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‘TONGUE DISORDERS’:

‘TONGUE DISORDERS’ Dr. Shafaq Salim

Acknowledgement :

Acknowledgement Dr. Batool Mohsin Khan prepared by Dr. Batool Mohsin Khan

PowerPoint Presentation:

A healthy tongue is pink in color and covered with small nodules called papillae. The healthy tongue is good reflection of general health status of human being. prepared by Dr. Batool Mohsin Khan

ANATOMY OF TONGUE:

Mass of striated muscle. Covered by mucous membrane. Anterior 2/3 lie in mouth, posterior 1/3 lie in pharynx. Tongue is divided into left and right half by ‘MEDIAN SULCUS / FIBROUS SEPTUM’ ‘SULCUS TERMINALIS’ divides the tongue into anterior an posterior part, at mid of sulcus is a foramen called ‘FORAMEN CECUM’ ANATOMY OF TONGUE prepared by Dr. Batool Mohsin Khan

Finger like projections on the surface of the tongue called ‘ PAPILLA’ :

Finger like projections on the surface of the tongue called ‘ PAPILLA’ prepared by Dr. Batool Mohsin Khan

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Tip Sweetness Back Bitterness Sides Saltiness & sourness prepared by Dr. Batool Mohsin Khan

BLOOD SUPPLY:

BLOOD SUPPLY ARTERIES Lingual Artery Tonsillar Artery Ascending Pharyngeal Artery VEIN Lingual Vein LYMPHATIC SUPPLY Sub mental (apex) Sub mandibular (body) Jugulo omohyoid (root/post) prepared by Dr. Batool Mohsin Khan

Nervous Supply:

Nervous Supply MOTOR: All the muscles of the tongue are supplied by ‘hypoglossal nerve’ except palatoglossus muscle which is supplied by pharyngeal plexus. SENSORY: Anterior 2/3 ‘ Chorda tympani’ Posterior 1/3 ‘ Glossopharyngeal Nerve’ prepared by Dr. Batool Mohsin Khan

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prepared by Dr. Batool Mohsin Khan

MUSCLES:

MUSCLES INTRINSIC EXTRINSIC Transverse Styloglossus Longitudinal Palatoglossus Vertical Hyoglossus Genioglossus prepared by Dr. Batool Mohsin Khan

Types of Tongue Disorders:

Types of Tongue Disorders prepared by Dr. Batool Mohsin Khan

TONGUE DISORDERS:

TONGUE DISORDERS CONGENITAL AND DEVELOPMENTAL CAUSES: Ankyloglossia Macroglossia Microglossia Aglossia Cleft tongue Lingual thyroid nodule prepared by Dr. Batool Mohsin Khan

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INFECTIOUS CAUSES: Hairy leukoplakia (EBV) Oral thrush ( Candia Albican ) TRAUMATIC CAUSES: Chemical burn Biting of the tongue Burning of the tongue ( hot liquid or food) Dental appliances (dentures) Trauma (laceration, contusion, abrasion) prepared by Dr. Batool Mohsin Khan

ANKYLOGLOSSIA (TONGUE TIE):

ANKYLOGLOSSIA (TONGUE TIE) Bottom of the tongue is attached to the floor of the mouth, restricting the ability to freely move the tip of the tongue like protrusion and lateral movements. The tongue is stuck to the bottom of the mouth by a band of tissue called the lingual frenum . Oral cleansing and speech may be impaired. Tongue tie may contribute to dental problems as well, causing a persistent gap between the lower central incisors. CAUSE,INCIDENCE. The exact cause is unknown. It may be genetic. prepared by Dr. Batool Mohsin Khan

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TREATMENT. Speech therapists (SLP) Surgery ( Frenolotomy , frenulectomy ) prepared by Dr. Batool Mohsin Khan

Macroglossia:

Macroglossia Enlarged tongue Types - True macroglossia and pseudo macroglossia . Pseudo macroglossia could be due to abnormal positioning of the tongue, eg - Habitual posturing of the tongue, Enlarged tonsils and/or adenoids displacing tongue, mandibular deficiency True is further divided into congenital causes acquired causes.

