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Tongue conditions occur in 15.5% of the US population. The most common tongue conditions are geographic tongue, fissured tongue, and black hairy tongue; these conditions do not require treatment. Median rhomboid glossitis can be associated with a candidal infection; symptomatic lesions usually improve with use of antifungals. Atrophic glossitis is often linked to a nutritional deficiency and resolves with treatment of the underlying condition. Oral hairy leukoplakia is caused by Epstein-Barr virus and most often presents in patients with severely compromised immunity; it can be treated with oral antivirals. Growths of the tongue usually require biopsy to differentiate benign lesions (eg, traumatic fibromas, squamous cell papillomas) from leukoplakia and squamous cell carcinoma. Referral to an oral and maxillofacial surgeon, otolaryngologist, or a dentist experienced in oral pathology may be indicated. Burning mouth syndrome often involves the tongue, and if it does not resolve spontaneously, studies have shown improvement with gabapentin, topical clonazepam, capsaicin, and cognitive behavior therapy. Oral lichen planus is a chronic inflammatory disorder that can affect the tongue and is best treated with topical or systemic corticosteroids and calcineurin inhibitors. There is a lack of consensus on the definition and treatment of ankyloglossia (tongue-tie); however, some evidence supports that frenotomy can improve breastfeeding and decrease lactation-associated nipple pain.

Traumatic Ulcerative Granuloma with Stromal Eosinophilia (TUGSE)/Riga Fede disease is a rare mucosal and submucosal benign reactive inflammatory process, usually involving the tongue. Trauma is believed to be a major factor amongst the multiple pathogenic mechanisms that have been hypothesized in TUGSE. The lesion presents as an isolated indurated or even ulcerated mass, which may mimic, clinically a squamous cell carcinoma (SCC). We herein report a case of TUGSE in a 63-year-old male referred by his treating physician for high suspicion of tongue malignancy. Histopathological examination confirmed the diagnosis of TUGSE, without any evidence of a neoplasic, infectious or hematologic process. TUGSE occurs in patients with an age range of 41-60 years. Sufficiently deep biopsies with comprehensive immunohistochemical and molecular analyses are mandatory to confirm the benign nature of the lesion and to, definitely, rule out malignancy. This report highlights the need for adequate histological differential diagnosis to avoid inappropriate heavy treatments in a benign condition., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest regarding the publication of this article., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

A 78-year-old man with a previous diagnosis of rheumatoid arthritis on prolonged treatment with corticosteroids presented with intense and progressive pain at the cervical level that prevented him from resting his head and walking, in addition to an ulcerative lesion covering 80% of the lingual area that was previously treated as oral candidiasis without improvement. On arrival, with no clinical or serological data of rheumatoid arthritis, immunosuppressive treatment was suspended, and a biopsy of the oral cavity was requested, confirming the diagnosis of lingual tuberculosis, an extremely rare disease, occurring in less than 1% of extrapulmonary cases. MRI of the cervical spine showed a crush fracture of the C6 and C7 bodies associated with spondylitis of probably infectious etiology that required surgical treatment, and histopathological studies confirmed Pott's disease. The patient displayed no evidence of pulmonary tuberculosis from arrival until the end of the follow-up.

Competing Interests: Competing interests: None.

Background: We used electromyography to characterize hypoglossal nerve function among radiation-treated head and neck cancer survivors with later onset unilateral tongue immobility., Methods: Patients with unilateral tongue immobility without evidence of recurrent cancer were seen at a tertiary academic institution between February and September 2021. All patients were at least 2 years post-treatment with radiation therapy for head and neck squamous cell carcinoma. Participants were under annual surveillance and displayed no evidence of operative injury to the hypoglossal nerve., Results: The median symptom-free interval for the 10 patients included in this study was 13.2 years (range 2-25 years). Myokymia alone was present in 3 of 10 patients, fibrillation potentials alone were present in 3 of 10 patients, and 1 subject displayed both fibrillation and myokymia. Three out of 10 patients had normal hypoglossal nerve function., Discussion: These findings highlight how disparate mechanisms may underlie similar clinical presentations of radiation-induced neuromuscular dysfunction., (© 2024 Wiley Periodicals LLC.)

