Monday, August 15, 2011

Developmental Disturbances Of Tongue And Gingiva

Developmental disturbances of tongue
Broadly classified into
Microglossia
Macroglossia
Ankyloglossia
Cleft tongue
Fissured tongue
Median rhomboid glossitis
Geographic tongue
Hairy tongue
Lingual varices
Lingual thyroid nodule

Microglossia
 Small or rudimentary tongue
Clinical features
Uncommon developmental condition
Aglossia rare
Often associated with one of a group of the overlapping conditions known as Oromandibular – limb hypogenesis syndrome
          Limb anomalies – hypodactylia (absence of digits)
           Hypomelia – hypoplasia of part or all of a limb
Some patients associated with cleft palate, intra oral bands
Also frequently associated with hypoplasia of mandible
 Treatment and prognosis
 Depends on the nature and severity of the condition
Surgery and orthodontics may improve oral function
Speech development is quite good but depends on tongue size

Macroglossia

Enlargement of the tongue
Caused by a wide variety of conditions including both congenital malformations and acquired diseases
True macroglossia – tongue enlargement
Relative macroglossia – insufficient space in the oral cavity
Clinical features
Most common in children
Degree of macroglossia – Mild to severe
Infants manifest noisy breathing, drooling, difficulty in eating, lispy  speech
Pressure of tongue against mandible and teeth produce
Crenated lateral borders of tongue
Open bite
Mandibular prognathism
Constant protrusion produces ulceration
If severe, airway obstruction can be produced
Feature of Beckwith-Wiedemann syndrome
Visceromegaly
Gigantism
Neonatal hypoglycemia
                                            (Prone to Wilms tumor, Adenocarcinoma and Hepatoblastoma)

Facial features include,
Nevus of forehead and eyelids
Linear indentations of the ear lobes
Maxillary hypoplasia
Autosomal dominant inheritance
Hypothyroid – macroglossia – enlargement is smooth, diffuse and generalized
Amyloidosis, neurofibromatosis and MEN IIB syndrome produce nodular type of enlargement
lymphangiomas – tongue surface shows blebbing with multiple vesicle like blebs
Down’s syndrome has papillary and fissured surface
Hemi-facial hyperplasia shows unilateral enlargement
Edentulous patients has lateral spread out of the tongue.
Histopathology:
Microscopy depends on the cause
Down’s and edentulous patients – normal
Amyloidosis shows abnormal proteins
Tumors show abnormal proliferation
Beckwith shows muscular enlargement
Treatment and Prognosis:
Mild – no surgery, speech therapy
Severe – Partial glossectomy

Ankyloglossia/Tongue tie
 Developmental anomaly
Characterized by short, thick lingual frenum
Complete – fusion between tongue and floor of the mouth
Partial – tongue tie – short lingual frenum attached to the tip of the tongue
Occur in 1.7 to 4.4% of neonates
Four times more common in boys than girls
Clinical features:
Speech difficulties due to restricted tongue movement
High mucogingival attachment cause periodontal problems
Some investigators say ankyloglossia cause open bite due to abnormal swallowing pattern
Ankyloglossia associated with upward and forward displacement of epiglottis resulting in dyspnoea.
A. superior (Glossopalatine ankylosis)
Rare - congenital adherence of tongue to the palate
Usually combined with other congenital anomalies in the maxillofacial region and extremities (A. superior syndrome)
Causes suckling and respiratory dysfunction
Treatment and prognosis:
Most cases do not exhibit any clinical problem and treatment is not required
In children, mostly self corrective
If functional and periodontal problems develop, frenectomy to allow free tongue movement
A.superior requires surgical separation

Devolopment Disturbances of Gingiva and Tongue- A Lecture NOTE(PPT)

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