This document provides a classification and overview of various tongue disorders and conditions. It discusses inherited, congenital, developmental anomalies as well as disorders affecting the lingual mucosa, body of the tongue, and tumors of the tongue. Specific conditions covered include geographic tongue, hairy tongue, median rhomboid glossitis, macroglossia, fissured tongue, ankyloglossia and more. For each condition, the document provides details on etiology, clinical features, management and related syndromes.

1. CLASSIFICATION OF TONGUE DISORDERS
A)Inherited, congenital and developmental
anomalies:
a) Minor variations:
1.Partial Ankyloglossia
2.Variations in tongue movement
3.Tongue thrusting
4.Fissured tongue
5.Patent Thyroglossal duct and cyst
6.Lingual thyroid
7.Median rhomboidal glossitis

2. b) Major variations:
1.Cleft, lobed, bifurcated and tetrafurcared tongue
2.aglossia, hypoplasia and macroglossia
3.hamartoma and desmoids
4.bald and depapillated tongue
5.papilomatous changes

3. B)Disorders of the lingual mucosa:
a)changes in the tongue papillae:
1.geographic tongue
2.coated or hairy tongue
b)Non-keratotic lesions:
1.thrush
2.white sponge nevus
3.vesiculobulous and other desquamative disorders

4. c) keratotic white lesions:
1.lichen planus
2. leukoplakia
d) Depapillation and atrophic lesions:
1. Chronic trauma
2. Nutritional deficiency

5. C) Disorders affecting body of tongue:
1.Amyloidosis
2.Infections
3.Neuromuscular disorders
4.Sleep apnea syndrome
5.TMJ Myofascial dysfunction
6.Vascular disease of body of tongue
7.Angioneurotic edema

6. D) Tumors of tongue:
• Benign
• Malignant

7. PARTIAL ANKYLOGLOSSIA:
• Partial Ankyloglossia refers to congenital shortness of
the lingual frenum or a Frenal attachment that
extends nearly tip of tongue, binding the tongue to
floor of mouth and restricting its extension.
• Clinical features:
• Restricted tongue movements
• Feeding problems
• Speech defects: lisping, inability to pronounce words
such as ta, te, time, water, cat etc.
• Tongue biting

9. Syndromes associated are:
• Ankyloglossum superioris syndrome
• Trisomy of 13
• Pirrie robin syndrome
• Rainbow syndrome
• Management:
• counselling
• surgery

10. VARIATION IN TONGUE MOVEMENT
• Ability to curl up the lateral borders of tongue into a
tube is noted in 65% of Caucasians and is inherited as
an autosomal dominant trait.
• Unusual extensibility of tongue, both forward to
touch tip of NOSE(GORLIN sign)and backward into
the pharynx occurs in Ehlers-Danlos syndrome.
• The tongue in tuberous sclerosis-long and narrow
• The mobility of tongue is also restricted in
epidermolysis bullosa as a result of fibrous scars
secondary to blister formation.

11. Tongue Thrusting
• Tongue thrust is a forward placement of the
tongue between the anterior teeth and against
the lower lip during swallowing, speaking or at
rest.
• It is an infantile swallowing pattern.
• It may be associated with macroglossia.

12. And:
1. Proclination of anterior teeth
2. Anterior open bite
3. Bimaxillary protrusion
4. Posterior open bite in case of lateral tongue thrust
5. Posterior cross bite

13. Fissured Tongue:
• Also called as scrotal tongue, plicated tongue, and lingua
dissecta.
• Characterized by furrows, one extending anteroposteriorly
and others laterally over the entire anterior surface.
• Patterns: plication, central longitudinal fissuring, double
fissures, transverse fissuring, lateral longitudinal.
• Bacteria and debris retained in the fissures causing irritation
or burning sensation.

14. • Syndromes: trisomy 21 (mongolism) ,melkerson
rosenthal syndrome.
• Management: maintenance of oral hygiene.