Purpose: We aimed to determine the tongue edema that may develop due to the pressure exerted by the endotracheal intubation (ETI) tube on the tongue during the follow-up period of mechanical ventilation in patients intubated in the intensive care unit (ICU) by submental ultrasonography (USG). Also, we aimed to investigate the effect of tongue edema on the oxygen saturation values (SpO 2 ) measured two h after extubation., Methods: One hundred patients aged 18-65 years, who were followed up with mechanical ventilation in the ICU from the 0th day of intubation, were included. Patients (n = 57) who were followed up on mechanical ventilation for four days or longer after ETI were included in the study group. Those who were followed up on mechanical ventilation for three days or less after endotracheal intubation and were extubated during this period were included in the control group (n = 43). The tongue cross-sectional areas (TSAs) of patients in both groups were measured twice with submental USG. The first measurement (TSA 1 ) was performed on the 0th day of ETI in all patients in both groups. The second measurement (TSA 2 ) was performed on the 4th day of ETI in the study group and just before extubation in the control group. The difference between TSA 2 and TSA 1 was defined as tongue edema. Also, the effect of tongue edema on the oxygen saturation levels measured at the 2nd h after extubation of the patients in the control group was investigated., Results: The tongue edema was more prevalent in the study group (p < 0.01). A significant negative correlation was found between the SpO 2 levels two hours after extubation and the increase in the mean TSA values indicating tongue edema (p < 0.01). The oxygen saturations of the patients with tongue edema were 4% lower than those without tongue edema., Conclusions: Tongue edema may develop due to the long-term application of pressure of the ETI tube on the tongue and may impair oxygenation after extubation., Gov Identifier: NCT05249738., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

An 83-year-old male patient presented due to a 3-week history of swelling of the tongue with tongue pain on eating, yellowish plaques, and a gray-brown lesion in the anterior portion of the tongue. Sudden loss of vision in the left eye and temporal headache occurred 3 days before presentation. Due to elevated C‑reactive protein, sonography of the supraaortic arteries as well as positron emission tomography/computed tomography was performed. Imaging revealed inflammation of the great arteries as well as a halo sign on ultrasound of the temporal artery. Thus, a diagnosis of giant cell arteritis with necrosis of the tongue was made. Immunosuppressive therapy with glucocorticoids was initiated. Necrosis of the tongue is a rare manifestation of giant cell arteritis that requires immediate immunosuppressive therapy to prevent further complications to the tongue (e.g., complete necrosis of the tongue, superinfection, tongue amputation)., (© 2023. The Author(s).)

Multiple myeloma (MM) is a malignant disease associated with clonal plasma cell proliferative disorder, characterized by extensive infiltration of clonal plasma cells in the bone marrow, for which a proportion of patients suffer poor outcome and exhibit no obvious symptoms in the early stages. Amyloidosis is a rare condition caused by MM. Immunoglobulin light chain amyloidosis (AL) is caused by the secretion of specific toxic light chain proteins from proliferating clonal B cells or plasma cells. These light chain proteins accumulate in human tissues and cause organ dysfunction and failure. Oral manifestations of amyloidosis include macroglossia, prominent lingual margins, coloured papules, purpura, and nodular protrusions. To describe and summarize the oral manifestations associated with AL amyloidosis in order to achieve an accurate clinical diagnosis. We present a case of AL amyloidosis associated with multiple myeloma and review the literature on other related cases identified from the inception of Medline. A female patient visited our clinic with a deep tongue ulcer. After oral biopsy and tissue staining, combined with the examination results from the Department of Haematology, the patient was diagnosed with oral AL amyloidosis related to multiple myeloma. This is the first case study of AL amyloidosis secondary to latent MM presenting as a solitary tongue ulcer. Chronic oral refractory ulcers may be associated with systemic diseases and should be considered in future clinical practice.

