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Macroglossia (Enlarged Tongue)

Macroglossia Definition

Macroglossia refers to enlargement of the tongue which leads to functional and cosmetic problems. It is a relatively uncommon disorder and can be congenital (present from birth) or acquired (develops in life). Speech and swallowing requires normal tongue anatomy, position and function. Any deviation from the norm can therefore  cause difficulties in speech and swallowing reflex. Although the tongue size varies from person to person, it needs to be comfortably housed within the oral cavity without hampering specific functions for which is needed or utilized. In macroglossia, an enlarged tongue is technically a tongue that is bigger in size for the specific oral cavity.

Macroglossia Symptoms

Mouth, Tongue and Teeth

Macroglossia can cause a variety of symptoms and signs. The tongue protrudes which increases the risk of trauma to the tongue. This also leads to drying of oral cavity as the lips are slightly parted and increases the risk of infections. The increase in size and deviated position of the tongue creates forces that cause displacement of teeth. Therefore  orthodontic problems are very common in patients with macroglossia. The border of the tongue shows scalloped margins or ulcers due to contact with teeth surfaces.

Speech, Swallowing and Breathing

The condition is more prominent in infants and may ease with age. The large size of the tongue also leads to variety of difficulties in speech, feeding and even breathing. The difficulty in swallowing, drooling and airway obstruction can lead to failure to thrive in children. A false enlargement of the tongue termed as psesudomacroglossia caused by abnormal positioning of the tongue is seen in patients with enlarged tonsils, small lower jaw and narrow palate.

Macroglossia Causes

Congenital

Macroglossia is associated with multiple disorders and conditions. It is congenitally acquired in certain syndromes such as Down syndrome and Beckwith-Wiedemann syndrome. Congenital disorders in region of the tongue such as hemangioma, lymphangioma and lingual thyroid can also lead to tongue enlargement.

Acquired

The inflammatory causes of macroglossia include tuberculosis, actinomycosis, dental infections, syphilitic gumma, ranula and sublingual infections. Trauma due to dental irritation such as sharp cusps or faulty dental prosthesis can also lead to enlargement of the tongue.
Metabolic disturbances such as myxodema, amyloidosis and acromagaly are also associated with macroglossia. The hypertrophy of tongue musculature can also lead to enlargement of the tongue.

Tumors

One of the serious causes of tongue enlargement includes neoplastic changes in the tongue tissue. Malignant lesions such as carcinoma and sarcoma and benign lesions such as neurofibroma and lipoma can lead to macroglossia.

Macroglossia Treatment

Non-Surgical

  • The physical therapy treatment should be started early in cases with congenital macroglossia.
  • Palatal devices are used to stimulate muscle tone of tongue muscles and proper tongue positioning.
  • Any causes triggering the inflammatory or traumatic enlargement should be corrected.
  • Malocclusions and dental problems should be corrected by orthodontic therapy.
  • Speech therapy is also advised to correct the defective articulation.

Surgery

Most of the cases of macroglossia are treated surgically. The aim of the surgery is to reduce the size of the tongue and improve the functional ability of the tongue. Indication for surgical intervention includes airway obstruction, swallowing difficulties, speech problems and aesthetics. The procedure employed is partial glossectomy.

References :

http://emedicine.medscape.com/article/873658-overview

http://www.nlm.nih.gov/medlineplus/ency/imagepages/17246.htm


Posted by in Mouth and Tongue

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