15. Patent Thyroglossal Ducts and
Cysts
• Thyroid gland develops from an analogue of endothelial
cells in the midline of the floor of the pharynx, between the
first and second brachial arches, just posterior to tubercular
impar.
• These cells sink into the base of developing tongue, descent
into the neck and proliferate below the larynx to form
thyroid gland.
• Remnant of the epithelium along this path are referred as
Thyroglossal duct.
• Cystic degeneration of it is called as duct cyst.

16. • In 70% of those with heterotopic thyroid ,the thyroid gland
is contained entirely within the tongue.
• Enlargement of the lingual thyroid , cystic changes, or
malignancy may be first recognized due to symptoms of an
enlarging tongue, dysphagia or less commonly, hypoglossal
palsy.
• Dysphagia with firm cystic mass in midline of neck will give
clue to the diagnosis.
• The cyst is lined by columnar, respiratory or stratified
squamous epithelium.
• Management: surgically excised or enucleated.

17. Median Rhomboid Glossitis
• ‘central papillary atrophy of tongue’
• Median rhomboid glossitis (MRG) is a benign uncommon usually
asymptomatic condition of tongue superimposed by secondary
infection usually by candida.
• It is characterized by central papillary atrophy of dorsal surface of
tongue particularly anterior to the circumvallate papillae.
• The etiopathogeness of MRG is uncertain but it was once
attributed to an embryologic fault caused by failure of
tuberculum impar to unite completely with lateral processes of
the tongue which results in area of smooth, erythematous oral
mucosa on posterior dorsal surface of tongue with scarcity of
papillae.

18. REFERENCE-
MEDIAN RHOMBOID GLOSSITIS: A PECULIAR TONGUE PATHOLOGY, REPORT OF A CASE AND REVIEW
OF LITERATURE
authors-1Daud Mirza, 2 Ghazal Raza, 3Zubair Ahmed Abassi
International Journal of Pharmacy and Biological Sciences ISSN: 2321-3272 (Print), ISSN: 2230-7605
(Online) IJPBS | Volume 6 | Issue 4| OCT-DEC| 2016 | 51-53
• A recent development revealed that posterior dorsal
surface of tongue is the main reservoir of candidal
microorganisms in oral cavity. However, there are some local
factors which include trauma or surface variation in the
anatomy which may allow candidal hyphae to proliferate
leading to the development of MRG.
• Studies has shown diverse predisposing factors associated
with median rhomboid glossitis such as denture wearing,
smoking, diabetes mellitus.

19. • c/f: m>f
• Generally asymptomatic
• The surface is dusky red and completely devoid of
filiform papillae and usually smooth.
• Kissing lesion-soft palate erythema may be seen where
the lesion of median rhomboid glossitis touch the
palate.
• Management:
• antifungal agents,
• Long standing cases: cryosurgery, excisional biopsy

21. Cleft, Lobed, Bifurcated and Tetrafurcated
Tongue:
• Separation of the dorsal
surface of tongue into 2
or 4 by deep grooves.
• Associated with orofacial-
digital syndrome, fetal
face syndrome, Meckel's
syndromes.
• Management: regular
cleaning of tongue.

22. AGLOSSIA,HYPOGLOSSIA,MICROGLOSSIA
• Aglossia: complete absent of tongue at birth.
• Hypoplasia: small rudimentary tongue.
• c/f:
• difficulty in eating
• Speaking
• High arched palate
• narrow constricted mandible
• Airways problems
• Associated with hypoglossia-hypodactylia syndrome,
hypomelia, Pierre Robin syndrome

23. AGLOSSIA,HYPOGLOSSIA,MICROGL
OSSIA

24. MACROGLOSSIA
• LARGE TONGUE, TONGUE
HYPERTROPHY
• Two broadest categories
• True macroglossia
• Pseudomacroglossia
• Physical examination of
the oral cavity and head
morphology is helpful to
deduce true macroglossia
from pseudomacroglossia

25. MACROGLOSSIA
•True macroglossia can be subdivided
into following categories:
• Congenital causes
• Idiopathic muscle hypertrophy
• Gland hyperplasia
• Down syndrome
• Beckwith-Wiedemann syndrome
• Laband syndrome

