Tongue diseases can be congenital or acquired, and are multiple in number. Considered according to a

surgical sieve The surgical sieve is a thought process in medicine. It is a typical example of how to organise a structured examination answer for medical students and physicians when they are challenged with a question. It is also a way of constructing answers to ...

, some example conditions which can involve the tongue are discussed below. Glossitis is a general term for tongue inflammation, which can have various etiologies, e.g. infection.

Congenital

Examples of congenital disorders which affect the tongue include: * Aglossia - complete absence of the tongue at birth * Ankyloglossia (tongue tie) - where the

lingual frenum The frenulum of tongue or tongue web (also lingual frenulum or frenulum linguæ; also fraenulum) is a small fold of mucous membrane extending from the floor of the mouth to the midline of the underside of the tongue. Development The tongue start ...

tethers the tongue to the floor of the mouth. If it interferes with oral hygiene and feeding, frenectomy may be indicated. * Hypoglossia - congenitally short tongue * Microglossia * Macroglossia - an abnormally large tongue, seen in some disorders such as Down syndrome (although macroglossia can be an acquired condition as well). * Hamartomata - for example Leiomyomatous hamartoma * Glossoptosis * Choristomata - For example, osseous choristoma of the tongue, a very rare condition characterized by a nodule on the dorsum of the tongue containing mature lamellar bone without

osteoblast Osteoblasts (from the Greek language, Greek combining forms for "bone", ὀστέο-, ''osteo-'' and βλαστάνω, ''blastanō'' "germinate") are cell (biology), cells with a single Cell nucleus, nucleus that synthesize bone. However, in the p ...

ic or osteoclastic activity. Cartilaginous (chondroid), and glial choristomas may also very rarely occur on the tongue. * Lingual thyroid * Cleft tongue (bifid tongue) - completely cleft tongue is a rare condition caused by a failure of the lateral lingual swellings to merge. More common is an incompletely cleft tongue, appearing as midline fissure. This is normally classed as fissured tongue.

Acquired

Vascular

* Caviar tongue - the veins underneath the tongue can become dilated and prominent, giving the undersurface of the tongue a caviar like appearance. * Hemangioma

Infective

* Glossitis - some types of glossitis are caused by infections, e.g. median rhomboid glossitis (

Candida species ''Candida'' is a genus of yeasts and is the most common cause of fungal infections worldwide. Many species are harmless commensals or endosymbionts of hosts including humans; however, when mucosal barriers are disrupted or the immune system is ...

), "strawberry tongue" (seen in

scarlet fever Scarlet fever, also known as Scarlatina, is an infectious disease caused by ''Streptococcus pyogenes'' a Group A streptococcus (GAS). The infection is a type of Group A streptococcal infection (Group A strep). It most commonly affects childr ...

), and syphilitic glossitis (seen in tertiary

syphilis Syphilis () is a sexually transmitted infection caused by the bacterium ''Treponema pallidum'' subspecies ''pallidum''. The signs and symptoms of syphilis vary depending in which of the four stages it presents (primary, secondary, latent, an ...

). * Oral hairy leukoplakia (seen in people with immunosuppression, caused by Epstein–Barr virus) * Oral candidiasis can affect the tongue. Risk factors for oral candidiasis include

antibiotic An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention of ...

and

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 ...

use, and

immunodeficiency Immunodeficiency, also known as immunocompromisation, is a state in which the immune system's ability to fight infectious diseases and cancer is compromised or entirely absent. Most cases are acquired ("secondary") due to extrinsic factors that a ...

(e.g.

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

), or diabetes mellitus).

Traumatic

* The tongue may traumatized by mechanical, thermal, electrical or chemical means. A common scenario is where the tongue is bitten accidentally whilst a local anesthetic

inferior alveolar nerve block Inferior alveolar nerve block (abbreviated to IANB, and also termed inferior alveolar nerve anesthesia or inferior dental block) is a nerve block technique which induces anesthesia (numbness) in the areas of the mouth and face innervated by one of ...

is wearing off. The tongue may develop scalloping on the lateral margins, sometimes termed crenated tongue. This appearance is the result of indentations of the teeth where the tongue is habitually pressed against the teeth ("tongue thrusting", and example of oral parafunction). A lesion similar to morsicatio buccarum can occur on the tongue (sometimes called morsicatio linguarum), caused by chronic chewing on the tongue. The ventral surface (under surface) of the tongue may also be traumatized during oral sexual activity such as cunnilingus ("

cunnilingus tongue The frenulum of tongue or tongue web (also lingual frenulum or frenulum linguæ; also fraenulum) is a small fold of mucous membrane extending from the floor of mouth, floor of the mouth to the midline of the underside of the tongue. Development T ...

