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
Igs, 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 ABs & 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