Developmental

Anomalies
Of Tongue
Guided by-
Dr Priyanka Rastogi(HOD)
Dr Sachin Kumar(Professor)
Dr Rudra Bharadwaj
(Senior Lecturer)

Submitted by-
Abhivyakti Shekhar
BDS 3rd Year
CONTENT
• Introduction
• Microglossia
• Macroglossia
• Ankyloglossia
• Cleft Tongue
• Fissured Tongue
• Median Rhomboid Glossitis
• Benign Migratory Glossitis
• Hairy Tongue
• Summary
• Conclusion
• Reference
 INTRODUCTION
The congenital malformations of the tongue are
common and ,are of a wide variety and may be
associated with a wide range of congenital
syndromes , knowing which can help to predict
possible deformities in other parts of the body .
Deformities of the tongue not only have effects on
the ingestion of food , taste sensation or speech,
but also is a prime determination of one’s facial
look and personality. Thus having mechanical and
social impacts as well.
Hence, its early detection and correction is of prime
importance.
MICROGLOSSIA
• It is a developmental condition that is
characterized by an abnormally small,
rudimentary tongue .
• A microglossia with extreme glossptosis
is then called AGLOSSIA SYNDROME.
• This anomaly is almost always
associated to malformations in the
extremities, especially the hands and
feet, cleft palate and dental agenesia.
• This syndrome show no predilection for
gender and has no genetic
implications.
MACROGLOSSIA
• It is characterized by enlargement of the tongue.
• The exact incidence of macroglossia is unknown,
some congenital syndromes like DOWN SYNDROME
& BECKWITH-WIEDEMANN SYNDROME often
express macroglossia.
• It may be due to dilation of lymphatics , muscle
hypertrophy or inflammation.
• The two main broad categories of macroglossia :
1. True Macroglossia
2. Pseudomacroglossia
CLINICAL FEATURES
• Common in children.
• Range from mild to severe in degree.
• In infants, manifested first by noisy
breathing, drooling and difficulty in
eating.
• Slurred speech.
• Open bite/ Mandibular prognathism.
• Malocclusion and displacement of
teeth because of strength of the
muscles.

TREATMENTMENT
• The goal is to reduce tongue size and
thereby improve the function.
Ankyloglossia
• Also known as tongue tie, which is said to exist
when the inferior frenulum attaches to the bottom
of the tongue and subsequently restricts free
movement of the tongue.
• It may be total or complete where the ventral
surface of the tongue is fused to the floor of the
mouth ,or partial , where the short lingual frenulum
is shorter.
• It occurs in approximately 1.7% of all neonates .
CLINICAL FEATURES
• In infants it can cause feeding
problem.
• In children ,it can cause speech
defects.
• Can cause gap between the
mandibular incisors.

TREATMENT
• Frenulectomy is recommended.
CLEFT TONGUE
• A completely cleft or bifid tongue is a rare
condition that is apparently due to lack of
merging of the lateral lingual swellings of the
organ.
• A partially cleft is considerably more common
and is manifested simply as a deep groove in
the midline of the dorsal surface. And it
occurs because of incomplete merging and
failure of groove obliteration by underlying
mesenchymal proliferation.
• Food debris and microorganism may collect
in the base of the cleft and cause irritation.
Complete Bifid Tongue Partial Bifid Tongue
 FISSURED TONGUE
• It is characterized by grooves that vary
in depth and are noted along the
dorsal and lateral aspects of the
tongue.
• The aetiology is unknown , a polygenic
mode of inheritance is suspected
because the condition is seen
clustering in families who are affected .
• Fissured tongue is also seen in
Melkersson -Rosenthal Syndrome
and Down Syndrome and is
frequently associated with benign
migratory glossitis.
 CLINICAL FEATURES
• It is a totally benign condition.
• Slightly male predilection.
• The prominence of the condition appears to
increase with increasing age.
• It affects the dorsum and extends to the lateral
borders of the tongue, the depth of the fissures
varies up to 6mm in diameter.
HISTOLOGIC FEATURES
• Shows an increase in the thickness of the
lamina propria, loss of filiform papillae of the
surface mucosa, hyperplasia of the rete pegs,
and a mixed inflammatory infiltrate in the
lamina propria.
TREATMENT
• No definitive therapy or medication is
required.
MEDIAN RHOMBOID GLOSSITIS
• Also known as CENTRAL PAPILLARY ATROPHY ,
POSTERIOR LINGUAL PAPILLARY ATROPHY.
• It is considered as the congenital defect of the
tongue to retract or withdraw before fusion of
the lateral halves of the tongue, so that the
posterior dorsal point of fusion is occasionally
defective, leaving a rhomboid-shaped, smooth
erythematous mucosa lacking in papilla or taste
buds.
CLINICAL FEATURES
• Male predilection (3:1).
• It is present in posterior midline of the
dorsum of the tongue, just anterior to
the V-shaped grouping of the
circumvallate papilla.
• Lesions are typically less than 2cm in
greatest dimension and mostly a
smooth, flat surface.
• Differential diagnosis include the
Gumma of tertiary syphilis , the
granuloma of tuberculosis, deep fungal
infections and granular cell tumor.
 HISTOLOGIC FEATURES
• Atrophic stratified squamous epithelium
overlying a moderately fibrosed stroma
with dilated capillaries.
• Fungiform and filliform papillae are absent.
• A mild to moderately intense inflammatory
cell infiltrate may be seen within
subepithelial and deeper fibrovascular
tissues.
• Pseudoepitheliomatous hyperplasia .

