Embryology, Tongue

Embryology, Tongue

Question. Defie anomaly. Describe in detail the developmental anomalies of the tongue.
Or
Enumerate and describe the developmental disturbances affecting the tongue.
Or
Describe in detail developmental disturbances affecting the tongue.
Or
Give an account of the developmental anomalies of the tongue.

Answer. Anomaly is defined as the irregularity or deviation compared to the normal structure.

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Enumeration Of Developmental Anomalies Of the Tongue

• Aglossia
• Microglossia
• Macroglossia
• Ankyloglossia or tongue tie
• Cleft tongue
• Fissured tongue
• Median rhomboid glossitis
• Geographic tongue
• Hairy tongue
• Lingual thyroid nodule
• Lingual varices

Aglossia

It is characterized by the complete absence of tongue

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Microglossia

This is in reality a microglossia with extreme glossoptosis. In such cases a rudimentary small tongue is observed.

Due to the lack of muscular stimulus between alveolar arches they do not develop transversely and mandible does not grow in anterior direction.

Macroglossia

Macroglossia is an uncommon condition characterized by enlargement of tongue.

Type Of Macroglossia

There are two broad categories under the heading of Macroglossia, i.e.

True Macroglossia

Pseudomacroglossia

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Causes

• Congenital and hereditary:
  • Vascular malformations
  • Lymphangioma
  • Hemangioma
  • Hemihyperplasia
  • Cretinism
  • Beckwith-Wiedemann syndrome
  • Down syndrome
  • Mucopolysaccharidosis
  • Neurofiromatosis

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•  Acquired:
  • Edentulous patients
  • Amyloidosis
  • Myxedema
  • Acromegaly
  • Angioedema
  • Carcinoma and other tumors

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Clinical Features

• It most commonly occur in children.
• In infants it is manifested by noisy breathing, drooling and diffilty in eating.
• Macroglossia result in lisping speech.
• Pressure of tongue against mandible and teeth produces lateral crenated border of tongue.
• Presence of open bite and mandibular prognathism is seen.
• Children with macroglossia often develop tongue thrusting habits, which may lead to malocclusion, open bite and diastema formation, etc.
• Macroglossia developing in adult people (as in acromegaly or in tumors, etc.) may produce spacing of teeth and distortion of the mandibular arch.
• Blockage of the pharyngeal airway due to macroglossia may result in a condition called obstruction sleep apnea.

Ankyloglossia

It is also known as tongue tie

Ankyloglossia is the condition which arises when the inferior frenulum attches to the bottm of tongue and subsequently restricts free movements of the tongue.

Clinical Features

• Males are affcted more commonly than females
• It can cause feeding problems in infants
• It causes speech defects specially articulation of the sounds l, r, t, d, n, th, sh and z
• It leads to persistent gap between the mandibular incisors.

Treatment

Frenulectomy is the treatment of choice.

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Cleft tongue

• It is a rare condition which arises due to lack of merging of lateral lingual swellings of this organ.
• A partial cleft tongue is more commonly seen.
• Partial cleft occurs because of incomplete merging and failure of groove obliteration by underlying mesenchymal proliferation.

Fissured tongue

It is also known as scrotal tongue.

Clinical Features

• More common among males.
• No clinical symptom is seen in fisured tongue but collection of food debris and microorganisms in the fisures or grooves sometimes cause discomfort.
• Fissures or grooves often radiate freely in central groove on the dorsal surface in oblique direction.
• Large and deep fisures may be inter-connected and they separate the dorsum of the tongue into multiple lobules.

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Histological Features

• There will be loss of fiiform papillae from the surface mucosa.
• Neutrophilic microabscess formation within the epithelium.
• Hyperplasia of the retepegs and increased thickness of the lamina propria.
• Mixed inflmmatory cell infitration in the connective tissue stroma.

Treatment

No treatment is required.

Hairy Tongue

• Hairy tongue is an unusual condition, which occurs due to hypertrophy of the fiiform papilla of tongue along with loss of normal desquamation process.
• Abnormal hair­like growth of the papilla eventually leads to formation of a pigmented, thick, mattd layer on the tongue surface often heavily coated with bacteria and fungi.

Etiology

• Poor oral hygiene
• Fungal infections
• Prolonged use of antibiotics
• Heavy smoking
• Excessive use of antiseptic mouth washes
• Chronic illness
• Lack of tooth brushing and consumption of soft foods with litte or no roughage.

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Pathogenesis

• Normally the keratinized surface layers of the tongue papillae are continuously desquamated through friction of the tongue with food, rough surface of the palate and the upper anterior teeth.
  Following desquamation,tongue papillae are replaced by newer epithelial cells from below.
• Lack of tongue movements due to local or systemic disease disturbs the regular desquamation process of the tongue papilla; especially the fiiform papillae, which lengthens considerably and produces a hairy appearance on the tongue surface.
• Such hypertrophied papillae are often coated with microorganisms and become discolored.

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Clinical Features

• Hairy tongue commonly affcts the mid dorsum of the tongue.
• Hypertrophy of the fiiform papillae produces a thick matted layer on the dorsal surface.
• Hypertrophied fiiform papillae may grow up to half a centimeter long, which often brushes the soft palate and produces gagging sensations.
• There can be irritation to the tongue due to accumulation of food debris and microorganisms.

Treatment

• Removal of etiological factor.
• Proper cleaning of tongue.