TONGUE DISORDERSSARANG SURESH HOTCHANDANI

INTRODUCTION• In generalized stomatis, tongue can also be

affected…• Examples• Generalized stomatitis in Herpes

• Tongue can also shows signs or lesions for indication of other systemic diseases.• Examples• Hairy leukoplakia in AIDS• Anemia

CLASSIFICATION OF TONGUE DISORDERS

DEVELOPMENTAL

Microglossia

Ankyloglossia

Cleft tongue

Fissured tongue

Median rhomboid glossitis

Benign migratory glossitis

Hairy tongue

ACQUIRED

Sore Tongue

Actinomycosis

Lichen Planus

Lingual Hematoma

Ulcer of Tongue

Foliate Papilla

SORE TONGUE• Sore = tender to touch, painful, inflamed, sensitive.

• CAUSES• Ulcers of tongue due to any cause• Glossitis• Sore tongue but physically normal tongue• Geographic tongue• Etc……….

ULCERATION OF TONGUE• CAUSES• Apthous ulcers

• Herpes stomatitis

• Lichen planus

• Carcinoma

• Mostly lateral border of tongue is affected with ulcer.

• If ulcer is on dorsum of tongue then don’t consider carcinoma at first because carcinoma on dorsum of tongue is rare.

GLOSSITIS•It is a term used for;•Red •Smooth•Sore tongue

•CAUSES• Anemia• Iron deficiency anemia• Pernicious anemia

• Vitamin deficiency• Candidiasis• Antibiotic use

CLINICAL FEATURES•WOMEN are more frequently affected in

glossitis due to anemia

• Tongue appears SMOOTH, RED & SORE.

• Smoothness of tongue is due to ATROPHY OF FILIFORM PAPILLA

VITAMIN DEFICIENCY• In RIBOFLAVIN DEFICIENCY and sometimes

NICOTINIC ACID DEFICIENCY GLOSSITIS can occur along with ANGULAR STOMATITIS.

• However diagnosis of glossitis in an healthy patient can not be made on basis of cause of vitamin deficiency alone.

• Although vitamin B group drugs are given for relieve of soreness in glossitis but these are frequently ineffective and this thing make it clear that VITAMIN DEFICIENCY ALONE IS NOT CAUSE OF GLOSSITIS

CANDIDIASIS (FUNGAL INFECTION)

• Candidiasis causes tongue to be RED, SORE AND EDEMATOUS

• Cause of this fungal infection is ANTIBIOTICS which causes ANTIBIOTIC STOMATITIS along with ANGULAR STOMATITIS.

• Acute antibiotic induced stomatitis occurs due to LONG TERM USE of broad spectrum antibiotics

• Example; Tetracycline

• In SJOGREN SYNDROME, tongue becomes;•Red•Cobblestone

appearance

LICHEN PLANUS• SMOOTH TONGUE due to atrophy of tongue papilla

• SORENESS

• NO ERYTHEMA

• BLUISH WHITE SHINING on tongue

SORE BUT PHYSICALLY NORMAL TONGUE

• This title means there is soreness but no other lesion or pathology is visible on tongue.

• This type of soreness creates difficulty in diagnosis

• This type of condition is mostly PSYCHOGENIC and is sometime called BURNING MOUTH SYNDROME which is type of ATYPICAL FACIAL PAIN.

• Diagnosis is by EXCLUSION OF ORGANIC DISEASE

ERYTHME MIGRANS LINGUAE

BENIGN MIGRATORYGLOSSITIS

ERYTHEMA AREATAMIGRANS

STOMATITIS AREATA MIGRANS

GEOGRAPHIC TONGUE

INTRODUCTION

• It is common BENIGN CONDITION mostly affecting DORSAL SURFACE OF TONGUE.

• Characterized by RECURRENT APPEARANCE & DISAPPEARANCE OF RED AREAS ON TONGUE

ETIOLOGY

•Cause is UNKNOWN but sometimes there is FAMILY HISTORY

•Sometimes due to PSORIASIS.

CLINICAL FEATURES….

• Lesion appears IrREguLaR, Smooth RED AREA with SHARPLY DEFINED MARGINS.

• RED AREA is due to shortening of FILIFORM PAPILLA• These lesions increase for few days and then disappear and then reappear in

another area.