").

Autoimmune

* Autoimmune conditions such as

Sjögren syndrome Sjögren syndrome or Sjögren's syndrome (SjS, SS) is a Chronic disease, long-term autoimmune disease that affects the body's moisture-producing (lacrimal and salivary) glands, and often seriously affects other organ systems, such as the lungs, k ...

can cause xerostomia, with resultant glossitis.

Inflammatory

* Glossitis * Oral lichen planus

Neurological

* Hypoglossal nerve weakness can cause

atrophy Atrophy is the partial or complete wasting away of a part of the body. Causes of atrophy include mutations (which can destroy the gene to build up the organ), poor nourishment, poor circulation, loss of hormonal support, loss of nerve supply t ...

and

fasciculation A fasciculation, or muscle twitch, is a spontaneous, involuntary muscle contraction and relaxation, involving fine muscle fibers. They are common, with as many as 70% of people experiencing them. They can be benign, or associated with more serio ...

of the tongue. *

Melkersson–Rosenthal syndrome Melkersson–Rosenthal syndrome is a rare neurological disorder characterized by recurring facial paralysis, swelling of the face and lips (usually the upper lip: cheilitis granulomatosis) and the development of folds and furrows in the tongue (fi ...

- a neurological disorder characterized by fissured tongue, facial palsy and orofacial swelling.

Neoplastic

* The sides (lateral) and undersurface (ventral) of the tongue are high risk sites for the development of oral cancer, most commonly

squamous cell carcinoma Squamous-cell carcinomas (SCCs), also known as epidermoid carcinomas, comprise a number of different types of cancer that begin in squamous cells. These cells form on the surface of the skin, on the lining of hollow organs in the body, and on the ...

Degenerative

* Motor neuron disease (Lou Gehrig's disease) can cause impaired control of tongue movement, affecting speech and swallowing.

Environmental

* Poor diet can cause malnutrition and nutritional deficiencies. Deficiency of iron, B vitamins and folic acid are common causes for atrophic glossitis. * Black hairy tongue - some factors thought to cause black hairy tongue are environmental, such as eating a soft diet, poor oral hygiene, smoking and antibiotic use.

Unknown

* Geographic tongue (benign migratory glossitis) - a common disorder which occasionally causes a burning sensation but is usually painless. Irregular patches of depapillation form on the tongue giving the appearance of a map. The cause is unknown. * Leukoplakia - can affect the tongue * Tongue coating - food debris, desquamated epithelial cells and bacteria often form a visible tongue coating. This coating has been identified as a major contributing factor in bad breath ( halitosis), which can be managed by brushing the tongue gently with a toothbrush or using special oral hygiene instruments such as tongue scrapers or mouth brushes. * Burning mouth syndrome - this chronic pain disorder commonly involves the tongue. In reflection of this, some of the synonyms for the condition include tongue-specific terms such as "glossodynia" or "burning tongue syndrome". Burning mouth syndrome is characterized by chronic burning sensation on the tongue and other oral mucous membranes in the absences of any identifiable signs or causes.

Iatrogenic

* Paratrichosis tongue - Real hair implanted on tongue.

Epidemiology

Tongue lesions are very common. For example, in the United States one estimated point prevalence was 15.5% in adults. Tongue lesions are more common in persons who wear dentures and tobacco users. The most common tongue conditions are geographic tongue, followed by fissured tongue and hairy tongue.

History

Hippocrates, Galen and others considered the tongue to be a " barometer" of health, and emphasized the diagnostic and prognostic importance of the tongue. Assessment of the tongue has historically been an important part of a medical examination. The shape and color of the tongue is examined and observed diagnostically in traditional Chinese medicine. For example, scalloping of the tongue is said to indicate qi vacuity. Some modern medical sources still describe the tongue as "the mirror of physical health". This is related to the high rate of turnover of the oral mucosa compared to the skin, which means that systemic conditions may manifest sooner in the mouth than the skin. Physical appearances such as

cyanosis Cyanosis is the change of body tissue color to a bluish-purple hue as a result of having decreased amounts of oxygen bound to the hemoglobin in the red blood cells of the capillary bed. Body tissues that show cyanosis are usually in locations ...

are also often more readily apparent in the mouth.

References

External links

{{Congenital malformations and deformations of digestive system *