Median rhomboid glossitis is a condition characterized by an area of redness and loss of

lingual papilla Lingual papillae (singular papilla) are small structures on the upper surface of the tongue that give it its characteristic rough texture. The four types of papillae on the human tongue have different structures and are accordingly classified as c ...

e on the central dorsum of the tongue, sometimes including lesions of the tongue and palate. It is seen in patients using inhaled steroids and smokers, and is usually a kind of chronic atrophic

oral candidiasis Oral candidiasis, also known as oral thrush among other names, is candidiasis that occurs in the mouth. That is, oral candidiasis is a mycosis (yeast/fungal infection) of ''Candida'' species on the mucous membranes of the mouth. ''Candida albica ...

, but

hematinic A hematinic is a nutrient required for the formation of blood cells in the process of hematopoiesis. The main hematinics are iron, B12, and folate. Deficiency in hematinics can lead to anaemia. In cases of hematinic deficiency, hematinics can be a ...

deficiency and

diabetes Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ap ...

should be excluded. Median Glossitis (edit)

Signs and symptoms

Rarely is any soreness associated with the condition. Apart from the appearance of the lesion, there are usually no other signs or symptoms. The typical appearance of the lesion is an oval or rhomboid shaped area located in the midline of the dorsal surface of the tongue, just anterior (in front) of the sulcus terminalis. The lesion is usually symmetric, well demarcated, erythematous and depapillated, which has a smooth, shiny surface. Less typically, the lesion may be

hyperplastic Hyperplasia (from ancient Greek ὑπέρ ''huper'' 'over' + πλάσις ''plasis'' 'formation'), or hypergenesis, is an enlargement of an organ or tissue caused by an increase in the amount of organic tissue that results from cell proliferatio ...

or lobulated and exophytic. There may be candidal lesions at other sites in the mouth, which may lead to a diagnosis of chronic multifocal oral candidiasis. Sometimes an approximating erythematous lesion is present on the palate as the tongue touches the palate frequently. The lesion is typically 2–3 cm in its longest dimension.

Causes

Predisposing factors include smoking, denture wearing, use of

corticosteroid Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are involv ...

sprays or inhalers and

human immunodeficiency virus The human immunodeficiency viruses (HIV) are two species of ''Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause AIDS, acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the ...

(HIV) infection. ''Candida'' species even in healthy people mainly colonizes the posterior dorsal tongue. Median rhomboid glossitis is thought to be a type of chronic atrophic (or erythematous) candidiasis. Microbiological culture of the lesion usually shows ''Candida'' mixed with bacteria.

Diagnosis

The diagnosis is usually made on the clinical appearance, and tissue

biopsy A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist. The process involves extraction of sample cells or tissues for examination to determine the presence or extent of a diseas ...

is not usually needed. The

histologic Histology, also known as microscopic anatomy or microanatomy, is the branch of biology which studies the microscopic anatomy of biological tissues. Histology is the microscopic counterpart to gross anatomy, which looks at larger structures vis ...

picture is one of superficial candidal

hyphal A hypha (; ) is a long, branching, filamentous structure of a fungus, oomycete, or actinobacterium. In most fungi, hyphae are the main mode of vegetative growth, and are collectively called a mycelium. Structure A hypha consists of one or ...

infiltration and a polymorphonuclear leukocytic inflammatory infiltrate present in the epithelium. The

rete ridges Rete pegs (also known as rete processes or rete ridges) are the epithelial extensions that project into the underlying connective tissue in both skin and mucous membranes. In the epithelium of the mouth, the attached gingiva exhibit rete pegs, wh ...

are elongated and hyperplastic (pseudoepitheliomatous hyperplasia, which may be mistaken for

carcinoma Carcinoma is a malignancy that develops from epithelial cells. Specifically, a carcinoma is a cancer that begins in a tissue that lines the inner or outer surfaces of the body, and that arises from cells originating in the endodermal, mesodermal ...

Treatment

Treatment may involve smoking cessation and prescription of topical or systemic

antifungal medication An antifungal medication, also known as an antimycotic medication, is a pharmaceutical fungicide or fungistatic used to treat and prevent mycosis such as athlete's foot, ringworm, candidiasis (thrush), serious systemic infections such as crypt ...

. Usually the mucosal changes resolve with antifungal therapy, but sometimes the lesion is resistant to complete resolution.

Epidemiology

It is an uncommon condition, occurring with equal prevalence in males and females and at any age.

History

Historically, this lesion was believed to be a developmental defect of the tongue, caused by failure of the

tuberculum impar The median tongue bud (also tuberculum impar) marks the beginning of the development of the tongue. It appears as a midline swelling from the first pharyngeal arch late in the fourth week of embryogenesis. In the fifth week, a pair of lateral li ...

to be covered by the lateral processes of the tongue. This was disproved when a study of 10,000 children were examined and no medium rhomboid glossitis lesions were found at all. Since, a consistent correlation with ''C. albicans'' has been demonstrated.

References

External links

{{oral pathology Conditions of the mucous membranes Tongue disorders Oral mucosal pathology