26. MACROGLOSSIA
• Acquired causes
• Metabolic causes(hyperthyroidism,
cretinism)
• Inflammatory causes (syphilis, amebic
dysentery)
• Systemic(uremia, myxedema)
• Traumatic(surgery, hemorrhage, intubation
injury)
• Neoplastic(lingual thyroid, hemangioma)
• Infiltrative(amyloidosis, sarcoidosis)

27. MACROGLOSSIA
• Pseudomacroglossia includes any of the
following conditions which force the tongue in
an abnormal position
• Habitual posturing of the tongue
• Enlarged tonsils and/or adenoids displacing tongue
• Low palate and decreased oral cavity volume
displacing tongue
• Trans verse, vertical, or anterior/posterior deficiency
in the maxillary or mandibular aches displacing the
tongue
• Severe mandibular deficiency (retrognathism)
• Neoplasm displacing the tongue
• Hypotonia of the tongue

28. MACROGLOSSIA
• C/F: noisy breathing, drooling of saliva, difficulty in
• eating, speech and airways problems.
• Recurrent upper respiratory tract infection.
• Displacement of teeth ,malocclusion
• Crenation of lateral border of tongue
• Management: surgical, orthodontic, speech therapy

29. MACROGLOSSIA

30. HAMARTOMAS AND DERMOIDS
•The tongue may be enlarged or
distorted by the presence of variety of
tumor like growths of
• developmental origin( hamartomas
neurofibroma, hemangiomas)
• or by epithelial inclusion cysts( dermoids,
branchial cleft cysts).

31. BALD OR DEPAPILLATED TONGUES
• An erythematous , edematous and painful
tongue that appears smooth because of loss of
filiform papillae and sometime fungiform
papillae secondary to certain nutritional
deficiency .
• Atrophy or loss of papillae may be caused by a
congenital anomaly ,or develop as a secondary
features

32. BALD OR DEPAPILLATED TONGUES
• Local causes:
• Eosinophilic granuloma
• Traumatic injuries-jagged teeth , rough margins of
restorations and inadvertent contact of tongue with dental
medicaments such as eugenol.
• Allergic stomatitis: monomer of denture, mouthwash,
chewing gum, and lipstick.
• Facial hemiatrophy

33. BALD OR DEPAPILLATED TONGUES
• Systemic causes:
• Iron deficiency anemia: first appears at tip,lateral
border of tongue with loss of filiform papilla. In extreme
cases , the entire dorsum becomes smooth and glazed.
Very painful either pale or fiery red.
• Plummer Vinson syndrome: siderophenic anemia,
atrophic glossitis, angular chelitis, generalized atrophic
oral mucosa, oral ulceration and secondary candidiasis
• Pernicious anemia: atrophy of filiform &fungiform
papilae.
• Niacin deficiency:

34. BALD OR DEPAPILLATED TONGUES
• Folic acid deficiency: tongue is fiery red and atrophy of
filiform & fungiform papillae. Tongue is swollen and
small cracks may appear on dorsal surface.
• Scleroderma: tongue shrinks, losing its mobility and
papillary pattern. Color of the tongue changes to a vivid
appearance due to circulatory disturbances. In the end
stages, the tongue lies as a stiff, reduced body in the
floor of mouth.
• Dermatomyositis: in early stages, tongue is markedly
swollen and later becomes harder. In the late phase,
tongue is atrophic.

35. BALD OR DEPAPILLATED TONGUES
• Diabetes: central papillary atrophy of the dorsum in which low
flat papillae are noticed just ant. to row of circumvallate
papillae.
• Syphilis: Depapillation of tongue usually occurs in secondary
and tertiary syphilis. Single or multiple mucous patch on the
tongue. A more diffuse, chronic, non-ulcerating, irregular
induration, with an asymmetrical pattern of grooves and
atrophic field covering the entire dorsum.
• Zoster infection: numerous vesicles occur on ventral surface of
tongue.
• Atrophic gastritis:

36. • Peripheral vascular disease: decreased nutritional
• of the lingual papillae as a result of vascular changes
• affecting the subpapillary dorsal capillry plexus.
• Using fluorescence-enhanced capillary microscopy in
• humans have documented variations in the fungiform
• papillae associated with age, sex, and the number and
• shape of terminal vessels in the papillae.
• Infarcts of the tongue may be associated with
• shrinkage of the affected side of tongue and atrphic
• changes in the overlying mucosa.