TREATMENT
• No specific treatment.
• Antifungal therapy will reduce clinical
erythema and inflammation due to
candida infection.
 BENIGN MIGRATORY GLOSSITIS
• Also known as
GEOGRAPHIC TONGUE.
• It is a psoriasiform mucositis
of the dorsum of the
tongue.
• Its characteristic is a
constantly changing pattern
of serpiginous white lines
surrounding areas of
smooth, depapillated
mucosa .
• Approximately 1-2% of the
population are affected.
 HISTOLOGIC FEATURES
• A thickened layer of keratin is infiltrated
with neutrophils.
• These inflammatory cells often produce
small micro abscesses , called Monro’s
abscesses in the keratin and spinous layer.
• Rete ridges are typically thin and
considerably elongated, with only a thin
layer of epithelium overlying connective
tissue papillae.

TREATMENT
• Symptomatic lesions can be treated with
topical prednisolone .
 HAIRY TONGUE
• Also known as Lingua Villosa.
• It is the hypertrophy of the filiform papillae on the
dorsal surface of the tongue, usually due to a lack of
mechanical stimulation like toothbrushing and
debridement.
• Contributory factors for hairy tongue are numerous and
include tobacco use and coffee or tea drinking.
CLINICAL FEATURES
• Normally filliform papillae are 1mm in length whereas
in hairy tongue these are more than 15 mm in length.
• Male predilection and patient with HIV .
• Halitosis.
• Tickling or gagging sensation .
• Burning tongue when candidal overgrowth occurs.
 HISTOLOGICAL FEATURES
• Consist of elongated filiform papillae and
mild hyperkeratosis and occasional
inflammatory cells.
• Debris accumulation among the papillae
and candidal psuedohyphae is not
unusual finding.

TREATMENT
• Brushing of the tongue to remove
elongated filiform papillae and retard
the growth .
• Surgical removal of papilla by using
electrodesiccation, carbon dioxide laser ,
or even scissors is the treatment.
 Summary
• Malformations of the tongue, are structural defects , present
at birth and happening during development. The
malformations are :
• Microglossia , characterised by the abnormally small,
rudimentary tongue.
• Macroglossia , are the enlargement of the tongue.
• Ankyloglossia is the tongue tie which occurs due to fused
ventral surface of the tongue and floor of the mouth.
• Cleft tongue is due to the lack of merging of the lateral
lingual swellings.
• Fissured tongue is characterised by the grooves on the
dorsal and lateral aspects of tongue.
• Median rhomboid glossitis is characterised by a rhomboid
shaped smooth erythematous mucosa lacking in papilla and
taste buds.
• Benign migratory glossitis or the geographic tongue is a
psoriasiform mucositis of the dorsum of tongue.
• Hairy tongue is the hypertrophy of the filiform papillae.
 Conclusion
Knowledge of anatomy, physiology and functions of
tongue is an essence to understand the complex
morphological and functional changes in the
tongue with aging.
The most important thing to remember is
diagnosing such common tongue lesions which will
be in the best interest of the patient.
REFERENCE

• Shafer’s by Oral Pathology