DEVELOPMENTAL

DISTURBANCES OF TONGUE

Banun Kusumawardani
Faculty of Dentistry
UNEJ
• During the fourth week of intrauterine phase, the
tongue is originated from the first three or four
branchial arches and a median swelling
(tuberculum impar) on the floor of pharynx and
two lateral lingual swellings joining this central
structure.
• These three swelling are originated from the first
pharyngeal arch.
• Copula or hypobranchial eminence is another
median swelling that is formed by mesoderm of
the second, third, and part of the fourth branchial
arch. It gives rise to posterior part of the tongue.
• Malformations of the tongue, are structural defects,
present at birth and happening during
embryogenesis.
• The development of the tongue begins in the floor of
the primitive oral cavity, when the human embryo is
four weeks old.
• More specifically, the tongue develops from the
region of the first three or four branchial arches
during the period that the external face develops.
• Developmental anomalies or defects may be major
or minor, single or multiple, depending on their size,
site and effect.
• The most common malformations of the tongue
combined with syndromes associated with them.
AGLOSSIA / MICROGLOSSIA SYNDROME

• Extremely rare
• Associated with
– Anomalis of hand and feet
– Cleft palate
– Dental agenesis
• Microglossia
– Lack of muscle stimulus
• Mandible fails to grow
forward
 MACROGLOSSIA
• True macroglossia
– Congenital
– Acquired
• Pseudo macroglossia
– Relative small jaw
– Atonia
– Vitamin deficiencies
– Neoplasms displacing tongue
• Congenital: • Acquired:
• Muscle hypertrophy • Hypothyroid
• Gland hyperplasia • Syphillis
• Down’s syndrome • Candidiasis
• Beckwith weidmann’s • Acromegaly
• Lymphangioma • Amyloidosis
• Gargoylism • Sarcoidosis
ANKYLOGLOSSIA
• Short lingual frenum
• Speech problem
CLEFT TONGUE
• Deep groove in midline of
the dorsal tongue
 FISSURED TONGUE (SCROTAL TONGUE)
• Grooves of varying depth 2-6 mm
• Asymtomatic/mild burning
• Hereditary factors
• Melkersson Rosenthal syndrome:
– Facial palsy
– Chelitis granulomatosa
– Fissured tongue
• Down’s syndrome
• Histology :
– loss of filiform papillae
– neutrophillic micro-abscesses
FISSURED TONGUE (SCROTAL TONGUE)
 MEDIAN RHOMBOID GLOSSITIS
• Dorsal surface of the tongue along the
midline, just anterior to the foramen
cecum
• Rhomboid or oval, well-demarcated shape
• Red, flat or slightly multilobulated smooth
• Depapillated surface
• 1 to 3 cm
• Usually asymptomatic
• Re-termed as POSTERIOR MIDLINE
ATROPHIC CANDIDIASIS:
– Atrophic stratified squamous epithelium
– Moderately fibrous CT
– Chronic candidal infection
– Always antifungal therapy prior to biopsy
MEDIAN RHOMBOID GLOSSITIS
ETIOLOGY CLINICAL FEATURES
 BENIGN MIGRATORY GLOSSITIS
• Psorasiform mucositis
• Multiple sensitive irregularly shaped
erythematous patches on the tongue
• Arcuate white rims that enlarge and
change
• Associations with human leukocyte antigen
DR5 (HLA-DR5), DRW6 (HLA-DRW6), and
Cw6 (HLA-Cw6)
• Similar to psoriasis
• Histopathology:
– Neutrophillic exocytosis
– Monro’s abscess
– Thin long rete ridges
– Small epithelium over the papillae
 HAIRY TONGUE
• Defective desquamation of filiform papillae
• Black –brown to white
• Etiology:
– Hypertrophy of filiform
– Lack of mechanical stimulation
– Tobacco
– Coffee
• Clinical features:
– M>F
– 1 –15 mm papillae
– Tickling soft palate
– Asymptomatic:
• Candida glossopyrosis
– Halitosis
• Histology:
– Mild elongated papillae
– Mild hyperkeratosis
– Occational inflammatory cells
– Accumulated debris
 HAIRY TONGUE
ETIOLOGY CLINICAL FEATURES
 LINGUAL VARICES

• Varix dialated, tortuous vein

– Increased hydrostatic pressure
– Poorly supported by surrounding tissue
• Lingual ranine veins
– Red to purple shot like cluster of vessels
– Ventral and lateral surfaces
• No direct association between varicosities
and organic diseases
• Aging process
• <50 years if present  premature aging
LINGUAL THYROID NODULE
ETIOLOGY CLINICAL FEATURES
 LINGUAL THYROID NODULE
HISTOPATHOLOGY DIFFERENTIAL DIAGNOSIS
 Anomalies of Tongue
1- Aglossia: Complete absence of tongue
2- Microglossia: Small sized tongue
3- Macroglossia: Large sized tongue
4- Bifid tongue: due to failure of fusion
between 2 lingual swellings
5- Tongue tie: short frenulum due to
defective formation of linguo-gingival groove