37. BALD OR DEPAPILLATED TONGUES

38. BALD OR DEPAPILLATED TONGUES

39. BALD OR DEPAPILLATED TONGUES
Deficiency:
• Vitamin-A
• Vit-B1
• Vit-B2
• Pantothenic acid
• Vit-B6(niacin)
• Vit-B2,B6,B12,niacin
• Folic acid,vit-B6,zinc
Symptoms:
• Poor sense of taste
• Furrowed tongue
• Purplish or magenta tongue
• Beefy enlarged tongue
• Scarlet red tongue
• Burning sore tongue
• Ulcer on tongue

40. PAPILLOMATOUS CHANGES
• In several congenital disorders the surface of
tongue is covered with multiple papilloma. When
extensive this abnormalities is known as pebbly
tongue.
• Lesions of this type is associated with congenital
lingual Lymphangioma, neurofibromatosis and the
Anderson-Fabry syndrome and Meckel’s syndrome.
• Management:

41. PAPILLOMATOUS CHANGES

42. GEOGRAPHIC TONGUE
• Also called as BENIGN MIGRATORY GLOSITIS,WANDERING
RASH, GLOSSITIS AREATA EXFOLIATIVA, and ERYTHEMA
MIGRANS
• It refers to irregularly shaped reddish areas of Depapillation
and thinning of the dorsal epithelium which is surrounded
by a narrow zone of regenerating papillae that are whiter
than the surrounding tongue surface.
• Etiology:
• Hypersensitive patient: h/o-asthma, hay fever, eczema.
• Other factors: immunological reaction, emotional stress ,
hereditary factors, nutritional deficiencies.

43. GEOGRAPHIC TONGUE
• C/F-
• common in young & middle age.
• Female predilection
• Commonly on dorsal surface & lateral border
• Asymptomatic but patient may complain of burning sensation,
stinging, pain
• Initially appears as a small erythematous, nonindurated,
atrophic lesion, bordered by a slightly elevated distinct rim that
varies from gray to white to light yellow.
• Loss of filiform papillae pink to red smooth shiny surface ,
fungiform papillae persist in desqaumated areas as small
elevated red dots.

45. GEOGRAPHIC TONGUE
• The condition may persist for weeks to months and
then regress spontaneously only to occur at later
date.
• The lesion is not always restricted to tongue and
similar irregular or circinate lesions occur elsewhere
in the oral cavity and are called as ectopic geographic
tongue or erythema circinate migrans or annulus
migrans.

46. GEOGRAPHIC TONGUE
• Diagnosis:
• clinically
• Biopsy shows loss of filiform papillae with hyper parakeratosis
and acanthosis.
• D/D-
• Psoriasis
• Reiter’s syndrome: skin, ocular, urethral lesion +
• Lichen planus: absence of raised whitish yellow rim.
• Use of strong mouth wash-h/o
• Anemic condition: hematological study and absence of raised
yellowish white border.

47. GEOGRAPHIC TONGUE
• Management:
• For control of burning-topical local anesthetic agents like
lidocaine, dyclonine hydrochloride, or diphenhydramine
can be given.
• Topical therapy: topical corticosteroids and topical
application of salicylic acid and tretinoin (retinoic acid)
• Psychological assurance

48. HAIRY TONGUE
• Lingua Villosa, Lingua Nigra, Black Hairy
Tongue
• An overgrowth of filiform papillae on the
dorsum of tongue , giving the tongue a
superficial resemblance as that of hairiness.
• There is marked accumulation of keratin on the
filiform papillae.(defective desquamation of
cells in filiform papillae)

50. HAIRY TONGUE
• Etiology:
• Fungal and bacterial overgrowth:
• Use of certain drugs: sodium perborate, sodium
peroxide, and antibiotics like penicillin and Aureomycin
• Poor oral hygiene
• After surgery
• Lowered ph-blocks the normal desquamation of
epithelial cells covering the filiform papillae

51. HAIRY TONGUE
• In Debilitated, dehydrated, terminally ill patients can
lead to very thick, leathery coatings on the tongue that
are referred to as earthy or encrusted tongue.
• C/F:
• papillae may reach a length of 2cm which occasionally
brush the palate and may produce gagging or bad taste.
• The hyperplastic papillae then become pigmented by
the colonization of Chromogenic Bacteria, which can
impart a variety of colors ranging from green to brown
to black to yellow.

