Enlarged Tongue Causes, Symptoms and Treatment

Enlarged tongue also called as Macroglossia or tongue hypertrophy or prolapses of the tongue. Macroglossia, meaning large tongue, has been a documented anatomical anomaly for several centuries. Severe enlargement of the tongue can cause cosmetic and functional difficulties including in speaking, eating, swallowing and sleeping. Macroglossia is uncommon and usually occurs in children. The exact incidence of Macroglossia is unknown because the causes are too numerous to quantify. In Beckwith-Weidman syndrome, 97.5% of patients have macroglossia. Macroglossia has an extensive list of possible causes. Its treatment has been largely surgical in the modern era

What are the Symptoms of Macroglossia?

• Dyspnea-difficult noisy breathing, obstructive sleep apnea (airway obstruction)
• Dysphagia-difficulty in swallowing and eating
• Dysphonia-disrupted speech, possibly manifest as lisping
• Sores ate the corners of the mouth
• Marks or indentations on the lateral border of the tongue caused by pressure from the teeth
• Open bite, orthodontic abnormalities including diastema and tooth spacing
• mandibular prognathism
• Mouth breathing
• A tongue that constantly protrudes from the mouth is vulnerable to drying out, ulceration, infection or even necrosis.

What are the Causes of Macroglossia?

Two types of Macroglossia are present

1.      True Macroglossia:-

True macroglossia is associated with definitive histopathological findings. True macroglossia may be primary—characterized by hypertrophy or hyperplasia of the tongue muscles and it may be secondary-the result of infiltration of normal tissue with anomalous elements.

Causes of true macroglossia include congenital and acquired causes

Congenital causes:-

• Idiopathic muscle hypertrophy
• Lymphangioma
• Hemangioma
• Down syndrome
• Trisomy 22
• Laband syndrome
• Chromosomal abnormalities including Beckwith-Weidmann syndrome
• Lingual thyroid
• Autosomal dominant inheritance
• Transient neonatal diabetes
• Tollner syndrome

Acquired causes:-

• Metabolic\endocrine-hypothyroidism, cretinism, diabetes
• Inflammatory/infectious-syphilis, amebic dysentery, Ludwig angina, pneumonia, typhoid, scurvy, pellagra, candidiasis, tuberculosis, rheumatic fever, smallpox
• Systemic medical conditions-uremi9a, myxedema, hypertrophy, acromegaly, neurofibromatosis
• Traumatic-surgery, hemorrhage, direct trauma, radiation therapy, intubation injury
• Neop[lastic-lingual thyroid, lymphangioma, Hemangioma, carcinoma,plasmacytoma
• Infiltrative-amyloidosis, sarcoidosis

2.      Pseudo Macroglossia:-

In Pseudomacroglossia, an individual has a normal sized tongue that, as a result of oral or skeletal abnormalities. It includes any of the following conditions, which force the tongue to sit in an abnormal position

• Habitual posturing of the tongue
• Enlarged tonsils and or adenoids displacing tongue
• Low palate and decreased oral cavity volume displacing the tongue
• Severe mandibular deficiency
• Neoplasms displacing the tongue
• Hypotonia of the tongue

What is the Treatment for Macroglossia/Enlarged Tongue?

Treatment of Macroglossia depends upon its cause and also upon the severity of the enlargement and symptoms it is causing. No treatment may be required for mild cases or cases with minimal symptoms. Surgery is indicated for the severe cases. The goal of the surgery is to reduce tongue size and thereby improve function. Those main functions include chewing, swallowing, protection of the airway, and gustation. Treatment may also involve correction of orthodontic abnormalities that may have been caused by enlarged tongue. Treatment o0f any underlying systemic disease may be required.