• Sometimes the lesion is ANULAR with slightly raised pale margins and then after sometimes these rings join to form a scalloped pattern.

• Mostly ASYMPTOMATIC but some patients complain of soreness.

• Sometimes children with geographic tongue complain that TONGUE IS HYPERSENSITIVE and this hypersensitivity prevents them from eating their food.

• The reason for this is that some areas of tongue have normal epithelium while at some areas these is inflamed epithelium.

HISTOLOGICAL FEATURES•Thinning Of Epithelium At Center Of Lesion

•HYPERPLASIA & HYPERKERATOSIS AT PERIPHERY

•Chronic inflammatory cells in underlying connective tissue•Loss Of Filiform Papillae At The Center Of Ring.

DIFFERENTIAL DIAGNOSIS

Chemical Burn

Candidiasis

Squamous Cell Carcinoma

Psoriasis

Lichen Planus

Contact Stomatis

TREATMENT

• As the lesion is benign and asymptomatic, usually there is no treatment required.

• However studies showed successful treatment with following drugs.• Cyclosporine

• Topical and systemic antihistamine

• Topical retinoid

• Topical corticosteroids

• Mouth rinses

• Zinc supplements

Hairy Tongue

Black Hairy

Tongue

Lingua Villus Nigra

INTRODUCTION•It is commonly observed condition characterized by ABNORMAL COATING on DORSAL SURFACE of tongue, due to DEFECTIVE DESQUAMATION of FILLIFORM PAPILLA.

ETIOLOGY CUM PREDISPOSING FACTORS

BACTERIA

POOR ORAL HYGEINE TOBBACO USE

BROAD SPECTURM ANTIBIOTICS

RADIOTHERAPY DRUGS (STEROID)

ANTISEPTIC MOUTHWASH

DEFECTIVE DIET

PATHOLOGY

In hairy tongue HYPERTROPHY OF FILIFORM PAPILLA occurs which then becomes elongated and then

forms thick fur on dorsum of tongue. These elongated papilla then covered by CHROMOGENIC BACTERIA.

CLINICAL FEATURES

•Lesion is mostly on DORSUM OF TONGUE.•Mostly Adults Males.•Mostly ASYMPTOMATIC but sometimes Burning During Swallowing•HALITOSIS and GAGGING SENSATION because of

retention of debris in between filiform papilla.

TREATMENT

Brushing tongue with Tongue

Scrapper.

MEDIAN RHOMBOID GLOSSITIS

• It is abnormality in the MIDLINE OF TONGUE at the junction of anterior 2/3 with posterior 1/3 characterized by RHOMBOID SHAPED SMOOTH ERYTHEMATOUS AREA LACKING LINGUAL PAPILLA AND TASTE BUDS.

• It is thought to be developmental but is not seen in children.

• Erythematous appearance is due to absence of filiform papilla.

• This lesion of MRG is susceptible to candida infection.

• Normally median rhomboid glossitis lesion is pink in color but sometime due to fungal infection its surface can appear white.

CLINICAL FEATURES

•Mostly in ADULTS and is ASYMPTOMATIC.•Appear as NODULAR, RED or PINK area of depapillation•Usually flat or slightly elevated.

DIFFERENTIAL DIAGNOSIS

•Lingual thyroid•Granuloma TB•Tertiary syphilis•Deep fungal infection•Granular cell Tumor

MANAGEMENT

No treatment necessary..Antifungal drugs if candidiasis…

Palliative…

MACROGLOSSIA

MACROGLOSSIA

CONGENITAL ACQUIRED

CONGENITAL CAUSES

MUSCLE HYPERTROPHY

DOWN SYNDROME HEMANGIOMA TRISOMY LYMPHANGIOM

A

ACQ

UIR

ED

METABOLIC

INFECTIOUS

SYSTEMIC

TRAUMATIC

INFILTRATIVE

NEOPLASTIC

• Hypothyroidism• Cretinism• Diabetes

Metabolic Infectious• Syphilis• Ludwig angina• TB

Systemic……. ACROMEGALY

Infiltrative

Amyloidosis Sarcoidosis

Traumatic

Surgery

Hemorrhage

Radiotherapy

Neoplastic

• Hemangioma• Lingual

thyroid• Plasmacytoma

THANKS!!