52. HAIRY TONGUE
• This gives it a coated or hairy appearance and retains
debris and pigments from substances from food,
tobacco, smoke, medicines.
• Management:
• Maintenance of oral hygiene
• Elimination of predisposing factors
• Topical keratolytic application- podophyllum in acetone
or alcohol suspension

53. THRUSH
• Acute pseudomembranous candidiasis
• Often appears as pearly white , pinhead size flecks scattered
over the dorsal surface.
• Etiology:
• overgrowth of Candida albicans in patient taking antibiotics,
immunosuppressant drugs, or having a disease that supresses
the immunity.
• C/F:
• f> m
• Prodromal symptoms like rapid onset of bad taste, discomfort on
spicy food, burning sensation
• White patches are easily wiped out

54. THRUSH
• d/d-
• Plaque form of lichen planus
• Leukoplakia
• Gangrenous stomatitis
• Chemical burn

55. THRUSH

56. THRUSH
• Management:
• Topical application of clotrimazole cream-2-3
times daily for 3-4 weeks.
• Ketoconazole 200-400 mg od for 2 weeks
• Fluconazole 50-100mg od for 2-3 weeks

57. White sponge nevus
• Congenital anomaly in which the surface of tongue as
well as other parts of oral mucosa are involved by
white spongy plaques without significant
hyperkeratosis.
• c/f-
• children are most commonly affected
• Friction may strip superficial keratotic area leaving zone
of normal looking epithelium or raw area.
• No treatment

58. White sponge nevus

59. VASICULOBULLOUS AND OTHER
DESQUAMATING DISORDERS
• Desquamating disorders are often mistakenly
identified as white lesions because coalescence of
whitish desquamating epithelium with areas of
papillary atrophy and scarring.
• Patches of regenerating papillae may also be
interspersed, giving red and white areas in a marble
like pattern.

60. LICHEN PLANUS
• Oral lichen planus is defined as a common chronic
immunological mucocutaneous disorder that varied in
appearance from keratotic to erythematous and ulcerative.
• Lacelike , erosive and bullous variety of this disorder may
affect the tongue in addition to the cheeks, lips, and gingiva.
• Etiology: unknown
• Immune system has primary role in development of this
disease.

61. LICHEN PLANUS
• Other factors: stress, habits, hypertension, diabetes
• c/f-
• oral lesions are characterized by radiating white and gray
velvety thread like papules in linear, angular or reticular
form arrangement.
• Tiny white elevated dots rays present at the intersection
of white lines, called as Wickham’s striae.
• In some cases superimposed candida infection

62. LICHEN PLANUS

63. LICHEN PLANUS
•d/d-
• Leukoplakia
• Candidiasis
• Drug induced reaction
• Geographic tongue

64. • Management:
• Removal of cause
• Steroids –topical and systemic
• Topical application of antifungal agents
• Retinoids
• Psychotherapy

65. LEUKOPLAKIA
• It is whitish patch or plaque that can not be
• characterised, clinically or pathologically, as any other
• disease and which is not associated with any other
• physical or chemical causative agent except the use of
• tobaco.
• It can occur anywhere in the oral cavity but tongue is
• one of the commonest site.
• If it occurs on tongue ,it is called as ‘chronic
superficial
• glossitis’

66. LEUKOPLAKIA
• Etiological factors are classically known as 6
S….smoking, syphilis, sharp tooth, sepsis, sprit, and
spices.
• Alcohol-facilitates the entry of carcinogen into
exposed cells and thus alters the oral epithelium and
its metabolism.
• Vitamin deficiency

