This document discusses various developmental disturbances that can affect the tongue, including microglossia (small tongue), macroglossia (large tongue), ankyloglossia (tongue tie), cleft tongue, fissured tongue, median rhomboid glossitis (reddish patch on dorsal tongue), benign migratory glossitis (geographic tongue), hairy tongue, lingual varices (dilated veins on tongue), and lingual thyroid nodule (thyroid tissue on tongue). Many of these conditions can cause difficulties with speech, swallowing, or irritation of the tongue. Treatment may include surgery, antifungal medications, or thyroid hormone supplements.

1. DEVELOPMENTAL DISTURBANCES
OF TONGUE

2.  1. Microglossia
 2. Macroglossia
 3. Ankyloglossia
 4. Cleft tongue
 5. Fissured tongue
 6. Median rhomboid glossitis
 7. Benign migratory glossitis
 8. Hairy tongue
 9. Lingual varices
 10. Lingual thyroid nodule

3. MICROGLOSSIA
 It is a rare congenital anomaly manifested by the
presence of Rudimentary or small tongue
 The condition when tongue being completely
absent is known as Aglossia
 Patient finds difficulties in eating and swallowing
CLASSIFICATION
True microglossia
Relative microglossia

4. MACROGLOSSIA
 It is a condition when patient have an enlarged tongue
 True macroglossia and pseudomacroglossia
 Pseudomacroglossia includes any of the following
conditions, which force the tongue to sit in an abnormal
position:
 habitual posturing of the tongue,
 enlarged tonsils/adenoids,
 low palate and decreased oral cavity volume displacing
tongue,
severe mandibular deficiency( retrognathism),
neoplasms displacing tongue,
hypotonia of the tongue.

5.  True macroglossia can be congenital or acquired
CAUSES FOR CONGENITAL MACROGLOSSIA
 over development of the musculature
 Down syndrome
 Beckwith-Wiedemann syndrome

6. DOWN SYNDROME (TRISOMY 21 SYNDROME,
MONGOLISM)

10. CAUSES FOR ACQUIRED MACROGLOSSIA
tumors in tongue such as
 lymphangioma, hemagioma, neurofibroma
 Acromegaly
 Myxedema
 Amyloidosis

11. CLINICAL FEATURES
 Noisy breathing
 Difficulty with chewing/ swallowing
 Drooling
 Slurred speech
 Widened interdental space
 Scalloping/ crenations
 Open bite/ mandibular prognathism
 Dry/ cracked tongue
 Ulceration/ secondary infection/ hemorrhage

12. TREATMENT
 Surgical reduction or trimming may be required
when macroglossia disturbs the oropharyngeal
function.

13. ANKYLOGLOSSIA
 It can be defined as a developmental condition
characterized by fixation of tongue to the floor of the
mouth, causing restricted movement
 It can be either complete ankyloglossia or partial
ankyloglossia (tongue tie)
 Complete ankyloglossia occurs as a result of
fusion between the tongue and the floor of the
mouth
 Partial ankyloglossia occurs as a result of short
lingual frenum or due to a frenum which attaches
too near to the tip of the tongue

14. CLINICAL FEATURES
 speech disorders
 deformities in occlusion
 Difficulties in swallowing
TREATMENT
 Partial ankyloglossia are self
corrective
 Complete ankyloglossia can be
surgically treated by frenulectomy

15. CLASS TEST – 24-03-2018
Topics- short notes and short essays
 Developmental disturbances affecting-
 Lip
 Palate
 Jaw
 Gingiva
 Salivary gland
 Tongue

16. CLEFT TONGUE
 Complete cleft tongue occurs due to lack of
merging of lateral lingual swellings.
 Partial cleft tongue occurs due to incomplete
merging and failure of groove obliteration by
underlying mesenchymal proliferation
 partially cleft tongue occurs more common and is
manifested as deep groove in the midline of dorsal
surface
 food debris and microorganisms collect in base of cleft
and cause irritation

17. FISSURED TONGUE/
SCROTAL TONGUE
 clinically - numerous small grooves on dorsal surface
radiating out from central groove along the midline
of tongue
 often extends to the lateral borders of the tongue and
form lobules
ETIOLOGY
 It also occurs as a sequel to geographic tongue
 Hereditary factors

18. Clinical Features
 Grooves / furrows – 2-6mm
 Asymptomatic / mild burning sensation rarely
 Melkerson Rosenthal syndrome-
triad of fissured tongue, Chelitis granulomatosa (swelling of
face & lips), facial paralysis (VII nerve- Bell palsy)
The lesions are ususally
asymptomatic unless debris is
entrapped within the fissure and
causes irritation

19. MEDIAN RHOMBOID GLOSSITIS
central papillary atrophy of the tongue /
posterior lingual papillary atrophy
 It is an asymptomatic elongated erythematous patch of
atrophic mucosa on the mid dorsal surface of the
tongue.