Introduction: Palate development involves a genetic regulation through a complex molecular mechanism that may be disrupted by environmental factors, resulting in impaired fusion and cleft palate formation. An encounter with a case of cleft palate due to dorsal tongue hamartoma prompted us to perform this systematic review., Objective: To review the clinical profile and management approach for a case with cleft palate and tongue hamartoma., Design: A systematic literature search was conducted using keywords related to cleft palate and tongue hamartoma in PubMed, Scopus, MEDLINE, and Scielo databases through December 2021, with no time or language restrictions., Patients, Participants: Studies reporting patients with cleft palate and tongue hamartoma were included., Main Outcome Measure(s): Information related to clinical profile, diagnostic tests, histopathology, management, and outcomes were extracted., Fourteen relevant publications were identified with 16 cases reported so far. Among them, thirteen patients were females (81.25%), and 3 were males (18.75%). The age of presentation varied from birth to 19 years. Oral-facial-digital syndrome (type II) was the most commonly associated syndrome., Congenital tongue hamartoma with cleft palate is a rare presentation, which can present as an isolated entity or part of a syndrome. Genetic evaluation is warranted, particularly for multiple hamartomatous lesions. The preferred treatment is immediate excision of hamartoma while following a standard timeline for palatoplasty., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Tongue necrosis is a rare clinical finding because of its rich vascularisation. Giant cell arteritis (GCA) is the most frequent cause of it, and when present, it is usually one side affected. We describe a patient with several months of constitutional syndrome; during that period, she develops headache followed by tongue necrosis, which lead to clinical suspicion of GCA, later confirmed by a temporal artery biopsy. Before the biopsy, she was treated with corticosteroids. We discuss this illness and tongue necrosis as a rare manifestation to consider., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Competing interests: None declared.

Background: Tonsillectomy is one of the most common surgical procedures in pediatric patients. The tonsillar retractor, which is routinely used during a tonsillectomy, applies high pressure to the patient's tongue and can lead to various complications., Aims: This study aimed to explore tongue edema induced by the pressure applied by tonsillar retractor, using ultrasonography in pediatric patients undergoing tonsillectomy surgeries., Materials and Methods: Sixty-one patients were included in the study. The tonsillectomy group included 31 patients who underwent tonsillectomy surgery, while the control group included 30 patients who underwent inguinal hernia and circumcision surgery. Submental coronal plane ultrasonography examinations of the tongue were performed twice for each patient. In the tonsillectomy group, the first examination of tongue area (TA 1 ) was done immediately after intubation but before the placement of tonsillar retractor. The second examination (TA 2 ) was done at the end of the tonsillectomy surgery after the removal of the tonsillar retractor but before extubation. In the control group, the first examination (TA 1 ) was done immediately after intubation, whereas the second examination (TA 2 ) was done at the end of the surgery before extubation. These results were compared with those for the control group., Results: Groups were similar in terms of demographics and intubation duration. Groups did not significantly differ in terms of TA 1 ( P = .212), but they significantly differed in terms of TA 2 ( P = .000). They also significantly differed in terms of tongue edema defined as TA 2 - TA 1 ( P = .000)., Conclusions and Significance: Tonsillar retractor does cause tongue edema in tonsillectomy surgeries. This tongue edema seems to be a result of the pressure applied by the tonsillar retractor. This study is the first to demonstrate the possible role of ultrasonography examination in determining the tonsillar retractor-induced tongue edema in pediatric patients.