67. LEUKOPLAKIA

68. LEUKOPLAKIA
• c/f- confined to ant. 2/3rd of tongue, dorsum and
lateral border.
• The affected area show milky-white patches with
fissure and cracks.
• Some patient may complain of burning sensation

69. LEUKOPLAKIA
• Management:
• Stop habits
• Conservative treatment-
• Use of beta carotenes, lycopene, L-ascarbic acid,
vit.E, retinoic acid,
• Surgical treatment: cold knife surgical excision,
laser surgery

70. PIGMENTATION
• Tongue may exhibit various patterns of racial melanin
pigmentation.
• Jaundice may be apparent on ventral mucosa
• Exogenous pigmentation of the filiform papillae of the
normal and coated or hairy tongue is very common and
results from microbial growth and metabolic products, food
debris, and dyes from candy, beverages, and mouth rinses.
• Pigmentation by chemotherapeutic agent, doxorubicin
hydrochloride

71. PIGMENTATION
• Extravasation of red cells around lingual varicocities
may give a patchy, bluish red discoloration, usually on
ant. Ventral surface of tongue.

72. PIGMENTATION
Actas Dermosifiliogr 2011;102:739-40 - Vol. 102 Num.9 DOI: 10.1016/j.adengl.2011.11.010
Pigmentation of the Fungiform Papillae of the Tongue: A Report of 2 Cases
Pigmentación de las papilas fungiformes linguales. A propósito de dos casos
J. Marcoval, J. Notario, S. Martín-Sala, I. Figueras

73. ULCERS AND INFECTIOUS DISEASES
• Quite severe ulcers, which are more in nature of
lacerations and contusions, are produced by sudden
biting trauma, either during epileptic seizure or as a
result of a sudden blow to the jaw while tongue lies
b/w upper and lower teeth.
• Rough surface of restorations and jugged, broken
cusps rapidly cause ulceration of the tongue.
• Lateral margins and ventral surface of tongue are also
frequently damaged by contact with rapidly revolving
burs, discs, or other dental equipment.

74. ULCERS AND INFECTIOUS DISEASES
• Ulcers on lingual frenum in neonates with natal lower
incisors rae referred as Riga’s ulcer or Riga-Fede disease.
• Shallow but persistent tongue ulcers , especially along the
posterior ventral surfaces, are common in patients with
lichen planus, various nutritional deficiencies, and
hematological problems.
• The lateral margins and tip of tongue are frequently
involved in severe episode of recurrent aphthous ulcers.

75. ULCERS AND INFECTIOUS
DISEASES
• Vesicobullous disorders also may involve lingual mucosa.
• Tuberculosis-post. ventral surface
• The ant. 1/3rd of the tongue may also be site of an extra
genital chancre in primary syphilis.
• In primary herpes simplex gingivostomatitis, the dorsum,
ventral and lateral margin may be ulcerated.
• In infections with erythrogenic, toxin producing
Streptococcus pyogens (scarlet fever), the sign of strawberry
tongue.

76. ULCERS AND INFECTIOUS
DISEASES

77. ULCERS AND INFECTIOUS
DISEASES

78. ULCERS AND INFECTIOUS
DISEASES
MANAGEMENT
• The most effective treatment to get rid of tongue
ulcer is to increase your body's immunity power by
taking Vitamin B complex tablets and vitamins
tablets.
• Glycerin: Rinsing your mouth and tongue with
glycerin on the affected parts of tongue is the best
way to alleviate the pain caused by ulcers under
tongue and throat.
Rinsing your mouth with glycerin also controls
the wounds or lesions further spreading and
expanding inside the mouth and throat.

79. SUPERFICIAL VASCULAR CHANGES
• Lingual varicosities are evident as prominent purplish blue
spots, nodules, and edges, usually on the anterior ventral
surface of the tongue and around the submandibular-
sublingual gland orifices.
• But they are rarely symptomatic
• They represent a normal age change
• Petechial hemorrhages and telangiectasia's also can
demonstrated on ventral surface
• Hemangiomas are relatively common on tongue.

