DEVELOPMENTAL

DISTURBANCES OF THE
TONGUE

MICROGLOSSIA
MACROGLOSSIA
ANKYLOGLOSSIA
LINGUAL THYROID
FISSURED TONGUE ( SCROTAL TONGUE)
HAIRY TONGUE
MEDIAN RHOMBIOD GLOSSITIS
BENIGN MIGRATORY GLOSSITIS
LINGUAL VARICES
BALD TONGUE

MICROGLOSSIA (HYPOGLOSSIA)
C/F
Abnormally small tongue
Associated with other conditions known as
oromandibular limb hypogenesis syndrome
( Hypodactaly absence of digits, hypomelia hpoplasia
of part or all of limb, cleft palate, intraoral bands)
Associated with Hypoplasia of mandible

MACROGLOSSIA
Characterized by enlargement of the tongue
Causes
Congenital & Hereditary
1. Vascular malformations
. Lymphangioma
. Hemangioma
2. Hemihyperplasia
3. Cretinism
4. Beckwith Widemann syndrome
5. Down syndrome
6. Mucopolysacchariodosis
7. Neurofibromatosis

Acquired

Edentulous patients
Amyloidosis
Acromegaly
Myxedema
Angioedema
Carcinoma & other tumors

C/F
Children
Mild severe in degree
Infants noisy breathing, drooling & difficulty
in eating
Lisping speech
pressure of the tongue against mandible &
teeth produce crenated lateral border to the
tongue, open bite, mandibular prognathism

If constantly produce from the mouth ulcerate &

secondarily infected or necrosis
Airway obstruction
Patients with Hypothyroidism Or Beckwith
wiedemann syndrome tongue shows a diffuse,
smooth, generalized enlargement
Multinodular in appearance amyloidosis,
neurofibromatosis
Lymphangiomas pebbly, multiple vesicle like blebs
that represent superficial dilated lymphatic vessels
Down syndrome papillary & fissured surface
Hemifacial hyperplasia - unilateral enlargement of
the tongue.
Edentulous patients elevated & spreads laterally

H/f
Macroglossia due to tumor neoplastic proliferation
of particular tissue is found
Muscular enlargement - Beckwith wiedemann
syndrome , Hemifacial hyperplasia
Rx
Speech therapy
Glossectomy

ANKYLOGLOSSIA ( TONGUE TIE)

Characterized by a short, thick lingual frenum resulting
in limitation of the tongue movement
C/F
Frenum extends forward & attaches to the tip
of the tongue & leading to clefting at the tip of the
tongue.
Open bite
High mucogingival attachements - periodontal
problems
Speech defects

Rx
Frenectomy functional & periodontal problems

HAIRY TONGUE ( BLACKY HAIRY

TONGUE)
Characterized by marked accumulation of keratin on the
filliform papillae of the dorsal tongue resulting in
hairlike appearance.
Causes
Heavy smoking
Antibiotic therapy
Poor oral hygiene
General debilitation
Radiation therapy
Use of oxidizing mouthwashes or antacids
Overgrowth of fungal or bacterial organisms

C/F
Affects the midline just anterior to the
circumvallate papillae ( lateral & anterior borders
excluded)
Elongated papillae are brown, yellow, or black
Asymptomatic
Bad taste in the mouth or gagging sensation
H/F
Marked elongation & hyperparakeratosis of
filliform papillae

BENIGN MIGRATORY
GLOSSITIS
Other names
Geographic tongue
Wandering rash of the tongue
Erythema migrans
C/F
Females
Anterior two thirds of the dorsal tongue mucosa
Appear as multiple, well demarcated zones of erythema
( concentrated at the tip & lateral borders
of the tongue & due to loss of filliform papillae)

 Atrophic

areas are surrounded by a slightly elevated ,

yellowish white, serpentine border
Lesion begins as a small white patch, then develops a
central erythematous atrophic zone & enlarges
centrifugally
Lesions are asymptomatic
H/F
Peripheral region Hyperparakeratosis, spongiosis,
acanthosis, elongation of epithelial rete ridges.
Collection of neutrophils ( Munro abscesses) within the
epithelium.
Lymphocytes,neutrophils in CT

Fissured tongue ( Scrotal tongue)

Numerous grooves, or fissures present on the dorsal

tongue surface

C/F
2 5% overall population
Children or adults
Severity increases with age
Male
Multiple grooves or furrows on the surface of the tongue,
2 6mm in depth
numerous fissures cover the entire dorsal surface &
divide the tongue papillae into multiple separate
islands.

 Some

fissures are located dorsolateral areas of

the tongue
Larger central fissure with smaller fissures
branching outward at right angles
Asymptomatic
Melkersson Rosenthal syndrome
H/F
Hyperplasia of the rete ridges & loss of keratin
hairs on the surface of the filliform papillae
PML in the epithelium.
Mixed inflammatory cell infiltrate in CT

Lingual thyroid
C/F
Females
Small, asymptomatic nodular lesions large lesions
Dysphagia, dysphonia, dysnea
Mass is vascular
Hpothyroidism
Rx : Thyroid harmone therapy or surgical excision

Median rhombiod glossitis ( central

papillary atrophy)
Defective in the fusion of posterior dorsal area
Appears as rhomboid shaped, erythematous
mucosa, lacking papillae & taste buds.
Area of susceptibility to recurring or chronic
atrophic candidiasis ( Posterior midline
atrophic candidiasis )

C/F
Posterior midline of the dorsum of the tongue,
anterior to the
V shaped grouping of the circumvalate papillae
Middle aged patients
Male predliction
Infected cases - midline soft palate erythema in the
area of routine contact with the underlying tongue
involvement ( Kissing lesion)
Less than 2 cm, smooth & flat surface

H/F
Smooth or nodular surface covered by atrophic
stratified squamous epithelium.
Moderately fibrosed stroma
Mild moderate intense chronic inflammatory cell
infiltrate
Chronic candida infection excess surface keratin
production or extreme elongation of rete processes &
premature keratin production with individual cells

Varicosities ( Varices)
Abnormally dilated and tortuous veins.
Etiology
Age Loss of connective tissue tone supporting the
vessels
Varicose veins of the legs
C/f
Oral varicosity sublingual varix
Above 60 yrs of age
Multiple bluish purple, elevated or papular blebs on
the ventral & lateral border of the tongue.

 Asymptomatic

Solitary varices - lip & buccal mucosa

H/F
Dilated vein, wall shows little smooth muscle &
poorly developed elastic tissue.
Secondary thrombosis lumen contains
concentrically layered zones of platelets &
erythrocytes ( Lines Of Zahan)