Tongue abnormalities are a group of congenital dental diseases, the cause of which is a violation of the intrauterine bookmark and the development of the organ. Some anomalies represent a purely anatomical defect, while others seriously affect such important functions as sucking, eating, swallowing, and speech. The main diagnostic methods include clinical and instrumental examination of the oral organs, anamnesis collection, telerentgenography. Treatment of tongue abnormalities is carried out in childhood to prevent further complications. Eliminate defects mainly with the help of surgical methods.
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Tongue abnormalities development are embryonic defects, including changes in the shape, size, and structure of the organ. In isolation, such anomalies are relatively rare, they usually accompany other dental disorders: gothic palate, jaw deformities, distal, open, crossbite, facial cleft. They are often a component of hereditary Down syndrome, Van der Wood, Treacher-Collins, Pierre Robin, Aper). As a rule, language anomalies are detected in childhood. In the presence of such defects, alimentary, articulatory function, aesthetic perception of an individual’s appearance suffers. All this adversely affects the socialization of the child, and therefore requires timely correction.
Tongue abnormalities have a polyethological nature. Anomalies are the result of a violation of intrauterine development, which may be due to hereditary, endogenous and exogenous causes. All these factors affect the child in the early stages of embryogenesis. Prerequisites for the occurrence of congenital pathologies of the language are:
- Genetic diseases. They can be inherited or develop as a result of new mutations. Thus, macroglossia is characteristic of Beckwith-Wiedemann, Down, Sotos syndromes, hereditary mucopolysaccharidoses; hypo- and aglossia – for Hangart syndrome; folded tongue is a sign of Cowden syndrome and hereditary keratoses, etc.
- Exogenous factors. This group of reasons includes the effects on the fetus of ionizing radiation, carcinogens, chemicals, radioactive radiation, pesticides in food consumed by a pregnant woman. The development of maxillofacial anomalies is facilitated by the harmful habits of parents (alcohol, drugs, smoking), the reception of medications with teratogenic effects by the expectant mother.
- Endogenous factors. They include infectious and metabolic diseases of a pregnant woman: trichomoniasis, toxoplasmosis, viral infections, hypovitaminosis and hypervitaminosis A, hypothyroidism, etc. The number of congenital craniofacial dysmorphia increases in proportion to the increase in the age of the mother at the time of conception.
The universal mechanisms of language malformations have not been determined. It is believed that anomalies occur when the development of the first and second gill arches and the growth of lingual rudiments is disrupted. It is believed that at the end of the second month of fetal development, the blood supply to the gill arch changes. Before the 2nd month, blood comes from the internal carotid artery, and after that – from the external carotid artery. The period of changes in blood supply can be a starting point in the formation of malformations of the maxillofacial region in the presence of endogenous and exogenous aggravating factors.
There is no generally accepted classification of tongue abnormalities in dentistry. Based on the main criteria (size, structure, method of attachment), anomalies can be divided into the following groups:
- Size anomalies – macroglossia (hypertrophied tongue), microglossia (reduced in size tongue).
- Anomalies of structure /form – aplasia and aglossia (absence of tongue), split tongue (double), goiter of the tongue root. The splitting of the language can be complete and incomplete. The goiter of the tongue is called the location of the thyroid gland in the thickness of the root of the organ.
- Attachment anomalies – ankyloglossia. This anomaly limits the mobility of the tongue in the oral cavity, and, consequently, its functions.
- Combined anomalies – folded (furrowed, scrotal) tongue. It is characterized by the presence of folds and furrows on the surface of the organ, due to which its size increases.
With a folded, deep furrows and folds are observed on its back. They are located in the longitudinal and transverse direction. Along the median line of the tongue is the deepest and longest furrow, which begins from the grooved papillae and reaches the tip. The transverse folds depart from the deep median, have a smaller size. When extending the tongue, you can well consider the folding, which divides the organ into many lobules. The mucous membrane of the bottom and lateral surfaces of the folds is covered with papillae characteristic of normal mucosa. The disease can be combined with an increase or decrease in the size of the organ. The anomaly does not bother a person, often going to the dentist is due to the fact that patients take folds for cracks.
Microglossia is characterized by underdevelopment and a decrease in the size of the tongue. Depending on the severity of the defect, there is a violation of sucking, and later – speech. There are cases when the anomaly is asymptomatic. Macroglossia is accompanied by a violation of food intake, speech and breathing. The child has an incorrect bite due to constant pressure on the dentition. Tooth prints are visible on the side surfaces of the tongue. Due to the constantly open mouth, the mucous membrane dries up, which causes discomfort. Ankyloglossia is characterized by shortening of the frenulum, its close attachment to the tip of the tongue or gum. The functions of speech, swallowing, and eating are impaired.