Objectives: The following case presents a pediatric patient with Riga-Fede disease (RFD), a rare disorder in children under 2 years of age characterized by sublingual ulceration of the tongue due to trauma from repeated rubbing against the primary teeth. Riga-Fede disease is well reported in dental literature but is relatively unknown to the general pediatric community. It can be confused with nonaccidental trauma (NAT) from forced feeding or other abusive trauma because it presents with injury of oral structures including the sublingual frenulum and often results in problems with growth. This case highlights the importance for physicians to recognize RFD as a source of isolated oral injury that is distinct from NAT. Although approximately 35 cases of RFD have been reported in the literature, this is the first case to describe the process of distinguishing this disease from child abuse., Methods: We present a case of an 8-month-old female infant who presented with extensive injury of her ventral tongue from RFD who underwent a full workup for NAT. We review the literature for guidance on diagnosing RFD and discuss how to distinguish it from abuse., Results: Infants with characteristic ulceration of the ventral tongue opposing new teeth and with no other medical, social, or developmental concerns do not need to undergo further workup. Clinical examination and thorough history are sufficient to make the diagnosis., Conclusions: Traumatic intraoral injury in nonmobile children is highly concerning for child abuse. However, RFD is a well described cause of sublingual ulceration in infants that is not associated with abuse., Competing Interests: Disclosure: K.W.F. provides legal consultation in child abuse cases. The authors declare no conflict of interest., (Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.)

Stüve-Wiedemann syndrome (SWS) is a rare, autosomal recessive disorder, causing dysautonomia and multisystem failure. Symptoms include skeletal malformations, restricted joint mobility and desensitisation to pain. Patients with SWS presenting with intraoral lesions are extremely rare and this is probably due to their shortened lifespan. We present a case of a 9-month-old patient who presented to our Oral and Maxillofacial Surgery (OMFS)Unit with a chronic inflamed ulcer affecting the tongue, secondary to trauma from erupting central incisors. We believe that depapillation in conjunction with an increased pain threshold contributed to its development. The patient was successfully treated by extraction of the lower central incisors and intralesional steroid injections under general anaesthetic. This case highlights that patients with SWS can present to the OMFS clinician with oral lesions and that they can be safely managed under general anaesthesia., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Intérêts concurrents: Aucun déclaré.

Background: Traditional Chinese medicine (TCM) tongue diagnosis plays an important role in differentiation of symptoms because the tongue reflects the physiological and pathological condition of the body. The automatic tongue diagnosis system (ATDS), which noninvasively captures tongue images, can provide objective and reliable diagnostic information. Chronic kidney disease (CKD) currently is an important global public health problem and contributor to morbidity and mortality from non-communicable diseases. Thus, it is interesting to analyze and probe the relationship between tongue examination and CKD., Methods: This protocol is a cross-sectional, case-controlled observational study investigating the usefulness of the ATDS in clinical practice by examining its efficacy as a diagnostic tool for CKD. Volunteers over 20 years old with and without CKD will be enrolled. Tongue images will be captured and the patients divided into 2 groups: CKD group and healthy group. Nine primary tongue features will be extracted and analyzed, including tongue shape, tongue color, tooth mark, tongue fissure, fur color, fur thickness, saliva, ecchymosis, and red dots., Result: The results of this study will systematically evaluate tongue manifestations of patients and examine its efficacy as an early detection and diagnosis of CKD., Discussion: The aim of this protocol is to investigate discriminating tongue features to distinguish between CKD and normal people, and establish differentiating index to facilitate the noninvasive detection of CKD., Trial Registries: ClinicalTrials.gov; Identifier: NCT04708743., Competing Interests: The authors have no conflicts of interests to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Stomatological complications of allogeneic hematopoietic stem cell transplantation (HSCT) are frequent and very uncomfortable for patients. The primary complication is the graft versus host disease reaction. Other side effects of the procedure include infections, taste disorders and carcinogenic risks. Various local treatments are used but remain imperfect. Within the framework of the 10th workshop of practice harmonization of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) held in Lille in September 2019, diagnostic approaches and treatments of tongue and oral complications following allogeneic HSCT were reviewed according to the analysis of published studies., (Copyright © 2020 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Traditional Chinese medicine tongue diagnosis can mirror the status of the internal organ, but evidence is lacking regarding the accuracy of tongue diagnosis to gastroesophageal reflux disease (GERD). This study was to investigate the association between GERD and tongue manifestation, and whether tongue imaging could be initial diagnosis of GERD noninvasively.We conducted a cross-sectional, case-controlled observational study at Kaohsiung Chang Gung Memorial Hospital in Taiwan from January 2016 to September 2017. Participants aged over 20 years old with GERD were enrolled and control group without GERD were matched by sex. Tongue imaging were acquired with automatic tongue diagnosis system, then followed by endoscope examination. Nine tongue features were extracted, and a receiver operating characteristic (ROC) curve, analysis of variance, and logistic regression were used.Each group enrolled 67 participants. We found that the saliva amount (P = .009) and thickness of the tongue's fur (P = .036), especially that in the spleen-stomach area (%) (P = .029), were significantly greater in patients with GERD than in those without. The areas under the ROC curve of the amount of saliva and tongue fur in the spleen-stomach area (%) were 0.606 ± 0.049 and 0.615 ± 0.050, respectively. Additionally, as the value of the amount of saliva and tongue fur in the spleen-stomach area (%) increased, the risk of GERD rose by 3.621 and 1.019 times, respectively. The tongue fur in the spleen-stomach area (%) related to severity of GERD from grade 0 to greater than grade B were 51.67 ± 18.72, 58.10 ± 24.60, and 67.29 ± 24.84, respectively.The amount of saliva and tongue fur in the spleen-stomach area (%) might predict the risk and severity of GERD and might be noninvasive indicators of GERD. Further large-scale, multi-center, randomized investigations are needed to confirm the results.Trial registration: NCT03258216, registered August 23, 2017.

