A Comprehensive Guide to Tongue Disorders: Symptoms, Causes, and Treatments
Classification of Tongue Disorders
Major Inherited, Congenital & Developmental Abnormalities
- Cleft, Lobed, Bifurcated, Tetrafurcated
- Aglossia (Hypoglossia)
- Macroglossia
Disorders of the Lingual Mucosa
- Changes in the Tongue Papilla
- Nonkeratotic and Keratotic White Lesions
- Depapilation and Atrophic Lesions
- Tertiary Syphilis and Interstitial Glossitis
- Pigmentation
Diseases Affecting the Body of the Tongue
- Infections
- Amyloidosis
- Neuromuscular Disorders
- Obstructive Sleep Apnea and Disorders
- TMJ Myofunctional Dysfunction
Malignant Tumor of the Tongue
- SCC
- Benign Cell Carcinoma of the Tongue Simulating Epidermoid Carcinoma
Geographic Tongue
Benign migratory glossitis; refers to irregularly shaped, reddish areas of depapillation and thinning of the dorsal epithelium that are usually surrounded by a narrow zone of regenerating papillae.
Differential Diagnosis
- Atrophic lichen planus
- Fixed drug eruption
The main characteristic feature of geographic tongue is the continuous daily migration of the lesion.
Nonkeratotic White Lesions
- Fordyce Spots
- Thrush
- Burns
- White Spongy Nevus
- Vesculobullous and Other Desquamating
Keratotic White Lesions
- L.P.
- Leukoplakia and Hairy Leukoplakia
Hemangioma
Is a common benign lesion of the oral cavity, characterized by the proliferation of blood vessels.
It is not a true neoplasm, but rather a developmental abnormality.
Why White Lesions Appear White
- Hyperkeratinization
- Acanthosis – an abnormal but benign thickening of stratum spinosum
- Abnormal keratins – imbibe fluids -(leukodema)
- Necrosis of the oral epithelium
Oral Submucous Fibrosis
An insidious chronic disease affecting any part of the oral cavity and sometimes the pharynx. Although occasionally preceded by and/or associated with vesicle formation.
Etiology
Not well established
Predisposing Factors
- Areca nut chewing: Arecoline, safrole, and nicotine inhibit collagen phagocytosis by fibroblasts in a dose-dependent manner.
- Spices
- Nutritional deficiency
- Genetic and immunological processes
Clinical Features
The onset is insidious over a period of 2 to 5 years.
Presenting Symptoms:
- Progressive inability to open mouth (trismus) due to fibrosis and scarring
- Burning sensation on eating spicy food
- Appearance of blisters on palate
- Ulcerations or recurrent generalized inflammation of the oral mucosa
Leukoplakia
A white patch or plaque that cannot be characterized clinically or pathologically as any other disease and is not associated with any physical or chemical agent except the use of tobacco.
Etiology
Local Factors
- Tobacco products – Smoked and smokeless
- Alcohol
- Chronic irritation
- Candidiasis
- Electro-galvanic reactions
- Possibly HSV and HPV
Clinical Features
- Males
- > 50 yrs
- Site – Buccal Mucosa, Vermilion Border of Lower Lip, Gingiva (commonly)
Types
- Homogenous
- Non-homogenous
- Speckled or Nodular
- Verrucous
- Proliferative Verrucous
Management
- Prevention
- Removal of irritants – regression – no treatment required
- Recall visit 6 months – 1 year
- No Regression – surgical excision, laser, cryosurgery
Blue/Purple Vascular Lesions
- Hemangioma
- Varix
- Angiosarcoma
- Kaposi’s Sarcoma
Brown Melanotic Lesions
- Ephelis and Oral Melanotic Macule
- Nevocellular Nevus and Blue Nevus
- Malignant Melanoma
- Drug-Induced Melanosis
- Physiologic Pigmentation
- Café au Lait Pigmentation
Brown Heme-Associated Lesions
- Ecchymosis
- Petechia
- Hemochromatosis
Gray/Black Pigmentations
- Amalgam Tattoo
- Graphite Tattoo
- Hairy Tongue
Hemangioma
Benign vascular proliferations
- Childhood-onset – regress after puberty
- The color is reddish-blue or a deep blue depending on the depth in the submucosa
Microscopically
- Numerous dilated vessels lined by endothelial cells without a muscular coat (cavernous hemangiomas).
- Endothelial proliferation (Cellular- or capillary-type hemangiomas).
Treatment
Conventional surgery, laser surgery, or cryosurgery
Varix
Pathologic dilatations of veins or venules are varices or varicosities.
- Site: ventral tongue, lower lip, buccal mucosa
- Etiology: trauma such as lip or cheek biting
- Age: old, once formed does not regress. Prominent with age
- Clinically: focal raised blue, red, or purple, the surface mucosa is lobulated or nodular
Kaposi’s Sarcoma
Slowly progressive tumor of vascular origin, no metastasis, multifocal origin
2 classical clinical forms:
- Elderly men (in the oral mucosa and on the skin of the lower extremities)
- Children in equatorial Africa (in lymph nodes).
The oral and cutaneous tumors are considered to be of multifocal origin rather than metastases from a distant primary tumor.
- Site: posterior hard palate, facial gingiva
- Oral tumors are red, blue, and purple
- Most common neoplastic lesion with HIV infection
Differential diagnosis includes pyogenic granuloma and giant cell granuloma.
Microscopically: proliferating spindle cells with mild pleomorphism associated
Brown Heme-Associated Lesions
- Ecchymosis, purpura/petechiae
Hemochromatosis
- Deposition of hemosiderin pigment in multiple organs and tissues
- Primary heritable disease with a prominent male predilection
- Secondary to chronic anemia, porphyria, cirrhosis, postcaval shunt for portal hypertension, and excess intake of iron.
The Oral Lesions
- Brown to gray diffuse macules occur in the palate and gingiva, results from iron deposition in the submucosa, basilar melanosis is also observed microscopically and may be the result of a secondary addisonian complication.
Diagnosis
- Oral biopsy helpful in the diagnosis
Amalgam Tattoo
- Etiology is the deposition of amalgam material into submucosal tissue.
- Lesions small, asymptomatic, macular and bluish-gray or even black in appearance.
- Gingiva, alveolar mucosa, buccal mucosa, and floor of mouth are most common sites.