With aglossia – the complete absence of an organ – the baby cannot suck, so this rare anomaly requires probe feeding. Splitting of the tongue is characterized by the presence of two halves that are completely or partially disconnected. The disease requires surgical intervention before the child learns to speak. Lingual tonsils are a congenital pathology in which the presence of enlarged lymph nodes in the root of the tongue is observed. In this case, the location of the lymph nodes of the pharyngeal ring is disturbed.
Goiter of the tongue is a rare pathology in which the thyroid gland is localized in the root of the organ. In the area of the blind hole of the root, a formation of the size from a pea to a nut is determined. The rudiments of the gland can be located in the thickness of the entire organ. The tongue is enlarged in size, prevents normal swallowing and articulation.
With insufficient hygienic care for the folded tongue, food residues and microorganisms accumulate in the furrows of the mucous membrane, inflammation occurs – glossitis. With a decrease in immunity, fungal flora begins to multiply in the grooves, which is accompanied by the appearance of a white curd coating and unpleasant itchy sensations – candidiasis develops. With macroglossia, the mucous membrane of the tongue dries out, is easily injured, becomes covered with crusts, bleeds. Saliva flows down from the corners of the mouth, causing maceration of the skin. The lingual amygdala can become inflamed with a decrease in the reactivity of the body. There is swelling, swelling, hyperemia and pain when swallowing. The rudiments of the thyroid gland in the root of the tongue can significantly increase, causing dysphagia, difficulty breathing, hoarseness of voice.
Diagnosis of lingual anomalies is not difficult. The presence of serious malformations is determined by a neonatologist even in the maternity hospital, less pronounced anomalies are diagnosed by a dentist-therapist or surgeon during a routine examination. Additional research methods are rarely used. Differential diagnosis of defects is carried out with glossitis, neoplasms, inflammatory processes. The main diagnostic methods are:
- Visual inspection. Intraoral examination is carried out with the help of two mirrors. Assess the size, shape, color, structure, anatomical and topographic location of the organ. Examine the mucous membrane of the tongue, the severity of papillae, the presence of primary and secondary lesions. Assess the degree of organ dysfunction.
- Telerentgenogram (TRG). The study in the lateral projection allows us to judge the size, area of the tongue, its relationship with teeth and jaws. The study of TRG parameters makes it possible to determine the presence of tongue abnormalities and occlusion. With complex combined defects, CT of the jaw and facial bones is performed.
Differentiation is required by innate and acquired folded language: in the latter case, it may be a manifestation of Melkerson-Rosenthal syndrome. With this syndrome, other symptoms are also present – facial paralysis, swelling of the lips or face. In some clinical cases, the anomaly resembles sclerosing glossitis in the tertiary syphilis, with which it is also necessary to differentiate.
Treatment of tongue abnormalities depend on the degree of their severity, functional disorders. In some cases, specialists choose observational tactics and only after a while decide on the need for surgical intervention. With a folded tongue, treatment is not carried out, it is recommended to observe oral hygiene. There is no therapy for lingual tonsils, microglossia.
Anomalies of attachment, enlargement, cleavage of the tongue are eliminated surgically. If ankyloglossia disrupts sucking, excision of the frenulum of the tongue is performed in the maternity hospital. If the sucking is not disturbed, then the operation is performed at an older age. During the intervention, the attached frenulum is dissected with scissors, a scalpel or a laser. At the same time, there is practically no bleeding, and no stitches are applied.
Surgical treatment of an enlarged tongue is carried out in case of violation of its functions, permanent injury, changes in bite. The operation to eliminate macroglossia depends on the degree of dysfunction. Cleavage of the tongue is operated at an early age. During plastic surgery, tissues are sewn together and a complete organ is formed. The struma of the tongue root is conservatively conducted, however, with complications (bleeding, swallowing and breathing disorders), partial or radical removal of ectopic glandular tissue is performed.
Prognosis and prevention
Complete absence of language in combination with other multiple malformations has an unfavorable prognosis, can lead to death. Macroglossia, ankyloglossia, cleavage of the tongue can be surgically corrected. The folded tongue, lingual tonsils, lingual goiter do not pose a threat to life, but should be monitored by specialists (dentist, endocrinologist, otolaryngologist). There is no specific prevention of developmental abnormalities. General preventive measures consist in giving up bad habits, treating chronic diseases, taking multivitamins for a pregnant woman, proper nutrition and lifestyle.
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