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)