DEVELOPMENTAL DISTURBANCE OF

TONGUE

Elvis Chiramel D
Third year BDS
 DEVELOPMENT OF TONGUE

Anterior two-third: From two lingual

swellings and one tuberculum impar, which
arises from the first branchial arch. The
tuberculum impar soon disappears.
Posterior one-third: From cranial large part of
the hypobranchial eminence, ie. from the
third arch
Posteriormost part from the fourth arch
 DEVELOPMENTAL DISTURBANCES OF
TONGUE

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
 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

I. True microglossia
II. Relative microglossia

TREATMENT

I. Orthognathic correction
II. Speech & language development

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microglossia
 MACROGLOSSIA
It is a condition when patient have an
enlarged tongue
May be congenital or acquired
ETIOLOGY FOR CONGENITAL
MACROGLOSSIA
Congenital macroglossia is due to an over
development of the musculature
Down syndrome
Beckwith-Wiedemann syndrome
CAUSES FOR ACQUIRED MACROGLOSSIA
1. tumors in tongue such as
lymphangioma,hemagioma and
neurofibroma
2. Acromegaly
3. Mxedema
4. Amyloidosis
5. Angioedema
macroglossia
 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
 TREATMENT

Surgical reduction or trimming may be

required when macroglossia disturbs the
oropharyngeal function

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 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 ankylogssia or

partial ankyloglossia (tongue tie)
Partial ankyloglossia occurs as a result of
shortlingual frenum or due to a frenum which
attaches too near to the tip of the tongue

Complete ankyloglossia occurs as a result of

fusion between the tongue and the floor of the
mouth
CLINICAL FEATURES
 speech disorders
 deformities in dental occlusion
 Difficulties in swallowing

TREATMENT
 Partial ankyloglossia are self corrective
 Complete ankyloglossia can be surgically
treated by frenulectomy

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Ankyloglossia
 CLEFT TONGUE

A complete cleft tongue occurs due to lack of

merging of lateral lingual swellings of this
organ
partially cleft tongue occurs more common
and is manifested as deep groove in the
midline of dorsal surface
Partial cleft tongue occurs due to incomplete
merging and failure of groove obliteration by
underlying mesenchymal prolifetation
food debris and microorganisms collect in
base of cleft and cause irritation
Cleft tongue
 FISSURED TONGUE
Its a malformation manifested clinically by
numerous small grooves on dorsal surface
radiationg out from central groove along the
midline of tongue

ETIOLOGY
It also occurs as a sequel to geographic
tongue
Hereditary factors
 Clinical Features

 Grooves / furrows – 2-6mm

 Asymptomatic / mild burning sensation rarely
 Melkerson Rosenthal syndrome
Chelitis granulomatosa, facial paralysis, scrotal tongue

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The lesions are ususally asymptomatic
unless debris is entrapped within the fissure
and causes irritation

Fissured tongue affects the dorsum surface

and often extends to the lateral bordres of
the tongue and form lobules
Fissured tongue
 MEDIAN RHOMBOID GLOSSITIS

Synonyms- central paillary atrophy of the

tongue / posterior lingual papillary atrophy

It is an asymptomatic elongated

erythematous patch of artophic mucosa on
the middorsal surface of the tongue
 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

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 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 slightyly elevated area
and stands out distinctly from rest of tongue
because it has no filliform papillae
Seen mostly in females in a ratio 3:1 when
compared with males
Kissing lesions are seen.
Median rhomboid glossitis
TREATMENT
antifungal agents-amphotericin B or
nystatin
 BENIGN MIGRATORY GLOSSITIS

Synonyms-georgaphic tongue,erythema
migrans and wandering rash of tongue
ETIOLOGY
The exact etiology remains unknown. It may
be genetic.
However many investigators believe that
emotional stress may precipitate this
condition
 CLINICAL FEATURES

 The lesion occurs in about 1 to 3 % of population

 Females are affected more frequently than males by a

2:1 ratio

 Geographic tongue is usually seen on the anterior

two third of the dorsal tongue mucosa

 the condition is characterized by multiple, well-

demarcated, erythematous, depapillated patches,
typically surrounded by a slightly elevated yellow
white scalloped border, and usually restricted to the
dorsumof the tongue
Benign migratory glossitis
 TREATMENT AND PROGNOSIS

there is no specific treatment for erythem

migrans
heavy doses of vitamins and and topical
steroids may produce someresutls in few
cases
 HAIRY TONGUE

 SYNONYMS- BLACK HAIRY TONGUE, LINGUA

NIGRA, LINGUA VILLOSA
Hairy tongue is characterized by marked
accumilation of keratin on filliform
papillae of the dorsal surface resulting in a
hair like appearence
 ETIOLOGY

Chronic smokers
It occurs due to 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
 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)
Hairy tongue
 TREATMENT

Cleaning and scrapping of tongue

Reducing the adminstration of long term
antibiotics
 LINGUAL VARICES

It is a dilated , tortous vein which is often subjected

to increased hydrostatic pressure but is poorly
supported by surrouonding tissue
 CLINICAL FEATURES

 Varices usually involves the lingual ranine viens

 the involved veins appears red of 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
 There is no specific treatment for lingual varices
LINGUAL VARICES
 LINGUAL THYROID
NODULE
it is an anomalous condition in which
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
 CLINICAL FEATURES

It 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

Chief symptoms are dysphagia, dyspnea,

dysphonia or fullnes of throat
Sagittal reconstruction of CT scan of the neck,
showing the lingual thyroid at the base of the
tongue.
 HISTOPATHOLOGY

Lingual thyroid nodule consist of normal

mature thyroid tissue
Occasionally thryodi nodules may exhibit
colloid degeneration or goiter
DIFFERNTIAL DIAGNOSIS
Thyroglossal tract cyst
Neoplasms

TREATMENT
Surgical excision
Suppresive therapy iwht supplemental
thyroid hormone can reduce the size of the
lesion
 REFERENCE

Oral pathology-Shafer’s
Oral and maxillofacial pathology-Neville
Human anatomy-Chaurasia’s