Tongue disorders

Filiform

Foliate papillae

Circumvallate papillae (fungiform shape)

Geographic tongue (Benign migratory glossitis or erythema migrans)

An inflammatory condition of the tongue

Aetiology

Poorly understood and tends to run in families

Vitamin B deficiencies, allergies, hormonal changes,

stress, or diets high in sugar or processed foods

White snaky lines (arrow) with parallel grooves

Geographic tongue

Geographic tongue

Geographic tongue

Geographic tongue

Mild geographic tongue

Mild geographic tongue

Erythema migrans

Erythema migrans

Diagnosis

Clinical examination

Exclude DM, anaemia, and oral fungal infections

Treatment

Phenolic essential oil MW and peroxidase toothpaste

Chewing mint leaves, sucking on a mint candy or gum

Topical steroid gel

Oral vitamin B complex or sublingual vitamin B12

Zinc supplements if strawberries or pineapple sensitivity

Antihistamines

Reassurance

Fissured tongue (Scrotal or placated tongue)

Deep grooves along the dorsal and lateral aspects of the tongue

Aetiology

Unknown

May inherited

Fissured tongue

Scrotal tongue

Fissured tongue and geographic tongue

Melkersson-Rosenthal syndrome

Fissured tongue in Melkersson-Rosenthal syndrome

Diagnosis: Clinical appearance

Treatment

No specific treatment.

Brush the top surface of tongue

Analgesic MW without alcohol

Lingual Thyroid (Ectopic lingual thyroid)

An uncommon abnormality of migration of the thyroid gland

Aetiology: when migration fails and the gland remains in the

base of the tongue

Lingual Thyroid

Lingual Thyroid

Diagnosis

Iodine radioisotope scan

Biopsy

Treatment

Most cases require no treatment

Surgical excision or radioiodine therapy +ve

Excision and autotransplantation -ve

Angioedema (Quincke's oedema)

A relatively common allergic disorder

Aetiology:

HAE or AAE

May be triggered by stress, drugs, food allergy,

chemicals, and infections

Urticaria

Angioedema of lips

Facial angioedema

Periorbital angioedema

Angioedema of tongue

Diagnosis

CBC, U&E, kidney function, LFT, TSH, T4, and T3, serum

Ig’s, and complement profile (HAE)

Skin testing and/or RAST and ELISA

Stool tests for ova, cysts, and parasites

Mast cell tryptase level elevated in acute allergic reaction

HAE and AAE do not respond to antihistamines,

corticosteroids or epinephrine

Treatment

HAE: C1-esterase inhibitor concentrate or FFP

AAE: tranexamic acid, treat lymphoproliferative disease

Antihistamines, adrenaline, and steroids are used in acute

allergic angioedema

Severe cases require desensitisation to the putative allergen

Carry an epinephrine auto-injector (EpiPen)

Tracheotomy is needed

Oral hairy leukoplakia

Seen in severe defects of immunity, particularly in

HIV infection

Aetiology: EBV

Oral hairy leukoplakia

Diagnosis

Clinical

Biopsy

Treatment

Topical tretinoin (Retin-A) or podophyllin resin solution

Oral acyclovir, valacyclovir, or famciclovir in high doses

Ankyloglossia (Tongue tie)

Varies in degree of severity from mild cases to

complete ankyloglossia

Aetiology: Congenital anomaly

Ankyloglossia

Ankyloglossia

Ankyloglossia

Diagnosis

Infants

Children

Treatment

Frenectomy (frenulectomy or frenotomy)

Wait-and-see approach

Coated tongue (Furred tongue)

The entire healthy tongue mucosa may appear coated in a

whitish or yellowish layer

Aetiology

Poor oral hygiene

Febrile illnesses

Dehydration

Soft diet

Coated tongue

Coated tongue

Diagnosis

Clinical examination

Can be scraped off

Treatment

■ Brushing or scraping the tongue

■ Rinse with peroxidase or sodium bicarbonate MW

■ Treat the underlying factors

Black hairy tongue (Hairy tongue)

A benign common oral condition that gives the tongue a

dark furry appearance

Aetiology:

Poor oral hygiene

Heavy smoking

Regular use of MW

Broad-spectrum AB’s & bismuth medications

Radiation of head and neck

Black hairy tongue Normal tongue

Black hairy tongue

Diagnosis

Cytologic smears (gram or PAS)

Culture swab

Treatment

Brushing or scraping the tongue

Topical antifungal therapy

Treat PP

Burning mouth syndrome

A chronic painful, frustrating condition

Aetiology:

Primary BMS - unknown (may be neuropathy)

Secondary BMS - local factors or systemic factors

Clinically normal lingual mucosa

Diagnosis:

Culture swab and smear

Allergy testing

CBC, serum ferritin, folate, vitamin B1, B2, B6,

B12, zinc levels, FBS level, thyroid function,

gastric reflux tests, salivary flow rate, immune

functioning, and psychological assessment

Temporarily stopping medications

Treatment

Primary BMS

Clonazepam lozenge (benzodiazepine)

Chlordiazepoxide tablet (benzodiazepine)

Tricyclic antidepressants (amitriptyline)

Capsaicin, with hot pepper and water oral rinse

ALA and gabapentin (gives best result)

Secondary BMS

Treat local or systemic causes

Granular cell tumor (Granular cell myoblastoma or Abrikossoff's tumor)

An uncommon lesion

Aetiology: a neoplastic process of neural derivation

Granular cell tumor

Granular cell tumor

Diagnosis - Biopsy

Treatment - Excisional biopsy

Macroglossia

An abnormal enlargement of the tongue

Aetiology

Pseudomacroglossia

True enlargement (congenital and acquired)

Macroglossia

Macroglossia

Diagnosis – Clinical

Treatment

Identify the aetiology

Surgery if unknown aetiology or neoplasm

Lingual varicosities (Sublingual varices)

Are abnormally dilated and tortuous veins

Aetiology

Unknown

May associated with chronic vitamin-C deficiency

Lingual varicosities

Lingual varicosities

Diagnosis – Clinical

Treatment – Assurance