Background: Tongue-related complications can be seen in suspension laryngoscopy (SL) procedures. Aims/objectives: This study aimed to detect tongue edema associated with the pressure exerted by a rigid direct laryngoscope by measuring the tongue area using ultrasonography (USG) in patients undergoing SL procedures. Material and methods: The study group included 31 patients and the control group consisted of 33 patients. Submental USG examinations of the tongue in the coronal plane were performed. In the study and control groups, the first examination (TA 1 ) was done immediately after intubation and the second examination (TA 2 ) was done after the surgery procedure but before extubation. The USG results regarding tongue area for both the groups were compared. Results: The study and control groups significantly differed in terms of the postoperative tongue area measurements (TA 2 ), as well as tongue edema (based on the TA 2  - TA 1 ) values. Conclusions and significance: Direct rigid laryngoscopes may cause tongue edema in SL procedures which was demonstrated by the USG. This tongue edema can be a result of ischemia-reperfusion injury in the tongue due to the pressure exerted by a direct rigid laryngoscope. This study is the first to demonstrate the possible role of USG examination in determining the side effects of SL procedures on the tongue. Trial Registration ClinicalTrials.gov Identifier: NCT04205253.

Background: The reflux of noxious contents of the stomach may cause oesophageal and extra-oesophageal complications either by direct contact of aspirated gastric refluxate with the upper airway or by a vago-vagal reflex. This study aimed to determine the prevalence of gastroesophageal disease (GERD) and extraesophageal manifestations among undergraduate students in a tertiary institution in Nigeria., Methods: This is a cross-sectional study involving undergraduate students in a private University in Nigeria. Study proforma had three parts. Part A consisted of self-administered questionnaire designed to obtain students biodata. Part B consisted of standard Carlsson-Dent questionnaire. A score of 4 and above on Carlsson- Dent questionnaire was considered diagnostic of gastroesophageal reflux symptoms (GERD). Thereafter those who had GERD were further questioned and examined for extra-oesophageal symptoms of GERD., Results: The total number of the study participants was 647, out of which 212 (32.8%) had GERD. One hundred and forty-four (67.9%) and 86 (32.1%) females and male had GERD respectively (p = 0.13). The extraesophageal symptoms found in those with GERD were, dysphagia, coated tongue, nocturnal cough, xerostomia, lump in the throat, asthma-like symptoms, recurrent sore throat, frequent throat clearing, halithosis and dental erosion among others., Conclusion: GERD is common among this study population, with a prevalence rate of 32.8%. Only age showed significant predictor for GERD. Varying extra-oesophageal manifestations were found in those with GERD.