80. SUPERFICIAL VASCULAR CHANGES

81. AMYLOIDOSIS
• Involvement of the tongue is described in both the primary
and secondary forms of amyloidosis.
• The characteristic fibrous glycoprotein of this disease is
deposited in the submucosa as well as in deeper muscular
layers of tongue.
• Generalized enlargement of the tongue(macroglossia) and
fungating swelling may result.

82. AMYLOIDOSIS

83. NEUROMUSCULAR DISORDERS
• Neuromuscular disorders of central, peripheral, or muscular
origin may produce symptom of dysphagia and choking as
well as disordered mastication and speech problems.
• Repetitive , uncontrolled movement of the tongue, head,
and jaws, depapillation, burning sensations and traumatic
ulcers of tongue are common in buccolingaul-facial
dyskinesia, parkinsonism, and the tardive dyskinesia.
• Weakness of tongue can occur in polymyositis, multiple
sclerosis and Duchenne’s muscular dystrophy.

84. NEUROMUSCULAR DISORDERS
• Damage to hypoglossal nerve, leads to
hypoglossal palsy.
• If bilateral, the tongue can not be extended
• If unilateral, the tongue deviates to the
unaffected side when extended.

85. Sleep Apnea Syndrome
• Sleep apnea is a disorder characterized by a reduction or
pause of breathing (airflow) during sleep.
• It is common among adults becoming more common in
children
• Obstructive sleep apnea is caused by the collapse of the
airway during sleep.
• Obstructive sleep apnea is diagnosed and evaluated by
history, physical examination and polysomnography (sleep
study).
• One of the most common signs of obstructive sleep apnea is
loud and chronic (ongoing) snoring.

86. Sleep Apnea Syndrome
• Sleep apnea is treated with lifestyle changes, mouthpieces,
breathing devices, and surgery.
• Medicines typically aren't used to treat the condition.
• The mouthpiece will adjust your lower jaw and your tongue
to help keep your airways open while you sleep.

87. Vascular disease of the body of
the tongue
• The lingual artery is very susceptible to the
development of atherosclerotic changes.
• The extent of the lingual atherosclerosis increases
with age, but age does not bring ischemic
complications secondary to atherosclerosis.
• Infarcts of tongue are fairly rare

88. Angioneurotic Edema
• Angioneurotic edema is one form of acute
anaphylactic reaction representing an immediate
hypersensitivity response allied to urticaria, allergic
rhinitis, and asthma.
• Antigenic stimuli are-respiratory allergens, food such
as shellfish, chocolate, nuts, various drugs and
occasionally cold and physical trauma to tongue.

89. Angioneurotic Edema
• Medications used to treat angioedema include:
• Antihistamines
• Anti-inflammatory medicines (corticosteroids)
• Epinephrine shots (people with a history of severe
symptoms can carry these with them)
• Inhaler medicines that help open up the airways

90. Benign tumors of tongue
• A benign mouth tumor is an abnormal growth
located in the mouth or tongue.
• The growths are not cancerous and very rarely spread
to other body parts.
• The condition is most common in adults over the age
of 60.
• The risk of developing an abnormal growth within the
mouth is greater increased in smokers.

91. Benign tumors of tongue
• c/f:
• bleeding lump –
• Mouth dentures don't fit
• difficulties swallowing
• lump in any part of the mouth
• poor pronunciation
• sore lump - mouth

92. Benign Tumors Of Tongue
• Benign tumors of tongue are as:
• Fibroma
• Papilloma
• Hemangioma
• Lymphangioma
• Granular cell myoblastoma
• Lipoma

93. Fibroma
• A fibroma is a benign, tumor-like growth made up
mostly of fibrous or connective tissue.
• Tumor-like growths such as fibroma develop when
uncontrolled cell growth occurs for an unknown
reason, or as a result of injury or local irritation.
• Fibromas can form anywhere in the body and
usually do not require treatment or removal.
• Usually painless
• Surgical exicision- management

94. Fibroma

95. Papilloma
• Papilloma is a general medical term for a tumor of
the skin or mucous membrane with finger-like
projections.
• Papilloma are either pedunculated or sessile growth
on any surface of oral mucous membrane.
• Multiple papilloma are occur in Cowden's syndrome,
down’s syndrome.
• Management-Surgical excision.