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Congenital – Down syndrome Beckwith- Wiedemann syndrome Lingual thyroid Acquired – Candidiasis Scurvy Pellagra Acromegaly Neurofibromatosis Amyloidosis Carcinoma

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Patient complains of difficulty in eating, speaking. Airways may slao be compromised causing difficulty in breathing. Tongue usually shows crenated borders. (scalloped lateral borders)

MEDIAN RHOMBOID GLOSSITIS :

MEDIAN RHOMBOID GLOSSITIS Congenital abnormality of the tongue due to lack of fusion of lateral processes in the midline over tuberculum impar , resulting in smooth, erythematous area devoid of papilla. ETIOLOGY: Congenital abnormality Candidal infection Smoking CLINICAL FEATURES: Lesion is rhomboid/diamond/oval shape, localized along the midline of the dorsum of the tongue anterior to circumvallete papilla. prepared by Dr. Batool Mohsin Khan

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Two clinical varities : Smooth well circumscribed red plaque devoid of circumvallate papilla. Raised multinodular firm reddish mass devoid of papilla. Usually asymptomatic. DIFFERENTIAL DIAGNOSIS: Geographic tongue Thyroglossal duct cyst Syphilitic Glossitis Erythematosis Candidiosis . prepared by Dr. Batool Mohsin Khan

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TREATMENT: Not required. In case of candidal infection topical use of antifungal drugs. Advice patient to quit smoking. prepared by Dr. Batool Mohsin Khan

GEOGRAPHIC TONGUE (ERYTHMA MIGRANS):

GEOGRAPHIC TONGUE (ERYTHMA MIGRANS) Benign asymptomatic condition in which there is recurrent appearance and disappearance of red areas on the surface of the tongue. INCIDENCE: Can occur in all ages, most commonly in middle age, females. Co exist with fissure tongue. prepared by Dr. Batool Mohsin Khan

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CLINICAL FEATURES: Multiple, painless, irregular smooth, erythamatous patches surrounded by raised whitish borders. Varies in size from mm to cm. Desquamation of filliform and fungiform papilla. The lesion persist for small time in one area, heal completely and reappears on another area of the tongue.( Migratory pattern). prepared by Dr. Batool Mohsin Khan

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prepared by Dr. Batool Mohsin Khan

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Time duration can be weeks, months and years. Usually on the dorsal surface of the tongue. Inflammatory changes can cause soreness of tongue. DIFFERENTIAL DIAGNOSIS: Psoriasis Lichen planus Lupus erythematosis Reiter syndrome TREATMENT: Reassurance. prepared by Dr. Batool Mohsin Khan

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prepared by Dr. Batool Mohsin Khan

FISSURE TONGUE (SCROTAL TONGUE):

FISSURE TONGUE (SCROTAL TONGUE) Fissured tongue is a benign condition characterised by grooves that vary in depth present along the dorsal and the lateral surface of the tongue. prepared by Dr. Batool Mohsin Khan

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ETIOLOGY: Unknown cause. Hereditary. Aging and environmental factors. CLINICAL FEATURES: Multiple fissures or grooves. Fissure vary in depth size (2-6 mm) and number. Symmetrical distribution. Usually asymptomatic. prepared by Dr. Batool Mohsin Khan

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prepared by Dr. Batool Mohsin Khan

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Food debris and micro organism may retain in the deeper fissures and may cause local irritation (burning and soreness). It may co exist with geographic tongue. DIFFERENTIAL DIAGNOSIS: Lobulated tongue in Sjoren’s Syndrome Chronic mucocutaneous candidiosis . TREATMENT: Reassurance. Advice the patient to brush the tongue and maintain oral hygiene. prepared by Dr. Batool Mohsin Khan

HAIRY LEUKOPLAKIA:

HAIRY LEUKOPLAKIA Hairy leukoplakia is a condition characterized by irregular white patches on the side of the tongue and occasionally elsewhere on the tongue or mouth. The basic defect in hairy tongue is a hypertrophy of filiform papillae on the dorsal surface of the tongue, usually due to a lack of mechanical stimulation and debridement. ETIOLOGY: Epstein-Barr Virus (EBV) Immunodeficiency CLINICAL FEATURES: It has vertically corrugated/shaggy surface. The plaque is soft, usually painless, frequently effect the lateral border of the tongue. Patients with suppress immune system (organ transplant recipient) and chemotherapy patients. Can occur in healthy individuals also (rare). prepared by Dr. Batool Mohsin Khan

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HIV ASSOCIATED HAIRY LEUKOPLAKIA: Hairy leukoplakia is an important manifestation of HIV infection. (20-25%) Common in patients with late stage of HIV infection. Prevalence rate increases as CD-4 lymphocyte count falls. DIFFERENTIAL DIAGNOSIS: Idiopathic leukoplakia Smokers keratosis Frictional keratosis Acute pseudo membranous candidiasis ‘Plaque like’ lichen planus White sponge nevus prepared by Dr. Batool Mohsin Khan

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MANAGEMENT: Treatment of underlying cause such as HIV or AID with anti-retroviral (Acyclovir 800mg 5 times daily for 1-3 weeks) medications usually help resolve lesions. Diagnosis is made on the basis of ‘biopsy’. prepared by Dr. Batool Mohsin Khan

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prepared by Dr. Batool Mohsin Khan

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