycin)-surgery-
radiation aproaches, use of neutron irradiation,
immunotherapy, and transoral laser resection for
accessible early stage carcinoma.