96. Papilloma

97. Hemangioma
• Hemangioma is a benign tumor of dilated
blood vessels.
• It is also known as port-wine stain,
strawberry hemangioma, and Salmon patch.
• They are characterized by hyperplasia of
blood vessels, usually veins and capillaries, in
a focal area of submucosal connective tissue.

98. Hemangioma

99. Hemangioma
• Surgical or invasive treatment of oral
hemangiomas has evolved.
• Complete surgical excision of these lesions
offers the best chance of cure, but, often,
because of the extent of these benign
lesions, significant sacrifice of tissue is
necessary.
• For example, lesions of the tongue may
require near-total GLOSSECTOMY

100. Lymphangioma
• Lymphangioma are benign hamartomatous tumors
of the lymphatic channels. They are thought to be
developmental malformations arising from
sequestration of lymphatic tissue that do not
communicate with the rest of the lymphatic
channels
• Oral lesions are most frequently found on the
tongue.
• Treatment: injection of sclerosing solutions,
cryosurgery, intravascular remobilization with
silicon spheres.

101. Lymphangioma

102. Granular Cell Myoblastoma
• Granular cell tumor, is a relatively uncommon
benign neoplasm, which is more commonly found
in females in the 4th to 6th decades of life even
though it can occur in all ages.
• Most of the intraoral lesions occur on the tongue,
usually on the lateral aspect.
• Granular cell tumors are slow-growing, painless
tumors with no known cause.
• They may start in nerve cells.
• They occur mostly on the top of the tongue.

103. Granular Cell Myoblastoma

104. Lipoma
• Lipoma is a rare benign tumor of mesenchymal origin
which infiltrates adjacent muscle and tend to recur
after excision
• It is prevalently found in the cheek and tongue, but
also in the lip, gingival and floor of the mouth.
• Particularly, lipoma accounts for 0.3% of all lingual
tumors

105. Lipoma

106. Malignant Tumors Of Tongue
• Cancer of the tongue is a malignant tumor that
begins as a small lump, a firm white patch, or a sore
(ulcer) on the tongue.
• If untreated, the tumor may spread throughout the
tongue to the floor of the mouth and to the gum
(jaws).
• As a tumor grows, it becomes more life threatening
by spreading (metastasizing) to lymph nodes in the
neck and later to the rest of the body
• Eg: squamous cell carcinoma,

107. Squamous Cell Carcinoma
• It is most common oral carcinoma with 60% cases
arising from the ant. 2/3rd of the tongue and
reminder from base of tongue.
• Etiology: physical trauma, alcohol, tobacco, smoking,
candidiasis, syphilis, sepsis, chronic dental trauma
and chronic superficial glossitis.
• About 80% of all people who develop tongue cancer
are smokers.

108. Squamous Cell Carcinoma

109. Squamous Cell Carcinoma

110. Squamous Cell Carcinoma
• c/f:
• middle and later decades, m>f ,
• Painless mass or ulcer later becomes painful
• Excessive salivation
• Offensive smell in mouth occurs due to bacterial
stomatitis.
• Sore throat
• Immobility of tongue-causes difficulty in speech.
• Hoarseness of voice and dysphagia
• It spread by infiltration and invasion

111. Squamous Cell Carcinoma
•Management:
• Early carcinoma of tongue(T1 and small
T2) responds equally well to surgical
excision or by radiation.
• T1 and T2 with no evidence of lymph
node metastasis, surgical treatment is
usually restricted to partial glossectomy.
• If it is T2 or T3 without node involvement,
prophylactic neck dissection is advised.

112. Squamous Cell Carcinoma
• Treatment of carcinoma of the ant. 2/3rd of tongue
with evidence of node involvement may include
radical neck dissection, partial mandibulectomy,
and intraoral dissection(commando operation) in
addition to glossectomy
• Better cure rates obtained with combined
chemotherapy(cis-platinum and bleomycin)-surgery
radiation approaches, use of neutron irradiation,
immunotherapy, and trans oral laser resection for
accessible early stage carcinoma.