20. ETIOLOGY
 It has been described as a congenital abnormality of
tongue due to failure of tuberculum impar to retract before
fusion of lateral halves of tongue so that structure devoid
of papillae is interpose between them.
 It is a focal area of susceptibility to chronic infections by
candida albicans

21. CLINICAL FEATURES
 Lesion appears Ovoid, diamond, rhomboid shaped
reddish patch on dorsal surface of tongue immediately
anterior to circumvallate papillae.
 it appears as a flat or slightly elevated area and stands out
distinctly from rest of tongue because it has no filiform
papillae
 Seen mostly in females in a ratio 3:1 when compared with
males
 Kissing lesions are seen (midline soft palate erythema in
the area of contact with tongue)

22. H/P:
 atrophic stratified squamous epithelium; occasionally
pseudoepitheliomatous hyperplasia, presence of
fungal hyphae, loss of papillae, elongated rete ridges
and lymphocytic infiltration.
TREATMENT
antifungal agents-amphotericin B or nystatin

23. BENIGN MIGRATORY
GLOSSITIS
Geographic tongue,
erythema migrans,
wandering rash of
tongue
ETIOLOGY
 The exact etiology remains
unknown.
 It may be genetic.
 However many believe that
emotional stress may
precipitate this condition

24. CLINICAL FEATURES
 The lesion occurs in about 1 to 3 % of population
 Females are affected more frequently than males by a 2:1
ratio
 seen on the anterior two third of the dorsal tongue
mucosa
characterized by multiple,
well demarcated, erythematous,
depapillated patches, typically
surrounded by a slightly elevated
yellow white scalloped border
and usually restricted to the
dorsum of the tongue.

25. H/P:
 hyperparakeratosis, spongiosis, acanthosis, elongated
rete ridges
 Red areas- keratin desquamated, neutrophils and
lymphocytes in epithelium
 Monro’s abscess (micro abscess in the keratin and
spinous layer)
TREATMENT
 no specific treatment
 heavy doses of vitamins and topical steroids

26. HAIRY TONGUE
BLACK HAIRY TONGUE, LINGUA NIGRA,
LINGUA VILLOSA
 characterized by marked accumulation of keratin on
filiform papillae of the dorsal surface resulting in a hair like
appearance

27. ETIOLOGY
 Chronic smokers
 microorganisms such as candida albicans
 Systemic disturbances like anemia, gastric upset
 Oral use of certain drugs like sodium perborate,
sodium peroxide and antibiotics such as penicillin
 Extensive x-ray radiation

28. CLINICAL FEATURES
 formation of a pigmented thick matted layer on the tongue
surface, heavily coated with bacteria and fungi
 Hair like appearence
 Halitosis
 Irritation of tongue due to accumulation of food debris
 Candidal over growth may cause
glossopyrosis ( burning tongue)

29. LINGUAL VARICES
 It is a dilated , tortuous vein which is often subjected to
increased hydrostatic pressure but is poorly supported
by surrounding tissue

30. CLINICAL FEATURES
 Varices usually involves the lingual ranine viens
 involved veins appear red or purple shotlike clusters
of vessels on the ventral surface and lateral borders of
tongue as well as in the floor of the mouth
 Presence of lingual varices before the ages of 50
indicates premature ageing
Treatment
 no specific treatment

31. LINGUAL THYROID
NODULE
follicles of thyroid tissue are
found in the substance of the
tongue.
ETIOLOGY
 It occurs when thyroid anlage that failed to migrate to
its predestined position or from anlage remnants that
became detached and were left behind.
 (the rudimentary basis of a particular organ or other part,
especially in an embryo.)

32. CLINICAL FEATURES
 appears as a nodular mass in or near
the base of tongue just posterior to
foramen caecum.
 Deeply situated and have a smooth surface
 The size varies from 2 – 3 cm
 dysphagia, dyspnea, dysphonia
or fullnes of throat

33. Sagittal reconstruction of CT scan of the neck,
showing the lingual thyroid at the base of the
tongue.

34. HISTOPATHOLOGY
 Lingual thyroid nodule consist of normal mature thyroid
tissue
 Occasionally thyroid nodules may exhibit colloid
degeneration
DIFFERNTIAL DIAGNOSIS
 Thyroglossal tract cyst
 Neoplasms
TREATMENT
 Surgical excision
 Suppresive therapy - supplemental thyroid hormone can
reduce the size of the lesion